Into the Great Wide Open: Family Risk and the Prevention of Eating Disorders

Into the Great Wide Open: Family Risk and the Prevention of Eating Disorders

Into the Great Wide Open: Family Risk and the Prevention of Eating Disorders

Consider six propositions strongly supported by research:
1. Eating disorders (EDs) are serious, sometimes chronic mental illnesses.

2. There will never be enough qualified therapists and other professionals to treat the number of patients with EDs, especially since mood disorders and substance use disorders are more prevalent.

3. EDs are frequently difficult to treat effectively, and a substantial percentage of patients recover only after a long time or do not recover completely.

4. If you have had an ED, your biological siblings are roughly nine times more likely than the general population to develop an ED. If you are a parent, so are your biological offspring.

5. Since the early 2000s we have learned about the important contributions the family can and should make to the treatment, support, and recovery of people with EDs.

6. To date, the most effective forms of ED prevention focus on those at moderate-to-high risk.

Given these six “truths,” two additional facts are astounding. First, since at least 2004, there have been periodic calls by distinguished genetics researchers such as Dr Cynthia Bulik (USA/Sweden) for targeted prevention with the at-risk daughters of mothers with EDs.

Second, my recent search of several databases for the period January 2000 through August 2021 yielded no studies meeting the following criteria:

(a) identified high-risk families with a child age 10 or older;

(b) devised a prevention program for the family; and

(c) evaluated program effects on risk/protective factors and on ED onset. In a 21-year period, there are zero studies of prevention for high-risk families with a child at high-risk developmental stages, as compared to approximately one such study per year for athletes 18 years and older.

In Part 2, I will consider what to do to rectify this mysterious hole in the prevention field.

  • This article first appeared in the monthly column “Weighing In on Eating Disorder Issues” ofThe Eating Disorder Journal (December 2021, 22[12]; EDReferrcom)
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Michael P Levine

About Michael P Levine

All articles by Michael P Levine

About Michael P. Levine Ph.D.

Michael is a retired Professor of Psychology at Kenyon College and a Fellow of the Academy for Eating Disorders. He has co-edited three books on prevention, and he has authored/co-authored three curriculum guides and three books on prevention, the most recent (2021) of which is described at Anyone interested in receiving his free Eating Disorders Prevention/Sociocultural Factors email newsletter is encouraged to contact him at

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