Prevention programs for eating disorders abound, though many people I’ve talked to (mostly on Twitter, because that’s where I have a lot of discussions of this type) have expressed the sentiment that limited resources might be better spent on early intervention or treatment in general. Still, it isn’t hard to understand why we still optimistically aim for eating disorder prevention; of course we would rather stop eating disorders in their tracks, before they wreak havoc on the lives of people and their loved ones. I’ve written about my own take on the “is prevention possible” debate elsewhere, highlighting some of my concerns, as well as some more optimistic sentiments about truly systemic prevention efforts.
One of the things I am most concerned about is the fact that prevention tends to take place in the school context, delivered by teachers who may or may not know much about eating disorders themselves and whose “healthy eating” messages may do more harm than good. In this post I will look at 3 studies focusing on the role of teachers in delivering prevention programming.
The first, by Yager & O’Dea (2005) lays out some key points about the critical issues to consider when thinking about school-based prevention. In the second, Piran (2004) highlights how teachers might be enlisted in eating disorder prevention in a way that implicates their own lived, embodied experiences. The last, by McVey, Gusella, Tweed & Ferrari (2009) outlines results from a training program for teachers aimed at increasing their proficiency in delivering prevention programs. Together, these studies help us to scratch the surface of what researchers have to say about teachers’ impacts on eating disorder prevention, including both pitfalls and benefits.
The Role of the Teacher
Trying to implement eating disorder prevention programs in our weight-obsessed society can be challenging; for one, there is a pervasive assumption that everyone shares a definition of healthy eating and a goal of weight loss. Teachers are certainly not immune to the kind of weight stigmatizing attitudes held in popular culture; so, why do we assume that teachers will be able to deliver eating disorder prevention without thinking about their situatedness in our society?
To disentangle the potential impacts of teachers’ Yager & O’Dea explored teachers’ attitudes, knowledge, and training in the delivery of eating disorders and obesity prevention. They note that we tend to assume that teachers hold knowledge around how to deliver health curriculum; however, many teachers (like most people) hold oversimplified understandings about the relationship between weight and health. Yager & O’Dea’s review revealed that many teachers:
- Felt negatively toward obese individuals
- Believed that eating disorders could be resolved if someone just “pulled themselves together”
- Suffered role confusion around whether they should be delivering prevention or treatment
The authors also note that there is at least equivalent, if not higher, prevalence of disordered dieting and exercise among physical education teachers as in the general population. This could be interpreted in a positive or negative light, they note: having been through struggles may increase teacher empathy for eating disorders, but could also lead to modeling problematic behaviours, in the case of an active eating disorder.
Yager & O’Dea provide the following suggestions for training teachers in appropriate ways of delivering eating disorder prevention:
- More thoroughly train teachers in body image, eating disorders and obesity
- Train teachers not only in content, but also in prevention science, including techniques for prevention
- Assess teachers’ personal and professional needs in this area
Niva Piran (2004) provides more information about how developing body awareness and centralizing teachers’ experiences might help to mitigate the potential biases teachers can bring to prevention delivery.
Piran suggests that the lacking focus on how teachers might shape (as opposed to simply delivering) knowledge students encounter is a missing link in prevention effectiveness. Like a growing contingent of others in the field, Piran opts for an ecological (whole system) approach to prevention. Looking at the literature around teacher interest and knowledge in prevention:
- Teachers sense a gap in their knowledge around how to be a “good role model” for positive body image, and may not explore the negative consequences of dieting with students in prevention contexts (Rayman & Piran, 2002)
- Teachers may desire, but not have access to, prevention strategies and “how tos” for doing weight-related disorder prevention (Neumark-Sztainer, Story & Coller, 1999)
- The format of this information is key: teachers tend to prefer short, to the point guidelines over time-consuming books, workshops, or lesson plans (Smolak et al., 2001)
To enlist teachers in eating disorder prevention, Piran suggests:
Centralizing bodily experience by encouraging a critical exploration on teacher misconceptions and prejudicial attitudes toward certain types of bodies
For Piran, this includes:
- A critical analysis of consumer capitalist society
- The promotion of respect and care for (all kinds of) bodies
- An exploration of the structural and attitudinal barriers that diversely positioned people face in accessing health, and
- Empowering teachers to “embody prevention”
Engaging teachers in focus groups around “body-anchored experiences”
These groups would enable teachers to explore:
- How they have experienced their body in society
- See how this has impacted behaviour, and
- Leverage these experiences while delivering prevention
Brain storming about teacher-involved initiatives that could bring these body-anchored experiences into practice
For example, teachers might participate in activities that challenge often taken-for-granted misconceptions about bodies in the school context.
