Eating Disorder Prevention Programs At Universities May Be Doing More Harm Than Good, Study Suggests

First Empirical Evaluation of a College Program Suggests It Fails By Trying To Do Too Much of a Good Thing

WASHINGTON -- Many colleges and universities across the
country have set up eating disorder prevention programs to address
the well-known fact that female college students are a high-risk
group for developing eating disorders. But as the authors of a
study in the May issue of Health Psychology (published by the
American Psychological Association APA) point out, "the simple fact
that eating disorder prevention programs exist does not mean that
the problem is being adequately addressed." To the contrary, the
authors found evidence that the typical college eating disorder
prevention program could be making the problem worse.

In what is the first empirical evaluation of a college eating
disorder prevention program, researchers from Stanford University
and the University of Santa Clara examined the effectiveness of the
program at Stanford. A total of 788 freshman females participated
in a study in which half were invited to participate in a eating
disorder prevention program and half were not. Participants filled
out questionnaires three months before the program and four weeks
and 12 weeks after the program.

The eating disorder prevention program at Stanford (which the
researchers found to be fairly typical of college programs)
consisted of a 90-minute discussion attended by 10-20 participants
at a time. It was led by pairs of Stanford students with different
histories of disordered eating (one was a recovered anorexia
patient, the other a bulimia patient who was not fully recovered). In one part of their presentation, the presenters offered
information about eating disorders, such as prevalence, symptoms,
how they are treated, the better prognosis for treatment if they
are detected early and where to get help on campus. In the second
part, the presenters told their personal stories about developing,
recognizing and then getting treatment for their eating disorders.

The purpose of the program, the researchers note, is to do
both primary and secondary prevention. That is, by giving students
this information about eating disorders it is hoped that students
who don't have an eating disorder would not develop one (primary
prevention) and that students who do have an eating disorder would
be motivated to seek help early in the course of the disorder
(secondary prevention).

In terms of primary prevention, the Stanford program was a
failure; it did not prevent eating disordered behavior in students
who attended it. "In fact," the authors note, "exploratory
analyses showed that students who attended the program reported
slightly more symptoms of eating disorders than did students who
did not attend the prevention program."

Did it at least motivate those at high risk of eating
disorders to seek help? Only three high-risk participants reported
seeking help, which was not enough, the authors say, to make any
sort of comparison worthwhile. "To consider the intervention a
success in terms of secondary prevention," the authors say, "we
would have to have seen many more high-risk participants seek
help."

The authors speculate that programs of this type may fail
because they are attempting to accomplish both primary and
secondary prevention. The educational messages for primary
prevention (emphasizing such things as the health dangers of eating
disorders and the difficulty treating them) are very different from
the messages that would be used for secondary prevention, such as
reducing stigma and emphasizing treatability. It may have been,
the authors say, that the Stanford program overemphasized the
secondary prevention component, inadvertently giving some of the
students the impression that anorexia and bulimia are fairly
common, even normal.

While both types of prevention programs are needed for a
college population, the authors suggest it might be more effective
to offer them separately -- rather than simultaneously -- to
appropriately defined student populations. In the meantime, the
authors point out that since this is the only intervention for
preventing eating disorders that has been evaluated to date, "as
far as we know, effective prevention programs for eating disorders
still do not exist."

Article: "Are Two Interventions Worse Than None? Joint
Primary and Secondary Prevention of Eating Disorders in College
Females," by Traci Mann, Ph.D., Susan Nolen-Hoeksema, Ph.D., and
Karen Huang, Ph.D., Stanford University; Debora Burgard, Ph.D.,
University of Santa Clara; Alexi Wright, Ph.D., and Kaaren Hanson,
Ph.D., Stanford University, in Health Psychology, Vol. 16, No. 3.

(Full text available from the APA Public Affairs Office.)

(Traci Mann, Ph.D., can be reached at (310) 794-0631 or
mann@ucla.edu)

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