HEALTH CAMPAIGN: EATING DISORDERS

We chose to focus our campaign on eating disorders, zoning in on anorexia nervosa,

because it is a mental illness whose prevalence is steadily increasing as the years pass, and it is

an illness not spoken about often enough to reflect just how many individuals suffer from it. In

the United States, 20 million women and 10 million men suffer from a clinically significant

eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge

eating disorder, or EDNOS (Wade, Keski-Rahkonen, & Hudson, 2011 as cited in Get the Facts

on Eating Disorders, n.d.). The Diagnostic and Statistical Manual of Mental Disorders defines

eating disorders as being characterized by a persistent disturbance of eating or eating- related

behavior that results in the altered consumption or absorption of food and that significantly

impairs physical health or psychosocial function (American Psychiatric Association, 2013).

This provides a glimpse of how broadly defined eating disorders are, as eating-related behavior

can refer to several different things, which is why there are different classifications of eating

disorders, as defined by The Diagnostic and Statistical Manual of Mental Disorders. Anorexia

Nervosa, the most common of eating disorders, is the most fatal mental illness, killing about 4%

of sufferers. Anorexia is diagnosed once the following criteria is met: food intake is restricted,

causing a low body weight with respect to the individuals sex and age, the individual maintains

a fear of gaining weight, and failure to recognize ones low body weight (American Psychiatric

Association, 2013).

Previous campaigns on eating disorders are scarce, and the ones out there are no very

thorough or well known. The National Eating Disorder Association advertises National Eating

Disorder Awareness week every year in February as a way of promoting healthy environments

and providing resources (NEDA, 2016). The association offers a free online screening that takes

less than three minutes; the screening is a way for anybody to discover if they have signs of an

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eating disorder or if they are at risk for developing one. Throughout their website, they offer

resources for students, teachers, managers, and coworkers to learn how to recognize the

symptoms of eating disorders, help those who are struggling, and foster a healthy campus or

workplace environment (NEDA, 2016). While all of this information can help improve

awareness and lead to more people getting help, this approach to communicating about eating

disorders leave out an important factor; what causes eating disorders? Viewers are made aware

of what they can do to help if somebody they know is struggling, but using the information

provided will not help them understand the eating disorder and why they occur. There is no clear

statement about why we should care about the issue and why it may be relevant to our individual

lives. Our campaign focused both on increasing awareness in addition to the underlying factors

that lead to the development of eating disorders.

The Alliance for Eating Disorders Awareness launched the Confidence is Beauty

campaign in 2010, which involved placing decals on dressing room mirrors with positive

messages such as Beauty Fits Every Size and Confidence is Beautiful. The purpose of this

campaign was to tell girls that size is not what makes us beautiful. This campaign has been

extremely successful and has spread to dressing rooms, restaurants, and other organizations

nationwide. The Alliance for Eating Disorders also launched the Did you Know poster

campaign, which presented statistics and trends in eating disorders. When you combine the two

campaigns run by The Alliance for Eating Disorders, there is a call to change behaviors and

attitudes about beauty and self-confidence, with the posters raising awareness and increasing

knowledge of the issue (Confidence is Beauty Campaign, 2013). However, little, if any,

information is provided on why the rates of eating disorders are occurring; suffering from an

eating disorder is more than looking the mirror and seeing yourself as less than beautiful, it is

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about suffering from a mental illness that causes one to have these feelings and needs for

changing their body. The Did You Know? poster campaign captures the facts and shocking

statistics about how prevalent the issue is, but it fails to address the underlying causes. Using the

information I learned from this campaign, I made sure to include the causes and symptoms of

eating disorders in my campaign, in addition to increasing awareness of its prevalence.

The public health burden is clear, and, as S. Bryn Austin argues, there is a compelling

need for public health professionals to address the issue. At this point in time, most of the

research done on eating disorders and preventative techniques has been done by psychologists,

but there is the potential, and the need, for a public health approach (Austin, 2012). Our

campaign is intended to address a rarely spoken about issue that is impacting thousands of lives.

A survey involving 30 Bryant University students provided us with useful information

regarding the way our target demographic, college-aged students, view eating disorders. These

surveys were distributed via email, as well through the qualtrics server on campus. We chose this

method and this audience because our campaign is going to be presented to Bryants campus,

and the qualtrics server is a quick way to get as many surveys sent out as possible. Our surveys

asked about eating disorders in general, and did not focus solely on anorexia. The reason for this

is because, prior to conducting formative research, we intended on focusing on our campaign on

anorexia, bulimia, and binge eating disorder, so our questions reflected that. Aside from asking

basic demographic information, our first question as designed to gauge peoples knowledge and

understanding of eating disorders. No participants responded that they have a strong

understanding of eating disorders; the majority said that they know somewhat about eating

disorders and what some are while the rest responded that they have a good understanding of

the different types of eating disorders, their classifications, and how they affect someones

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health. To further assess Bryant students understanding and knowledge, we asked if they

defined eating disorders as mental illnesses, physical illnesses, or both. Surprisingly, only 50%

of survey respondents were able to correctly identify eating disorders as both mental and

physical illnesses. Lastly, this survey asked participants to indicate which, based on a provided

list of eating behaviors, they or somebody they know have engaged in. All 30 participants

responded to at least one of the behaviors, with the most common eating related behaviors being

dieting, abstaining from eating, binge eating, and laxative use. We were able to use this

information to determine which eating disorders we should be targeting in our campaign;

abstaining from eating and binge eating were the two most frequently selected answers, leading

us to narrow our campaign to anorexia nervosa and binge eating disorder at this stage of the

process.

