The Importance of Prevention

Two of the things that I have always admired about Carolyn Costin as a person and as a professional are (1) her patient dedication to implementing her vision of high quality, multifaceted care of people suffering from eating disorders; and (2) her commitment to understanding and changing the cultural contexts that generate and reinforce eating disorders, while making recovery an ongoing challenge. One arena in which I’d like to think these two aspects of Carolyn’s life intersect with mine is the field of prevention, which has been a second- or third-class citizen in the eating disorders world since at least 1980, the year that DSM-III was published by the American Psychiatric Association.

In late March 2014 I attended the International Conference on Eating Disorders, held in New York and sponsored by the Academy for Eating Disorders (AED), of which I am a Fellow. Now I am back home in central Ohio. Thanks in large part to the leadership and presence of Susan Paxton (Psychologist at the University of Melbourne, Australia, former president of AED) and Dianne Neumark-Sztainer (University of Minnesota’s School of Public Health), and to the passion and patient dedication of an increasingly large group of dynamic, research-oriented and advocacy-oriented young professionals, I have never been so optimistic and enthusiastic about the future of prevention and related topics (e.g., sociocultural and cross-cultural aspects of eating disorders), both in the Academy and in the field in general. The business meeting, the conference program, and the discussions in the lobby and elsewhere, all left no doubt that the field and those who are shaping its future are devoting a growing amount of attention and energy to prevention and to the first principle of prevention: “everything is advocacy.”

Three things in particular stood out:

1. With respect to AED Leadership, Of the 5 members of the Executive Committee for next year, 3 are noted experts in prevention: Carolyn Becker (USA; who will be President in 2015), Deborah Franko (USA), and Steffi Bauer (Germany). Moreover, the Director for Annual Meetings is renowned prevention expert, S. Bryn Austin from Harvard’s School of Public Health, making 4 of 12 board members who are engaged in multifaceted prevention work.

2.  I had the chance to speak at some length with each of the four, as well with others who are shaping the prevention/advocacy fields, such as: Gail McVey (Canada), Megan Jones (Stanford), Rachel Rodgers (UK; currently working with Deborah Franko, in Boston), Phillippa Diedrichs (UK), Simon Wilksch (Australia, working with noted Australian eating disorders expert Dr. Tracey Wade), and Zali Yager (Australia, working with Jennifer O’Dea).

3. The Body Image and Prevention Special Interest Group (SIG) sponsored a panel entitled “Preventing Eating Disorders: Is it Possible and What is the Current Role and Status of Universal Prevention Efforts.” The participants were Drs. McVey and Wilksch, along with journalist and activist Carrie Arnold, Dr. Kendrin Sonneville (colleague of Dr. Austin’s at Harvard’s School of Public Health), and myself. This panel was noteworthy because it drew much-needed (in my opinion) attention to the need for and role of universal prevention, which has gotten lost in the excitement about the effectiveness of selective and targeted dissonance-based approaches developed by Eric Stice and Carolyn Becker.

I will forever be indebted to Eric Stice for his successes in single-handedly making prevention a key part of scientific risk-factor research and for his insistence on rigorousness in prevention outcome research. Nevertheless, I continue to believe, as does Carolyn Costin, Margo Maine, and many others, that we must put resources into the types of universal, public health-oriented prevention that will address the sociocultural “nervosa” that is so pervasive and insidious in our cultures.

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One Comment

  1. Chris said:

    Nice words, Michael, but people have been excited about prevention for decades, and I see no sign of progress. Why should the broader society, therefore, continue to give you and your colleagues money to fund your prevention efforts? What evidence can you give us that the money will be well spent? What evidence can you give that the prevention efforts will be effective? If prevention will take place in schools, what do you recommend dropping from the existing curriculum in order to make way for prevention programs? Will parents be able to opt out of these programs if they feel the programs are a waste of time and they’d rather have their kids spent their time studying rigorous academic subjects instead?

    July 11, 2014
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