Blog Assignment 11

Problem Definition: The incidence of anorexia nervosa and bulimia nervosa has increased over the past 15 years in female American adolescents between ages 12 and 19.

Out of the three interventions I came up with to address the issue of eating disorders in young females, the one with the highest chance of success would be a program designed to prepare coaches of high-risk teams to tackle the issue in their female athletes. Considering that the prevalence rates of eating disorders are 33% in cheerleaders, 50% in gymnasts, 45% of modern dancers and 45% of cross-country athletes (Black 1), targeting this specific group, female athletes in high-risk sport teams, would address a good portion of the adolescents that suffer from eating disorders. The intervention would consist of an online program on a disk being created for coaches of these teams to watch. They would be educated on how to recognize eating disorders, prevent them, and on how to help their athletes if they are on a path or already have anorexia or bulimia. Coaches want their athletes to be healthy and in their best physical and mental state, so the safety and athletic performance of their athletes would be their incentive to watch and implement this program.

To implement this intervention, a council of experts on eating disorders and its prevention would be gathered to formulate the information that will be provided on the online disk. These would include pediatricians, therapists, researchers, nutritionists, and others who are knowledgeable on eating disorders. Together, this group will provide the nutritional information, how to recognize onset and signs of eating disorders, ways to help athletes avoid negativity towards their bodies, and methods of promoting a positive self and body image, that will be programmed on this educational disk. An IT team would be called in to put all of this information into an online program on an easily accessible computer disk. This team will design the program to be easy to read, use, and understand by coaches who may not have any background in the issue. Once the program is made, it will be promoted and distributed by an advertising team to schools, sport centers, and coaches where it can be purchased and put to use. A barrier to implementation would be the cost, as schools and the coaches, themselves, might not want to pay for a program if they don’t see it as useful. However, this disk would not be very expensive, could be purchased through a phone call or online, and the advertising team would bring to light how important this issue is and how it could benefit the coaches by improving their athletes’ athletic performance.

The way the program would be communicated is through a team of advertisers, salespeople, and distributers who will work together to contact schools across the nation and get them to purchase this program. Additionally, a website could be made where the program could be purchased and which contains all the necessary information about the importance of this issue and how the program can help. This way, parents or athletes that come across it could also suggest it to their coaches. Either the school could purchase it and charge the coaches or the coaches could purchase the program themselves. The coaches want their athletes to be healthy and if this program were to prevent eating habits that will cause poor athletic performance, such as a loss in stamina, energy, and muscle mass, then I believe that coaches would want to purchase the disk. 

            Once the intervention is in place, there a few ways to evaluate its success. One process measure would be to look at purchase records and see how many schools and individual coaches were convinced enough to buy the program. Another process measure could be to survey the coaches to see how many used the program and how many found it useful and applicable to their athletes. An outcome measure could be to survey the athletes and question them as to whether they feel they have benefited mentally or physically. This includes asking them whether they have healthier thoughts and eating habits, whether their coaches have helped them improve their self esteem, and whether they think less negatively about their bodies. This would tell us if the intervention was able to prevent or at least decrease the negative thoughts that may lead to an eating disorder. Another outcome measure could be to assess pediatrician and hospital records to determine if rates of eating disorders have decreased in areas where the disk is being used. If schools are actually buying the program, if coaches are actually utilizing it and implementing its information, if athletes are feeling helped by their coaches, and if rates of eating disorders are decreasing than the intervention would be successful.

Works Cited

Black, D.R., L.J. Larkin, D.C. Coster, L.J. Leverenz, and D.A. Abood. Physiologic Screening

Test for Eating Disorders/disordered Eating among Female Collegiate Athletes. Journal of Athletic Training. N.p., 2003. Web. 17 Apr. 2013.

Blog Assignment 10

The most common form of intervention that is currently in place to address anorexia and bulimia nervosa are various forms of therapy, such as Cognitive Behavioral Therapy (CBT) and Family Based Therapy (FBT).

CBT is a form of therapy only recommended once weight has been stabilized in the patient first (ED 1). This type of therapy helps patients understand the thoughts and feelings that cause them to act the way they do, allowing them to change the destructives thoughts that negatively influence them (Cherry 1). Anorexics and bulimics that receive CBT had lower rates of relapse and better outcomes than those who did not (ED 1). In this type of therapy, the key determinants that are addressed all have to do with the mindset and mental issues of the patient, including poor body image, peer factors (dealing with negative comments and teasing), and the media (changing the way the patient views media images).

FBT requires the entire family of the patient to attend therapy sessions (ED 1). In this type of therapy, the entire family deals with the issues that are affecting the patient, which helps with the family’s understanding of the disorder and its recovery in order to create a healing environment for the patient (ED 1). Like CBT, FBT helps with the key determinants: poor body image, peer factors, and the media, but additionally addresses parental factors by improving family communication and working through family issues.

In order to improve the issue of eating disorder in the female youth population, a few possible interventions include an in school education campaign about eating disorders, online educational program for coaches, and insurance covered therapy once diagnosed with the disorder.

