Chapter 13– Managing Obesity and Eating Disorders
186 Secondary prevention also aims to prevent a further worsening of the condition. For obese individuals, this means preventing further weight gain. Secondary prevention efforts increase awareness and are geared to individuals with or at risk for the disease. Tertiary prevention aims at limiting disability or impairments associated with a disease and is really a part of treatment. For obese patients, tertiary prevention means decreasing the progression to more severe levels of obesity or decreasing the risk of obesity-related problems such as high blood pressure, type II diabetes, or cardiovascular disease. More patients recover fully from eating disorders than from obesity, so tertiary prevention is not always necessary. However, in the smaller proportion of patients for which an eating disorder becomes a lifelong battle, tertiary prevention aims at reducing the mortality and morbidity associated with the disorder. Tertiary prevention efforts are geared to individuals with the disease. Primary prevention for eating disorders should be geared to school-aged children, adolescents, and college-age students, since eating disorders usually first appear in these age ranges. Primary prevention programs should target reduction in the behaviors that can trigger eating disorders: dieting and dietrelated behaviors such as bingeing, vomiting, and misuse of laxatives. Primary prevention programs for eating disorders should also teach individuals to resist the pressures from the media to be overly thin and to resist peerpressure to diet or engage in harmful diet-related behaviors. Secondary prevention for eating disorders involves educating the public about general features and nature of eating disorders so that they can be recognized and treated early. Many times individuals wait to seek help for eating disorders. Obstacles to seeking help include (Fairburn, 1995) •
The disorder is not viewed as a problem. This is especially true for those with anorexia ner-
vosa; thus a concerned significant other is often the one persuading the individual with the disorder to seek help. •
The individual hopes the disorder will go away on its own.
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The individual believes the eating disorder is not severe enough to merit professional help, or that they do not deserve professional help.
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The individual does not want others to know they have a problem, since feelings of shame, guilt, and secrecy are common, especially among those with bulimia nervosa.
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Individuals have difficulty telling their doctor about their problem. Often the patient will present with a related problem instead, such as menstrual irregularity, gastrointestinal problems, or depression.
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Individuals fear treatment and weight gain.
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Individuals do not have the financial resources to pay for treatment.
Because of the high rate of obesity among the U.S. population, education programs aimed at obesity prevention will probably be working at all three levels of prevention simultaneously. Six outcome measures have been identified for population-based approaches to preventing obesity (Food and Nutrition Board, 1995) 1. Reduce the prevalence of obesity in the general population. 2. Reduce average body weight in the U.S. population. 3. Improve nutritional intake, eating habits, exercise, and health-related activities. 4. Improve knowledge, attitudes, and norms regarding nutrition, weight, eating habits, and exercise habits. 5. Decrease rates of co-existing problems, such as hypertension and diabetes. 6. Make public policy and environmental changes