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© 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
Summary
SUMMARY
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.



1. Introduction
Nowadays a rising number of people suffering from eating disorders can be observed [1]. 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 [18]. 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 [31].
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 [33].
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% [18], from 0.7% to 1.0% of the whole population [5, 25], 1%-2% [24], and 1:200 for adolescent girls aged 15-19 [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 [24]. 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 [36].
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 [7] submitted during the First International Scientific Conference: A human being chronically ill and handicapped – interdisciplinary care aspects, which took place in Szczecin in 2004.
2. 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.
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].

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Piśmiennictwo
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Adres do korespondencji:
Wojciech Chalcarz
Zakład Żywności i Żywienia AWF w Poznaniu
ul. Droga Dębińska 7, 61-555 Poznań, Poland
tel + 48 61 835-52-87
e-mail: chalcarz@awf.poznan.pl

New Medicine 1/2006
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