Body & Mind: An Eating Disorders FAQ
The Terry project is pleased to announce a new section in the Terry blog. Here, we will present excellent FAQs written in our ASIC200 on various topics of note. We aim to collect these remarkable papers, so that we can build a great repository of readings in socially responsible issues. Below is the first one by Kyla Jamieson – Enjoy!
– – –
Images by Kyla Jamieson - click on image to go to see more.
“World War IV, the war for freedom, is being fought inside our heads”[1]
Risk factors that have been identified for the development of eating disorders include “puberty, being female, societal emphasis on thinness, thin-ideal internalization, body dissatisfaction, unhealthy dieting, participation in activities that place substantial emphasis on body weight and shape, negative affect, adverse life events, childhood sexual and/or physical abuse, insecure attachment and family dysfunction.”[2]
– – –
What are eating disorders?
Eating disorders are psychological disorders that involve serious disturbances in eating behaviour. Currently recognized disorders include Anorexia (AN), Bulimia (BN), Binge Eating Disorder (BED) and Eating Disorders Not Otherwise Specified (EDNOS). Anorexia is characterized by refusal to maintain a minimally normal weight for one’s age and height, as well as intense fear of weight gain, disturbed body image, and amenorrhea (missing period cycles). Bulimia involves eating large amounts of food in a short period of time and then vomiting, using laxatives, fasting or exercising excessively (binging and purging). Binge eating disorder involves binging without compensatory purging, and EDNOS is an umbrella term for eating disorders that do not fit the full diagnostic criteria for AN, BN, or BED.
Don’t most girls fear weight gain and have distorted body images, even without an eating disorder?
Yes, which is extremely worrying. A British study done in 2005 found that 47% of 6-year-old girls wanted to be slimmer in order to become more popular.[3] In Canada, 53% of healthy weight girls in grades 7-12 were trying to lose weight in 2008. Forty-six percent of girls reported dieting, 36% reported binge eating and 8% reported purging.[4] These statistics show that patterns of thinking and behaviour which are symptomatic of eating disorders are extremely prevalent in our society, and the number of young girls at risk of developing eating disorders is huge.
What is thinness bias?
Thinness bias is the pervasive belief that thinness correlates with health, strength of character, and beauty. Thinness bias contributes to the stigmatization of overweight and obese individuals and may explain why 47% of British 6-year-old girls want to be slimmer in order to become more popular,[1] and 53% of healthy weight Canadian girls in grades 7-12 were trying to lose weight in 2008. (Forty-six percent of girls reported dieting, 36% reported binge eating and 8% reported purging.)[5]
What’s the difference between abnormal eating behaviour and an eating disorder?
Only “overeating associated with other psychological disturbances,” such as emotional stress, is included in the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10).[6] It is important to note that eating disorders are characterized by emotional and psychological distress in addition to abnormal eating behaviours; i.e., while all types of overeating can be harmful, they do not always cause distress to the eater. Fear of weight gain, negative and/or distorted self-image, and preoccupation with/negative feelings about food are common psychological aspects of eating disorders. These elements are what distinguish individuals with eating disorders.
So is it easy to tell if someone has an eating disorder? Will their abnormal behaviour be obvious?
Not necessarily. Individuals with eating disorders tend to be embarrassed by their behaviour; they may go to extreme lengths to hide their disorders. Binging and purging are often done secretively. Digging a hole in the yard and vomiting into it, then covering the hole up may seem rational to someone with bulimia.[7] Individuals with atypical anorexia, bulimia, BED and EDNOS may appear to be within a normal weight range, yet struggle with disordered behaviour and ways of thinking. Furthermore, at any given time, 70% of Canadian women and 35% of men are dieting; the prevalence of dieting and concern with self-image in our society may make it difficult to distinguish the outwardly observable manifestations of eating disorders from “normal” behaviour.[8]
Why would someone hide an eating disorder? Don’t they want help?
Some individuals develop eating disorders as a way of coping with stressful situations that are beyond their control (ex. parents’ divorce), personal struggles with self-identity and self-esteem, and other deeper emotional and psychological issues that they find too painful to deal with directly.[9] Asking someone to give up their eating disorder is asking them to give up a (self-destructive) coping mechanism, and may force them to address difficult issues they might not be equipped to deal with. Furthermore, for athletes or individuals in the entertainment industry, seeking treatment for an eating disorder may require letting go of a career, self-identity, or source of income.
What are the physical consequences of eating disorders?
