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Eating Disorders

Why We Need the Eating Disorders Prevention Act 2020

It's time to shift focus from childhood obesity to eating disorder prevention.

Key points

  • The foundations for eating disorder development begin before adolescence.
  • Childhood obesity prevention gets more funding than eating disorder prevention.
  • If implemented, the Eating Disorders Prevention Act would educate children about eating disorders and offer screeners.

While eating disorders (EDs) are most often diagnosed in adolescence, and young adulthood, the foundations for their development begin in childhood, which makes early life ED prevention important.

Nonetheless, few policies have been designed and implemented with the purpose of ED prevention in children.

One reason for this is limited funding for ED prevention. Another is that when funding is allocated for ED prevention programs, the money is usually directed towards childhood obesity prevention programs instead.5 This is because childhood obesity is perceived as a bigger, more dangerous problem than childhood eating disorders.

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Education about EDs is lacking.
Source: Annie Spratt/Unsplash

This is a misconception, however. EDs are both an individual and societal burden.6 They reduce the productivity, health, and wellbeing of many individuals, with some cases resulting in death. On a societal level, treatment is expensive and often ineffective. For the 2018-2019 fiscal year alone, it was estimated that EDs cost the US nearly $400 billion in added economic burdens and reduced wellbeing.

Early Life Foundations for Disordered Eating

We need ED prevention in childhood because the groundwork for disordered eating development begins during this time. Our early life environments help establish our relationships with food and how we think about our bodies.

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Children learn eating habits from others.
Source: Alex Green/Pexels

Children learn acceptable eating behaviors, what foods are good or bad, and which body sizes are valued most through observing and modeling peers and family.2 These interactions influence brain development and can contribute to ED development.

To better understand how our environments influence brain development, we can think of the brain as a lump of clay. During childhood, the clay is soft; this flexibility allows certain factors, like the environment, to influence how the brain is connected and how it functions. However, with age, the clay becomes less flexible, and we can no longer shape it as freely as we once could.

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Environments influence brain development in childhood.
Source: Julia M Cameron/Pexels

Like clay, the brain’s neural pathways become less flexible as we age. Consequently, pathways that are repeatedly shaped a specific way during childhood might stay that way in adulthood.9 This is how psychological disorders can develop.

Recent research shows that parents who routinely and consistently teach and model food behaviors (i.e., discussing food habits) with their children might influence the relationships their children develop with food on a neurological level.3 For example, overweight children with parents who teach and model food behaviors show higher brain activation in regions associated with reward when looking at food images than overweight children whose parents don’t discuss food behaviors with them. This suggests that neural circuits related to food relationships are flexible in childhood and that parents can influence how these circuits develop.

Brain-environment interactions are not a new finding. For example, studies show that specific maternal behavior patterns (i.e., poor child attachment) can disrupt brain processes (e.g., synaptic formation; dendritic growth) from maturing; this can prevent children from developing resilience to psychological disorders.8

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Parental interactions can influence brain development and, subsequently, increase ED susceptibility.
Source: Karolina Grabowska/Pexels

These environmental influences become especially concerning when children have a parent with a current or previous ED, increasing hereditary and environmental risk factors for ED development. These factors include cognitive and emotion regulation/recognition difficulties.4

It’s important to acknowledge that environmental factors won’t singularly cause an ED, and however, they do contribute to ED development in at-risk individuals. Consequently, childhood is a crucial time for ED prevention; it is a time when we can identify children who are at-risk for developing an ED and educate all children about ED symptoms and severities.

Obstacles to Eating Disorder Prevention

 Velizar Ivanov/Unsplash
Funding and public misconceptions hinder ED preventions.
Source: Velizar Ivanov/Unsplash

Not all children have access to eating disorder preventions, though. This is partly because the public is overwhelmingly uneducated about EDs.7 Through interviews, we’ve learned that most people deny that EDs are biological, dismiss that these disorders are difficult to treat, and believe that EDs are singularly about food. Consequently, support to increase public funding for ED prevention isn’t there.

