This essay will discuss the public health issue

This essay
will discuss the public health issue of eating disorders in adolescence in the
UK, with consideration to the global population for the purpose of critical
analysis and greater depth of information. It will identify the epidemiology of
eating disorders, their impact, and social determinates that affect young
people suffering from eating disorders. It will then examine how nurses use
health promotion, and collaborate with other health services to tackle this
public health challenge.  The rational of
identifying adolescence as a particularly significant target group when
considering eating disorders is supported by a study done between 2000-2009
which shows the peak age of developing eating disorders is between 15-19 for
both males and females (Micali et al,
2013). Wilkinson and Pickett (2011)
state that out of 1000 secondary school students at least 5-10 of them will
have an eating disorder. Additionally, Sonja et al. (2011)
Identifies eating disorders in adolescence as an important public health
concern, as treatment needs are often unmet.

It should be
noted that when examining the epidemiology of adolescence with eating disorders
that secrecy and shame are often closely linked with eating disorders, discouraging
the sufferer from seeking treatment (Le Grange & Lock, 2011). Therefore,
the rates of eating disorders are often underestimated. Along with age, gender
is also an important factor to consider when identifying individuals at risk of
developing an eating disorder. According to the DSM (2014) The prevalence of
anorexia and bulimia in males is one tenth of that in females. Whilst the
prevalence of binge eating disorders is 3.5% among woman, and 2.0% among men,
showing less dissimilarity between genders (Agras,

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with an eating disorder are at risk of mental and physical comorbidities, for
example, in the case of bulimia, the rates of comorbidities of young people are
as high a 60% (Le Grange et al.
2007). There is a significant correlation between eating disorders such as
anorexia and bulimia, with role impairment, suicidality, and other psychiatric
disorders (Sonja et al. 2011).
Additionally, the World Health Organisation (2017) found that suffering a mental
disorder in adolescence can have a significant effect on development and wider
health. As well as stigma, isolation and discrimination, poor mental health in
adolescence is connected to health and social outcomes. These include higher
tobacco, alcohol and illegal drug usage, as well as antisocial behaviours and
failure to attend school (WHO, 2017). During puberty, eating disorders can
cause significant, lifelong health problems as malnourishment, often seen as a
symptom of eating disorders, affects growth, fertility, and cognitive
development (Agras, 2010). Furthermore, Harbottle et al. (2008) found that females with chronic anorexia between the
ages of 10-15 will have an estimated reduced life expectance of 25 years.  Physical comorbidities may also be linked to
obesity, findings from epidemiological studies show that one half to two thirds
of individuals suffering from BED are also obese, which increases the risk of
developing conditions such as diabetes and heart disease (Alexander et al, 2013). 

government has recently published an initiative called the “green paper” with
the aim of providing more mental health support for children and young people (Beat, 2018). This includes 1.4 billion pounds
invested over five years, to recruit more trained staff into evidence based
treatments, and ensure more young people have access to services (Department of Health and Department for Education, 2017). The
initiative is comprised of further support in schools and colleges, where
they’ve proposed to set up mental health teams, and designated mental health
lead, to link in with NHS services (Beat, 2018). An earlier intervention in the
treatment of eating disorders amongst young people was a campaign by the
government to reduce hospital admission of young people, the most affected
being 14-25 years of age (, 2014a). Prior to this the Health and Social
Care Information Centre released statistic showing that the number of hospital
admissions cased by eating disorders had gone up by 8% over a year (lead up to
October 2013), to 2560 patients (, 2018). It also showed
that patients with an eating disorder were more likely to have longer hospital
stays in comparison to other admission episodes, 1 in 17 people with an eating
disorder stayed for longer than six months, and the most common admissions were
15-year-old females (, 2018). The campaign also aimed to
treat young people in a timelier manner within the community, to reduce the
number of young people being treated as adults (,
2014a). Alongside this the first waiting time standards for mental health
services were introduced to bring mental health services to the same standard
as other NHS services (, 2014b).



historically white women were often seen as the primary sufferers of eating
disorders, a small study done amongst female students found that African Black
students had higher rates of disordered eating and body dissatisfaction than
Caucasian students (Alexander and Treasure, 2013). However, when examining
studies such as this one, the majority are conducted using convenience samples,
such as university students, which is therefore not considerate of individuals
in lower social classes (Alexander and Treasure, 2013). Research is often
collected and conducted within western cultures, meaning it is unrepresentative
of the global population (Agras, 2010). However, whilst cross cultural evidence
suggests that anorexia is still prevalent in non-western cultures, there is
little evidence to suggest that bulimia is, as it seems to be more closely
linked with western ideals (Agras, 2010). Keel and Klump (2003) relate this to
access to large quantities of food and plumbing, which enables an individual with
bulimia to purge in private. Binge eating disorder (BED) seems to be the most
racially and ethnically diverse, from a pooled study by the National Institute
of Mental Health Collaborative Psychiatric Epidemiological Studies, they found
that there was little to no difference of prevalence or incidence of binge
eating disorder between different groups (Alexander et al, 2013). However, Wilkinson and Pickett (2011) does state that
eating for comfort is more prevalent among unequal societies.  

