Interventions to reduce the stigma of eating disorders: A systematic review and meta‐analysis

Abstract

Stigma is a problem for individuals with eating disorders (EDs), forming a barrier to disclosure and help-seeking. Interventions to reduce ED stigma may help remove these barriers; however, it is not known which strategies (e.g., explaining etiology to reduce blame, contact with a person with an ED, or educating about ED) are effective in reducing stigma and related outcomes. This review described effectiveness of intervention strategies, and identified gaps in the literature. A search of four databases was performed using the terms (eating disorder* OR bulimi* OR anorexi* OR binge-eating disorder) AND (stigma* OR stereotyp* OR beliefs OR negative attitudes) AND (program OR experiment OR intervention OR education), with additional texts sought through LISTSERVs. Two raters screened papers, extracted data, and assessed quality. Stigma reduction strategies and study characteristics were examined in critical narrative synthesis. Exploratory meta-analysis compared the effects of biological and sociocultural explanations of EDs on attitudinal stigma. Eighteen papers were eligible for narrative synthesis, with four also eligible for inclusion in a meta-analysis. Biological explanations reduced stigma relative to other explanations, including sociocultural explanations in meta-analysis (g = .47, p < .001). Combined education and contact interventions improved stigma relative to control groups or over time. Most studies examined Anorexia Nervosa (AN) stigma and had mostly female, undergraduate participants. Despite apparent effectiveness, research should verify that biological explanations do not cause unintentional harm. Future research should evaluate in vivo contact, directly compare education and contact strategies, and aim to generalize findings across community populations.

Barriers to seeking treatment for eating disorders: The role of self‐recognition in understanding gender disparities in who seeks help

“…Importantly, increasing health literacy may not address stigma as a barrier to ED treatment-seeking (Doley et al, 2017). To reduce stigma, community programs may use contact-based initiatives, highlighting personal narratives of those with EDs and particularly men (Doley et al, 2017).…”

Reducing the stigma associated with anorexia nervosa: An evaluation of a social consensus intervention among Australian and Chinese young women

“…To date, most interventions seeking to reduce AN stigma in Western settings fall into three categories: direct contact, education, and offering different types of etiological accounts (Doley et al, ). Direct contact is based on the assumption that personal contact with an individual with an eating disorder reduces stigma, while educational approaches seek to correct misinformation regarding the causes, symptoms, treatments, and help‐seeking in the context of eating disorders.…”

“…Direct contact is based on the assumption that personal contact with an individual with an eating disorder reduces stigma, while educational approaches seek to correct misinformation regarding the causes, symptoms, treatments, and help‐seeking in the context of eating disorders. Yet minimal support has been found for either approach (Doley et al, ). The third approach is related to education but focuses exclusively on examining the impact of different causal accounts (e.g., biological vs. sociocultural) on stigma.…”

“…To date, most interventions seeking to reduce AN stigma in Western settings fall into three categories: direct contact, education, and offering different types of etiological accounts (Doley et al, 2017).…”

“…Yet minimal support has been found for either approach (Doley et al, 2017). The third approach is related to education but focuses exclusively on examining the impact of different causal accounts (e.g., biological vs. sociocultural) on stigma.…”