We noted a couple of issues with our processing of surveying. First, our sample size was

30 students, which is a relatively small sample. Having a larger size, closer to 100 students,

would have benefited us and given us a better idea of the general consensus among Bryant

students. Furthermore, multiple students skipped a question, giving us fewer answers for a

couple of the questions. We did not have an equal number of male and female respondents, and

the majority of our sample consisted of juniors and seniors, omitting feedback from

underclassmen. However, we furthered our research through an in-class presentation and

REDday to reach a broader audience and gain adequate feedback.

After conducting our surveys, we pretested our campaign ideas to classmates and other

faculty members. The judges for our in-class presentation noted that they agreed that a greater

awareness was needed in todays culture, where there is more pressure than ever to look a certain

way and to be successful. There is little talk about eating disorders in comparison to other health

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issues, such as smoking and drunk driving, but it is an issue that is growing more prevalent and

required more attention. This gave us the idea to target perceived severity and perceived

susceptibility; the prevalence and impact of eating disorders on individuals is underestimated and

often overlooked due to the health issues so commonly spoken about. It is a common

misconception that eating disorders only affect females, while the statistics show that males are

susceptible to it as well, with a lifetime prevalence of 3% (NEDA, 2016). Self-efficacy was

incorporated into the feedback we received from our classmates as well, particularly with regards

to what one can do to help a loved one who is suffering. When we asked students during

REDday what they would like to see in a campaign targeting eating disorders, they shared that

they wanted us to provide them with resources to help loved ones, as most people seem to know

somebody struggling or who has previously struggled. This feedback led us to alter our target

audience and include friends and family members of eating disorder sufferers, in addition to

those struggling. When discussing self-efficacy, we incorporated facts and information about

treatment procedures to highlight what individuals can do to help themselves and their loved

ones, as well as provided resources on Bryants campus for people to seek help.

We also showcased a rough draft of a website we were designing as part of campaign at

REDday. Generally, students and faculty members liked the idea, and they provided constructive

feedback to help us further its development. Multiple students shared that they would like to see

a forum or a blog where students can post and interact with others struggling to cope with an

eating disorder or that of a loved one. They also want to see stories of survivors on our website;

posting stories found in the media or campaign or advertisement images may help students to

convey how they feel about the subject and provide a base for community support.

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When we presented to the class, we were focusing our campaign on anorexia and binge

eating. However, after feedback from our classmates and the judges, narrowed our campaign to

focus only on anorexia. The reason we decided to do this was because our presentation did focus

heavily on anorexia and neglected many of the issues associated with binge eating disorder.

Kathryn Cantwell and Judith Farell judged our presentation that day, and one of them noted that

a weak point of our campaign was that we downplayed the need for action regarding binge eating

compared to that of anorexia. Because anorexia is the most prevalent and most fatal eating

disorder, it worked out better for us to focus on increasing the awareness of this disorder.

Following our formative research, we began finalizing our implementation plans. Our

campaign was designed following the health belief model. This model targets five factors:

perceived severity, perceived susceptibility, perceived barriers, perceived benefits, and cues to

action (Cho, 2012). Self-efficacy is also included sometimes in this model, and is used in our

campaign as a variable. Perceived susceptibility was an important factor in our campaign, as

many people view anorexia as something that will not happen to them, and as something that is a

choice. We needed to increase perceived susceptibility by enforcing the fact that anorexia

impacts both men and women, and revealing that our surveys showed that everybody has or

knows somebody who has participated in an unhealthy eating behavior, whether it be behaviors

related to anorexia or another disorder. We aimed to increase perceived severity by stressing the

statistics that show anorexia as the most fatal mental illness, in addition to using our survey

results to discuss the physical and mental aspects of having an eating disorder. On our website,

we have a section dedicated to providing statistics, as well as first-hand accounts of those who

have struggled to give students real life depictions of the implications of developing an eating

disorder. Also relevant to the severity of anorexia is the importance of early treatment; only 33%

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of individuals receive treatment, and early treatment is a critical component to recovery and

survival (NEDA, 2016).