Wilkinson and Pickett (2011) found British women in higher social
classes were more likely to monitor their weight and diet, than women of lower
social groups, this is due to the perception in more affluent countries, that
thinness signals higher social class, and attractiveness. In comparison, within
areas of the developing world thinness is more likely associated with poverty,
hunger and drug abuse (Wilkinson and Pickett, 2011).    





One health
promotion model that can potentially be used to tackle eating disorders amongst
adolescence is Tannahill’s model of health promotion. This model is a
combination of health education, health prevention and protection (Evans et al, 2017). These three sections of
Tanahill’s model contain several sub-sections, which often overlap, and can be
used to complement each other (Whitehead & Irvine,

education involves teaching individuals and communities how to live healthily,
as well as encouraging positive lifestyle choices, it includes preventative
health education (Davis & Macdowall, 2006). This is an approach applied by
the National Eating Disorder Information Center who give guidance to families
and educators, which aims to prevent eating disorders among children and young
people by giving them age appropriate information about eating disorders and
body image. (, 2018)

Nurses often
use patient education as a tool to increase adherence to treatment and empower
the individual to self-care, this is often achieved by giving support during
the transition of being dependant to self-managing their own health need. (Bastable,
2014). Glanville (2000) (cited in Bastable, 2014. Pg. 12) states patients
should be able to maintain or improve their health status autonomously when on
their own, and if this does not happen, nurses have failed to help the patient
reach their full potential.

refers to, preventing the spread of a disease to an individual and within the
population, it often involves a strategy or tactic, and determines a method of
operation to be carried out (Tulchinsky & Varavikova, 2014). Prevention includes
screening and immunisation, it also links in with health education as a
preventative measure (Whitehead & Irvine, 2010).
However, Geoffrey rose (1981) (cited in Davis & Macdowall, 2006. Pg. 82),
theorised a “prevention paradox” which means that if an exposure to a disease
or condition to an individual is homogeneous with the rest of the population,
the risk to the individual would not be detected. For example, Abraham (2008)
outlines that images and ideals shared across mass media is potentially to “blame”
for the triggering of eating disorders in adolescence. However, the majority of
the population exposed to these images are discerning about the information
shared, whilst those with a lower level of media literacy may be far more at
risk. (Abraham, 2008)

Health protection,
involves preventing health and safety dangers to individuals and groups, it can
also incorporate health education, in the form a public health policy (Whitehead
& Irvine, 2010). An example where all three sections of the Tannahill model
overlap would be the “green paper” mentioned earlier in this essay, as this encompasses
health education for preventative health protection (Whitehead & Irvine,

A weakness
of this model is that it’s potentially an oversimplified way to view health
promotion, as it does not explore its underlying values or principles (Whitehead & Irvine, 2010). It also assumes that individuals
will respond rationally and accordingly with information and education (Davis
& Macdowall, 2006). However, eating is strongly associated with mood and
emotion, and individuals with an eating disorder often suffer from cognitive
dissonance (Agras, 2010).


Sonja et al. (2011) found that whilst majority
of adolescent’s sought treatment for their eating disorder, only a minority
received treatment explicitly tailored to their eating or weight problems.

A group
which may not have equal access to universal care are males, who may not seek
treatment as readily as females, and when they do may be less likely to receive
it. Fox & Goss (2012) State that women are
more likely to seek treatment for eating disorders than men, Additionally, they
suggest that males are often less likely to receive treatment due to cultural
bias, as the stereotype of an individual who suffers from an eating disorder is
typically female. Alexander and Treasure, (2013) suggests between 10-20% of
cases of anorexia and bulimia occur in men, however for the previous reasons
this may be an underestimate.

the core diagnostic criteria for eating disorders may not be suitable for both
genders. Whilst eating disorders among females are often related to body
dissatisfaction, and desire for thinness, eating disorders among males are more
closely linked to body sculpting, low body fat, and strength (Alexander and
Treasure, 2013). When examining this among adolescents, it’s suggested that the
social pressure boys are faced with to achieve leanness and masculinity are
rarely noted by clinicians (Alexander and Treasure, 2013)

Fox & Goss (2012) found that women from minority groups were less likely to
disclose an eating disorder, and when they did they were less likely to be
referred to further services than white patients within the same population. There
is no clear answer as to why this is the case, although Swain (2003) suggests
this is due to women from minority groups being more distrustful of medical
professionals, potentially because they may be overlooked or misdiagnosed.