Prevention Programs for Eating Disorders and Obesity in Germany: Results from the Evaluation of Efficacy, Effectiveness and Broad Dissemination

Disordered eating and partial eating disorder (ED) syndromes are widespread in childhood and adolescence. They are associated with decreased psychosocial functioning, internalizing and externalizing disorders and reduced quality of life. Since ED courses are often chronic, they are accompanied by treatment difficulties and high treatment costs. Consequently, there has been an increasing amount of prevention programs. However, most programs lack a comprehensive evaluation according to the Society for Prevention Research (SPR) standards. Additionally, too little attention has been paid to sustainable prevention dissemination.

The project LooP (Long-term effects school based prevention programs related to eating behavior and the development of eating disorders and obesity) aims to describe disordered eating from early adolescence to young adulthood depending on the participation in the consecutive prevention programs PriMa and Torera for 6^th- and 7^th-graders in Germany. The efficacy trial was conducted between 2004 and 2006 followed by the effectiveness evaluation in 2007-2008 and 2016. The examination of the broad dissemination completed a comprehensive prevention program evaluation. During the entire process, mixed methods have been used. In order to assess the programs’ effects on disordered eating and body self-esteem quantitative (online-) questionnaires were applied. For a substantiation of these findings secondary health insurance data were analyzed. It was examined whether the program participation led to a decreased utilization of health care services concerning eating problems in the long-term. In order to bridge the gap between research and everyday practice, teachers who integrated the programs into daily school life were interviewed using qualitative content analyzes.

The primary prevention programs for eating disorders and obesity impacted participants insofar that body self-esteem as a key protective factor could be strengthened from early adolescence to young adulthood. In disordered eating, no group differences were obtained. Risk-group members profited the most as well as pupils who participated in two programs, rather than one. Results from the examination of secondary data will be presented and discussed. Considering that one aim of the project was examining the current dissemination eight years after the implementation of the program, the teachers’ interviews revealed helpful insights for improving broader dissemination. Challenging factors were primarily a lack of the individual teacher’s interest, organizational barriers such as curriculum difficulties, and missing structural support via school administrations and political decision makers.

The results of the different evaluation levels will be aggregated and discussed. A prevention strategy will be proposed which might serve as a model for health promotion in different areas.