Political Bodies: What is the Impact of National or Regional-Level Eating Disorder Prevention?

When it comes to prevention, I’ve noticed a strong interest in working toward large-scale prevention initiatives. I’ve written about prevention before, noting the potential for unintended effects, as well as schoolgirls’ reactions to and acceptance of prevention interventions (here). But what about the larger scale efforts to prevent body image concerns and eating disorders?

Countries from the US to Australia to Israel have taken strides to implement initiatives aimed at improving national body image (a lofty goal? Perhaps.); you might have heard about bans on thin runway models and airbrushing, among other efforts. We know that eating disorders are not solely caused by thin-ideal internalization or bad body image; in fact, body image might not even be that useful of a concept for everyone, as I wrote about here.

However, improving body satisfaction could be a useful end goal in and of itself. Why not try to help people feel more comfortable with themselves? So, I find it hard to argue with large-scale, national- or regional-level attention being paid to improving body image. I do wonder, however, what kinds of campaigns are effective and worth the effort.

Keeping things close to home, this post will explore a Canadian effort in this vein: the Québec Charter for a Healthy and Diverse Body Image. Gauvin & Steiger (2012) evaluated the campaign, writing about its reach, acceptability and perceived potential 6 months after implementation.

THE CHARTER

In 2009, the Ministry of Culture, Communications and the Status of Women worked together to create an initiative designed to promote diversity in body image representation. A 30-person working group comprised of governmental officials, fashion and advertising industry and health care representatives worked to develop a number of principles to which individuals and organizations could adhere. Esther Bégin, a TV journalist, and Dr. Howard Steiger, director of the Eating Disorders Program at the Douglas Institute in Montréal, Québec, co-chaired the committee.

Signing the Charter is voluntary and indicates a pledge to:

1. Promote a diversity of body images, including different heights, proportions, and ages;
2. Encourage healthy eating and weight-control habits;
3. Discourage excessive weight-control practices or appearance modification;
4. Refuse to subscribe to esthetic ideals based on extreme thinness;
5. Remain vigilant and diligent so as to minimize the risks of anorexia nervosa, bulimia nervosa, and unhealthy preoccupations with weight;
6. Act as agents of change so as to promote healthy eating and weight-control practices and realistic body images; and
7. Promote the Québec Charter for a Healthy and Diverse Body Image among partners, clients, and others while actively respecting and adhering to its principles.

While the Charter is not explicitly designed to prevent eating disorders per se, it is designed to minimize socio-cultural pressures surrounding thinness and “excessive weight-control practices.”

THE STUDY 

Dr. Steiger and Dr. Lise Gauvin conceptualized a research initiative that sought to determine whether this Charter was recognizable, acceptable to and perceived as potentially impactful by Québec residents. They surveyed 1003 adults in Québec, asking questions about whether these individuals knew about the Charter, whether they found the Charter a worthwhile initiative, and whether they saw potential impact in specific Charter aims.

Their response rate was relatively high for this type of study (38%). The authors achieved a relatively gender-balanced sample, with 49.4% male and 50.6% female respondents; participants were also relatively well balanced in terms of age, education level, income, marital status, and number of children.

THE MAIN RESULTS

Reach

The main result the authors report is that over 35.1% of the sample knew about the Charter, which they suggest indicates a relatively strong reach for the initiative. However, it is important to note that only 7.3% of the sample recognized the Charter without any prompting (i.e. knew what the Charter was when only its name was mentioned). The remaining 28.5% were prompted with a brief description of the Charter.

This also means that 64.9% of those surveyed did not recognize the Charter even after being given a description. Still, the fact that 35% of the sample were at least somewhat familiar with the Charter is respectable, especially given that the survey was conducted only 6 months after the release of the survey. The authors acknowledge that more work needs to be done in terms of increasing awareness of the Charter, particularly for individuals with a lower educational levels, who were unlikely to recognize the Charter even following prompting.

Acceptability

So, 35% of respondents recognized the Charter. But how likely are these individuals to adhere to it? The authors report that “very favorable” attitudes toward the Charter among were highest among those who recognized the Charter:

• 55.5% of individuals who spontaneously recognized the Charter felt “very favorable” toward it, vs. 33.6% of those who did not spontaneously recognize it
• 40.1% of individuals who recognized the Charter after being prompted felt “very favorable” toward it, vs. 32.8% of those who did not recognize it following prompting

That seems like good news; it is an encouraging indication that those who were familiar with the Charter seemed to like its content.

Perceived Impact

Looking at the figures for perceived impact of the Charter, it would seem that respondents were somewhat ambivalent about the potential for the Charter to effect change; overall, 32.7% of respondents indicated that they felt the Charter had good potential. Respondents found it to hold some potential, particularly in the following areas:

• 26.9% of respondents felt that that the Charter had strong potential to make people more aware of the potential consequences of disordered eating/unhealthy weight control
• 23.1% thought it could potentially inform people about the potential health hazards associated with extreme thinness

However, only 14% found the Charter to be likely to reduce sociocultural pressures favouring thinness (note that this was the Charter’s explicit goal).

It seems that this ambivalence could be related to a more general sentiment that it is really difficult to reduce these sociocultural pressures. Looking at respondents’ endorsement of various statements related to ways of enacting this change, for example:

• 36.6% completely agreed that a reduction in images that favoured beauty ideal could reduce these pressures; however,
• 29.3 % completely disagreed that more public vigilance around decreasing risk factors for anorexia, bulimia, and “an unhealthy preoccupation with weight” would reduce these pressures

Responses were concentrated in “somewhat agree” and “somewhat disagree” categories for suggestions that the following could reduce sociocultural pressures toward thinness:

• A focus on healthy eating and “healthy weight control practices”
• A reduction in emphasis on excessive weight control/image modification
• An increased presence of healthy/realistic body images in public fora

Put together, only 13.9% of respondents thought the Charter was highly likely to reduce pressures toward thinness.

WHAT NOW?

Personally, I find the fact that people seem relatively ambivalent about the potential for regional campaigns such as this Charter to effect change in sociocultural pressures toward thinness one of the most interesting findings stemming from this study. The authors suggest that continued advocacy in conjunction with media and industry partners could help to increase the potential for the Charter. This could certainly be helpful in terms of marketing the Charter to appeal to more people, particularly for increasing its’ reach.

Something I wonder about, when reading prevention literature in general, is how often some things go unproblematized. For example, there is a strong tendency, in the literature of this type, to toss around terms like “healthy weight control” or “healthy eating.” Maybe this is the overly-critical grad student in me speaking, but whose definitions of healthy eating are we using, here? Is one of the reasons why people feel ambivalent about such campaigns that there is a lack of clarity about what we really mean when we say “healthy eating,” “healthy role models,” or “good body image”?

Taking off my critical graduate student hat and putting on my eternal optimist cape, I still think that vying for better bodily relationships is a worthwhile goal. Is this the perfect way to “prevent eating disorders”? No. Are there other factors we need to be focusing on in designing prevention, like the broader promotion of coping skills and a move beyond “body image”? I think so. Still, there is something to be said about a collective interest in moving toward more self-acceptance and body esteem.

References

Gauvin, L., & Steiger, H. (2012). Overcoming the unhealthy pursuit of thinness: reaction to the Québec Charter for a Healthy and Diverse Body Image. American Journal of Public Health, 102 (8), 1600-6 PMID: 22698056