HEALTH EDUCATION RESEARCH
Theory & Practice
Vol.21 no.6 2006
Pages 770–782
Advance Access publication 8 September 2006
Prevention of obesity and eating disorders:
a consideration of shared risk factors
Jess Haines* and Dianne Neumark-Sztainer
Abstract
Introduction
In response to the high prevalence of obesity,
eating disorders and disordered eating behaviors among youth, researchers in both the obesity
and eating disorders fields have proposed using
an integrated approach to prevention that addresses the spectrum of weight-related disorders within interventions. The identification
of risk factors that are shared between these
weight-related disorders is an essential step to
developing effective prevention interventions.
This article provides preliminary support for
the existence of shared risk factors for obesity
and eating disorders. Specifically, the authors
examined and found preliminary evidence that
dieting, media use, body image dissatisfaction
and weight-related teasing may have relevance
for the development of the spectrum of weightrelated disorders. Future etiologic research
designed to specifically test these and other potentially shared risk factors is needed and
would provide important insights into the relevant factors to be addressed in interventions
aimed at preventing a broad spectrum of
weight-related disorders.
Obesity, eating disorders and unhealthy dieting
practices among youth are of serious public health
concern due to their high prevalence and adverse
effects on psychosocial [1, 2] and physical health
[3–5]. The prevalence of overweight [body mass
index (BMI) > 95th percentile for age and sex
based on Centers for Disease Control and Prevention growth charts [6]] among children and
adolescents has increased steadily over the past
three decades; currently, 15% of youth aged 6–19
are overweight [7]. Eating disorders, such as
anorexia nervosa, bulimia nervosa, and binge eating
disorder, affect a much smaller percentage of the
adolescent population (1–3%), but are of great
concern given their serious health consequences
[8, 9]. Eating disorders not meeting clear Diagnostic and Statistical Manual of Mental Disorders—
fourth edition diagnostic criteria affect a much
larger segment of the adolescent population, with
prevalence estimates as high as 15% [10]. Furthermore, the Youth Risk Behavioral Surveillance
System (YRBSS) found that >11% of high school
girls and 7% of high school boys in the United
States reported taking diet pills, powders or liquids
to lose weight [11]. Eight percent of girls and close
to 4% of boys reported vomiting or taking laxatives
in the past month [11].
In response to this ‘rising tide’ [12, p. 755] of
weight-related disorders, obesity and eating disorder researchers have begun calling for collaboration between the fields to address these disorders
[13–17]. Researchers have provided strong empirical and practical arguments for integrating
efforts to prevent obesity and eating disorders
Division of Epidemiology and Community Health,
University of Minnesota, 1300 S. Second Street,
Suite 300, Minneapolis, MN 55454, USA
*Correspondence to: J. Haines.
E-mail: [email protected]
Ó The Author 2006. Published by Oxford University Press. All rights reserved.
For permissions, please email: [email protected]
doi:10.1093/her/cyl094
Shared risk factors for obesity and eating disorders
[13–15]. Empirical support for this integrated approach is provided by research suggesting that these
weight-related disorders are not distinct from each
other [13]. Evidence from cross-sectional studies
suggests that these disorders can occur simultaneously in the same individual [13]. For example, in
a large population-based survey of adolescents,
Boutelle et al. [18] found that overweight adolescents are more likely than their non-overweight
peers to engage in unhealthy weight control behaviors, such as diet pill use, vomiting and laxative use.
Research also suggests that individuals may crossover from one condition to another [13]. Fairburn
et al. [19] used a case–control design to identify
factors associated with the development of bulimia
nervosa and found that the odds of being obese as
a child was three times higher among individuals
with bulimia as compared with healthy controls.
Practical reasons to simultaneously address obesity
and eating disorders in prevention interventions
include the economic efficiency of addressing two
conditions within a single intervention [13, 15] and
a reduced risk of inadvertently causing one disorder
(e.g. obesity) while trying to prevent another (e.g.
clinical eating disorder) [13, 14, 20].
