International Journal of Humanities and Social Science Vol. 1 No. 19; December 2011 39 Avoiding Conflicting Health Promotion Messages between Eating Disorders and Obesity Prevention. Can Systems Thinking Act as a Mediator, and How? Manuela Ferrari, MHSc., PhD (C) Dalla Lana School of Public Health University of Toronto 155 College St., 7th floor Toronto, ON M5T 3M7 Canada Abstract Body shape and weight concerns and more extreme clinical conditions such as Eating Disorders (ED) and Obesity (OB) are considered serious health problems. Despite evidence of shared risk factors between ED and OB, the two fields of prevention appear to work independently with little or no interaction. Can systems thinking act as a mediator between the ED and OB field? Using Jackson’s System of Systems Methodologies as a theoretical framework, this article starts by discussing the unitary and than moves to pluralist and coercive approaches, to show how different methodologies can help to further understand the spectrum of weight-related problems. Systems thinking can act as a third party to connect the fields of ED and OB. It can help to capture the complexity of weight-related problems, as well as further explore shared prevention strategies. Furthermore, it helps to ensure fairness and diversity within the fields when implementing prevention interventions. Key words: eating disorders, obesity, weight-related problems, prevention, system thinking, System of Systems Methodologies. 1. Introduction In the present health climate, Eating Disorders (ED) and Obesity (OB) are considered serious medical and public health problems (Treasure, Schmidt, & Furth, 2003). However, a topic of potentially greater concern is that some of the behaviours and attitudes, such as body dissatisfaction, body shape and weight concerns, which precede these clinical issues are in and of themselves major social-cultural problems affecting youth, especially young women. Eating Disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder affect between 1- 3% of the adolescent population (Treasure et al., 2003). Based on world data, 23.2% of the adult population was overweight (24.0% in men and 22.4% in women), and 9.8% was obese (7.7% in men and 11.9% in women) (Wadden & Stunkard, 2004). Beyond this, clinical ED and OB are part of a spectrum of weight-shape related problems (e.g. negative body image, weight/shape concerns, etc.) that produce significant morbidity even though they do not meet the full ED and/or OB clinical criteria (Levine & Smolak, 2005). A Canadian study found that 30% of female and 25% of male students in grades 6-8 (age 10-14) engaged in weight loss and muscle-gaining behaviours; girls were more likely to use skipping meals as a way to lose weight, whereas boys increased the amount of protein in their meals and time spent lifting weights in order to increase their body muscle (McVey & Davis, 2002; McVey, Davis, Tweed, & Shaw, 2004; McVey, Pepler, Davis, Flett, & Abdolell, 2002). In a U.S. study, negative body image, defined as the discontent with some aspect of one’s physical appearance, has been self-identified in 48% of young adult females (Cash & Pruzinsky, 2002). A further study by Cash and Fleming (2002) found that 20% of the 116 American college women interviewed felt that body image negatively affected their satisfaction with life: 35% reported frustration at their inability to control their weight and 7% indicated that their body image had a negative effect on their relationships with friends. Empirical studies have suggested that ED and OB can be experienced simultaneously, and that individuals may cross over between the two conditions (Fairburn & Brownell, 2002; Neumark-Sztainer et al., 2007). Furthermore, there is substantial evidence to show how weight-related teasing by family, personal weight concerns, and dieting/unhealthy weight-control behaviours are shared risk factors between these two conditions (Neumark- Sztainer et al., 2007). Despite this understanding, prevention interventions are nonetheless conducted under, and informed by, two separate silos of knowledge and practices (McVey et al., 2008).