Table 1 Goals and strategies for prevention, early identification, and intervention
Goal | Strategy | Obstacles | Navigation |
|---|---|---|---|
Prevention | |||
Implement comprehensive health education programs that meet the National Health Education Standards (from the CDC) and include culturally-appropriate information that focuses on social-emotional development, enhancement of protective factors, and establishment of healthy peer norms | Use legislative efforts to enforce mandates and measurements for state education departments | Not every state can or will enforce/adopt the mandates due to: Limited resources Lack of recognition and prioritization of eating disorders Lack of collaborative effort focused on early detection and prevention between the public and mental health disciplines | Nominate/identify a group that lobbies for these initiatives Build grassroots support and understanding for the importance of implementing preschool through 12th grade comprehensive health education with built in assessments Use other health indicators such as dietary patterns, diabetes, and mental illness rates as a way to build support for eating disorder screenings and implementation of preschool-secondary school comprehensive health education Develop a mechanism for cross-discipline dialogue between public and mental health professionals using easy-to-implement, low cost programs (e.g., existing technology programs)a |
Early identification and intervention | |||
Recognize risk behaviors, at-risk statuses, early development of the illnesses in typical and atypical clinical presentations; and appropriately intervene and/or refer | Broadly disseminate evidence-informed content, strategies, and tools via NCEED, a nationally-recognized, not-for-profit organization with the ability to reach a diverse group of stakeholders | There will likely be difficultly in adequately reaching all stakeholders who might play a role in detection and early intervention. This is particularly true for primary care and frontline providers as they already are heavily burdened with screening a variety of mental and physical health conditions | Key partnerships with organizations will help promote strategy (e.g., ACCME; Boards of primary care specialties; the CDC; teachers’ unions; state education departments; NASMHPD; etc.)b |
Implement developmentally, age, gender, race, culturally-appropriate screening practices in primary care and ambulatory care settings | Preschool—secondary school and public colleges and universities: Engage with legislative bodies to enact legislation that compels providers (and other stakeholders) at publicly-funded institutions to receive education and training on eating disorder detection and early intervention Adults: Develop standards of practice for screening and early intervention and/or leverage the power of electronic medical records (e.g., Epic) to help providers engage in this process. For example, an electronic medical record/clinic workflow might include a brief screening for eating disorders which then triggers specific steps and/or referrals for patients at high riske | Lack of awareness or buy-in from primary care providers and other frontline clinicians who may see screening for yet another condition as an additional burden; viewing eating disorders as a low priority concern; prioritization of addressing “obesity problem” overeating disorders; and general lack of understanding about the screening process | Identify and use influencers and/or consensus building organizationsc,d |
Include eating disorder-informed content into existing higher education and workplace wellness initiatives (e.g., employee-based programs that promote improving dietary and physical activity patterns, stress reduction, mindfulness practices, etc.) | Promote the cost-saving value of the wellness initiatives | Lack of awareness or buy-in from employers/companies, schools, and organizations | Use influencers to encourage change from within corporate governance Sell as a quality improvement in the workplace (lower cost associated with health insurance; increased importance in value-based care, etc.) Highlight the cost to employers from absenteeism, turnover, etc. of undiagnosed or untreated eating disorders |