Among the physical consequences of eating disorders are weakness, dizziness, ulcers in the esophagus, thyroid disorders, osteoporosis, dental caries, increased risk of chronic disease, cardiac arrest, and death. The effects upon the female reproductive system can include amenorrhea, infertility, miscarriages and fetal complications.[10]
How are eating disorders a global issue?
While eating disorders have historically been classified as culture-bound syndromes, limited to western nations and North America in particular, they have also been documented in Korea, Nigeria, and Iran.[11] One group of researchers recently investigated eating disorders amongst Pakistani schoolgirls and found that the occurrence of eating disorders and dieting in that demographic is increasing at “an alarming rate.”[12] In countries without established infrastructure to treat and support individuals with eating disorders, the threat of these issues going untreated is higher than in Canada or the United States, where eating disorders have been a significant issue for forty years. Eating disorders are crossing cultural, race, class and gender boundaries now more than ever before.[13]
How common are eating disorders in Canada?
We don’t know. Canada’s Public Health Agency estimates that “3% of women will be affected by an eating disorder during their lifetime,” but notes that “Existing data provide a very limited profile of eating disorders in Canada.”[14] We don’t know the actual number of Canadians affected by eating disorders because estimates based on the number of individuals hospitalized for eating disorders don’t include individuals who seek treatment from clinics, family doctors, outpatient services or community organizations. Furthermore, individuals are often unwilling to acknowledge they suffer from an eating disorder or are unwilling to seek treatment. Thus official rates reflect only the most severe cases of eating disorders.
Are eating disorders an issue in B.C. or here at UBC?
B.C.’s Ministry of Health Services estimates that in 2008, 53,187 females and 5,267 males aged 10-54 years were “living with a clinically diagnosed eating disorder.”[15] UBC-specific data is unavailable, but eating disorders are among the most common psychological disorders amongst populations of female college students in North America.[16] Furthermore, a researcher at the University of Alberta who surveyed female UofA students at the beginning and end of a school term found that 33% reported binge eating and 51% reported binging triggered by stress and academic pressures.[17] These pressures may trigger eating disorders in male students as well. This information suggests that eating disorders may be a serious health issue at UBC, and more common in B.C. than recent records reflect.
What policies are in place to reduce the prevalence of eating disorders?
There is no integrated national organization for eating disorders, which means that federal funding is unavailable for national programs to address this specific issue.[18] On a provincial level, B.C.’s Ministry of Health Services administers services for people with eating disorders. Current policies focus on two areas: prevention and treatment. In B.C., prevention programs are either universal (directed towards a large low-risk population, such as the entire student body of a school or the general public) or targeted (directed towards identified high-risk individuals).[19] The system of care for individuals with eating disorders in BC is broken into three levels. One is the primary care level of assessment: diagnosis, monitoring, and counseling by physicians, dieticians and other community service providers. Secondary care is provided primarily by mental health specialists at community based mental health centres. Tertiary care—hospital inpatient and outpatient care provided by specialists upon referral—is provided at BC Children’s Hospital and St. Paul’s Hospital.
What are the flaws in prevention programs?
The main problem with universal prevention programs is that they often try to address a wide range of issues related to body image, weight, and health. These attempts, where they focus on body size as an indicator of bodily health, may exacerbate body-image issues that can develop into eating disorders. Research has found that weight-centered models of health also lead to the stigmatization of obese individuals, causing them to become socially isolated.[20] The loss of self-esteem that this involves makes it difficult for obese individuals to recover from disorders such as binge eating or bulimia.[21] These programs can also perpetuate the myths that people can change their weight at will, that dieting is effective and improves health, and that fatness correlates with disease, whereas thinness equals health. Diets have been proven ineffective as methods of losing weight and maintaining weight loss; dieting can have serious health consequences and increase the risk of developing binge and other eating disorders, and being moderately overweight has not been found to pose serious health threats.[22] Universal prevention programs need to focus on debunking the aforementioned risks and moving away from weight-based conceptualizations of health.
Targeted prevention programs can also create stigma by singling out individuals who are considered high-risk. In fact, the risk factors that have been identified for eating disorders include include “puberty, being female, societal emphasis on thinness, thin-ideal internalization, body dissatisfaction, unhealthy dieting, participation in activities that place substantial emphasis on body weight and shape, negative affect, adverse life events, childhood sexual and/or physical abuse, insecure attachment and family dysfunction.”[23] Basically, targeted prevention programs need to be reconceived as programs for girls between the ages of 10 and 18. All prevention measures would benefit from more research on the effectiveness of the prevention programs currently promoted.
