Intervention Review

Interventions for preventing eating disorders in children and adolescents

  1. Belinda M Pratt1,*,
  2. Susan Woolfenden2

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 22 APR 2002

Assessed as up-to-date: 2 SEP 2004

DOI: 10.1002/14651858.CD002891

How to Cite

Pratt BM, Woolfenden S. Interventions for preventing eating disorders in children and adolescents. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD002891. DOI: 10.1002/14651858.CD002891.

Author Information

  1. 1

    The Children's Hospital at Westmead, CPPPC, Psychological Medicine, Westmead, NSW, Australia

  2. 2

    Liverpool Hospital, B Wing, Liverpool, NSW, Australia

*Belinda M Pratt, CPPPC, Psychological Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia. Bel_Mike@bigpond.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 APR 2002

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Eating disorders represent an extremely difficult, time-consuming and costly condition to treat. Being young, female, and dieting are some of the few identified risk factors that have been reliably linked to the development of eating disorders. There is currently limited evidence in the published literature to suggest that any particular type of program is effective in preventing eating disorders and there has been concern that some interventions have the potential to cause harm.

Objectives

To determine if eating disorder prevention programs for children and adolescents are effective in: (1) promoting healthy eating attitudes and behaviours; (2) promoting protective psychological factors; (3) promoting satisfactory physical health; (4) having a long-term, sustainable, and positive impact on mental and physical health; and, (5) ensuring safety in relation to possible harmful consequences on mental or physical health.

Search methods

Relevant trials are identified through searching the Cochrane Controlled Trial Register (CCTR) and relevant biomedical and social science databases, as well as reference lists from articles identified through the search strategy and contact with experts in the field.

Selection criteria

Randomised controlled trials (RCTs) with a major focus on eating disorder prevention programs for children and adolescents, where there is no known DSM-IV diagnosis of an eating disorder, are eligible for inclusion in the review. Trials must include a control group and at least one objective outcome measure (e.g., BMI) or a standardised psychological measure used with the intervention and control group, pre- and post-intervention.

Data collection and analysis

A total of 1016 titles have been identified through the search to date. Twenty-two studies were located that reported use of a randomised controlled trial methodology and were critically appraised by two independent reviewers. Twelve studies met the selection criteria outlined above.

Main results

Combined data from two eating disorder prevention programs based on a media literacy and advocacy approach indicate a reduction in the internalisation or acceptance of societal ideals relating to appearance at a 3- to 6-month follow-up (Kusel 1999; Neumark* 2000) [SMD -0.28, -0.51 to -0.05, 95% CI]. There is insufficient evidence to support the effect of five programs designed to address eating attitudes and behaviours and other adolescent issues in the general community or those classified as being at high risk for eating disorder (Buddeberg* 1998; Dalle Grave 2001; Killen 1993; Santonastaso 1999; Zanetti 1999) and insufficient evidence to support the effect of two programs designed to improve self-esteem (O'Dea 2000; Wade 2003). Data from two didactic eating disorder awareness programs could not be pooled for analysis. There is not sufficient evidence to suggest that harm resulted from any of the prevention programs included in the review.

Authors' conclusions

The one significant pooled effect in the current review does not allow for any firm conclusions to be made about the impact of prevention programs for eating disorders in children and adolescents, although none of the pooled comparisons indicated evidence of harm. The meta-analysis is in the process of being revised to account for the impact of cluster randomised trials.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Preventing eating disorders in children and adolescents

Eating disorders represent an extremely difficult, time-consuming and costly condition to treat. Being young, female, and dieting are some of the few identified risk factors that have been reliably linked to the development of eating disorders. Several eating disorder prevention programs have been developed and trialled with children and adolescents. There is currently limited evidence in the published literature to suggest that any particular type of program is effective in preventing eating disorders and there has been concern that some interventions have the potential to cause harm. The aim of this systematic review is to determine whether these interventions are effective in the prevention of eating disorders in children and adolescents. Only one statistically significant result was found in the present meta-analysis - a slight effect of media literacy and advocacy programs in reducing acceptance of societal body image ideals. There is not sufficient evidence to suggest that harm was caused by any of the 12 randomised controlled trials included in the review at short-term follow-up. The meta-analysis is in the process of being revised to account for the impact of cluster randomised trials.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

