© Borgis - New Medicine 1/2006, s. 26-28
Wojciech Chalcarz, Aleksandra Musieł, Małgorzata Stefaniuk
Proposition for implementing and realising the national programme for prevention and treatment of eating disorders
Department of Food and Nutrition University School of Physical Education, Poznań
Head of Department: Professor Wojciech Chalcarz MD, PhD
Introduction: In Poland and worldwide we can observe a disturbing, systematic increase in the incidence of eating disorders. These ailments include anorexia nervosa, bulimia nervosa and other eating disorders collected in a classification called DSM-IV in a group known as eating disorders not otherwise specified.
Aim: The aim of this work was to introduce the assumptions and possibilities for realisation of the National Programme for Prevention and Treatment of Eating Disorders.
Material and method: Assumptions of the National Programme for Prevention and Treatment of Eating Disorders are elaborated on successful national programmes of cholesterol prevention.
Results: The National Programme for Prevention and Treatment of Eating Disorders is based on population and individual strategies.
Conclusions: Uniting representatives of the National Education Department, Health Department, families, local governments, non-governmental organizations, the Church and mass media in the National Programme for Prevention and Treatment of Eating Disorders should reduce the incidence rate of further eating disorders and formulate optimal treatment.
Nowadays a rising number of people suffering from eating disorders can be observed . These ailments include anorexia nervosa, bulimia nervosa and other eating disorders collected in a classification called DSM-IV in a group known as eating disorders not otherwise specified [14, 18]. These are complex disease entities including biological, social, cultural and psychological aspects [2, 4, 5, 9, 19, 24, 25].
These illnesses are particularly widespread among girls and women . This may be accounted for by societal pressure, promoting the ideal of a thin figure in the mass media [3, 9, 14, 17, 26, 33]. Anorexia nervosa occurs ten times more often among women than men [14, 26], and bulimia nervosa affects women from 10 to 47 times more often than men .
The best known disease is anorexia nervosa. It is believed to be a complicated disease with numerous symptoms, due to the range of mental and physical disturbances connected with its course, including those involving intensively starving oneself [9, 11, 17, 18, 30, 33]. The most characteristic symptoms are: total food avoidance, weight-regulating practices such as self-induced vomiting, laxatives and diuretic abuse, mental fear of gaining weight caused by a disordered perception of one´s body [11, 14, 18, 20, 26, 33] as well as low self-esteem and self-acceptance level [12, 29]. This disease is associated with a high mortality rate [11, 30]. Only 60% of patients fully recover .
The number of people affected by anorexia is systematically growing [30, 33]. What is more, different authors provide different figures, namely from 0.1% to 0.7% , from 0.7% to 1.0% of the whole population [5, 25], 1%-2% , and 1:200 for adolescent girls aged 15-19 . This illness most often appears among people aged 13-19 [19, 24, 25]. The number of patients is highest in Europe and North America . Bulimia nervosa affects 1%-2% of adolescent girls and young women [18, 32].
The exact number of ill people is difficult to measure due to the implementation of inconsistent diagnostic criteria, undergoing treatment by doctors with various specialties, or termination of medical care. From our research concerning anorectic readiness syndrome among girls training for volleyball and swimming, a high level of susceptibility to anorexia nervosa was apparent among 45% of volleyball players and 36% of swimmers.
In order to counteract the spread of eating disorders, prevention programmes have been introduced [6, 8, 10, 15, 16, 21, 22, 27, 28, 30, 34, 35, 36]. From a review of the contemporary literature it appears that those designed programmes achieve only short-term goals, not maintaining themselves in follow-up research [8, 15, 16, 21, 28]. There are attempts to improve the effectiveness of those programmes by taking into consideration risk factors, by specifying the structure of the programmes and assessing their effectiveness and potential harmfulness .
We firmly believe that the aim of introducing temporary prevention programmes has limited scope from the very beginning and is not capable of providing us with long-term results. Normally such implemented programmes have time constraints and are conducted with the participation of a small number of specialists, who are very often outside the closest surrounding. Adolescents who are subjected to short-term research are left without any positive support, because society is not prepared to help. The only solution is to work out an interdisciplinary National Programme for Prevention and Treatment of Eating Disorders based on successful national programmes of cholesterol prevention. This was affirmed by discussion over a thesis from our work  submitted during the First International Scientific Conference: A human being chronically ill and handicapped – interdisciplinary care aspects, which took place in Szczecin in 2004.