A major challenge to developing interventions
that are able to prevent both obesity and eating
disorders is the identification of potent and modifiable factors that have relevance for both conditions
[20]. Identification of appropriate risk factors for
the condition being targeted is essential to developing effective prevention interventions [21].
The aim of this paper is to identify and explore the
evidence for factors of potential relevance for
obesity and eating disorders that could serve as
focal points for integrated prevention interventions.
The paucity of etiologic research investigating
the shared risk factors among obesity, eating
disorders and disordered eating behaviors precludes
the presentation of conclusive evidence of these
shared factors. Thus, this article is intended neither
as a definitive nor as a comprehensive review of
all risk or protective factors that may be shared
between obesity and eating disorders. Instead, this
article is an initial exploration of the evidence for
the following factors that may have relevance for
both weight-related disorders: dieting, media use,
body image and weight-related teasing. These
factors were selected on the basis that they are
both amenable to change and suitable for addressing within prevention interventions among youth.
For each of these potential shared risk factors,
a number of potential pathways by which these
factors may be associated with obesity and eating
disorders are described and illustrated. These pathways are not presented as conclusive causal pathways, but rather as plausible pathways that have
a theoretical basis, are supported by empirical
findings and are worthy of further exploration.
Dieting
A high number of adolescents and children report
dieting for weight loss. In population-based surveys
with youth, dieting is often assessed using a single
item (e.g. how often have you been on a diet to lose
weight), which may or may not provide a brief
definition of dieting (e.g. by diet, we mean change
the way you eat to lose weight) [22]. In 2003, the
YRBSS found that almost 60% of female and
29% of male school students were trying to lose
weight [11]. Prevalence estimates for dieting
among children aged 6–11 range from 20 to 56%
for girls and from 31 to 39% for boys [23, 24].
Research suggests that dieting behavior may be
causally linked to both obesity [25] and eating
disorders [26].
Dieting and obesity
Although dieting is often touted as a solution to the
rising obesity epidemic, a number of prospective
studies suggest that dieting is not effective in
preventing weight gain [27–29]. Furthermore, recent cross-sectional and prospective data suggest
that dieting may actually be associated with an
increased risk of obesity among children and
adolescents. Cross-sectional data have consistently
shown BMI to be positively correlated with dieting
behaviors among both children [30–32] and adolescents [18, 22]. While these cross-sectional data
do not provide evidence regarding the direction
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J. Haines and D. Neumark-Sztainer
of the association, prospective data from three
large observational studies have shown that dieting
predicts weight gain among adolescents [25, 33,
34]. The largest of these three prospective studies
followed 8203 girls and 6769 boys for 3 years and
found that adolescents who reported dieting at
baseline gained more weight than non-dieters, adjusting for baseline BMI, pubertal development,
dietary intake and physical activity/inactivity [25].
The dietary restraint model, developed by Polivy
and Herman [35], attempts to explain how dieting
could lead to weight gain (Fig. 1). As posited by the
model, dieting requires the acquisition of a ‘cognitive style’ of eating as opposed to eating in response
to physiological cues of hunger and fullness [35].
Using cognitive control puts individuals at risk
for disinhibited overeating, which involves loss
of cognitive control over eating and is thought to
occur as a result of the breakdown of prior restraint
[36]. Thus, this disinhibition may increase vulnerability to bingeing and overeating. Findings from
prospective studies showing that dieting predicted
the development of binge eating behavior among
adolescent girls provide support for the dietary
restraint model [37–39].
Dieting may also lead to an increase in metabolic
efficiency (Fig. 1). Therefore, those that have restricted caloric intake for a certain period of time
may alter their metabolism such that they require
fewer calories to maintain their weight [40].
Another potential explanation for the association
between dieting and weight gain is that individuals
may engage in short-term dieting behaviors instead
of more sustained eating and exercise behaviors
that would likely be more effective in reducing or
Hunger
Dieting
Loss of
Restraint
Bingeing
Increased metabolic
efficiency
Dieting and eating disorders
Retrospective data from individuals with eating
disorders provide evidence of the association
between dieting and eating disorders. A number
of studies involving clinical samples have found
that the majority of individuals with eating disorders report that they started to diet before they
initiated their disordered eating behaviors [45, 46].
