Protective factors against disordered eating in family systems: a systematic review of research

OBJECTIVE: This systematic review aims to identify and evaluate the literature investigating protective factors and eating disorders (EDs), to establish what is known about factors in family systems that could be considered protective against the development of ED/disordered eating. METHODS: A systematic review of the literature was conducted on five databases, using search terms related to ED/disordered eating and protective factors. Studies were systematically screened and included if they made reference to a protective factor within the family system and explored associations with a quantitative measure of ED/disordered eating behaviours. All included studies were evaluated for study quality. RESULTS: Twenty-five studies met criteria for inclusion. Ten papers made use of longitudinal or prospective designs appropriate to identify factors potentially protecting against the development of disordered eating difficulties, while a further 15 papers report cross-sectional associations between family factors and disordered eating outcomes. Studies looked at aspects of family relationships and family practices around food or eating. There was a particular research focus on the potential protective role of regular family meals. CONCLUSIONS AND IMPLICATIONS: Many of the potential protective factors identified, such as family support and connectedness, may be non-specific to eating difficulties, promoting general adaptive development and a range of positive development outcomes. Factors in the family environment around food, eating and weight, such as frequent family meals and avoiding comments about weight, may be more specific to ED and disordered eating. Issues with the methodologies used severely impact on the ability to draw conclusions about whether factors are ‘protective’.