The aim of this work was to introduce the assumptions and possibilities for realisation of the National Programme for Prevention and Treatment of Eating Disorders.
3. Assumptions of the National Programme for Prevention and Treatment of Eating Disorders
3.1. General thoughts
The National Programme for Prevention and Treatment of Eating Disorders should be based on population and individual strategies, in accordance with national programmes of cholesterol prevention. Representatives of the National Education Department, Health Department, families, local governments, non-governmental organizations, Church and mass media ought to take part in working out this programme. With the joint effort of parents, teachers, healthcare workers, psychologists and nutritionists it is possible to further reduce the incidence rate of eating disorders and to formulate optimal treatment [23, 30, 33].
The Department of Food and Nutrition is ready to undertake organization of this Programme.
3.2. Population strategy
The population strategy should be aimed at the whole of society. Its basic target ought to be the lowering of anorectic potential and finding adolescents with the first symptoms of eating disorders. Persons with eating disorders of varying intensities should be subjected to individual strategies with special attention paid to literature recommendations.
In order to achieve success in realisation of the population strategy, government organizations, the Church and mass media, especially teachers, doctors, psychologists and nutritionists, should take part in this programme. Thanks to shared interdisciplinary action, preventing the spread of eating disorders is possible [23, 30, 33].
The first link to prevent the increase of eating disorders must be the family home. Parents should be equipped with basic knowledge of eating disorders, their causes, and ways of identifying and counteracting them [23, 30, 33].
The second one is school. Not only do teachers have to supplement their knowledge about eating disorders as fast as possible, they must also include the elements of prophylaxis in the school curriculum. A very important task is given not only to class tutors and teachers of biology, physical education and religion, but also to foreign language and history teachers [23, 33].
The last one is healthcare. The most vital role lies with specialists with experience in prophylaxis and prevention of eating disorders. These are the people who are in charge of preparing educational materials for society as far as prevention and treatment of eating disorders is concerned. General practitioners and paediatricians should be sensitive to finding the first symptoms of disease. A similar role should be placed upon nurses, public health experts (hygienists) and laboratory analysis workers .
Nutritionists should work out books, on different levels, on contemporary recommendations concerned with nutrition and practical examples . Giving misleading information in books and magazines should be treated as a violation against health.
Both healthcare workers and nutritionists ought to highlight the importance of the influence of the proper body mass index on health and be able to effectuate those recommendations in everyday life [17, 30, 33].
In order to keep the proper body mass, appropriate food is necessary. How to choose it should be considered by nutritionists. However, the responsibility for production of such nourishment and its proper marking should lie with the food processing industry. Verification of food produced nowadays is believed to be a necessity as far as recommendations for metabolic disease prevention are concerned. Food produced for children should obtain certificates. It is absolutely unacceptable to advertise food, especially for children, whose composition hinders a balanced diet. The sale of expired food or not following existing norms should be regarded as a violation against life, not a minor offence.
A crucial role is given to the mass media, especially television and radio. The broadcasting of programmes with discussions of the above problems by specialists from different fields of study and organizations should be a habit . Specialists in different fields of knowledge, not always journalists, should be authors of published articles in various magazines.
It is necessary to involve Government and Parliament in realisation of the National Programme for Prevention and Treatment of Eating Disorders. Without proper acts of law and financial support it is impossible to fulfil this programme as well as the other programmes affecting public life.
Depending on local needs for realisation of the Programme, local government and church should also be involved.
3.3. Individual strategy
The essence of an individual strategy is detection and treatment of patients with eating disorders. At the time of realisation of this programme, detection of adolescents with eating disorders at an early stage should not cause any problems, because not only will youth be aware of the symptoms of the disease but also parents, teachers and healthcare workers.
An individual approach to each ill person will guarantee him/her the best treatment conditions and working out of optimal procedures .
The next step in an individual strategy is education programmes for parents, healthcare workers, teachers and other co-workers. It should include national achievements of particular education centres as well as a review of contemporary world literature.
