Primary prevention

Due to the serious morbidity and mortality associated with AN and the challenges of its treatment, effective methods to prevent the development of AN have long been sought. Prevention programmes may be classified as universal (applied to a whole population regardless of risk factors), selective (targeted towards those at higher risk due to the presence of risk factors) or indicated (targeted towards those with early/sub-threshold symptoms of a condition).[54][55]​​ In practice, interventions may span two or more of the above groups. The most promising results stem from targeting high-risk individuals and those who have begun to develop symptoms (selective and indicated interventions), but the low frequency of AN makes it difficult to judge their utility.[56] A limitation of current research is that the target population for most prevention studies has been female high school and university-aged students; further studies are needed which include a more diverse patient population.[57]

Specific types of intervention which show promise for primary prevention of AN include cognitive dissonance-based programmes (including online and peer-led programmes), mindfulness-based prevention programmes, healthy-lifestyle modification prevention programmes, media literacy-based programmes, and self-esteem/self-efficacy prevention programmes.[56][57][58][59]​ To date, cognitive dissonance-based programmes demonstrate the strongest evidence for efficacy in prevention, and appear to be particularly effective for selective prevention (for those with risk factors), resulting in an almost 60% reduction in the risk of future eating disorder development in girls and young women experiencing body dissatisfaction compared to controls.[60][61][62] Although universal prevention appears to be less effective than selected or indicated approaches, programmes such as multi-risk factors school-based programmes may be effective in reducing important risk factors including body dissatisfaction.[63]

Early intervention for AN (within the first 3 years of illness) is associated with better outcomes and increased recovery rates, particularly in children and adolescents.[64] Early intervention is key for individuals with recent onset of symptoms and for those who may not yet meet full diagnostic criteria (i.e., those with sub-threshold AN).[65]​ The critical goal is to interrupt restriction of caloric intake before it becomes an established pattern of behaviour. Psychological treatments such as those described in the management section of the topic may be used (e.g., eating disorder-focused cognitive behavioural therapy or specialist supportive clinical management), with involvement of the family for younger individuals.

Secondary prevention

Management of acute AN should be followed by an extended period of treatment aimed at relapse prevention. Following weight restoration, relapse prevention treatment should commonly include regular outpatient meetings with one or more clinicians for one year or more.

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