There are several barriers associated with eating disorders. The main one is denial; many

individuals who are struggling fail to recognize that they have a problem, or they are afraid to

speak out. Similarly, those who know somebody suffering are afraid of discussing with them,

and theyre not sure how to go about it. To overcome some of these barriers, we began by

identifying three helpful resources on Bryants campus; the Hochberg Womens Center, health

services, and counseling services. These services will provide useful information for those

seeking help, as well as give individuals a chance to talk about the issue. However, we also

learned through our formative research that many members of our target audience were

concerned with anonymity. To preserve this, we have included a forum on our website where

students can speak out on any aspect of the issue, whether it be them suffering or a friend. There

will be an optional box to leave your name, but students can choose to remain anonymous if they

wish.

Regarding perceived benefits, we focused on increasing awareness of the benefits of

seeking help and early treatment. Those who seek help for themselves or for a loved one are

more likely to be directed to the correct resources to obtain treatment, which, as stated in my

discussion of perceived severity, is crucial to recovery. Understanding eating disorders, their

classifications, the symptoms, and the treatment options can make a difference and help increase

the number of people who seek treatment.

The core assumptions of the health belief model are that a person will take a health

related action if they feel that a negative condition can be avoided, believe that taking the

recommended action or behavior will allow them to avoid the negative condition, and believe

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that they can successfully follow the recommended health action. This was a good fit for our

campaign because we are recommending that people seek early help and speak out about the

struggle associated with eating disorders. If an individual seeks out early treatment and resources

for themselves or a loved one, they can avoid or lessen the consequences of anorexia and other

eating disorders (Glanz, Rimer, Lewis, 2002).

To implement our campaign, we planned a series of steps that will get us to our goal. The

biggest part of our campaign is the formation of our website. This website features several

sections, including pages for terminology relevant to all eating disorders, statistics, treatment

information, resources on campus, and a link to a forum for students to come together and

discuss the issue. This forum allows individuals to remain anonymous, with the intention of

increasing the number of people who will speak up about the severity of eating disorders in

college aged students. This website will be available through the health services page on every

students MyBryant portal. We are also planning an event that will last a week and take place on

campus. Working with the Hochberg Womens Center and health services, we will set up

activities in the rotunda and pass out bracelets with the acronym B.R.A.V.E.R.Y. Before and

after this event, we are also going to showcase pamphlets in these offices and in the counseling

center.

To evaluate the success of our campaign, we have several issues to consider. One is the

issue of trolling on the Internet; on an online forum, we need to make sure that those using it are

genuine. Because of concerns of robots and trolling, this website will only be accessible to

Bryant students, which is why we are making it available only through the portal. It is our hope

and intention to limit it only to those on Bryant Universitys campus. We will also have a

security check that everybody must pass before posting anything on the forum; this check will

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involve correctly typing in a sequence of letters or numbers to rid of any robots. To identify how

successful our website is, as part of our process evaluation, we will be monitoring the number of

visitors monthly. Regarding the events on campus, we are going to monitor attendance rates and

ask for student and faculty feedback. In addition, we will be tracking how many pamphlets we

are printing as a way of monitoring how many are being used on campus. Tracking attendance

and printing rates is part of our summative evaluation of the campaign; once the event is over,

we need to evaluate how successful we were at attracting a crowd and spreading our message

(Scriven, 1967).

Because people see eating disorders differently, it is important that we considered what

stage of change students are in. Our formative research showed us that, more often than not,

students were in the precontemplation or contemplation stage, meaning that they were thinking

about this issue and how to undertake a behavior change. Using the health belief model, we

aimed to increase perceived severity and susceptibility while encouraging the positive aspects of

overcoming the barriers of denial and fear often associated with speaking about eating disorders,

whether a victim or the loved one of a victim.

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Works Cited

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed). Arlington, VA: American Psychiatric Association.

2. Austin, S. Bryn. (2012). A Public Health Approach to Eating Disorders Prevention: It's

Time for Public Health Professionals to Take a Seat at the Table. BMC Public Health,

12(1), 854-859. doi:10.1186/1471-2458-12-854

3. Cho, H. (2012). Health communication message design: Theory and practice. Thousand

Oaks, CA: SAGE Publications.

4. Confidence is Beauty Campaign. (2013). Retrieved February 23, 2016, from

http://www.allianceforeatingdisorders.com/portal/confidence-is-beauty-

campaign#.VsvBBvkrJD8

5. Get the Facts on Eating Disorders. (n.d.). Retrieved February 21, 2016, from

http://www.nationaleatingdisorders.org/get-facts-eating-disorders

6. Glanz, K., Rimer, B.K. & Lewis, F.M. (2002). Health Behavior and Health Education.

Theory, Research and Practice. San Fransisco: Wiley & Sons.

7. NEDA. Feeding Hope. (2016, February 21). Retrieved February 23, 2016, from

http://nedawareness.org/.

8. Scriven, M. (1967). The methodology of evaluation. R.W. Tyler, R M. Gagne, M.

Scriven (eds.), Perspectives of curriculum evaluation, pp.39-83. Chicago, IL: Rand

McNally.

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