預防兒童青少年飲食疾患的處置

飲食疾患是一種相當困難、耗時、相當花錢來治療的疾病。年輕、女性和節食是少數已被確認出的危險因子,這些因素是和飲食疾患的發展有關連。目前發表的文獻中只有有限的證據顯示任何特定型態的計畫對於預防飲食疾患都有效,並且關心一些處遇是否有可能造成傷害。

目標

決定是否預防兒童和青少年的飲食疾患計畫能產生效果在(1) 提升健康的飲食態度和行為(2)提升心理的保護因子(3)提升對於生理健康的滿意(4)產生對身心健康長期、持續、正向的影響(5)在可能對心理或身體健康產生有害後果時確保安全。

搜尋策略

搜尋the Cochrane Controlled Trial Register (CCTR)和相關生化、社會科學的資料庫來確認相關的研究,並且搜尋文章後的參考目錄,並與這領域的專家聯繫。

選擇標準

納入主要是針對目前還未有飲食疾患診斷的兒童和青少年的預防計劃的隨機對照試驗(RCTs)。試驗必須包括一個控制組和至少一個客觀的結果測量(例如,BMI)或標準化心理測驗使用在實驗組、對照組、前測和後測。

資料收集與分析

到搜尋日期為止,總共發現1016個標題。22個研究使用隨機對照試驗方法,且由2名作者分別嚴格的審核。12個研究符合上述選擇標準。

主要結論

從兩個以媒體文字和宣傳為基礎的預防飲食疾患計劃的綜合資料顯示,在3 – 6個月的追蹤評估中,對於外貌的社會標準內化的程度或接受度已下降Kusel 1999; Neumark* 2000) [SMD −0.28, −0.51 to −0.05, 95% CI].。有五個實行在一般社區,或那些被列為高風險的人的方案中,強調飲食的態度、飲食行為及其他青少年問題並沒有充足的證據支持其有效(Buddeberg* 1998; Dalle Grave 2001; Killen 1993; Santonastaso 1999; Zanetti 1999)。在兩個設計來改善自尊的方案也沒有足夠的證據支持有效(O'Dea 2000; Wade 2003).。從兩個教導飲食疾患的宣傳教育方案的資料不能整合進行分析。在本文獻中也沒有足夠的證據表明任何預防計劃會造成傷害。

作者結論

在本文獻中一個重要整合效果並無法形成任何確定的結論,有關預防方案對於預防飲食疾患的兒童和青少年的影響,雖然也沒有比較的資料證據證明有害。而後設分析需進行校正來說明集束隨機試驗的影響。

翻譯人

本摘要由彰化基督教醫院胡淑惠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

飲食疾患是一種相當困難、耗時、相當花錢來治療的疾病。年輕、女性和節食是少數已被確認出的危險因子,這些因素是和飲食疾患的發展有關連。飲食疾患的幾個預防計劃已經發展並進行試驗在兒童和青少年身上。目前發表的文獻中只有有限的證據建議任何特定的型態的計畫對於預防飲食疾患都有效,並且關心一些處遇有可能造成傷害。此篇系統性回顧文獻的目的是決定是否飲食疾患的預防計畫對兒童和青少年能產生效果。在我們目前的後設分析中只有一個統計學顯著意義的結果媒體文化和媒體宣傳計劃在減少對外貌的社會的標準的身體形象的接受度有輕微下降。在本文中所納入的12個隨機對照試驗的短期追蹤中,並沒有足夠的證據表明有造成損害。而後設分析需進行校正來說明集束隨機試驗的影響。