Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach.

BACKGROUND: Eating Disorders (ED) are mental health disorders that typically effect women of childbearing age and are associated with adverse maternal and infant outcomes. UK healthcare guidance recommends routine enquiry for current and past mental illness in antenatal and postnatal care for all women, and that pregnant women with a known ED are offered enhanced monitoring and support. Midwives and health visitors are ideally placed to identify and support women with ED as they are often the primary point of contact during the antenatal and postnatal periods. However, research on the barriers to identifying ED in the perinatal period is limited. This study aimed to understand the barriers to disclosure and identification of ED in pregnancy and postnatally as perceived by women with past or current ED, and midwives and health visitors working in the UK National Health Service. METHODS: Two studies were undertaken: mixed-measures survey of pregnant and postnatal women with current or past ED; focus groups with student and qualified midwives and health visitors. RESULTS: Five themes emerged on the barriers to disclosure in pregnancy as perceived by women: stigma, lack of opportunity, preference for self-management, current ED symptomatology and illness awareness. Four themes were identified on the barriers to identification of ED in pregnancy and in the postnatal period as perceived by health professionals: system constraints, recognition of role, personal attitudes, and stigma and taboo. CONCLUSIONS: Several barriers to the identification of ED during and after pregnancy were described, the main factors were stigma and poor professional training. Perinatal mental health is becoming increasingly prioritised within national policy initiatives; however, ED continue to be neglected and increased awareness is needed. Similarly, clinical guidance aimed at responding to the rising prevalence of obesity focus on changing nutrition but not on assessing for the presence of ED behaviours that might be affecting nutrition. Improving education and training for health professionals may contribute to reducing stigma and increase confidence in identifying ED. The barriers identified in this research need to be addressed if recognition and response to women with ED during the perinatal period is to improve

An experimental study of pro-dieting and anti-dieting psychoeducational messages: Effects on immediate and short-term psychological functioning and weight control practices in college women

While dieting is relatively normative in our society, it is controversial within the fields of eating disorders and obesity. Dieting for weight loss has been touted by the obesity prevention field as a solution to the growing obesity epidemic, yet a body of research in the eating disorders field has also implicated it in the etiology and maintenance of eating pathology. Thus, a divergence in approaches toward dieting has emerged, with both prodieting and anti-dieting messages being recommended. Little is known, however, about the impact of these two types of messages on immediate and short-term psychological functioning and weight control intentions and behaviors. The current study sought to explore this gap in the extant literature by conducting an experimental study that evaluated the two messages. Undergraduate women (N=139) were randomly assigned to either a pro-dieting, anti-dieting, or no-dieting (control) message condition. Psychological functioning and weight control variables were assessed at baseline, posttest, and a two-week follow-up. Results indicated that the pro-dieting message resulted in significantly greater post-test perceived pressure to lose weight, dieting intentions, and thin-ideal internalization intentions while the anti-dieting message yielded significantly lower post-test bulimic intentions. Healthy eating behavior significantly increased from baseline to follow-up in the pro-dieting condition while there were no changes in the other two conditions. Post-test perceived pressure was found to fully mediate the relationship between diet message and post-test dieting, bulimic, thin-ideal internalization, and healthy eating intentions as well as follow-up healthy eating behavior. Trait thin-ideal internalization levels moderated the relationship between diet message and post-test perceived pressure and thin-ideal internalization intentions. Exploratory analyses revealed that overweight participants in the pro-dieting condition increased significantly from pre to post-test on state body dissatisfaction and had the highest level of post-test perceived pressure compared to all other groups. Nonoverweight participants in the pro-dieting condition also had significantly greater posttest perceived pressure to lose weight than both weight status groups in the other two conditions. Findings are discussed in the context of the prevention goals of the obesity and eating disorders fields. Limitations of the study and directions for future research are offered