Further evidence of the association is provided by
prospective studies within community samples of
adolescents. Among adolescents, self-reported dieting has been shown to predict increased risk of
disordered eating behavior [39, 47–49] and subthreshold eating disorders [26, 50, 51]. These
results suggest that self-reported dieting among
adolescents may lead to more severe eating pathology (Fig. 2).
Seemingly conflicting results have been found
in experimental studies with females, which have
shown that assignment to a prescribed low-calorie
diet was associated with greater decreases in eating
Obesity
Decrease in more
sustained dietary and
physical activity
behaviors
Fig. 1. Hypothesized associations between dieting and obesity.
772
maintaining weight (Fig. 1). A related explanation
is that self-reported dieting more aptly represents
a mind-set than an actual set of behaviors. Dieters
may feel that they are restricting their dietary
intake; however, their actual caloric intake may
not be reduced. Indeed, studies have found that
dieters and non-dieters may not differ significantly
with regard to their caloric intake [41, 42]. Furthermore, findings from qualitative research suggest
that there is a wide variability in the behaviors that
adolescents define as ‘dieting’ [43, 44]. Additional
research is needed to more clearly define dieting
behaviors among youth and to examine whether
or not dieting behaviors are used by youth in place
of more effective and sustained behavior change.
Dieting
Disordered
Eating
Behaviors
(e.g., vomiting,
laxatives)
Subthreshold
Eating
Disorders
Eating
Disorder
Fig. 2. Hypothesized association between dieting and eating
disorders.
Shared risk factors for obesity and eating disorders
disorder symptoms as compared with controls
[52–56]. A plausible explanation for these apparent inconsistent findings is that the experimental
interventions, which typically involve education
sessions promoting healthy dietary behaviors (i.e.
eating a balanced diet, eating regular meals), result
in participants engaging in more healthful weight
loss behaviors than are typically practiced in the
general population.
Collectively, findings from the cross-sectional
and prospective studies investigating associations
between dieting and weight gain and between
dieting and disordered eating behaviors suggest
that interventions aimed at preventing youth from
engaging in dieting behaviors have the potential to
reduce the incidence of obesity and eating disorders. Given the strong influence that peers and
families can have on the dieting behaviors of youth
[57–59], interventions that include strategies focused on changing peer and family norms, such as
educating parents that the comments they make
about their own weight or their child’s weight can
be counterproductive to obesity prevention efforts
and implementing anti-dieting campaigns in school
settings, may be effective in reducing dieting
among youth. In addition, providing youth with
the skills and support for healthy alternatives to
dieting, (i.e. healthy eating and regular physical
activity) may also be effective in reducing dieting
behavior among youth [60, 61].
Media
Media are ubiquitous in American society. A
recent study surveyed a nationally representative
sample of youth and found that, on average, youth
spend 6.5 hours per day watching television and
videos, using print media, playing video games,
using computers and listening to CDs, MP3 players, tapes and the radio [62]. Media use and the
internalization of the messages promoted by the
media have been explored as putative risk factors
for both obesity [63, 64] and eating disorders
[65, 66].
Media and obesity
In general, cross-sectional studies have shown a
positive association between media use and BMI
in children and adolescents [64, 67–72]. While
several prospective studies [56, 66, 67, 68] have
found a positive association between television
viewing and obesity, others have found no association [76]. Stronger evidence of this association
between television use and obesity is provided by
two school-based obesity intervention trials, which
found that reducing television use predicted decreases in obesity prevalence among middle school
girls [60] and BMI among elementary schoolchildren [77].
