All the components that contribute to, and interact in the complex evolution of an eating disorder are still unknown. There are many different factors that may contribute, as part of a dynamic system, to the development of an eating disorder.
Because of this complexity, finding an answer is equally complex. Any "answer" that underestimates the multi-causational aspect of this disease does a disservice to this intricate illness, because it is unlikely that there will be a simple answer.
It is yet unclear what may help most in the prevention and treatment of eating disorders. It has been shown that catching an eating disorder early, arresting the progression, and participating in individual and family therapy, can help, as can medication, for some people.
As we gain a more complete understanding of eating disorders, it is hoped that diverse methods of intervention will continue to become more and more effective.
Individuals involved with youth and adolescents: educators, parents, health professionals and physicians, can be alert to situations and circumstances surrounding young people and instrumental in the encouragement of generally healthy attitudes.
For Parents, Educators, Coaches and Others Who Work with Young People:
1. Examine, explore and, if necessary, modify the expectations you have of your child.
2. Examine your own attitudes, beliefs, prejudices and behaviors about food, weight, body image, physical appearance, health and exercise.
3. Do not "model" or otherwise communicate the message that you cannot dance, swim, wear shorts, or enjoy a summer picnic because you do not look a certain way or weigh a certain amount.
4. Encourage eating in response to body hunger. Encourage balanced eating of a variety of foods.
5. Link respect for diversity in weight and shape with respect for diversity in race, gender, ethnicity, intelligence, etc.
6. Convey to children that respect cannot be achieved first and foremost through appearance and that weight and appearance are not the most critical aspects of their identity and self-worth.
7. The most important gift that adults can give children is self-esteem. When adults show children that they value and love them unconditionally, children can withstand the perils of childhood and adolescence with fewer scars and traumas. Self-esteem is a universal vaccine that can immunize a youngster against eating problems, body image distortion and exercise abuse, as well as other psychological problems and life dilemmas. Providing self-esteem is the responsibility of both parents. Girls especially need support and validation from their fathers.
8. Encourage open communication. Encourage children to talk openly and honestly, and listen to them. Let them know that their opinions and feelings are cared for and valued. When young people are encouraged to assert themselves, they find it easier to resist pressures to conform. Feeling loved and confident allows them to accept that they are unique individuals.
9. Encourage critical thinking. The only sure antidote to the tendency to conform to the powerful seduction of the media and peer pressure is the ability to think critically. Encourage young people to challenge concepts and brainstorm alternative ideas. Girls especially need to learn that men are not the ultimate authorities, and that they themselves have something important to contribute.
10. Develop a value system based on internal values. Help children understand the importance of equating personal worth with care and concern for others, wisdom, loyalty, fairness, self-care and self-respect, personal fulfillment, curiosity, self-awareness, the capacity for relationships, connectedness and intimacy, individuality, confidence, assertiveness, a sense of humor, ambition, motivation, etc.
11. Help children accept and enjoy their bodies, and encourage physical activity.
12. Don't use food as a reward or punishment. Doing so sets food up as a potential weapon for control.
13. Don't constantly criticize your own shape ("I'm so fat, I've got to lose weight."). Such self-criticism implies that appearance is more important than character.
14. Don't equate food with positive or negative behavior. The dieting parent who says she was "good" today because she didn't eat much implies that eating is bad, and that avoiding food is good. Similarly, "don't eat that, it will make you fat" implies that being fat makes one unlikable.
15. Be aware of some of the warning signs of eating disorders. Understand that these warning signs can appear before puberty. Watch for signs: refusing typical family meals, skipping meals, comments about self and others like "I'm too fat; she's too fat," clothes shopping that becomes stressful, withdrawal from friends, irritability and depression. Watch especially for any signs of extreme dieting, bingeing or purging.
16. Love, accept, acknowledge, appreciate and value your children - out loud.
17. Trust your children's appetites. Never try to limit their caloric intake, unless requested to do so by a physician for a medical problem.
