National Review of Eating Disorder Services Implementation Group: final report

6. Public Health Strategy

The National Review recommended developing a public health strategy for eating disorders as a long-term recommendation:

Recommendation 5: Public health

The Scottish Government should fund and support the development of a comprehensive public health strategy for Scotland that makes eating disorders' prevention everyone's business.

In summary, this recommendation includes, working across government, agencies, and industry to promote a positive body image culture and positive body image parenting advise within Scotland.

The Implementation Group considered the current research, and existing national public health campaigns for the prevention of eating disorders and consulted public health campaigners in Scotland to make recommendations.

There has historically been very little research into the prevention of eating disorders. What research there is has mostly investigated targeted prevention programmes with very few universal societal approaches.

In Scotland, there have been no evidence-based public health studies focusing on eating disorders prevention. Even though there are some local initiatives, including bringing together many stakeholders which was supported by the Scottish Government Conference held at the Scottish Parliament, it has not been followed up by a dedicated Public Health directive to NHS Boards and the wider stakeholder groups.

However, there are some campaigns that Scotland can learn from:

• Quebec 2009 - Charter for a healthy and diverse body image. Click here to read the publication in the American Journal of Public Health.
• Australia 2009 - National media and industry voluntary code on body image. To read the report, click here.
• Catalonia 2012 - Roundtable on the Prevention of Eating Disorders: The Catalan public policy initiative. To read the published paper in the Eating Behaviors Journal, click here.
• USA - Eating Disorders Coalition: advances the recognition of eating disorders as a public health priority throughout the United States. To view their website, click here.

In addition, Scotland has some successful Public Health Campaigns, from which significant changes have resulted, and therefore from which there is applicable experience and learning. Representatives from The Obesity Alliance, Alcohol Action Scotland, Taking Action on Smoking and Health (ASH) Scotland shared some of their learning, a summary of the most applicable for this public health Campaign is below:

• Clear vision, mission, and aims
• Strategic plan with associated organisational and work plan.
• Any Public Health network / Campaign needs financial support, or it will fall apart
• Public health groups need allies inside the government and advocates outside.
• Legislation is important
• Be opportunistic – link up with other work or campaigns that are ongoing
• A helpful framework to think about who needs to be involved in a campaign is: top-down regulation and the media and bottom-up: lived experience/recovery
• Take a long view of what you are trying to achieve and then bring it back to the specifics
• Concentrating on the macro environment work grounded in and justified by the evidence but not at a systematic review level.
• Lived experience speaks more loudly than evidence – so needs to represent evidence and also bring real life elements to the evidence.
• The best voices to front campaigns are clinicians, families, and celebrities
• Music, sport, and fashion are the best for marketing for young people

It is recommended that the National Eating Disorder Network should include support for recommendation 5 with a member of the Network employed with the skills and competencies in public health to be able to lead on a dedicated strategy.

In addition, it might be beneficial to hold a roundtable discussion with the following stakeholders: fashion, advertising, sports and fitness, food industry, social media, schools and education, parenting, and youth organisations. With the help of public health experts, the aim of the round table would be to engage organisations in creating the first iteration of the eating disorders prevention strategy. The National Network could then take the strategy forward.