Television has been proposed to contribute to
obesity through two main mechanisms: by reducing
energy expenditure due to displacement of physical
activities and by increasing dietary intake during
viewing or as a result of food advertising (Fig. 3)
[63, 78]. Evidence is strongest for this second
mechanism [79]. Children view ;40 000 advertisements per year [80], the majority of which are
for sugared cereals, candy and fast food [81]. In a
recent review of the literature examining the effect of
television on children’s consumption patterns, Coon
and Tucker [82] conclude that exposure to food
advertisements significantly increases the likelihood
that a child will select or request the advertised
product. Cross-sectional studies have found associations between television viewing and higher
intakes of fast foods [83] and soda pop [84], suggesting that a higher exposure to advertisements for
unhealthy foods may increase intake of those foods.
Increased Dietary
Intake
Television
Viewing
Obesity
Decreased
Physical Activity
Fig. 3. Hypothesized association between television viewing
and obesity.
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J. Haines and D. Neumark-Sztainer
Media and eating disorders
Due to the ubiquitous nature of media in our culture
and its relentless promotion of the thin beauty ideal,
media has long been identified as a potential risk
factor for eating disorders [65, 66]. A key tenet of
sociocultural theories of eating disorders is that
society, through avenues including mass media,
pressures individuals to conform to the cultural
ideal for size and shape [85]. This cultural ideal has
changed throughout history, becoming increasingly
thin for females [86] and increasingly lean and
muscular for males [87]. Theoretically, media’s
pressure to conform to the ideal promotes internalization of this ideal [88, 89]. Internalization, in turn,
leads to body dissatisfaction because the cultural
ideal is unattainable for most people [89]. Body
dissatisfaction then leads to disordered eating and
negative affect, which may lead to an increased risk
for eating disorders (Fig. 4) [88]. Findings from
cross-sectional, prospective and experimental studies provide evidence in support of this model.
Several cross-sectional surveys have found a
positive association between media use and body
dissatisfaction and disordered eating behavior
among both children and adolescents [90–94].
Evidence from a recent prospective study provides
further support for this association; Vaughan and
Fouts [95] found that decreases in magazine reading over 16 months were associated with decreases
in eating disorder symptoms among a sample of
adolescent girls.
Numerous laboratory-based experiments have
also examined the short-term effects of exposure
to media images of the thin fashion models among
samples of adolescent and young adult women.
A recent meta-analysis of these laboratory-based
Dieting/
Disordered Eating
Media
Exposure
Internalization
of Thin-Ideal
Body
Dissatisfaction
Eating
Disorder
Negative Affect
(Depression/Anxiety)
Fig. 4. Hypothesized association between media exposure and
eating disorders.
774
experiments suggests that exposure to thin-ideal
images causes a modest, acute increase in body
dissatisfaction [96]. Randomized experiments have
also shown that exposure to thin-ideal images results in increases in negative affect [97–99]. Among
males, experimental research examining exposure
to media images and body satisfaction has produced
mixed results. Some studies have found that exposure to muscular ideals has acute negative effects on
body build satisfaction in young men [100–102],
while others have found no association [103, 104].
Findings from prospective research provide
evidence for the hypothesized association between
thin-ideal internalization and eating disorder symptoms. Thin-ideal internalization has been shown
to predict body dissatisfaction [49] and disordered
eating behaviors [39, 47]. In one study, Field
et al. [47] found that girls who reported at baseline
trying to look like females in the media were
almost two times more likely to report purging
behavior one year later than those that did not
report trying to look like figures in the media, after
adjustment for age and BMI.
The implications of these findings are that interventions aimed at decreasing media use and increasing children’s critical viewing skills through
media literacy may be effective in reducing the
incidence of obesity and eating disorders in youth.
Practitioners and interventionists could implement
strategies that encourage parents/caregivers to restrict youth’s media viewing times and access by
taking televisions out of bedrooms and limiting the
types of magazines that are available in the home.
Schools and community-based organizations that
serve youth could implement media literacy interventions that strive to educate youth about the
advertising process and provide them with skills to
critically analyze the media they consume [105–108].
Body dissatisfaction
Body dissatisfaction is common among children and
adolescents. Approximately 50% of girls and 30%
of boys report that they are dissatisfied with their
bodies [22, 109, 110]. Body image dissatisfaction
Shared risk factors for obesity and eating disorders
may have relevance for the development of
obesity due to its association with binge eating
[100] and lower levels of physical activity [101].
