Teach Eating Disorder Prevention

Eating disorders are becoming increasingly common, and should be viewed as an emergent public health concern in dire need of evidence-based solutions and treatment. The prevalence of all eating disorders has been on the rise over the past several decades (2), particularly amongst college-aged women and other groups, such as men, people of color, and members of the LGBTQ community. In fact, a 2015 study of nearly 300,000 college students found that transgender students were more likely to report being diagnosed with an eating disorder and using diet pills, laxatives, or other methods than heterosexual men or women (3).

Tragically, all eating disorders greatly increase young people's risk of mortality. In particular, anorexia nervosa has the highest mortality rate out of all eating disorders, as one in five individuals with anore- xia nervosa who died had committed suicide, according to a recent meta- analysis of studies (4)

Given this stark reality, New York State's health curriculum should be more responsive to students who are at high risk of developing an eating disorder or are already struggling with an eating disorder. New York State's health curriculum currently places a great amount of focus on obesity prevention and weight loss skills, as the State Health Curric- ulum standards currently state that by commencement, students should be able to "know the components of personal wellness (nutrition and weight control)" (5).

However, these standards currently make no mention of eating disorder prevention, even as the prevalence of eating disorders has markedly increased across diverse populations over the past several decades. The state health curriculum should recognize that disordered eating behav- iors, such as restricting caloric intake, binging, purging, abusing diet

pills, and compulsively over-exercising, pose as much of a threat to young people's well-being as obesity does.

New York State's health curriculum currently focuses on a traditional, calorie-based approach to weight management, an approach that some studies have correlated with disordered eating (6), Rather than focus on counting calories, our state should embrace "intuitive eating", an anti- dieting, hunger-based approach to eating which has been correlated with both lower body mass indexes (BMIs) and higher rates of pleasure from eating (7).

Research has shown that age-appropriate, culturally responsible health education that specifically helps young people build positive self-es- teem, enjoy healthy eating without developing a fear of food, and engage in regular enjoyable physical activity can simultaneously prevent the development of eating disorders and encourage a healthy lifestyle (8).

This sort of curriculum can also help to dispel the many harmful stere- otypes surrounding eating disorders, such as the idea that all individ- uals with eating disorders are female-identifying, white, and extremely thin. Additionally, many people are unaware that not all eating disor- ders are restrictive in nature, as conditions like binge eating disorder are not frequently discussed. Making young people aware of the fact that eating disorders do not have any specific "look" can help to tear down common self-perceived barriers to accessing eating disorder treatment, such as one's weight or race (9).

This legislation, which would require schools to include instruction regarding the prevention of eating disorders in their nutrition programs, would ensure that vulnerable young people are receiving support and resources needed to assist in the development of healthy eating habits, a positive body image, and high self-esteem.

Legislative history

New bill

Effective date

This act shall take effect on the first of September next succeeding the date upon which it shall have become a law. (1) Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disor- ders in U.S. adolescents: Results from the National Comorbidity Study-A- dolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980- 989 (2) Battle, E. Katherine, and Kelly D. Brownell. "Confronting a rising tide of eating disorders and obesity: treatment vs. prevention and poli- cy." Addictive Behaviors 21.6 (1996): 755-765. (3) Diemer EW, Grant JD, Munn-Chernoff MA, Patterson DA, Duncan AE. Gender Identity, Sexual Orientation, and Eating-Related Pathology in a National Sample of College Students. J Adolesc Health Off Publ Soc Adolesc Med. 2015;57(2):144-149. doi:10.1016/j.jadohealth.2015.03.003. (4) Arcelus, Jon, et al. "Mortality rates in patients with anorexia nervosa and other eating disorders: a meta-analysis of 36 studies." Archives of general psychiatry 68.7 (2011): 724-731. (5) Learning Standards for Health, Physical Education, and Family and Consumer Sciences at Three Levels, New York State Department of Educa- tion, page 6, http://www.nysed.gov/common/nysed/files/programs/ curriculuminstruction/healthpefacslearningstandards.pdf (6) Courtney C. Simpson, Suzanne E. Mazzeo, Calorie counting and fitness tracking technology: Associations with eating disorder symptomatology, Eating Behaviors, Volume 26, 2017, Pages 89-92. (7) Smith, TeriSue, and Steven R. Hawks. "Intuitive eating, diet compo- sition, and the meaning of food in healthy weight promotion." American Journal of Health Education 37.3 (2006): 130-136. (8) O'dea, Jennifer. "School-based interventions to prevent eating prob- lems: First do no harm." Eating Disorders 8.2 (2000): 123-130. (9) Ali, Kathina, et al. "Perceived barriers and facilitators towards help-seeking for eating disorders: A systematic review." International Journal of Eating Disorders 50.1 (2017): 9-21.