Despite having the best of intentions, occasionally health promotion efforts can cause unintended harm.
When attitude and behaviour change occurs in the direction opposite to that which was intended, it is known as the ‘boomerang effect.’
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 vice versa.
The leading areas of concern for health promotion include:
- The measurement of weight/BMIs especially in school settings and overemphasising 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 join forces to 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 e.g. physical activity, eating habits, 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.