18. Don't support pornography or other "institutions" that cast women as objects for the pleasure of men, objects without personal integrity.
19. Give boys and girls the same opportunities and encouragement (in assignment of chores, choosing a sport, etc.) and avoid restricting children to gender-specific activities (boys can enjoy cooking and girls can fix cars). Value females for who they are and what they say, feel and do, rather than for what they look like.
20. Teach children about good relationships and how to deal with difficulties when they arise. Males and females alike may use food to express or numb themselves instead of dealing with difficult feelings or relationships. Because of messages that suggest that the perfect body will dissolve all relationship problems, young people often put energy into changing their bodies instead of their feelings, behaviors or their relationships.
For Mental Health Professionals:
1. Educate yourself about the warning signs of eating disorders.
2. In your work with children, emphasize self-esteem, critical thinking, self-assertion and communication skills. These strengths will inoculate children against pressures that they experience to change and harm their bodies in the pursuit of "perfection, goodness and happiness."
3. Become political and socio-cultural advocates. Invite children you work with to challenge the ways in which our culture glorifies thinness.
4. Encourage the young men you work with to examine their own "weightist" attitudes and behavior toward females.
5. Become knowledgeable about and able to discuss the scientific evidence concerning a variety of complex topics, including: the physical development of boys and girls during puberty, "set point" regulation and defense of natural body weight, the futility and dangers of dieting and the ways in which our culture has exaggerated the "risks" of being overweight.
6. Develop systems whereby you can connect with teachers and coaches who can, in turn, reach out to help children who are expressing problems with their eating and body image.
7. Strengthen and support families so that they are able to more effectively provide the security, acceptance, support and direction that children need in order to inoculate themselves from negative media influences.
8. Help parents reclaim their rights as experts. Empower parents to listen to their children and find solutions that will be best for them.
9. Recognize how our changing world alters what children need from parents today. Sociocultural pressures surrounding drugs, sexuality, body image and perfectionism require great character strength, self-assurance and decision-making in young children. Support parents to give more attention to children in these areas.
10. Appreciate with families how we all use food for the wrong reasons at times. Help families to understand the power and role of food in their own lives as it soothes, rewards and punishes. Family members should be actively involved in meal planning and preparations so that food and nurturing do not appear to be exclusive responsibilities or burdens for one person. Encourage families to return to the traditional shared family meal in any way they can.
11. Educate your community about the dangers of eating disorders while at the same time being careful not to promote or teach young people how to become eating disordered. In some ways, children are actually the highest risk audience. Audiences with less risk are school personnel, parent groups, athletic directors and day-care personnel. Have a system in place if a child does have a problem, and be supportive of family and friends of the person with the problem. You may work with the family while someone else is working with the identified patient. Give information and support. Reduce shame and guilt. Blaming parents guarantees treatment failure. Work with families to create and restore healthy eating and interaction patterns.
For those Wishing to Combat the Stereotypical Social and Cultural Views of Women:
(Developed by Michael Levine, Ph.D., and Linda Smolak, Ph.D., Kenyon College)
1. Develop an historical perspective on the politics of the control of women's bodies. Demonstrate respect for all people.
2. Work toward and speak out for women's rights: to fair pay, to safety, to respect and to control of their bodies.
3. Demonstrate a respect for women as they age, in order to work against the cultural glorification of youth and a tightly controlled, ideal body type. (Why is it that only men should become distinguished as they age, while women become wrinkled and need face-lifts?)
4. Educate your children about the existence, the experience, and the ugliness of prejudice and oppression, whether it is directed against people of color or people who are overweight.
5. Devote yourself to raising non-sex-stereotyped children by modeling and living gender equality at home.
6. Remain close to and supportive of your daughters as they experiment and struggle with body image, grooming and cosmetic issues, flirtatiousness and sexuality, etc.
7. Talk to your sons about the way that body shape and sexuality (for both boys and girls) are manipulated by the media and the struggle that their sisters or girlfriends have in trying to conform or not to conform.