This week we are discussing disordered eating and eating disorders. This is a triggering topic, so before engaging with this week’s content, please make sure to check in with yourself and make sure you are comfortable engaging in this conversation.
I wanted us to discuss eating disorders this week as we gear up towards Thanksgiving: a time of reflection, but also a challenging time when we are surrounded by food and oftentimes harsh criticisms from the ones we love most. I personally struggle a lot with my own body image and I think it's important for us to realize how detrimental it can be to comment on someone else's appearance. So keep reading to understand the ramifications of your words and how important language can be around topics of food, weight, and disordered eating.
Let’s lay out some terms before we jump in. Disordered eating is used to describe a range of irregular eating behaviors that may or may not warrant a diagnosis of a specific eating disorder. Where as eating disorders, such as anorexia nervosa, or AN, or bulimia nervosa, or BN, are diagnosed according to specific and narrow criteria, excluding a majority of people suffering with disordered eating. Many individuals with disordered eating symptoms are diagnosed with an Eating Disorder Not Otherwise Specified (ie. EDNOS). However, similar to AN or BN, EDNOS has specific criteria that must be met in order for the patient to receive this diagnosis, and that criteria also is narrowing. The main difference to know is that disordered eating is a phase and where as eating disorders are mental health diagnosis.
In July 2019, news came out the Macy’s released plates on their shelves that critics believe was reportedly encouraging disordered eating or an unhealthy relationship with food. The plates released indicated portion sizes relative to type of pants that one would so call be able to fit into. Business Insider shares, “The plates have painted circles with the words "skinny jeans," "favorite jeans," and "mom jeans," seemingly implying portion sizes to be able to fit into each item of clothing. Some described the plates as offensive.” The incident provoked a viral reaction online and Macy quickly proceeded to take down existing plates and no longer sells them. The issue received national attention because many people feel it is indicative of a larger societal issue, that of a normalization of disordered eating habits.
1. This is not just a white, upper middle class girl’s problem
A common misconception about eating disorders is that they only affect a subgroup of society, ie. white, upper middle class women, but that is untrue. No matter one’s gender, racial or ethnic identity, or socio-economic background, one can still develop an eating disorders and disordered eating habits alike. NEDA (The National Eating Disorders Association) released 2014 research that found that men represent 25% of individuals with anorexia nervosa, and they are at a higher risk of dying, in part because they are often diagnosed later since many people assume males don’t have eating disorders. Additionally, researchers found that subclinical eating disordered behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among males as they are among females. Specialists are saying that existing stigma around men and boys and eating disorders are keeping these individuals from seeking help and getting the support they need. A 2012 study conducted a survey on eating disorders in men and identified issues specific to males, such as weight history, sexual abuse or trauma, gender orientation, depression and shame, exercise and body image, and media pressures. They found that men with eating disorders are currently under-diagnosed, under treated, and misunderstood by many clinicians who encounter them. Eating disorders are not gendered but neither are they racially discriminatory, in fact, NEDA released data supporting that they affect people from all demographics and of all ethnicities at similar rates. People of color – especially African Americans – are significantly less likely to receive help for their eating issues. NEDA released the following statistics: black teenagers are 50% more likely than white teenagers to exhibit bulimic behavior, such as binging and purging (Goeree, Sovinsky, & Iorio, 2011).
In a study of adolescents, researchers found that Hispanics were significantly more likely to suffer from bulimia nervosa than their non-Hispanic peers. The researchers also reported a trend towards a higher prevalence of binge eating disorder in all minority groups. Asian, Black, Hispanic and Caucasian youth all reported attempting to lose weight at similar rates, while among of Native American adolescents, 48.1% were attempting weight loss (Kilpatrick, Ohannessian, & Bartholomew, 1999). People of color with self-acknowledged eating and weight concerns were significantly less likely than white participants to have been asked by a doctor about eating disorder symptoms, despite similar rates of eating disorder symptoms across ethnic groups (Becker, 2003). What this information tells us is that eating disorders affect all people and we can not discriminate.
