Primary prevention of eating-related problems in the real world

Aim As known from meta-analyses, prevention programs for eating disorders yield significant effects under ideal conditions. However, it is still unclear how these programs can be more widely disseminated. Since 2004 in Thuringia, Germany, several programs for preadolescent girls and boys (aged 10 to 15 years) covering a wide geographical range have been developed in order to prevent eating-related problems. Subjects and Methods Over 3,500 pupils and more than 100 schools participated in the internal evaluation following the three-step standard of the Society of Prevention Research (SPR). To examine the program efficacy (step 1) and effectiveness (step 2), we conducted pre-post design studies with control groups. In order to describe the implementation process and the program dissemination (step 3), the Health Promoting School Approach (HEPS) was applied. Results Girls (6th grade) showed significant improvements in eating attitudes and self esteem about their bodies, whereas boys only improved their knowledge about eating and physical activity. The evaluations of the programs for 7th and 8th graders are still pending. On the HEPS checklist, our health promotion concept fulfilled 64 points out of a maximum of 74, which indicates a high intervention quality. Conclusion Broad dissemination of prevention programs requires methodological compromises and organizational flexibility. Quality assurance should be considered to be as important as the optimal level of evidence, which depends on the needs of all stakeholders and could not be derived from the standards for clinical studies. Furthermore, health promotion needs political support that is independent of legislative periods and the turnover of institutional staff.