Friday March 1, 2019

Not Just Skinny White Girls

This week is 2019 Eating Disorders Awareness Week. Championed by the National Eating Disorders Association, with the theme Come as You Are, programs around the world are hosting awareness raising activities and connecting people who might be struggling with an eating disorders to others who can help.

I have worked in this field for decades, focusing particularly on identifying risk factors and developing effective treatments. Despite dramatic increases in understanding of eating disorders, I am struck by the ways in which myths still dominate the public discourse. And although some myths, like the tooth fairy, might be benign imaginings, the myths about eating disorders come at a high cost.

 

1.

Myth 1: You can never really recover from an eating disorder. This is frankly untrue. Most people recover: up to 80% of patients who receive and complete eating disorder treatment will recover. There are a wide variety of evidence-based treatments for eating disorders, including cognitive behavioral therapy, interpersonal psychotherapy, and family-based treatment. The cost of the myth that recovery is elusive is that if people think they cannot get better, they are less likely to pursue treatment so it becomes a self-fulfilling prophecy.

 

2.

Myth 2: Eating disorders are restricted to rich white girls. It is correct that Anorexia Nervosa and Bulimia Nervosa are more common among females but the rich white part does not hold up. Moreover, a growing number of men have eating disorders. Men represent and almost half of all individuals with Binge Eating Disorder2 out of every 10 cases of Bulimia Nervosa, and about 1 out of every 10 cases of Anorexia Nervosa. Whereas girls and women report higher rates of weight dissatisfaction as well as dieting and purging to control weight, boys and men are more likely to report binge eating and the use of excessive exercise for weight control. Over the past ten years, boys and men represent one of the groups that has reported the fastest rise in eating disorders. Eating disorders are also common among LGBTQIA+ individuals. Among men who have eating disorders, 42% identify as gay. Compared to heterosexual men, gay men disproportionately report body image disturbances and eating disordered behavior. Transgender individuals are also at higher risk for eating disorders. In 2015, transgender students were most likely among undergraduates to have been diagnosed with an eating disorder in the past year.

These data make it abundantly clear that it is important to screen for eating disorders among females, males, and non-binary individuals to ensure that everyone receives equitable access to treatment. Perpetuating the myth that eating disorders are restricted to rich white girls increases barriers to treatment seeking for many who could otherwise benefit.

3.

Myth 3: Anorexia is the most common eating disorder. It may be the most iconic, but it is actually the least prevalent of the eating disorders. In the United States, about 1 out of every 100 women will suffer from Anorexia in their lifetime. Bulimia Nervosa, Binge Eating Disorder, and Unspecified Eating Disorders (conditions that have symptom patterns similar to, but not exactly the same as, Anorexia Nervosa, Bulimia Nervosa, or Binge Eating Disorder) are all more common than Anorexia Nervosa. Anorexia Nervosa is serious and can be life-threatening and needs serious attention. But we need to move from spotlighting this single condition to lighting the whole stage so that we better identify and integrate care for all who suffer from eating disorders.

 

4.

Myth 4: Obesity is an eating disorder. When someone’s weight is higher than what is considered a healthy weight for a given height, the person is described as being overweight or obese. Body Mass Index, or BMI, is often used to describe overweight status (BMI is 25.0 to < 30) or obese (BMI is 30 or higher). It is true that most individual who present for treatment for Binge Eating Disorder are at higher weights than would be ideal, but in the general (non-treatment-seeking) population, this is not the case. Today, there are many online BMI calculators for people to find out where they fall. Obesity describes a physical state of adiposity, not a mental disorder. There are many illnesses that can be associated with being obese so it is an important marker of health, but not necessarily an indication of an eating disorder, and the majority of people who are overweight or obese do not meet criteria for an eating disorder.

 

5.

Myth 5: Eating disorders only exist in Western cultures. Hilda Bruch’s publication of The Golden Cage in 1978 is often referenced as the start of the modern study of eating disorders. The focus was on Anorexia Nervosa in Europe and the United States. That was 40 years ago and since then, pretty much anywhere we look, we find eating disorders. In general, eating disorders increase as societies modernize, industrialize and globalize. Societies in transition mean changes in gender roles, food supply, physical activity and beauty ideals – all of which impact risk for eating disorders. Dispelling the myth that the West has a monopoly on eating disorders will facilitate global learning and early intervention in places where eating disorders are emerging.

 

Dispelling common myths about eating disorders during this National Eating Disorders Awareness Week and beyond will help increase understanding and access to appropriate care for all in need. Eating disorders come in many forms. They impact a wide cross-section of the population and exist around the globe. Most importantly, eating disorders are treatable, and getting help sooner rather than later bodes well for recovery.