Unfortunately, because public misconceptions about EDs are widespread, most interactions children have will be with people (e.g., parents; teachers) who aren’t familiar with ED symptoms, risk factors, or treatment.

This becomes problematic when we consider obesity discussions in the public sphere. Specifically, the way we talk about healthy eating for obesity prevention differs from how we talk about healthy eating for ED prevention.

Nathan Crowley/Pexels
In an obesity context, healthy eating can mean weight loss.
Source: Nathan Crowley/Pexels

Childhood obesity campaigns have a substantial media presence. Consequently, the dominate way we think about healthy eating is with regards to weight loss. For most, healthy eating is synonymous with weight loss. This pairing, however, is dangerous for those at-risk for developing EDs.

Polina Tankilevitch/Pexels
In an ED context, food enjoyment and intuitive eating are considered healthy.
Source: Polina Tankilevitch/Pexels

In an ED prevention context, healthy eating means emphasizing healthy relationships with food. This means not labeling certain foods as “good” or “bad” (i.e., cake is “bad”) and not engaging in restrictive eating (i.e., I can never eat cake). Rather, ED prevention encourages people to develop intuitive eating (i.e., eating when hungry) and to enjoy their food. Food enjoyment contradicts anti-obesity campaigns.

These nuanced and conflicting definitions about eating, coupled with public fixation on childhood obesity, contributes to ED miseducation and lack of funding for ED prevention.

The Eating Disorders Prevention in Schools Act 2020 (ED PSA)

To take action against ED ignorance, the Eating Disorders Prevention in Schools Act 2020 (ED PSA)1 was developed. These policies aim to reduce ED risk in children by providing US American students with access to ED education and ED screeners. Significantly, these resources would be developed with professionals in the ED field.

Are Eating Disorder Preventions Effective?

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ED preventions have shown effectiveness in reducing ED risk.
Source: RODNAE Productions/Pexels

Truthfully, because EDs are complex and highly heterogeneous, no single prevention will be 100% effective. Nonetheless, ED prevention programs have shown to effective by significantly reducing ED risk in multiple populations. Specifically, we know that prevention strategies that focus on one or two ED risk factors (e.g., body dissatisfaction), have an interactive component, and use cognitive behavioral therapy are most effective.10

Looking forward, what we don’t know is the effect of ED prevention on the brain and body, and such research would be challenging to conduct. However, doing so could advance our understandings of EDs in ways that further validate the need for ED prevention.

References

1) Update: Eating disorders PSA: A new act to help prevent disordered eating in schools. Eating Disorders Review, 31.

2) Balantekin, K. (2019). The influence of parental dieting behavior on child dieting behavior and weight status. Current Obesity Reports, 8, 137-144.

3) Allen, H., et al. (2016). Relationship between parental feeding practices and neural responses to food cues in adolescents. PLoS One, 11.

4) Martini, M., et al. (2020). Eating disorder mothers and their children: A systematic review of the literature. Archives of Women’s Mental Health, 23, 449-467.

5) Neumark-Sztainer, D. (2015). Eating disorders prevention: Looking backward, moving forward; looking inward, moving outward. Eating Disorders, 24.

6) Austin, S. (2016). Accelerating progress in eating disorders prevention: A call for policy translation research and training. Eating Disorders, 24, 6-19.

7) Harrison, A., & Bertrand, S. (2016). To what extent do the public need educating about eating disorders? Journal of Obesity & Eating Disorders, 2.

8) Glynn, L., & Baram, T. (2019). The influence of unpredictable, fragmented parental signals on the developing brain. Frontiers in Neuroendocrinology, 53.

9) Caliskan, G., Muller, A., & Albercht, A. (2020). Long-term impact of early-life stress on hippocampal plasticity: Spotlight on astrocytes. International Journal of Molecular Sciences, 21.

10) Ciao, A., Loth, K., & Neumark-Sztainer, D. (2014). Preventing eating disorder pathology: Common and unique features of successful eating disorders prevention programs. Current Psychiatry Reports, 16.

11) Streatfeild, J, et al. (2021). Social and economic cost of eating disorders in the US: Evidence to inform policy action. International Journal of Eating Disorders, 54, 851-868.

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