2. There isn't one type of Eating Disorder
Another perspective to think about is when and how we draw the line between disordered eating and an eating disorder, more specifically, in terms of what warning signs to look out for. NEDA released a document addressing that disordered eating might be a precursor to an eating disorder and shares that disordered eating may include (and is not limited to) a rigid food and exercise regime, feelings of guilt or shame when unable to maintain said regime, a preoccupation with food, body, and exercise that has an impact on quality of life, compulsive eating, excessive exercise, food restriction, fasting, purging, and laxative or diuretic use, and weight loss supplement use. What NEDA emphasizes is that understanding the intentions one has behind behaviors around food and exercise may be helpful in determining if it is an unhealthy relationship. Eating disorders may include the behaviors mentioned, but it is important to remember that they are complex psychiatric illnesses with biological components. Simone Seitz, NEDA Network Vice-Chair says, “eating disorders are 50-80% genetically based - they are not a choice.” Another guiding sign is frequency and intensity around behaviors, because when an individual is struggling with an eating disorder, they generally engage in multiple behaviors with more frequency and intensity. The level of obsession with food, exercise, and body thoughts and behaviors can distinguish disordered eating from an eating disorder. NEDA explains that these thoughts are generally all-consuming and may include (but are not limited to) fixation on calories; good and bad foods; ingredients; measurement; taste; body size and shape; type and frequency of exercise; feelings of failure when unable to sustain these behaviors; and avoidance of social activities. The most commonly discussed eating disorders are Anorexia, Bulimia, and Binge Eating Disorder (BED), but there are plenty of other less common disorders such as Avoidant/Restrictive Food Intake Disorder (ARFID), Other Specified Feeding or Eating Disorder (OSFED), Unspecified Feeding or Eating Disorder (UFED) or Atypical Anorexia Nervosa. All of the more uncommon eating disorders share the commonality of feeding or eating behaviors that cause clinically significant distress and impairment in areas of functioning, but do not meet the full criteria for any of the other feeding and eating disorders. The take-away is that intentionality, frequency, intensity and mental/physical distress are guidelines for whether someone is engaging in disordered eating habits or are developing an eating disorder. In either case, family and friends support and appropriate health care interventions are important in helping the individual who is struggling.
3. If society says so...
When did it become culturally acceptable to talk about someone else’s weight? Many are saying that the Macy’s Plates scandal is an indication of a greater societal issue: the fact that we have normalized disordered eating habits and behaviors. Critics are pointing their fingers at today’s pervasive diet culture and the way it promotes misinformation around health, food and bodies. In a time where diets become cultural fads and everyone is trying a new popular diet with the change of the seasons, it is hard to not be influenced by these quick fixes or supposedly sustainable lifestyles. From paleo, to keto, to vegan, to Whole 30 and juice fasting to name a few, it feels we are constantly told what and what not to eat in order to lose weight. The National Eating Disorder Association believes that weight stigma is so firmly entrenched in our culture that “even healthcare professionals often substitute fatphobia for actual diagnoses, and substitute diets for the evidence-based interventions that a thin person with the same health issues would receive.” Diets are not a novel thing in our society, in fact dieting has been a cultural phenomenon throughout history, from ancient Greece, to the 1950s until today. The the word “diet” (ie. diaita) was invented in ancient Greece and in its original context, it wasn’t solely focused on eating certain foods to achieve weight loss—it was meant to represent an entire way of life, encompassing food, drink, lifestyle, and exercise. “They didn’t get everything right,” Louise Foxcroft, the author of Calories and Corsets: A History of Dieting Over 2,000 Years, told Gastropod, “but they did know that a healthy mind and a healthy body made for a healthy society.” Within the nutrition community, there has been a recent push to return to a similar mentality around food in the form of adopting intuitive eating habits, a process where the body’s needs and hunger cues are at the core of how one nourishes oneself. The Macy’s Plates are problematic because they are encouraging the idea that portion size is equivalent to weight, and research shows that portion size is hugely dependent on the individual’s unique nutritional needs. So, is diet culture to blame for the normalization of disordered eating habits in our society, or is there more to it?