Body image dissatisfaction is also an established
risk factor for eating disorders [111].
Body dissatisfaction and binge eating
A number of prospective studies have shown body
dissatisfaction to be predictive of binge eating
behavior (Fig. 5) [38, 112, 113]. For example,
Johnson and Wardle [112] followed a sample of
960 adolescent girls for 10 months and found that
girls who were dissatisfied with their body were at
1.5 times the odds of initiating binge eating as
compared with those who were satisfied with their
body. This association between body dissatisfaction and binge eating may be mediated by dieting
behavior, which may lead to hunger, followed by
overeating [38, 39, 114]. Alternatively, the association between body dissatisfaction and binge eating
may be mediated by negative affect [38], since
body image plays a central role in adolescents’
overall feelings of self-worth [115].
Body dissatisfaction and physical activity
Researchers have hypothesized that body image
dissatisfaction may conceivably be beneficial for
individuals with average or above-average BMI
values because it may be a motivating factor to
engage in healthy weight management behaviors
[116, 117]. However, results from qualitative,
cross-sectional and prospective studies examining
the association between body image and physical
activity among adolescents suggest that body dissatisfaction may not be a motivator for physical
activity and that it may actually be associated
with decreased participation in physical activities
(Fig. 5) [113].
Negative
Affect
Body dissatisfaction and eating disorders
Body dissatisfaction is one of the most consistent
and robust risk factors for eating disorders [111].
Body dissatisfaction is hypothesized to lead to
increased risk of eating disorders via three mechanisms (Fig. 6). The first proposed mechanism
Dieting/Disordered
Eating Behaviors
Eating
Disorder
Body Image
Dissatisfaction
Binge Eating
Body Image
Dissatisfaction
Olafson [118] conducted individual interviews
and three focus groups with adolescent girls to
investigate adolescent girls’ experiences in physical
education classes. Not liking how they felt about
their bodies was identified by the girls as a major
obstacle to engaging in physical activity. Crosssectional findings similarly suggest that lower
levels of body satisfaction are associated with lower
levels of physical activity [119–121].
Prospective findings from a large, populationbased study suggest that lower levels of body image
satisfaction are predictive of lower levels of physical activity among both male and female adolescents, after controlling for baseline level of physical
activity and demographic variables [113]. When
BMI was added to the model, the association remained significant among the girls, but not among
the boys. Thus, it appears that the association between body image satisfaction and physical activity may differ by gender [113]. Given the paucity of
longitudinal research examining the association
between body image and physical activity and
the potential importance this association may
have for obesity risk among youth, additional
studies are needed to further elucidate the association between body dissatisfaction and physical
activity levels among adolescents.
Obesity
Dieting
Decreased
Physical Activity
Fig. 5. Hypothesized association between body dissatisfaction
and obesity.
Negative Affect
Fig. 6. Hypothesized association between body dissatisfaction
and eating disorders.
775
J. Haines and D. Neumark-Sztainer
suggests that body dissatisfaction leads to elevated
attempts to reach the thin ideal using dieting
behaviors, which in turn increases the risk for
eating pathology [26, 47]. The second hypothesized
mechanism is that body dissatisfaction contributes
to negative affect (anxiety or depression), which,
in turn, is thought to increase the risk of binge
eating and the use of radical compensatory behaviors, such as purging behavior [49]. Third, body
dissatisfaction may directly promote the development of eating disorders [111].
There is a substantial support for the role of body
dissatisfaction in the development of dieting behaviors. Cross-sectional studies have shown that
children and adolescents with higher levels of body
dissatisfaction also engage more frequently in
dieting behaviors [122–124]. Prospective studies
involving adolescent girls have found that elevated
body dissatisfaction at baseline were significantly
associated with dieting behaviors at follow-up
8 months later [114], 9 months later [125] and
20 months later [49]. There is also evidence from
prospective studies that body dissatisfaction predicts negative affect [126–128]. Numerous prospective studies have found body dissatisfaction to
predict bulimic behaviors [39, 47, 129] and eating
pathology [50, 114].