Are there issues with B.C.’s provision of care?
In general, primary care providers need to be aware of the problems with weight-centered approaches to healthcare. General Practitioners are also a key component to early detection of eating disorders. GP’s should inquire about eating habits when patients visit with other complaints, especially with patients who are part of a high-risk demographic. Community-based secondary care providers could benefit from the foundation of a national eating disorder association, which would provide support and help secure federal funding for research, prevention and treatment program development. With regards to the system of care in B.C., the isolation of tertiary care in Vancouver means that patients who require this level of care may be separated from their families, or this may cause difficulties that hinder the familial support & family therapy aspects of recovery. Tertiary care programs need to be made available throughout the province, otherwise they marginalize individuals living outside of the lower mainland.
What else can we do?
There are four types of policy that have been recognized as essential to taking action against eating disorders: prevention, treatment, research, and media & advertising regulations.[24] Current policy in B.C. addresses only prevention and treatment. Research funding is crucial and needs to be made available in spite of the current absence of a national organization (examples of other national organizations include the Autism Society of Canada, Canadian Cancer Society, Lupus Canada). Increased provision of resources for education, prevention and the training of healthcare professionals to enable an expansion of tertiary care are necessary. Funding for and implementation of media and advertising regulation as well as health and eating disorder awareness advertising is also urgently needed.
Why and how would we regulate the media to help prevent eating disorders?
Media and advertisements have a pervasive presence in our society. They shamelessly and incessantly promote thin-ideals, featuring unrealistic representations of female bodies that are often the result of excessive photoshopping. Research has shown that exposure to mass media is correlated with obesity and negative body image, which can develop into eating disorders (257).[25] The influence of advertising on children has led Quebec to ban print and broadcast advertising aimed at kids under twelve.[26] Advertisements also make scientifically unsupported claims about the efficacy of diet programs and products.[27] Magazines like Elle offer advice on how to “change your body forever,” and fix your “bad sex life/job/relationship.”[28] Regulations need to be created that prohibit such statements, unless they can be scientifically proven to achieve the promised results. French politicians have proposed a law requiring photoshopped images to be labeled “Photograph retouched to modify the physical appearance of a person”[29] and a law banning underweight models from commercials and catwalks was passed in Israel.[30] All of these regulations can be implemented in Canada.
How can media and advertising be used to create change on this issue?
Advertisements can be used to raise awareness about eating disorders and to develop media literacy. Health information that debunks the thinness bias (thin=health myth) and discusses the risks associated with weight-loss methods needs to be promoted to the general public in ways that decrease weight-related stigmas and thinness biases.
What organizations can work together to create these changes?
A national eating disorder foundation could be created which connects community health service providers, charities and NGOs to lobby for change at a federal level. The Eating Disorders Foundation of Canada was established in 1985 but is not an umbrella-style foundation. The national eating disorder foundation could obtain federal funding to address the issue of eating disorders and expand awareness, research, prevention and treatment. This could be done with the support of the Canadian Mental Health Association and the National Eating Disorder Information Centre, a non-profit that provides extensive information about eating disorders. Federal and Provincial governments could provide funding to launch public campaigns about eating disorders, health, and media literacy.
What can UBC do?
UBC can develop policy that enables students to maintain scholarships, student status and student loans if they take medical leave to seek treatment for an eating disorder. Awareness and media literacy campaigns on campus as well as exhibitions of student plays or art relating to body-image issues, eating disorders, and the meaning of the body in our society should be encouraged. An open and honest discussion around these issues can help reduce the shame that isolates and perpetuates eating disorders.
What can I do?
Educate yourself and your friends about thinness bias in our society. Have honest discussions about body image, societal ideals, and media images with your friends and family. Create a body map if you’re feeling creative and want to take control of your body image by defining beauty for yourself. Try not to be judgmental of others and understand that criticizing individuals for their physical appearance is discouraging and won’t motivate them to make healthy decisions. Above all, practice empathy with others and yourself.
– – –
Check out these media literacy and eating disorder awareness ads:
http://www.nationaleatingdisorders.org/about-us/
http://www.adbusters.org/spoofads/fashion
For more information, and a list of community services in B.C., view the Kelty website:
http://keltyeatingdisorders.ca/
And take a look at my creative component for this project:
http://realbodyproject.tumblr.com/
– – –
FOOTNOTES:
[1] Adbusters. Online. Accessed March 27, 2012.
