Austin S B
Division of Adolescent Medicine, Children's Hospital, Harvard School of Public Health, Boston, MA, USA.
Prev Med. 2001 Mar;32(3):268-83. doi: 10.1006/pmed.2000.0797.
Several decades of concerted research on eating disorders have generated a broad range of proposed causal influences, but much of this etiologic research does not elucidate practical avenues for preventive interventions. Translating etiologic theory into community health interventions depends on the identification of key leverage points, factors that are amenable to public health intervention and provide an opportunity to maximize impact on the outcome of interest. Population-based preventive strategies, elaborated by epidemiologist Geoffrey Rose, can maximize the impact of public health interventions. In the case of eating disorders, Rose's model is instructive: Dieting stands out as risk behavior that may both fit Rose's model well and be a key leverage point for preventive intervention.
Grounded in Rose's work, this article lodges a theoretical argument for the population-based prevention of eating disorders. In the introductory section, existing research on the epidemiology of dieting is reviewed, showing that it is extremely common among adolescent girls and women and that the behavior has been implicated as a causal factor for disordered eating. Next, new evidence is offered to build a case for how a population-wide reduction in dieting may be an effective strategy for prevention of eating pathology. Finally Rose's prevention framework is used to introduce a unique and provocative perspective on the prevention of eating disorders.
Dieting is a normative behavior in our culture with psychological and physiological effects in the causal chain leading to eating pathology. This behavior may represent an ideal target for population-based prevention.
Theoretical and empirical evidence suggests that a population-wide reduction in dieting may be a justifiable and effective strategy for prevention of eating pathology.
几十年来对饮食失调进行的协同研究产生了一系列广泛的因果影响假设，但许多病因学研究并未阐明预防性干预的实际途径。将病因学理论转化为社区健康干预措施取决于确定关键的杠杆点，即那些适合公共卫生干预并为最大程度影响感兴趣的结果提供机会的因素。由流行病学家杰弗里·罗斯阐述的基于人群的预防策略，可以使公共卫生干预的影响最大化。就饮食失调而言，罗斯的模型具有指导意义：节食作为一种风险行为脱颖而出，它可能既非常符合罗斯的模型，又是预防性干预的关键杠杆点。
基于罗斯的研究成果，本文提出了基于人群预防饮食失调的理论观点。在引言部分，回顾了关于节食流行病学的现有研究，表明节食在青春期女孩和女性中极为普遍，并且该行为被认为是饮食失调的一个因果因素。接下来，提供新的证据来论证在全人群中减少节食为何可能是预防饮食问题的有效策略。最后，运用罗斯的预防框架引入关于预防饮食失调的独特且具有启发性的观点。
节食在我们的文化中是一种常见行为，在导致饮食问题的因果链中具有心理和生理影响。这种行为可能是基于人群预防的理想目标。
理论和实证证据表明，在全人群中减少节食可能是预防饮食问题的合理且有效策略。