In a school oriented education campaign, which would be a primary intervention, the signs, symptoms, and complications of eating disorders, as well as the importance of healthy eating habits and high self-esteem, would be promoted throughout the school. This could be done by monthly assemblies, morning media briefs, signs and posters throughout the school, after-school classes, and/or through clubs and organizations. The key determinants that would be addressed would be peer factors, since it might encourage students to refrain from teasing about other students’ weight and poor body image by promoting healthy attitudes about self-image.

Another primary intervention could target female adolescents in sport teams, such as dance, gymnastics, and cheerleading, since the prevalence of eating disorders is significantly greater in these populations. This intervention would entail a nationwide education program for coaches of these at risk teams. If these coaches could be educated on how to recognize eating disorders and how to promote a healthy body image amongst their athletes through an online program, the rates of anorexia and bulimia in these groups could be decreased. The key determinants that would be addressed would be the higher pressures faces by females in sport teams and poor body image through the promotion of high self esteem.

Lastly, a secondary intervention, which would take place after the diagnosis of an eating disorder, could be the implementing of health insurance paid therapy for anorexic and bulimic patients. A patient suffering from an eating disorder needs to change their mental health in addition to their physical health. If they don't, they could relapse and continue down the disordered path. Since therapy is often very expensive and cannot be afforded by all, therapy sessions paid by the health insurance companies could improve how fast a patient recovers and reduce the likelihood of a relapse. The key determinants that would be addressed would be poor body image, family factors, peer factors, and the media, since therapists would help the patient work through all of these types of mental thoughts and issues.

Decision Matrix: (3 – best, 1 – worst)

Options Decision Criteria	Intervention 1: School Education Campaign	Intervention 2: Online Program to Educate Coaches	Intervention 3: Health Insurance Paid Therapy
Effectiveness	2	2	3
Feasibility	2	3	1
Sustainability	2	3	1
Cost	2	3	1
Cost effectiveness	2	3	1
Political acceptability	2	3	1
Social will	2	2	2
Potential for unintended risks	2	2	2
Potential for unintended benefits	2	2	2
Total/conclusion	18	23	14

According to the decision matrix, the intervention with the greatest possibility of success would be the online program to educate coaches of high-risk athletic teams. I used the criteria that we used for the lab because I felt this encompassed many, if not all, the criteria that should be considered when attempting to implement any sort of public health intervention. It is important to not only look at thinks like how effective and feasible an intervention could be, but also how costly and politically acceptable it is as well. Even if an intervention seems ideal on the drawing board, if it is extremely difficult to put into place, due to cost or lack of acceptance, it won’t work. Thus, the online program, which would be the cheapest and acceptable, even if it might not be the most likely to succeed, is the best-recommended intervention.

Works Cited

Cherry, Kendra. "What Is Cognitive Behavior Therapy?" About.com Psychology. N.p., n.d. Web.

19 Apr. 2013.

"Eating Disorders: Best Practices in Prevention and Intervention." Mental Health and Spiritual

Health Care. N.p., 2006. Web. 19 Apr. 2013.

Blog Assignment 9

In the process of addressing the increased incidence of anorexia and bulimia nervosa, there are numerous stakeholders that would be affected. A stakeholder is a person, group, or organization that is impacted by the issue of eating disorders and would be impacted by an intervention.  Which stakeholders are specifically involved depends on the particular intervention that is designed to improve the issue. Possible interventions include an in school education campaign about eating disorders, school mandated quarterly physicals, and insurance covered therapy once diagnosed with the disorder.

In a school oriented education campaign, the signs, symptoms, and complications of eating disorders, as well as the importance of healthy eating habits and high self-esteem, would be promoted throughout the school. This could be done by monthly assemblies, morning media briefs, signs and posters throughout the school, after-school classes, and/or through clubs and organizations who go from class to class. In such an intervention, the stakeholders would include: the students, the school board, the teachers, school staff, as well as those who organize and implement the campaign. In order for a campaign to work in schools across the nation, students would need to get on board and be willing to participate. Students would be needed to distribute and post signs, to participate in a club that promotes eating disorder awareness, and would need to support a campaign for it to be effective. The school board and school staff would need to find such a campaign important enough to fund and to find time in a school schedule for it to be implemented. They might oppose such an intervention considering eating disorders are not extremely prevalent and a campaign would cost money and staffing. However, if the board could be convinced that the students would get on board and help spread awareness, they might be willing to adopt it. The organizers and creators of a campaign would need to design the most efficient way for students to be educated, and would be the ones entering schools and providing the assemblies and information that is to be taught.

Another intervention could be school mandated quarterly physicals, where the height and weight of each student is checked four times during the school year. By checking weight more frequently, an onset of an eating disorder can be more quickly diagnosed and thus stopped sooner. This intervention would affect the students, their parents, the school board, and the school staff. Students would have to be weighed more often and in a school setting, which might make some uncomfortable and annoyed. Parents, additionally, might oppose their kids being forced to undergo frequent weigh-ins, which they might deem unnecessary. To accommodate complaints, students and parents could be assured that the weights would be kept private so the students feel more comfortable. The school board would have to find a way to fund this as well as to make schools comply with it. They might oppose this simply because of the cost of funding, as they might not see it as worth the money since eating disorders are relatively rare. The staff of each individual school would need to hire a nursing staff, if not already present, and find a way to track and organize the physical of each student.