Propagation of achievements is supported by scientific conferences concerned with prevention and treatment of eating disorders as well as professional textbooks discussing these problems from academic status to specialist monographs.
1. The increasing danger of eating disorder diseases makes it necessary to work out a National Programme for Prevention and Treatment of Eating Disorders.
2. Representatives of the National Education Department, Health Department, families, local governments, non-governmental organizations, the Church and mass media ought to take part in realisation of this programme.
3. Implementing the National Programme for Prevention and Treatment of Eating Disorders should result in a decrease in the incidence of development of eating disorders and an increase in the effectiveness of their treatment.
1. American Psychiatric Association. Practice guideline for the treatment of patient with eating disorders. (Revision). Am. J. Psychiatry 2000; 157-7 (supl.): 1-39. 2.American Psychiatric Association: Diagnostic and Statistical Manual, Fourth Edition. American Psychiatric Association, Washington DC 1994. 3.Abraham S.: Lewelyn- Jones D.: Anoreksja, bulimia, otyłość. Wydawnictwo Naukowe PWN, Warszawa 1995. 4.Abraham S., Llewelyn- Jones D.: Bulimia i anoreksja: zaburzenia odżywiania, Gdańsk: Gdańskie Wydawnictwo Psychologiczne 2000. 5.Banaś A., Januszkiewicz-Grabais A., Radziłłowicz P.: Wieloczynnikowe uwarunkowania zaburzeń odżywiania się. Psychiatria Polska 1998, 32 (2), 165-176. 6.Baranowski MJ, Hetherington MM. Testing the efficacy of an eating disorder prevention program. Int. J. Eat. Disord. 2001; 29: 119-124. 7.Chalcarz W., Stefaniuk M.: Konieczność wprowadzenia Narodowego Programu Profilaktyki Anoreksji Psychicznej. I Międzynarodowe Sympozjum Naukowo-Szkoleniowe: Człowiek przewlekle chory i niepełnosprawny - Interdyscyplinarne aspekty opieki. Szczecin 14-15 maj 2004, Wydawnictwo Pomorskiej Akademii Medycznej, str. 24-25. 8.Fairburn CG. The prevention eating disorders. W: Brownel KD, Fairburn CG, red. Eating disorders and obesity. New York, London: Guilford Press: 1995: 289-293. 9.Grande le D., Tibbs J., Noakes D. T.: Implications of a Diagnosis of Anorexia Nervosa in a Ballet School. Int. J. Eat. Disord. 1994; 15: 369-376. 10. Hoagwood K., Olins S. S.: The NIMH blueprint for change report: Research priorities in child and adolescent psychiatry. J. Am. Acad. Child. Adolesc. Psychiatry 2002; 41, 760-767. 11.Imbierowicz K., Curkovic I., Braks K., Giser F., Reinhard L., Jakoby G. E.: Effect of Weight-Regulating Practices on Potassium Level in Patients with Anorexia or Bulimia Nervosa. Eur. Eat. Disorders Rev. 2004;12: 300-306. 12.Iniewicz G.: Obraz siebie dziewcząt chorujących na anoreksję psychiczną. Psychiatria Polska. 2005; tom XXXIX, 4: 709-717. 13.Iniewicz G.: Samoocena i jej związki z obrazem siebie dziewcząt chorujących na anoreksję psychiczną. Psychiatria Polska. 2005; tom XXXIX, 4: 719-729. 14. Józefik B.: Anoreksja i bulimia psychiczna. Rozumienie i leczenie zaburzeń odżywiania się. Wydawnictwo Uniwersytetu Jagiellońskiego, Kraków 1997. 15. Killen J. D., Barr Taylor C., Hammer L., Wilson D. M., Rich T., Hayward C., Simmonds B., Kreamer H., Varady A.: An attempt to modify unhealthful eating attitudes and weight regulation practices to young adolescent girls. Int. J. Eat. Dosord. 1993; 13: 369-384. 16.Mann t., Nolen-Hoeksema S., Huang K., Burgard D., Wright A., Hanson K: Are two interventions worse than none? Join primary and secondary prevention of eating disorders in collage females. Health Psychol. 