Prevention of eating disorders: 2023 in review

Figures & data

Figure 1. The cycle of prevention theory, research, and advocacy. Adapted from Levine and Smolak (2021).

Table 1. Phases of prevention cycle and the 16 prevention-related articles in the 2023 issues of Eating Disorders (Volume 29).

Note: With the exception of Linardon (2023), the single surnames that are separated by a semicolon are the first authors of an article with two or more co-authors.

^aAlthough the article by Byrne et al. (2023) is an integrative review, it is categorized under Risk Factors because the focus is longitudinal studies of the development of disordered eating in male adolescents.

Table 2. Proposal for a prototypical definition of disordered eating.

Criterion A

“subclinical” but unhealthy, maladaptive, and misery-inducing levels of negative body image and concerns about weight and/or shape (e.g., as seen in rumination, checking, and/or avoidance)

dietary restraint and/or binge eating

Criterion B: at least two of the following

individual ED symptoms such as self-induced vomiting after eating

abuse of laxatives, diuretics, diet pills, and exercise

unrealistic beauty standards, including an idealization of thinness, leanness, and/or muscularity

irrational and maladaptive beliefs about body fat and fat people, often coupled with a high drive for thinness, leanness, and/or muscularity

relatively high levels of negative affect that the person finds difficult to tolerate and manage

harsh self-surveillance and self-criticism, often in transaction with low and unstable self-esteem and/or with perfectionism

Criterion C: Does not meet the criteria for an Eating Disorder, including Other Specified Eating and Eating Disorders and Unspecified Feeding and Eating Disorder

Sources: Alhaj et al. (2022); Levine and Smolak (2021); Smolak and Levine (2015).

Table 3. Eight putative DE and/or ED risk factors deserving of more attention prevention scientists.

1. Traumatic experiences with body-based teasing, harassment, and/or assault

2. Weight-based discrimination and internalized weight stigma

3. Weight suppression and weight cycling

4. Disturbances of interoceptive awareness, including those expressed as feeling bloated or full after eating a small amount or even anticipating eating a small amount

5. Intersectional racism: gendered and/or sexual

6. Gender dysphoria as a form of body dissatisfaction anchored in identity formation

7. Self-perceptions of inflexibility, rigidity, and resistance to change

8. Muscularity-oriented DE

Note. These risk factors are biopsychosocial, so there is a need to consider prevention at multiple levels, ranging from cultural norms and practices to individual attitudes.

Levine, M. P., & Smolak, L. (2021). The prevention of eating problems and eating disorders: Theories, research, and applications (2nd ed.). Routledge.

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*Linardon, J. (2023). Investigating longitudinal bidirectional associations between appearance comparisons to fitspiration content on Instagram, positive and negative body image, and dietary restraint. Eating Disorders, 31(5), 450–463. https://doi.org/10.1080/10640266.2023.2190973

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Byrne, S. E., Basten, C. J., & McAloon, J. (2023). The development of disordered eating in male adolescents: A systematic review of prospective longitudinal studies. Adolescent Research Review. Advance online publication. https://doi.org/10.1007/s40894-023-00217-9

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Alhaj, O. A., Fekih-Romdhane, F., Sweidan, D. H., Saif, Z., Khudhair, M. F., Ghazzawi, H., Nadar, M. S., Alhajeri, S. S., Levine, M. P., &Jahrami, H. A. (2022). The prevalence and risk factors of screen-based disordered eating among university students: A global systematic review, meta-analysis, and meta-regression. Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity, 27(8), 3215–3243. https://doi.org/10.1007/s40519-022-01452-0

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Levine, M. P., & Sadeh-Sharvit, S. (2023). Preventing eating disorders and disordered eating in genetically vulnerable, high‐risk families. International Journal of Eating Disorders, 56(3), 523–534. https://doi.org/10.1002/eat.23887

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Smolak, L., & Levine, M. P. (2015). Body image, disordered eating, and eating disorders: Connections and disconnects. In L. Smolak & M. P. Levine (Eds.), The Wiley handbook of eating disorders (vol. 1): Basic concepts and foundational research (pp. 3–10). John Wiley & Sons.

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