[2] Hayley K. Dohnt and Marika Tiggemann, “Peer Influences on Body Dissatisfaction and Dieting Awareness in Young Girls,” British Journal of Developmental Psychology 23:1 (2003): 114.
[3] Hayley K. Dohnt and Marika Tiggemann, “Peer Influences on Body Dissatisfaction and Dieting Awareness in Young Girls,” British Journal of Developmental Psychology 23:1 (2003): 114.
[4] A Smith et al. & McCreary Centre Society. A Picture of Health: Highlights from the 2008 BC Adolescent Health Survey. Vancouver: McCreary Centre Society, 2009.
[5] A Smith et al. & McCreary Centre Society. A Picture of Health: Highlights from the 2008 BC Adolescent Health Survey. Vancouver: McCreary Centre Society, 2009.
[6] World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders. (Geneva: WHO, 1993), 31.
[7] Anonymous, conversation with author, March 3, 2012.
[8] “Eating Disorders,” Canadian Mental Health Association, accessed March 25, 2012, http://www.cmha.ca/bins/content_page.asp?cid=3-98.
[9] “Eating Disorders.”
[10]Ezna Gucciardi et al., “Eating Disorders,” Women’s Health Surveillance Report. Ottawa: Canadian Institute for Health Information, 2003.
[11] Steven J. Heine. “Culture Bound Syndromes,” in Cultural Psychology. (New York: W. W. Norton & Company, 2008), 414.
[12] Zain-Ul-Abideen et al. “Impact of Media on Development of Eating Disorders in Young Females of Pakistan,” International Journal of Psychological Studies 3:1 (2011), 122
[13] Jeanine C. Cogan and Paul Ernsberger. “Dieting, Weight, and Health: Reconceptualizing Research and Policy,” Journal of Social 55:2 (1999), 187-205.
[14] “A Report on Mental Illnesses in Canada,” Public Health Agency of Canada, accessed March 20, 2012, http://www.phac-aspc.gc.ca/publicat/miic-mmac/chap_6-eng.php.
[15] “Action Plan for Provincial Services for People with Eating Disorders,” B.C. Ministry of Health Services, accessed March 27, 2012,
[16] Heine, “Culture Bound Syndromes,” 413.
[17] Labiba Haque, “Anxiety, eating disorders on the rise,” Queens Journal, September 28 2010. Accessed March 22, 2012.
[18] Eating Disorder Foundation of Newfoundland and Labrador, “Presentation to Gauge the Interest across Canada for an Eating Disorder Foundation of Canada” (presented at Shades of Grey Conference, Toronto, Ontario, May 11, 2009).
[19] “Action Plan for Provincial Services for People with Eating Disorders,” B.C. Ministry of Health Services.
[20] Jeanine C. Cogan and Paul Ernsberger. “Dieting, Weight, and Health: Reconceptualizing Research and Policy,” 197.
[21] “A Report on Mental Illnesses in Canada,” Public Health Agency of Canada.
[22] Jeanine C. Cogan and Paul Ernsberger. Dieting, Weight, and Health: Reconceptualizing Research and Policy, 191.
[23] Evans, D.L. et al.Treating and Preventing Adolescent Mental Health Disorders. New York: Oxford University Press, 2006.
[24] “Eating Disorders,” UK Parliamentary Office of Science and Technology. Accessed March 20, 2012, www.parliament.uk/parliamentary_offices/post/pubs2007.cfm.
[25] Jennifer L. Derenne and Eugene V. Beresin, “Body Image, Media, and Eating Disorders,” Academic Psychiatry, 2006, 30:257-261.
[26] “Special Issues for Young Children,” Media Awareness Network, accessed March 22, 2012, http://www.media-awareness.ca/english/parents/marketing/issues_kids_marketing.cfm.
[27] Lisa G. Berzins, Protecting the Consumer Through Truth-in-Dieting Laws. Journal of Social Issues, 55:2, 2002. 371.
[28] Elle USA March 2012, cover.
[29] Dodai Stewart, “France Proposes ‘Health Warning’ Label on Photoshopped Images,” Jezebel, September 22, 2009. Accessed March 20, 2012.
[30] Dailymail UK Online, “Israel Bans Adverts Featuring Super Skinny Models in Bid to Crack Down on Eating Disorders,” Mail Online, March 20, 2012. Accessed March 27, 2012.
– – –