1997; 16:215-225. 17.Montero A., Lopez-Varela S., Nova E., Marcos A.: The implication of the binomial nutrition-immunity on sportswomen´s health. Eur. J. Clin. Nut. 2002; 56; Suppl 3: 38-41. 18.Ogawa A., Mizuta I., Fukunaga T., Takeuchi N., Honaga E., Suita Y., Mikami A., Inoue Y., Takeda M.: Electrogastrography abnormality in eating disorders. Psychiatry and Clinical Neuroscience. 2004; 58: 300-310. 19.Oświęcimska J.: Jadłowstręt psychiczny u dzieci i młodzieży. Lekarz 2003, (4),.36-39. 20.Pawłowska B., Chuchra M., Masiak M.: Obraz siebie a obraz innych ludzi w percepcji pacjentek chorych na jadłowstręt psychiczny. Psychiatria Polska. 2004; tom XXXVIII, 6: 1019-1030. 21.Pearson J., Goldklang D., Striegel-More R. H.: Prevention of eating disorders: challenges and opportunities. Int. J. Eat. Disorders. 2002; 31: 233-239. 22. Piran N. Prevention of eating disorders: directions for future research. Psychopharmacol. Bull. 1997,; 33: 413-417. 23.Powers S., P.: The Last Word. Athletes and Eating Disorders. Eat. Disord. 1999; 7: 249-255. 24.Rajewski A.: Zaburzenia odżywiania się. Przew. Lek. 2003, (3), 110, 112-115. 25.Rybakowski F., Słopień A., Czerski P., Rajewski A., Hauser J.: Czynniki genetyczne w etiologii jadłowstrętu psychicznego. Psychiatria Polska 2001, 35 (1), 71-80. 26.Starzomska M.: Z historii psychiatrii: anorexia nervosa jako optymalne zachowanie w socjokulturowym kontekście. Psychiatria Polska 2001, 24 (4), 669-679. 27.Stewart A. Experience with a school-based eating disorders prevention programme. In: Noordenbos G, Vandereycken W. (Ed.): Prevention of eating disorders. London: Athlone Press; 1998: 99-136. 28.Steward DC., Carter JC., Drinkwater J., Hainsworth J., Fairburn CG. Modifications of eating attitudes and behaviour in adolescent girls: a controlled study Int. J. Eat. Dosord. 2001; 29: 107-118. 29.Talarczyk M., Rajewski A.: Poziom samoakceptacji u chorych na jadłowstręt psychiczny. Psychiatria Polska. 2001; 35: 389-398. 30.Tonoike T., Takahashi T., Watanabe H., Kimura H., Suwa M., Akahori K., Itakura Y.: Treatment with intravenous hyperalimentation for severly anorectic patients and its outcome. Psychiatry and Clinical Neuroscience. 2004; 58: 229-235. 31.Turnbull S., Ward A., Treasure J., Jick H., Derby L. The demand for eating desorders care. An epidemiological study using the general practice research database Brit. J. Psychiatry 1996; 169: 705-712. 32.Wade T., Heath AC., Abraham S., Treloar SA., Martin NG., Tigemman M. Assessing the prevalence of eating disorders in an Australian twin population. Austr. NZJ Psychiatry 1996; 30: 845-851. 33. Ziółkowska B.: Ekspresja syndromu gotowości anorektycznej u dziewcząt dziewcząt stadium adolescencji. Wydawnictwo Fundacji Humaniora, Poznań 2001. 34.Żechowski C., Namysłowska I., Korolczuk A., Siewierska A., Jakubczyk A., Bażyńska A., Bronowska Z.: Program profilaktyki zaburzeń odżywiania się - badania pilotażowe. Psychiatria Polska 2004; 38: 51-63. 35.Żechowski C., Namysłowska I., Korolczuk A., Siewierska A., Jakubczyk A., Bażyńska A., Bronowska Z.: Profilaktyka zaburzeń odżywiania się u dzieci i młodzieży. Część I. Założenia ogólne i czynnmiki ryzyka. Psychiatria Polska 2004; 38: 65-73. 36.Żechowski C., Namysłowska I., Korolczuk A., Siewierska A., Jakubczyk A., Bażyńska A., Bronowska Z.: Profilaktyka zaburzeń odżywiania się u dzieci i młodzieży. Część II. Programy profilaktyczne i ich efektywność. Psychiatria Polska 2004; 38: 75-83.