Friends, rather than parents, may have more opportunities to recognize disordered eating.
Reprinted from Eating Disorders Review
September/October Volume 25, Number 5
A novel program among eighth and ninth graders enlists powerful social ties and peer networks to encourage girls to “look out” for their close friends and thus to report concerns about friends’ disordered eating (Eating Disorders 2014; Aug 4:1-13. [Epub ahead of print]).
Drs. Lisa K. Damour, Tori S. Cordiano, and Eileen P. Anderson-Fye, at Case Western University, Shaker Heights, OH, designed the intervention to train middle school and high school girls how to inform adults if they became worried that a friend might have an eating disorder. This is the first study designed to evaluate whether middle and high school girls can be taught to report early signs of an eating disorder in their peers, and in themselves as well. The researchers noted that school lunch periods are fertile ground for making social connections, and American schools generally allow teens to eat lunch without close observation by an adult. Adolescent girls may actually eat more meals with friends than with family members. For these reasons, Thus, peers are well suited to observe their friends’ eating patterns and also to “know when eating behavior may be grounds for concern.”
The intervention program
The authors designed a single lesson delivered during a 48-minute classroom period at an all-girls’ private school. The study population included 50 eighth graders (mean age: 13 years) and 66 ninth graders (mean age: 14 years) at a girls’ school in the Cleveland suburbs. Using a PowerPoint presentation titled “Eating Disorders: What you should know and what you should do,” the program presenter provided basic definitions of anorexia nervosa (AN) and bulimia nervosa (BN and stressed the low recovery rates and high death rates of both disorders, as well as the physical complications. Causal factors were discussed and once an eating disorder starts, “the person with the eating disorder no longer thinks rationally and is usually unwilling to seek help.”
Early intervention was stressed, as was the fact that friends often know about the disorder long before adults. The program specifically avoided discussing any weight loss techniques or body or self-image or any negative messages about food in general. The emphasis was on well-being and helping a friend.
The students were offered examples of how to approach a friend with their concerns, while at the same time making sure that a responsible adult would be informed at about the same time. As an alternative, students were also offered suggestions on communicating anonymously.
Measuring changes in attitude
Dr. Damour and colleagues used three questionnaires to follow the girls’ progress: at baseline (time 1), immediately after the intervention (time 2) and at a 3-month follow-up (time 3). The questionnaires assessed the likelihood that a girl would share her concern with a peer, share concerns with an adult at school, and share information about her own eating disorder with an adult at school or at home.
Ratings of willingness to share concerns changed with intervention, and this was greater among eighth graders than for ninth graders. However, girls’ willingness to discuss concerns about their own eating disorders initially increased but returned to baseline levels by the 3-month follow-up session. This reinforced the investigators’ theory about the importance of input from peers.