Lastly, an intervention that would take place after the diagnosis of an eating disorder could be the implementing of health insurance paid therapy for anorexic and bulimic patients. A patient suffering from an eating disorder needs to change their mental health before their physical health can improve. If not, they may relapse and continue down the disordered path. Since therapy is often very expensive and cannot be afforded by many, therapy sessions paid by the health insurance companies could improve how fast a patient recovers and reduce the likelihood of a relapse. Stakeholders would include the insurance companies, the therapists, and the patients. Insurance companies would have to find a way to cover therapy sessions, which would undoubtedly be a difficult task. They might oppose this because eating disorders occur in such a small percentage of people, and generally in adolescents who are not paying for their own insurance. Therapists would have to agree to a more likely lower cost of service, if the insurance companies were to come on board. The patients would have to be willing to take the time to attend these sessions as well as willing to be open minded in these sessions, as not to waste them. To accommodate all of these concerns, group therapy sessions could be conducted. This would produce a support team for patients, provide more payment for the therapists, and ease the cost by each individual’s insurance company. 

Blog Assignment 8

Current problem definition: The incidence of anorexia nervosa and bulimia has increased over the past 15 years in American women between ages 12 and 19.

A key determinant for anorexia or bulimia nervosa is a factor that influences or causes a female adolescent to develop one or both of these disorders. There are numerous determinants for these eating disorders, which can fall under multiple categories such as biological, social, and cultural. Often, in the case of eating disorders, it is not one, but a combination of these factors that is present in each individual case of the disease.

Biological determinants for anorexia and bulimia nervosa include race, family history, and genetics. Numerous studies have suggested that the race of a female adolescent alters the risk they are at for developing an eating disorder. In a study published in the American Journal of Health Behavior, white college females displayed a significantly higher rate of body dissatisfaction related to eating disorders than did black college students (Abood 1). Thus, being of Caucasian decent increases the probability of developing an eating disorder. In addition, genetics and family history of the disease are also factors in development. According to the study, Genetic Factors in Eating Disorders, “there is a substantial genetic influence for [eating] disorders” (Himney 1). According to this study, the relative risk of a first-degree female relative of someone diagnosed with an eating disorder is 11.3 for anorexia and 12.3 for bulimia (Himney 1). This provides evidence that a female’s genes can predispose her to an eating disorder. In another study called, Variation in the ESR1 and ESR2 genes and genetic susceptibility to anorexia nervosa, an association was proven between prevalence of a certain gene and the development of anorexia nervosa, thus suggesting the influence of genetic factors on the disease (Eastwood 1).

Additionally, there are social determinants which increase a female’s risk of developing anorexia or bulimia. Peer factors have been shown to show an association, such as in a study cited in the Annual Review of Psychology in 2002, which stated that increased symptoms of eating disorders occurred with self-reports of weight and body related teasing (Polivy 195). Also, a study cited in the Annual Review of Psychology in 2002 stated that adolescents that rate their overall family communication and parental caring as low are at an increased risk for developing eating disorders (Polivy 194). Also, in the study, Parental Factors, Mass Media Influences, and the Onset of Eating Disorders in a Prospective Population-Based Cohort, girls with single parents were at higher risk for eating disorders (Martinez-Gonzalez 1). Thus, these studies show that a female’s family situation can greatly affect her susceptibility towards anorexia or bulimia.

Lastly, cultural factors can additionally be determining factors of eating disorders. The media and its portrayal of the ideal body have been researched on its affect of female adolescents. The study cited last also found a link between the amount of time reading printed media (teen girls’ magazines, especially) and higher rates of eating disorders in adolescent females (Martinez-Gonzalez 1).

Works Cited

Abood, Doris A. "Race and the Role of Weight, Weight Change, and Body Dissatisfaction in

Eating Disorders." APA PsychNet. N.p., Jan. 1997. Web. 6 Apr. 2013.

Eastwood, Brown H. "Variation in the ESR1 and ESR2 Genes and Genetic Susceptibility to

Anorexia Nervosa." PubMed.gov. N.p., 2002. Web. 6 Apr. 2013.

Hinney, Anke, Dr. "Genetic Risk Factors in Eating Disorders - Springer." American Journal of

Pharmacogenomics. N.p., 01 Aug. 2004. Web. 06 Apr. 2013.

Martinez-Gonzalez, Miguiel Angel. "Parental Factors, Mass Media Influences, and the Onset of

Eating Disorders in a Prospective Population-Based Cohort." Official Journal of the

American Academy of Pediatrics. Pediatrics, 1 Feb. 2003. Web. 06 Apr. 2013.

Polivy, Janet. "Causes of Eating Disorders." Annual Review of Psychology. N.p., 2002. Web. 06

Apr. 2013.