Together, these actions encourage teachers to explicitly position themselves as not just vessels for the delivery of neutral information (and we know that information about bodies, food, and weight are never neutral) but as part of prevention efforts.
So, both of these articles build evidence for the case that we need to be taking the role of teachers seriously when designing and implementing prevention efforts. However, we also know that time and resources are limited. How effective are strategies that encourage teachers to embody prevention, and what has been tried?
Gail McVey has been at the helm of many Canadian initiatives aiming to more thoroughly train teachers and health care professionals in eating disorders and body image issues. Here, I’ll briefly describe an article from 2009 in which she and colleagues detail experiences testing an online prevention program with 78 teachers and 89 public health practitioners in 2 provinces.
McVey et al. note that in the wake of an uptick in anti-obesity messaging and general concern about children’s health, there is a particular need to provide teachers with more information about how to provide students with balanced and helpful information about weight and shape.
They tested a curriculum and training tool called The Student Body: Promoting Health at Any Size, a 6-module, online program for teachers and other school professionals. They wanted to find out if teachers were comfortable with the program, whether the program provided an effective way to give teachers information about prevention that they felt able to use to work against weight biases in the school environment.
Participants were divided into intervention and control groups; both health practitioners and teachers were involved, but for the purposes of this post I’ll focus on the results related to teachers in particular. Those in the intervention group improved in their knowledge of:
- Restrictive dieting (e.g. that diets may lead to weight gain)
- Peer influences on weight bias (e.g. that peers may actively or passively encourage dieting amongst one another)
Unfortunately, despite being satisfied with the program, teachers did not feel more able to fight weight bias upon completion of the modules. The authors suggest that to bring increases in knowledge into practice, teachers need more support in developing strategies to counter weight bias.
Unlike some other articles I’ve seen on the subject, McVey et al.’s article provides a detailed outline of topics covered in the intervention. They also define “healthy eating,” which is surprisingly rare in prevention articles. This kind of transparency could hopefully help in other trials for the program, or tweaks to make the intervention more effective.
So, what does it mean?
It is encouraging to see prevention programs focused on making changes in the broader environment rather than focusing on the individual. McVey et al.’s article helps to provide evidence against a common refrain one might encounter when arguing for the need to provide more training opportunities for teachers: that it requires too much time and effort to train teachers how to do prevention. Counter to this argument, this study showed how teachers were satisfied with a program delivered online and aligned with curriculum.
I also enjoyed how Piran’s article in particular highlighted that if we want to make cultural change around weight, bodies, and food, in schools and beyond, we need to critique not only “thin ideal internalization” (which places the onus on the individual) but the broader consumer capitalist society in which we live. Instead of assuming that “media literacy” in a traditional sense (i.e., awareness of airbrushed models, etc.) this extends into the realm of being critical about why and in whose interests (hint: not mine or yours, but certainly the pocket books of large corporations) these standards are produced.
Together, these articles underline the necessity of approaching prevention from beyond the individual. They encourage us to make changes at a systemic level (i.e. the school as a system) to support a more body-, food- and weight-positive environment for children. Whether changes in teacher training help to: a) prevent iatrogenic (unintended negative) impacts of prevention programs for children exposed to prevention and b) actually prevent eating disorders remains to be seen. At the very least, this could be a positive step toward less weight-stigmatizing environments that could be more supportive for students, teachers, and others.
McVey, G., Gusella, J., Tweed, S., & Ferrari, M. (2009). A controlled evaluation of web-based training for teachers and public health practitioners on the prevention of eating disorders. Eating disorders, 17 (1), 1-26 PMID: 19105058
Piran, N. (2004). Teachers: on “being” (rather than “doing”) prevention. Eating disorders, 12 (1), 1-9 PMID: 16864300
Yager, Z., & O’Dea, J.A. (2005). The role of teachers and other educators in the prevention of eating disorders and child obesity: what are the issues? Eating disorders, 13 (3), 261-78 PMID: 16864532