Serious eating disorders such as anorexia, bulimia and binge eating, afflict more than 30 million Americans, and millions more experience disordered eating and weight control behaviors. All have consequences on health and quality of life.
Reimagine the Frontier of Public Health Approaches to Eating Disorders Prevention, a Harvard-wide symposium at Harvard Medical School on April 30 drew more than 350 participants from across health care disciplines and from around the country.
“Eating disorders have the highest mortality rate of any psychiatric disorder in this country,” said S. Bryn Austin, HMS professor of pediatrics and director of STRIPED (Strategic Training Initiative for the Prevention of Eating Disorders) of the Harvard T.H. Chan School of Public Health and Boston Children’s Hospital.
Research gains in prevention have been made, but too slowly, according to Austin.
“We need to work together compassionately to hack the problem of eating disorders prevention,” she said.
The symposium was convened by STRIPED, a public-health incubator that does strategic training for preventing eating disorders in collaboration with Harvard Catalyst’s Health Disparities Research and Child Health programs.
The daylong symposium started with 15 expert presentations on related research, weight stigma and innovative programs for underserved communities. In the afternoon, participants and panelists broke into groups for a hackathon to develop research ideas.
Eligible researchers stand to receive one of four $50,000 pilot grants offered by Harvard Catalyst. Letters of intent for proposals are due June 1. One collaborator on each proposal must be a Harvard faculty member.
Health without weight stigma
The symposium began with a panel that focused on weight stigma and negative assumptions made about large-bodied people.
“We need to promote health but without weight stigma,” pointed out panelist Kendrin Sonneville, from the Department of Nutritional Sciences at the University of Michigan School of Public Health.
Her pilot study of adolescent girls found that the unintended consequences of being told they are overweight include reduced body satisfaction and negative emotions and behavior.
“Weight-focused approaches common in clinical practice today may not produce intended outcomes,” Sonneville said.
Dieting typically doesn’t produce lasting weight loss and often leads to unhealthy weight cycling up and down. “We should focus on healthy behaviors and well-being instead of weight,” she said.
“Weight discrimination is rampant,” said Lisa Du Breuil, a “fat activist” and clinical social worker in outpatient psychiatry at Massachusetts General Hospital, who treats people with co-occurring eating disorders and substance use disorders.
In a society obsessed with body size and weight loss, the continual message is that only the thin are truly worthy.
“If you want to prevent eating disorders, you have to make it safe to be fat,” Du Breuil said.
She added, “Body size is not a disease that needs treating. Look at the data. If focusing on body mass index (BMI) worked, we’d all be thin and happy.”
Discussion included how media, fashion and food industry practices and public policy affect eating disorders. A sign of progress mentioned includes the ad campaigns of lingerie retailer Aerie, which since 2014 uses nonairbrushed photos of women of various body shapes and colors.
In a keynote address, Sarah Sliwa, a health scientist in CDC Healthy Schools at the Centers for Disease Control and Prevention, outlined efforts to help more children meet recommendations for physical activity and diet, including recommending moving away from school screenings for eating disorders to having school wellness policies instead.
A panel on early detection and intervention highlighted efforts to reach underserved populations. The U.S. Department of Veterans Affairs, for example, is strengthening its eating disorders screening and treatment efforts for both men and women in its 170 centers. Eating disorders often accompany trauma, pointed out Renee Gibbs, a clinical psychologist who coordinates eating disorders treatment at the Central Arkansas Veterans Healthcare System.
Vikram Patel, the HMS Pershing Square Professor of Global Health, has long been a champion of improving mental health globally.
“We have solutions for those at risk of mental health problems,” he said. “We know how to deliver solutions in an affordable and acceptable way, like we do in Africa.”
His advice is to move away from labeling someone either with or without eating disorders.
“It’s more like where you are on the spectrum from wellness to disability and, wherever you are, you want to move to wellness,” he said.
After breaking into groups for the hackathon, participants reconvened to present their research ideas. “People had fabulous ideas,” Austin said.
One group proposed following up on what occurred in Michigan, currently the only state that since 1974 has a law that makes it illegal to discriminate based on weight. They plan to evaluate its effectiveness and use results to find ways to expand protections elsewhere.
The premise is that issues of stigma and discrimination must be addressed first.
“We can’t ignore the obesity epidemic, but stigma and discrimination are undermining our efforts to address it,” Austin commented later. “Those who feel stigmatized won’t seek care and that makes the problem worse.”
In closing, she expressed the hope that everyone leave “with new resolve and strategies to change structures in our society that undermine us, structures that cause body shame and loathing and the devastating impact of eating disorders.”