At present, the health promotion strategies for obesity and eating disorders tend to be conducted separately.
However, there is growing evidence to suggest that a shared approach could be of benefit, with the joint goal of utilising health promotion to shape the knowledge and behaviours of community members to prevent disease and improve health.
Coordinated and consistent messaging promoting health outcomes for overweight and eating disorder problems is possible, especially in the area of prevention. Focusing on the risk factors and protective factors that are common to both obesity and eating disorders presents an opportunity to collaborate and redirect people in a positive direction.
Weight and eating-related conditions often occur in an environment where ambiguous and opposing demands and messages are present; for example, “taking diet pills will help you lose weight and are therefore good for your health” is often presented in the same space as warnings to the effect of “diet pills are unhealthy and dangerous.”
To reduce the risks and increase the protective factors for obesity and eating disorders, we need to recognise that we all aspire to the same goal – a healthy, disease-free population who eat well, are physically active and are satisfied with their bodies.
We should also adopt strategies that consider both eating disorders and obesity as a coupled illness and that seek to communicate joint messages that are relevant to both areas, such as negative body image and disordered eating behaviours.
Obesity and the effects of harmful messaging
Despite having the best of intentions, occasionally health promotion efforts can cause unintended harm.
When inappropriate or inaccurate messages are promoted, it can cause people with eating disorders to adopt a process of ‘reversal.’ That is, their attitudes and behaviour-changes can occur in the opposite direction to that which was intended.
Hence, those who struggle with a healthy level of eating may find themselves eating excessively and those who are (or were) obese may adopt disordered eating habits that can lead to an eating disorder, such as Anorexia Nervosa, Bulimia Nervosa or Binge Eating Disorder.
Very little research has been done in the eating and weight fields to ascertain whether obesity prevention programs may be harmful in relation to eating disorders and whether obesity programs and communications can have a negative effect on someone with an eating disorder.
The leading areas of concern for health promotion include:
- The measurement of weight/body mass index, especially in school settings, and overemphasis of these measures as indicators of health
- Moralisation of eating; e.g. labelling foods as ‘good’ or ‘bad’ and food choices as ‘right’ or ‘wrong’
- The possibility for weight bias and stigmatisation, especially in the media
- Nutritional advice that may encourage food fears and unhealthy dieting
- Inappropriate messages that may increase body dissatisfaction, dieting and use of unhealthy weight control practices
The concept of ‘do no harm’ is paramount to contemporary medicine. It is essential for those who work in the fields of eating disorders and obesity to work together to approach, change, review and deliver positive messages that promote the health of the entire population and eliminate harm. Central to this is an obligation to evaluate eating disorder and obesity prevention initiatives as they are developed and to continuously monitor their effectiveness.
Public health messages – the way forward
Interventions and public health messages designed to reduce the prevalence of obesity and eating disorders should take the following guidelines into account:
- Interventions should focus on health, not weight, and be delivered from a holistic perspective, with equal consideration given to social, emotional and physical aspects of health
- Weight is not a behaviour and therefore not an appropriate target for behaviour modification; interventions should focus only on modifiable behaviours, such as physical activity, eating habits or time spent watching television
- People of all sizes deserve a nurturing environment and will benefit from a healthy lifestyle and positive self-image
- The ideal intervention is an integrated approach that addresses risk factors for the spectrum of weight-related problems and promotes protective behaviours
- Interventions should honour the role of parents and carers and support them to model healthy behaviours at home without overemphasising weight
- Representatives of the community should be included in the planning process to ensure that interventions are sensitive to diverse norms, cultural traditions and practices
- It is important that interventions are evaluated by qualified health care providers and/or researchers who are familiar with the research on risk factors for eating disorders
Please click here for a full list of the AED guidelines