Prevention of eating disorders: current evidence-base for dissonance-based programmes and future directions

Abstract

Representative data from the USA, Europe and Australia show that around 13% of females experience a threshold or sub-threshold eating disorder (ED) by young adulthood, which are marked by chronicity, relapse, emotional distress, functional impairment and risk of future obesity, mood, anxiety and substance use disorders, suicide and mortality [1–5]. It is critical that EDs, which show significant and prolonged medical and psychosocial morbidity and stronger relations to functional impairment, suicide attempts and mortality than other psychiatric conditions (comprising mood disorders and schizophrenia), carry high healthcare costs and family burden and are one of the highest-ranking causes of mental health disability [6–12], are successfully fought. Yet over 80% of ED cases never receive treatment [2, 3] and existing treatments only result in lasting ED symptom remission for half or less patients [13]. Thus, a top public health and research priority is to design and broadly implement efficacious ED prevention programmes. These may be effective for EDs whose peak risk period for onset is around ages 16–19 [1, 2, 4], implying that broad implantation of efficacious ED prevention programmes during adolescence could decrease the population prevalence of EDs. At the turn of the millennium, the state of the science on the prevention of EDs was severely inadequate. The roundtable discussion on the topic convened by the National Institute of Mental Health (USA) [14] highlighted that no prevention programmes had produced meaningful reductions in ED symptomatology or future ED onset, two crucial outcomes for ED prevention. Since then, the field of ED prevention has made significant strides in successfully translating basic ED risk factor research into efficacious interventions able to reduce ED risk factors and symptomatology and future onset of EDs. This Editorial aims at briefly documenting the aforementioned progress focusing on an intervention model, i.e. the dissonance-based ED prevention approach which, according to recent meta-analytic evidence, produces the largest intervention effects compared to any other type of extant selective (e.g. targeting high-risk people) or indicated (e.g. targeting people who exhibit symptoms, but do not meet ED diagnostic criteria) prevention programmes [15]. Further, this is the only ED prevention approach that meets the American Psychological Association’s [16] designation as an efficacious intervention, meaning that it has been found to (a) yield positive effects that have been replicated by independent labs/researchers and (b) significantly outperform active and credible alternative interventions in multiple randomized controlled trials. In addition to increasing awareness in the scientific community and community stakeholders on the empirical evidence base for dissonancebased ED prevention programmes [including basic ED risk factor research underpinning the development of these programmes and rigour tests on the intervention (cognitivedissonance) theory underlying them], this Editorial offers several important research directions, particularly in areas in which queries remain open or we see room for improvement.