Laia Asso Ministral: "We observe that eating disorders are being diagnosed at increasingly younger ages."
November 30th is International Eating Disorders Awareness Day , symbolized by a blue ribbon. This initiative, observed annually since 2012, aims to raise awareness of the importance of prevention and early detection of eating disorders and to combat the stigma and excessive social judgment that often surround them.
Eating disorders (EDs) are a group of mental disorders characterized by abnormal eating behaviors and distorted thoughts about diet, weight, and body shape. These distorted thoughts and behaviors can lead to serious physical problems and affect a person's psychological and social functioning.
Eating disorders are multifactorial pathologies involving genetic, biological, psychological, and sociocultural variables. They primarily affect adolescent and young adult women. The most well-known eating disorders are anorexia nervosa (AN) and bulimia nervosa (BN), but others exist, such as binge eating disorder (BED).
We spoke with pediatrician and dietitian-nutritionist Laia Asso Ministral, who currently works in the Maternal and Child Service of the Sub-directorate General of Health Promotion of the Public Health Agency of the Generalitat of Catalonia and is part of the Taula de Diàleg, a platform for the prevention of eating disorders of the Generalitat of Catalonia.
What are the keys to preventing eating disorders?
"One of the keys to preventing eating disorders is the involvement of all actors who take part in the lives of children."
- School: It is a key element in child development. Fostering respect for diversity and contributing to the development of critical thinking are elements that can be addressed and reinforced within the educational setting.
- Family: It is a fundamental pillar in the prevention of eating disorders. It's important to remember that prevention begins in early childhood, with simple actions such as having at least one family meal a day.
- Primary care: It plays a particularly important role in supporting parenting and establishing healthy habits at an early age. It will also be crucial in the early detection of eating disorders.
- Media and advertising: they should be mindful of their practices and promote self-esteem and respect for difference. This is something we have addressed with the Decalogue of good practices on promoting self-esteem and body image in social media and advertising .
What should pediatricians consider for early detection?
"We are seeing more and more children diagnosed with eating disorders at younger ages. Pediatric teams need to be aware of the early signs and predisposing factors of these types of illnesses so they can identify them during consultations and make an appropriate differential diagnosis."
Often, the earliest signs are not visible during a pediatric consultation. Therefore, building a trusting relationship with children and adolescents and their families is essential to creating a supportive environment where they can express their concerns or worries.
Close collaboration with the child and adolescent mental health team will be another crucial element in achieving an early diagnosis that contributes to improving the prognosis."
The Pandemic Triggers Cases of Anorexia and Bulimia
How should we act to prevent childhood obesity?
"Preventing childhood obesity begins during pregnancy and even before, in the preconception stage. It is a disease involving numerous factors, including socioeconomic ones. To promote the prevention of this disease, which represents a very serious public health problem, in addition to the family, the involvement of:
- Health professionals: promoting healthy lifestyle habits from the earliest ages (including active leisure and rest), as well as addressing vulnerability, are key factors in preventing obesity.
- Society can play an important role in prevention, but even more so in combating the stigma that obesity often entails. Critical thinking and the promotion of positive relationships are also responsibilities that fall on society.
What should we keep in mind to ensure that obesity prevention does not become a risk factor for the development of an eating disorder such as anorexia nervosa or bulimia nervosa?
"It is important to promote healthy attitudes, taking special care with the messages conveyed in either direction. Messages should always be balanced and measured, avoiding both restrictive and excessively lax eating habits, and encouraging respect for each person's hunger and satiety cues. Furthermore, building self-esteem should be a central focus in the prevention and treatment of both disorders."
A collaborative platform to prevent eating disorders
What is the Diàleg Taula?
"It is a platform that works in a multidisciplinary way and aims to become a loudspeaker for raising social awareness about the prevention and recovery of eating disorders."
What entities comprise it?
"The Taula was promoted by the Associació Contra l'Anorèxia i la Bulímia (ACAB) and the Agència Catalana del Consum. It is made up of universities, scientific societies, health centers, entities, professional associations and various departments of the Generalitat de Catalunya." In the last project, the organizations involved are: Catalan Society of Family and Community Medicine (CAMFIC), Fundació Imatge i Autoestima (IMA), Hospital Clínic de Barcelona, Universitat Autònoma de Barcelona (UAB), Servei Especialitzat en Disorders de la Conducta imentària (SETCA), Associació Catalana d'Infermeria Pediàtrica, Col·legi de Farmacèutics de Barcelona, Societat Catalana de Pediatria, Hospital de Santa Creu i Sant Pau, Hospital Germans Trias i Pujol, Hospital de Bellvitge, Associació contra l'Anorèxia i la Bulímia (ACAB), Agència de Salut Pública de Barcelona (ASPB), Hospital de Sant Joan de Déu (SJD), Hospital Universitari Mútua de Terrassa, Col·legi de Dietistes-Nutricionistes de Catalonia (CoDiNuCat), Official College of Psychology of Catalonia (COPC), Associació d'Infermeria Familiar i Comunitària de Catalunya (AIFICC), FITA-Fundación Fita, Ita-Salut Mental, Consell Català de l'Esport, Universitat Oberta de Catalunya (UOC), Generalitat de Catalunya (Departament de Treball, Afers Socials i Famílies; Department of Health-Pla Director of Mental Health and Addictions; Public Health Agency of Catalonia; Catalan Youth Agency; Department of Education and Catalan Consumer Agency).
What is the working methodology?
"The Taula works on temporary, monographic projects, usually lasting two to three years. Once a topic is chosen, an exhaustive literature search is conducted to find all the published scientific literature on the subject. Depending on the topic, the collected literature may be supplemented by a study carried out by the centers participating in the Taula. The data from this study will be used to identify needs and design actions or materials aimed at professionals or the general public, with the goal of improving the approach to eating disorders. In other cases, awareness campaigns are developed, targeting the entire society or a specific segment of it, to promote the prevention of these types of disorders."
What have been the monographic projects to date?
"To date, work has been done on three monographic projects:
- Anorexia and advertising.
Some types of advertising tend to promote unrealistic and unhealthy beauty standards, which place particular pressure on the bodies of women and girls. As a result of the work of the Working Group on this special issue, the Decalogue of Good Practices on Promoting Self-Esteem and Body Image in Social Media and Advertising was developed.
- Anorexia and the Internet.
The internet and social media can play a role in the development and evolution of eating disorders. A study conducted by Taula de Diàleg, which analyzed a sample of people affected by an eating disorder, revealed that 85.4% had carried out searches related to eating disorders. In 60% of cases, the content was considered harmful to health. This study resulted in the creation of the Safe Browsing Guide . Furthermore, the Catalan government approved regulations to penalize the promotion of anorexia and bulimia on websites, blogs, and social media.
- Anorexia and family.
The family is a key element in the prevention and treatment of eating disorders. Throughout this monograph, the Dialogue Table was divided into two subgroups. One focused on the role of the family in the prevention of eating disorders, while the other addressed the family as caregivers for individuals with eating disorders. The first subgroup carried out the "Get Involved" campaign to promote attitudes and actions that can act as protective agents against eating disorders and other illnesses, starting from early childhood. The other group conducted a study among family members to identify their needs during the support process and developed a guide for families of people with eating disorders.
What project are you currently working on?
Currently, the Taula de Diàleg has decided to dedicate its next monograph to the topic of "Anorexia and Obesity." The challenge this time is to combine two areas of great importance to public health: the prevention of eating disorders and the prevention of excess weight.
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