Nursing Strategies for Treating Eating Disorders: A Review

Statement of the Problem and Significance

One of the most widespread and substantial health dilemmas in the Western world, in general, and in America, in particular, is the eating disorder. Nurses have developed several strategies for treating eating disorders among both young and old members of the population. This paper assesses the effects of some of these treatment strategies on the medical complications associated with eating disorders.

Eating disorders are not a new health concern — people of all ages have long suffered from these conditions. For instance, Shisslak, Crago, and Estes (1995) studied the spectrum of eating disorders and found that adolescents face a much greater risk of developing one. While eating disorders span a broad range, two forms are particularly prevalent in Western societies: anorexia nervosa (AN) and bulimia nervosa (BN). The existence of both disorders poses a significant challenge for the nursing profession, as the problem has been observed to escalate year after year (Shisslak, Crago, & Estes, 1995).

Bunnell, Shenker, Nussbaum, Jacobson, and Cooper (1990) compared and contrasted sub-clinical and formal eating disorders. Their results revealed that 35% to 50% of girls surveyed had been suffering from partial eating disorders, and that partial eating disorders were present in a higher proportion than complete eating disorders. The study also found that as adolescents grow and develop, it is highly likely that their partial eating disorders will develop into a full-fledged syndrome (Bunnell, Shenker, Nussbaum, Jacobson, & Cooper, 1990).

Bruch (1973) argued that eating disorders are most prevalent among adolescents, particularly during the period in which they are developing their sense of independence, mastery, and capability — a process crucial to acquiring adulthood and gaining freedom from parental control. Abraham and Llewellyn-Jones (2001) further revealed that the over-perception of body mass among children is the underlying issue driving eating disorder behavior, predominantly in the Western world.

Telch and Agras (1996) studied the influence of emotions on obese individuals and found that people who engage in binge eating do not experience anorexia nervosa — because their body mass index (BMI) exceeds 17.5 — nor do they experience bulimia nervosa, because they do not employ unsafe weight-control techniques. The results suggest that binge eaters use food to regulate mood or manage complex emotions, predominantly unhappiness, irritation, and feelings of inadequacy (Telch & Agras, 1996).

These studies, along with numerous others, have established that eating disorders represent a major health concern for the nursing profession. It is imperative that appropriate skills and strategies be developed and practiced so that successful, productive outcomes can be achieved. Nurses have demonstrated considerable commitment in this regard, producing several treatment options and anchoring their practice in both guiding principles and the enduring foundations of their profession. Among all treatment strategies employed, some naturally yield greater success. The aim of this literature review is to assess the most relatively successful strategies employed by nurses in treating eating disorders.

Eating Disorder Treatment Through Education

Huon, Braganza, Brown, Ritchie, and Roncoloto (1998) studied dieting-induced eating disorders in detail. Their results revealed that while several programs are operated through the American healthcare system, very few empirical studies have documented their success and productivity. Research has been carried out in diverse locations, though schools and hospitals have been the most common settings. The results also indicate that risk factors for eating disorders — including those addressing health problems and associated risks — should be incorporated into programs operated by nurses throughout America. Many studies have found that education and knowledge about health risk factors can redirect people's attitudes toward their eating habits (Huon, Braganza, Brown, Ritchie, & Roncoloto, 1998).

On the other hand, many studies have downplayed the role of education in producing behavioral change around eating habits, on the grounds that transforming behavior does not necessarily increase knowledge, or vice versa. Several programs have been initiated that include education about the consequences of unhealthy eating habits in order to address eating disorders; however, most have not yielded positive results. For instance, Carter, Stewart, Dunn, and Fairburn (1997) studied eating disorder prevention and treatment programs, adding a cognitive-behavioral dimension to their education curricula in an effort to alter clients' thinking about food and body image. Unfortunately, while the program showed efficiency at the end of the intervention compared to baseline, dietary self-control actually increased above baseline scores at the six-month follow-up. It is worth noting here that Huon et al. (1998) cautioned against education programs that may inadvertently motivate the very behaviors they aim to eliminate — much as drug prevention programs have long been considered to enhance drug use rather than reduce it.

Eating disorder programs operated by nurses not only target dieting practices but also address psychological factors such as body dissatisfaction and negative body image. Winzelberg, Taylor, Sharpe, Eldredge, Dev, and Constantinou (1998) evaluated a computer-mediated eating disorder program and found that women could use computer-based tools to improve body image and reduce body dissatisfaction. The researchers hypothesized that results might have been stronger had there been greater oversight, as subjects completed only 50% of the software program.

Springer, Winzelberg, Perkins, and Taylor (1999) studied the effects of a body image curriculum for college students. Their research demonstrated the success of an educational program on body image delivered on a university campus. The content covered biological, historical, and developmental perspectives on body image without focusing on personal transformation. Significant pre-test and post-test differences were recorded: the program decreased attitudinal and behavioral risk factors associated with eating disorders without altering BMI or self-esteem. The researchers attributed their results to a deliberate decision to exclude information on nutrition and weight management from the curriculum.