Population-based prevention of eating disorders: an application of the Rose prevention model.
BACKGROUND
Several decades of concerted research on eating disorders have generated a broad range of proposed causal influences, but much of this etiologic research does not elucidate practical avenues for preventive interventions. Translating etiologic theory into community health interventions depends on the identification of key leverage points, factors that are amenable to public health intervention and provide an opportunity to maximize impact on the outcome of interest. Population-based preventive strategies, elaborated by epidemiologist Geoffrey Rose, can maximize the impact of public health interventions. In the case of eating disorders, Rose's model is instructive: Dieting stands out as risk behavior that may both fit Rose's model well and be a key leverage point for preventive intervention.


METHODS
Grounded in Rose's work, this article lodges a theoretical argument for the population-based prevention of eating disorders. In the introductory section, existing research on the epidemiology of dieting is reviewed, showing that it is extremely common among adolescent girls and women and that the behavior has been implicated as a causal factor for disordered eating. Next, new evidence is offered to build a case for how a population-wide reduction in dieting may be an effective strategy for prevention of eating pathology. Finally Rose's prevention framework is used to introduce a unique and provocative perspective on the prevention of eating disorders.


RESULTS
Dieting is a normative behavior in our culture with psychological and physiological effects in the causal chain leading to eating pathology. This behavior may represent an ideal target for population-based prevention.


CONCLUSIONS
Theoretical and empirical evidence suggests that a population-wide reduction in dieting may be a justifiable and effective strategy for prevention of eating pathology.
Division of Adolescent Medicine, Children's Hospital, Harvard School of Public Health, Boston, MA, USA. bryn.austin@tch.harvard.edu
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D000293:Adolescent; D000328:Adult; D018672:Community Health Planning; D004038:Diet, Reducing / Q000523:psychology*; D001068:Feeding and Eating Disorders / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008962:Models, Theoretical; D015980:Public Health Practice; D012307:Risk Factors; D014481:United States / Q000453:epidemiology