4. What’s social media got to do with it?
Another perspective to consider is the role of social media in promoting unhealthy eating behaviors. Although we cannot pinpoint social media itself as the sole cause of an eating disorder, recent research has shown that fuels individuals to engage in disordered patterns of eating. According to research, “media is a causal risk factor for the development of eating disorders” and has a strong influence on a person’s body dissatisfaction, eating patterns, and poor self-concept.” Social media’s culture of comparison enables users to constantly compare themselves to thin models and their peers, as well as famous social media users and start to feel inadequate about their own self-image. Apps, like Instagram, allow one to judge their self-worth based on the number of likes their photos receive certainly do not improve the situation. So perhaps, hiding likes on the app will help with comparison, but social media influencers and celebrities alike are promoting diets and exercise routines that can perpetuate negative self talk and unrealistic standards.
A recent report from the BBC paints a bleak picture of an eating disorder epidemic developing on Instagram. The news organization details that posts and comments promoting eating disorders are “spiraling out of control”, as “vulnerable” people, many of them children, use the platform to find “anorexia buddies” to support them in fasting and weight loss. This problem is not new; back in 2012, Pinterest, Tumblr, and Instagram banned “thinspiration” and pro-eating disorder tags entirely in the hopes of curbing this type of behavior. While that move did decrease the availability of pro-eating disorder content, it could not satiate users that still craved the kind of supportive peer communities that social platforms like Instagram provide. Social media has become a hub for niche online communities, where people with similar interests or expertise can share ideas and tips. Unfortunately, it has lent itself to the creation of niche eating disorder sub-groups where users are exchanging unhealthy tips.
5. Maybe disordered eating is just an American thing
Another perspective to consider is that many people feel that only Americans experience disordered eating. Many people believe that eating disorders and disordered eating alike are only issues relevant to Western culture. Researchers found in a 2004 study that prevalence rates in Western countries for anorexia nervosa ranged from 0.1% to 5.7% in female subjects. Prevalence rates for bulimia nervosa ranged from 0% to 2.1% in males and from 0.3% to 7.3% in female subjects in Western countries. Prevalence rates in non-Western countries for bulimia nervosa ranged from 0.46% to 3.2% in female subjects. Studies of eating attitudes indicate abnormal eating attitudes in non-Western countries have actually been gradually increasing instead of decreasing. This misconception that disordered eating is only happening in the Western world is making a lot of abnormal behavior go unseen in the developing world. With globalization, comes the globalization of ideas, and therefore, this does not exclude diet culture and disordered eating habits. Eating disorders in Singapore have been increasing since the 1990s. Studies have shown that body dissatisfaction has grown within the population, especially among university students. Rates of eating disorder diagnoses are continually climbing in part due to population growth, even though these rates are still lower than those of Westernized countries. The take-away is that diet culture, disordered eating and eating disorders are not issues that only occur in our country but they happen on a global level.
6. Sticks and stones will break my bones, but words will always have the power to hurt me.
Another perspective to consider is the weight our words carry when we talk about weight, bodies and health. We live in a culture where commenting on someone else’s weight is deemed the norm and where we are encouraged to publicly celebrate weight loss or bring to attention weight gain. Language is at the root of cultural dialogue around these topics, so maybe it’s time we think about changing the language we use to promote healthier relationships with food on a societal scale. Starting with compliments, we should consider shifting the focus of our compliments away from one’s body and more towards who they are as person. For instance, instead of saying “You look great! Have you lost weight?”, which focuses on a person’s appearance instead of their personality, a better compliment might be “You seem to be doing great and taking care of yourself!” By shifting the focus of a compliment on one’s character versus their appearance, we are encouraging a culture where people can feel valued much more for who they are rather than what they look like. If you find yourself in a position where someone is commenting on your body this Thanksgiving, here's what I would do. (Please note this is only from my own personal experiences). First, try to understand the person making the comment truly cares about you and believes this comment is helping you, so in a kind, calm way, I would say something along the lines of "I know you are bringing this up with the best of intentions, but I want you to know that when you comment on my body in this way, it is far more detrimental to me than it is actually helping me, so I would really appreciate it if you didn't make this comment about my appearance, but rather focus on all of the things going on in my life that make me, me, since my worth is much more than my weight." Send me a message if this works for you, and let me know if you have any other tactics in mind. So, all in all, this week, when you're at the Thanksgiving table, give thanks to your body for being the vessel carrying you through life, and if someone tries to make a negative comment on your body, kindly point them towards this article and this week's podcast!