Findings from cross-sectional and prospective
research investigating the association between body
dissatisfaction and binge eating, body dissatisfaction and physical activity and body dissatisfaction
and eating disorders suggest that interventions
aimed at improving body satisfaction may have
implications for the prevention of obesity and
eating disorders among youth. Body image dissatisfaction is more commonly addressed in eating
disorder interventions than in obesity prevention
interventions [130, 131]. However, the findings
presented here suggest that body image dissatisfaction could be a potential risk factor rather than just
a consequence of weight gain and obesity. Therefore, thought needs to be given to how to address
issues of body image within obesity prevention
programs. Incorporating intervention strategies
that enhance body satisfaction will likely be more
effective than motivating adolescents toward be776
havioral change via decreasing their comfort with
their bodies [113]. Strategies that may effectively
promote a positive body image among youth
include individual-level strategies, such as psychoeducational activities that provide youth with
opportunities to learn about and challenge sociocultural ideals of body size and shape [e.g. 132],
and environmental-level activities, such as working with peer groups to reduce the level of body
comparison and negative body talk that occurs
among youth [e.g. 133].
Weight-related teasing
Weight-related teasing is prevalent among adolescents and children with overweight youth reporting
higher levels of weight-related teasing compared
with their average weight peers [134–137]. Weightrelated teasing has been shown to be associated
with both binge eating and other disordered eating
behaviors (e.g. purging, restricting), suggesting
that it may have a potential relevance for the development of both obesity and eating disorders.
Teasing and binge eating behavior
A large, cross-sectional survey of adolescents found
that among overweight adolescents, those who
experienced weight teasing had two times the
odds of engaging in binge eating behavior as
compared with youth who did not report teasing
[135]. Data from a case–control study by Brown
et al. [138] provide further support for the hypothesis that teasing is associated with binge eating
behavior. Brown et al. [138] compared a sample of
adolescent female binge-purgers with a matched
group of female controls and found that bingepurgers were more likely than controls to report
that peers had made fun of them or rejected them
because of their appearance during childhood.
Longitudinal evidence of an association between
weight teasing and binge eating is provided by
a large study of adolescents, which found that
weight teasing was predictive of binge eating
among both females and males after adjustment
Shared risk factors for obesity and eating disorders
for age, race/ethnicity and socio-economic status
[139]. When BMI was added to the model, the
association remained significant among males and
was marginally significant among females [139].
Given the importance placed on body shape and
size in the US culture and the important role weight
plays in how adolescents feel about themselves, it
is possible that being teased about weight may result in depressive symptoms or body dissatisfaction [140–142], which may lead to binge eating
behavior [38]. Being teasing about weight may also
cause an individual to diet in an attempt to avoid
future weight-related stigmatization, which may
lead to binge eating behavior. Binge eating, in
turn, can lead to an increased risk for weight gain
and obesity [33], as depicted in Fig. 7.
Teasing and eating disorders
Teasing has also been shown to be associated with
disordered eating behaviors, such as purging and
restricting behaviors. Among adult populations,
studies have examined the relation of retrospective
reports of teasing and use of disordered eating behaviors and found that women who were teased
about their appearance as children demonstrate
higher levels of restrictive eating patterns than
women who did not report being teased [134,
143–145].
Among adolescents and children, cross-sectional
research has shown that being teased about weight
is associated with higher levels of disordered eating
behaviors [90, 135, 146, 147]. Fewer prospective
studies have examined the effects of teasing on
the development of disordered eating behaviors.
Cattarin and Thompson [142] followed a sample of
adolescent girls for 3 years and found that teasing
was directly associated with the level of appearance
dissatisfaction, which in turn predicted use of
restrictive and bulimic behaviors. Wertheim et al.
[114] found that weight-related teasing predicted
subsequent levels of bulimic behaviors among
adolescent girls. Conversely, Field et al. [47] found
that weight-related teasing was not related to subsequent purging behaviors, after accounting for
other relevant factors.
