Prevention and early intervention in eating disorders: findings from a rapid review

Abstract

Background Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs. Methods This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review. Results In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist. Conclusions Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.

Weight Restoration and Symptom Remission for Longstanding, Untreated Anorexia Nervosa in a Remote Eating Disorder Treatment Program: A Case Study

“…This case demonstrates that longstanding severe AN can be successfully treated in a remote intermediate level of care setting using an evidence-based practice approach. The positive outcomes of this case are particularly noteworthy given prior research suggesting that lower baseline BMI, engagement in binge/purge behaviors, and longer illness duration are poor prognostic factors (Miskovic-Wheatley et al, 2023). Although Gertrude’s team initially considered residential treatment, she was admitted at the PHP level of care, stepped down to IOP, and then discharged having completed her goals for intermediate level of care.…”

“…While recovery is possible, approximately one-third continue to struggle with a chronic course (Eddy et al, 2017). Factors such as lower body mass index (BMI), binge/purge behaviors, and longer illness duration, have been identified as predictors of poor outcomes for AN (Miskovic-Wheatley et al, 2023).…”

“…Although she did not report having received a specific diagnosis, Gertrude likely met criteria for Bulimia Nervosa initially according to the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013). As is common for individuals with EDs, Gertude appeared to experience diagnostic crossover in young adulthood (Miskovic-Wheatley et al, 2023), developing symptoms consistent with an AN presentation that persisted until the present time (i.e., for more than 20 years). She described engaging in restrictive eating resulting in significant low body weight (i.e., < 85% of ideal body weight; IBW), with no more than 1–3 weeks at a time of refraining from bingeing and purging.…”

“I Haven’t Told Anyone but You”: Experiences and Biopsychosocial Support Needs of People With Type 2 Diabetes and Binge Eating

“…Reasons for BE are multifactorial, including biological (e.g., genetic), behavioral (e.g., prior dieting), and psychosocial components (e.g., trauma or adverse childhood events) ( Harris et al, 2021 ; Rienecke et al, 2022 ), and, if left untreated, subthreshold eating disorders tend to evolve into clinical eating disorders ( Koreshe et al, 2023 ). In this article, the term “BE” refers to BED and subthreshold BED with the distinction being whether an individual fulfills the diagnostic criteria to obtain the BED diagnosis or not ( American Psychiatric Association, 2013 ).…”

A Bibliometric Analysis of Scientific Publications on Eating Disorder Prevention in the Past Three Decades

“…Another important fact is that the majority of patients with EDs do not seek professional help; only about 20% of those afflicted present for treatment [ 3 ], and of those who seek such treatment, only a minority receive evidence-based treatment [ 5 , 6 ]. One potential way to lower the prevalence of EDs and the suffering caused by these conditions and to reduce the costs to society is prevention [ 7 , 8 , 9 ].…”