The PRECEDE-PROCEED Model and Eating Disorders in Adolescents
Karen Harper
National University
January 11, 2015
The PRECEDE-PROCEED Model and Eating Disorders in Adolescents
According to Healthy People 2020, 14.9 percent of adolescents engaged in disordered eating behaviors in an attempt to control their weight in 2009. The target goal for 2020 was to reduce this number to 12.9 percent; however, the percentage has instead increased to 16.7 percent in 2013. Eating disorders affect both males and females, with 10.4 percent of males and 23.0 percent of females in grades 9-12 reporting disordered eating behaviors in 2013. Eating disorders include diagnoses such as anorexia nervosa, binge eating disorder, and bulimia and may lead to cardiovascular and neurological complications as well as impaired physical development (National Institutes of Health, 2007). Eating disorders are often co-occurring with other psychiatric disorders.
Phase 1- Quality of Life Diagnosis
Adolescents with eating disorders may have lower quality of life than their peers with other psychiatric conditions (Leung, Ma, & Russell, 2013). In one study, patients being treated for eating disorders presented with low self-esteem, low sense of belonging, low self-image, impairment in life skills and leisure activities, poor financial situation and living conditions, and a lack of sense of purpose. Another study found that former patients treated for eating disorders continued to have a poor quality of life (Leung, et al, 2013).
Phase 2- Epidemiological Diagnosis
The overall mortality rate for anorexia nervosa is 5.9 percent. For bulimia and eating disorder not otherwise specified, the mortality rate is 1.9 percent (Marti, Rohde, & Stice, 2013). There is also a high mortality rate due to suicide among adolescents affected by eating disorders. The suicide rate for those with anorexia is 4.7 and it is 6.5 for those with bulimia and eating disorder not otherwise specified (Marti, et al, 2013). The average duration of a single eating disorder episode was 8 years, while one study showed a 100 percent remission rate after 2 years (Marti, et al, 2013). The lifetime prevalence of any eating disorder by age 20 was 13.1 percent. Peak age of onset for eating disorders is between 16-20. Depression and anxiety are often comorbid conditions with eating disorders (Leung, et al, 2013).
Phase 3- Environmental Diagnosis
Risk factors for eating disorders include dieting, elevated body mass, body dissatisfaction, perceived peer pressure to be thin, and modeling of disordered eating behaviors ( Presnell, Spangler, & Stice, 2002). Binge eating was predicted by negative affect (depressive symptoms and low self-esteem) in adolescent girls, possibly because the girls used food as a means of comfort (Presnell, et al, 2002). Body dissatisfaction was the highest predictor of eating disorders, with adolescent girls reporting the highest level of body dissatisfaction at a fourfold higher risk than their peers (Durant, Marti, & Stice, 2011).
Predisposing, Enabling, and Reinforcing Factors
Predisposing factors, as noted above, include body dissatisfaction, dieting, perceived pressure to be thin, and modeling of disordered eating behaviors. Depressive symptoms are also a predisposing factor. Enabling factors can include media portrayals of thinness as desirable, as well as lack of adequate treatment facilities and mental health providers specializing in eating disorders. Reinforcing factors may come from the family, such as parents who are overly critical, overprotective, shaming, or family members who also engage in disordered eating behavior (Treasure, Sepulveda, MacDonald, Whitaker, Lopez, Zabala, Kyriacou, & Todd, 2008). Family members’ compulsivity, rigidity, and focus on detail can also be enabling factors (Treasure, et al, 2008).
Phase 4- Intervention Alignment and Administrative and Policy Assessment
Positive results have been attained among at-risk teen girl athletes who attended health education programs targeting eating disorders. The girls were taught about healthy eating behaviors, self-esteem, exercise, resisting peer pressure, and body image (Langmesser & Verscheure, 2009). Because athletics are an important part of middle and high school life for many adolescents, school athletic departments should consider implementing eating disorder prevention programs for young athletes, who are especially at risk due to the competitive nature of sports and focus on being thin in some activities such as gymnastics or dance (Langmesser & Verscheure, 2009).
Phase 5- Implementation
A health education program will be implemented in public schools for grades 9-12. This program will be specifically targeted at adolescents participating in school athletic programs. It will include topics such as body image, healthy eating and exercise habits, peer pressure, body image, and self-esteem. Students will be encouraged to share their own experiences with their peers and instructors. Instructors should assure the students that if they have concerns about eating disorders and would like help, the instructor will keep their concerns confidential from their peers. Coaches and physical education teachers will be trained to teach the program and to be aware of warning signs of eating disorders. If the instructor feels that a student may be showing signs of an eating disorder, he or she should speak to the student individually and make a referral to the school psychologist or social worker as appropriate. School mental health workers also need to be aware of the program and have adequate training in identifying and treating eating disorders.
Financial costs of implementation should be relatively low, as the program will be taught by existing school staff. Funding will be required at the federal level to plan and coordinate program implementation.
Stages 6, 7 and 8- Evaluation
The program shall be evaluated on an annual basis. Data will be collected about the number of eating disorder cases identified in schools and the overall prevalence of eating disorders in the grade 9-12 population. Instructors will complete an annual survey to evaluate any potential problems in the process. The curriculum will be re-evaluated annually based on instructor feedback. If by 2020 a decrease in the prevalence of eating disorders among adolescents grades 9-12 has not been achieved (per Healthy People 2020 goals), the program shall be discontinued.
References
Chavez, M., & Insel, T. R. (2007). Eating Disorders: National Institute of Mental Health’s Perspective. The American Psychologist, 62(3), 159–166. doi:10.1037/0003-066X.62.3.159
Healthy People 2020 Objective Data Search. (n.d.). Retrieved January 12, 2015, from https://www.healthypeople.gov/2020/data-search/Search-the-Data?nid=4811
Langmesser, Lisa,M.S., A.T.C., & Verscheure, Susan, PhD,A.T.C., C.A.T.(C.). (2009). Are eating disorder prevention programs effective? Journal of Athletic Training, 44(3), 304-5. Retrieved from http://ezproxy.nu.edu/login?url=http://search.proquest.com/docview/206652233?accountid=25320
Leung, S., Ma, J., & Russell, J. (2013). Enhancing quality of life in people with disordered eating using an online self-help programme. Journal of Eating Disorders, 1, 9-9.
Stice, E., Marti, C., & Durant, S. (n.d.). Risk Factors For Onset Of Eating Disorders: Evidence Of Multiple Risk Pathways From An 8-year Prospective Study. Behaviour Research and Therapy, 49(10), 622-627.
Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal Of Abnormal Psychology, 122(2), 445-457. doi:10.1037/a0030679
Stice, E., Presnell, K., & Spangler, D. (2002). Risk factors for binge eating onset in adolescent girls: A 2-year prospective investigation. Health Psychology, 21(2), 131-138. doi:10.1037/0278-6133.21.2.131
Treasure, J. G. (2008). The assessment of the family of people with eating disorders. European Eating Disorders Review, 16(4), 247-255.
Karen Harper 