Gardner et al. [148] followed a sample of children
aged 6–14 for 3 years, and observed that teasing
predicted higher eating disorder scores among
males but not females. Similar gender differences
were seen in longitudinal analyses of a large sample
of adolescents [139]. It is possible that because
females receive more messages about achieving
the ‘thin ideal’ from a larger range of sources than
their male counterparts, weight teasing does not
independently explain as much of the variance in
these behaviors in females as it does in males.
Taken together, the cross-sectional and prospective research on the impact of teasing on dieting
and disordered eating behaviors suggests that being
teased about weight may function directly or indirectly through body/appearance dissatisfaction to
influence the use of dieting and disordered eating
behaviors. As discussed previously, dieting and use
of unhealthy weight control behaviors may increase
the risk for developing an eating disorder (Fig. 8)
[26, 47].
Although prospective research examining the
association between weight teasing and these
behaviors is limited, the evidence from the existing cross-sectional and prospective studies suggest
that being teased about weight is positively associated with binge eating and other disordered eating
behaviors (e.g. purging, restricting). Thus, interventions aimed at reducing weight-related teasing
Negative Emotions
Body/Appearance
Dissatisfaction
(e.g., depression, stress)
Weight- Related
Teasing
Body
Dissatisfaction
Binge Eating
Obesity
Dieting
Fig. 7. Hypothesized association between teasing, binge eating
and obesity.
Weight- Related
Teasing
Dieting/
Disordered
Eating
Eating
Disorder
Fig. 8. Hypothesized association between teasing, dieting and
eating disorders.
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J. Haines and D. Neumark-Sztainer
in youth may have relevance for obesity and eating
disorders. Strategies that may be effective in reducing weight-related teasing among youth include
(i) the implementation of clear no-teasing policies
at schools and community-based organizations
that serve youth and (ii) intervention activities
focused on reducing verbal harassment and improving conflict resolution and communication
skills among youth.
Conclusion
As a result of the high prevalence of obesity, eating
disorders and disordered eating among youth and
the evidence suggesting these disorders may not be
distinct from one another, there has been increasing interest among obesity and eating disorder researchers to utilize an integrated approach to the
prevention of these disorders. Identification of risk
factors that are shared among these weight-related
disorders is an essential step to developing effective
prevention interventions. This article provides preliminary support for the existence of shared risk
factors for obesity and eating disorders. Specifically, this article examined and found preliminary
evidence that dieting, media use, body image and
weight-related teasing may have relevance for the
development of the spectrum of weight-related
disorders.
This information can be used to inform future
etiologic research and intervention design. Prospective studies can be designed to specifically test the
pathways proposed in this article. These associations
can also be examined using experimental research,
such as community-based trials, which would provide stronger evidence of causality than can be
achieved with prospective studies. In addition to the
factors and pathways highlighted here, other potential shared risk and protective factors that may be
worthy of further etiologic inquiry include selfesteem, depression, dietary intake patterns (e.g. meal
patterns), the role of parental encouragement or role
modeling of weight-related behaviors and the role of
a home environment that is supportive of healthy
eating and physical activity behaviors.
778
The findings from this review also have implications for the development of prevention interventions. This review provides preliminary evidence of
factors that are amenable to intervention and that
may have relevance for both obesity and eating
disorders. Thus, these factors may serve as important focal points for an intervention aimed at
simultaneously addressing both obesity and eating
disorders.
Many of the factors reviewed in this paper are
more commonly addressed in interventions focused
on the prevention of eating disorders rather than
obesity. However, as evidenced by this review of
the literature, many of these factors, including
dieting, body dissatisfaction and teasing, can lead
to increased weight gain and obesity. Thus, the
effectiveness of obesity prevention programs may
be improved by including messages that address
these risk factors, in addition to the typical obesity
prevention messages of increased physical activity
and improved dietary intake. Interventions that
use this more integrated approach may also have
the added benefit of reducing the risk of eating
disorders among youth.
Conflict of interest statement
None declared.
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Received on March 15, 2006; accepted on July 17, 2006