Eating disorders and obesity are serious public health concerns. Both are increasingly prevalent and have significant adverse effects on physical and psychosocial health. While many focus on the perceived differences between the two health conditions, they share common risk factors, similar long-term consequences, and are both highly resistant to treatment.
Disordered eating is a shared pathway into both eating disorders and obesity. Up to 30% of people seeking treatment for obesity engage in binge eating and between 10 and 20% meet the criteria for binge eating disorder. There is also evidence that obesity can be a serious outcome for people with bulimia nervosa.
In fact, obesity and eating disorders may be viewed as occurring at the same end of a spectrum: at one end, health promoting beliefs, behaviours, and physical indicators, buffer against these conditions; at the opposite end, weight-related syndromes and eating disorders are potential outcomes (NEDC , Healthy Weight Related Messages).
Identification of appropriate, common risk factors is therefore essential to developing effective prevention interventions. While numerous interrelated factors have been implicated in the development of eating disorders and obesity, a comparison to distinguish specific, overlapping risk factors can be difficult due to discrepancies across study designs, samples, diagnostic procedures and risk measures.
In a recently published paper, Krug and colleagues (2013) attempted to overcome some of these methodological limitations by assessing risk and protective factors for different weight-related conditions within the same study. Specifically, they assessed early eating influences as well as individual, family and social eating patterns and attitudes to food in a sample of underweight eating disorder patients and obesity patients concurrently.
The eating influences found to be shared by the underweight eating disorders and obesity groups included:
- Teasing about body shape by friends
- Family weight/shape concerns
- Negative family environments
In view of these similarities and shared risk factors, recent research has called for the development of prevention programs that address common issues in the context of a broad range of eating- and weight-related problems.
In addition to addressing shared risk factors and preventing similar consequences, approaching prevention to these two health conditions simultaneously is economically efficient and reduces the risk of inadvertently causing one disorder while trying to prevent another (Haines & Neumark-Sztainer, 2006).
Health professionals, families, schools, peers and the mass media need to collaborate to provide consistent, reliable information about the complexities of weight-related disorders and the negative effects of ineffective weight regulation and weight loss attempts (Krug et al., 2013).
Despite the need for early interventions that can reduce the risk factors for both eating disorders and obesity, only two school-based programs have been evaluated for their efficacy:
- Planet Health is a 2-year interdisciplinary obesity prevention program with girls and boys in Grades 6-8. Austin et al., (2005) found that the program significantly reduced both obesity onset and growth of purging behaviours amongst girls in the program
- Healthy Buddies is a 21-week program pairing students in Grades 4-7 with a student in Kindergarten-Grade 3. Stock et al., (2007) found that the program led to significantly lower increases in body mass index (BMI) amongst the older students in the intervention condition, while no significant differences were found for the body image variables
In addition to these programs, Wilksch and Wade (in press) recently piloted Life Smart, an eight-lesson, school-based program that seeks to build on earlier interventions by not only including eating disorder risk factors and traditional obesity prevention targets, but also targeting several psychological risk factors that have rarely been addressed in combined prevention programs.
Results of the pilot study indicated that the program was well-received and valued by participants. Informed by the findings of the pilot study, the program has since been revised, and is now being evaluated in a randomised controlled trial.
For further reading on the shared risk factors for eating disorders and obesity, and integrated prevention interventions, take a look at some of the other articles included in the NEDC Knowledge Hub.
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