01 Mar See the Change, Be the Change: Building Awareness to Prevent Eating Disorders

Every year, National Eating Disorder Awareness Week casts a much-needed light on the daily realities of eating disorders and the relationship we have with food and personal body image. While an estimated 24 million Americans suffer from an eating disorder, symptoms are varied, often difficult to identify, and still not fully understood. It is believed there are millions who struggle and go undiagnosed. Part of the difficulty in diagnosis lies in the fact that eating disorders (ED) present in a variety of forms and symptoms can often be hard to identify or easy to conceal.

As a whole, ED are a set of behavioral conditions characterized by ongoing, acutely disordered relationships with food that are accompanied by distressing emotions and thought patterns. Their impacts are wide ranging, can affect physical and mental well-being, and cause disruptions to relationships and social engagements. Devastatingly, eating disorders are the second most fatal mental illness following opioid misuse.

This year, the National Eating Disorder Association (NEDA)’s theme was “See the change, Be the change.” It highlights the critical need to educate the public, detail common signs and symptoms, and publicly destigmatize the conversation to affect real change. To this end, NEDA is supporting a variety of initiatives, including a comprehensive DEI (diversity, equity, and inclusion) initiative. Historically, the media has shared ED stories that primarily feature young, straight, Caucasian women, which has resulted in a limited public understanding of who may be impacted. While women between the ages of 12 and 35 are at the greatest risk, eating disorders can affect anyone, regardless of age, gender, demographic, or socioeconomic level. Over the past few years, the Association has worked to dispel stigma, share stories that feature a diverse array of voices, and raise awareness around how eating disorders impact marginalized populations.

Eating Disorders: A Primer

Persistent and all-consuming preoccupations with food, weight, or body image characterize the majority of eating disorders, along with anxieties around the act of eating, types of food, and mealtimes. Those who struggle with ED often develop some of the following habits, including restrictive or avoidant eating, binge eating, and purging by way of forced vomiting or over-exercise.

Research suggests that having a family history of eating disorders may increase one’s risk of developing an ED; however, they are not exclusively inherited. Psychological factors such as co-occurring psychiatric disorders play an outsized role in risk, including anxiety, depression, OCD, and substance dependence. Society and cultural standards can also increase risk, and include acculturation and the pressure to assimilate to Western beauty standards; ideals portrayed in popular culture, advertising, and across social media; and pressure among certain groups such as athletes, who are more likely to feel pressure to maintain a certain physical appearance and body weight.

Types of Eating Disorders

Individuals with anorexia nervosa display an intense preoccupation with – or fear of – gaining weight, and will self-starve and pursue consistent weight loss. Anorexia is often regarded as the most dangerous eating disorder, because it is characterized by an unhealthily low body mass index that may result in life-threatening complications, including heart rhythm abnormalities and seizures. Anorexia can impact both men and women. Losing menstruation is a common symptom for those assigned female at birth. Other symptoms include:

• Dehydration-induced dizziness or fainting
• Brittle hair or nails from lack of nutrients
• Cold intolerance
• Muscle weakness or wasting
• Heartburn and reflux
• Stress fractures from compulsive exercise and loss of bone density
• Depression, irritability, anxiety, poor concentration, and fatigue

 
Those struggling with bulimia nervosa are known to alternate between dieting extremes, vacillating from eating only low-calorie foods to binge eating high-calorie foods. Binges typically occur weekly, during which an individual loses the sense of control over what he or she is eating, and compulsively consumes a large amount of food in a very small amount of time – to the point of discomfort or even nausea. These episodes often come with intense feelings of shame, guilt, or embarrassment, and typically lead to “compensatory behaviors” to combat weight gain, including fasting, vomiting, using laxatives, or resorting to intense amounts of exercise.

Bulimia nervosa is distinct from anorexia nervosa in that individuals affected may be slightly underweight, of normal weight, overweight, or even obese, but not truly or severely underweight. This can make bulimia difficult to identify, as habits may be concealed, and symptoms are more subtle than in anorexia nervosa. Signs of bulimia include:

• Regular trips to the bathroom right after meals
• Chronic sore throat
• Dental decay resulting from overexposure to stomach acid
• Heartburn and gastroesophageal reflux
• Recurrent diarrhea
• Dehydration-induced dizziness or fainting

 
Binge eating disorder (BED) is characterized by intense episodes driven by a sense of loss of control and an all-consuming need to consume large amounts of food very quickly. Feelings of guilt, shame, and embarrassment often follow these periods; however, those affected do not regularly act to purge the food. BED is chronic, occurs weekly for a period of at least three months, and can lead to serious health complications, including obesity, diabetes, hypertension, and other cardiovascular diseases. Other signs include:

• Eating more rapidly than normal
• Eating past the point of fullness, towards discomfort
• Eating large amounts of food despite not feeling hungry
• Eating alone, due to embarrassment around the quantity of food
• Feeling disgusted with oneself, depressed, or guilty after a binging episode

 
When disordered eating results in personal distress, negative health consequences, and impacts family, social, or professional relationships, but does not align with the definitions of anorexia, bulimia, or BED, it is diagnosed as “other specified feeding and eating disorders.” This category is useful for early identification of pre-anorexic or pre-bulimic tendencies or behaviors. Regardless of diagnosis or severity, rapid changes to body weight of any kind are considered serious as they are often associated with long-term medical complications.

There are other less common, but equally important disorders to understand in the eating disorders spectrum. They include:

Avoidant Restrictive Food Intake Disorder (ARFID) is characterized by recurrent food avoidance or a limiting and restricted palette that results in nutritional deficiencies. While unlike anorexia or bulimia, in that it is not categorized by a fear of weight gain or controlled concern around body shape, the effects of ARFID can be equally as consequential due to resulting extreme weight loss, nutritional deficiency, and impact on social relationships.

Pica is a disorder in which individuals persistently consume non-food items, such as paper, soap, hair, clay, pebbles, or metal. Onset in early childhood is most common, although it may also occur in later childhood, adolescence, or adulthood. Individuals with pica often suffer from intestinal blockages or toxic side effects from ingested items.

In rumination disorder, individuals voluntarily and regularly regurgitate previously swallowed food, in order to re-chew and re-swallow, or spit it out altogether.

The Pandemic’s Impact on Eating Disorders

Understanding and addressing eating disorders is perhaps more important now than ever before. The pandemic’s disruption to our lives has spurred far-reaching behavioral health consequences – including spikes in disordered eating – that are only beginning to be understood.

This February, the CDC issued a report highlighting an alarming trend in pediatric emergency department visits due to mental health conditions. Prominent, is a sharp increase in the number of emergency room visits due to eating disorders, especially among teenage girls. According to the report, these visits were spurred by pandemic-specific risk factors including a “lack of structure in daily routine, emotional distress, and changes in food availability.” Separately, NEDA has reported a 40% increase in call volume since the start of the pandemic.

Experts have identified a unique set of factors, including isolation, lack of daily structure, and heightened anxiety as three potential driving reasons behind the increase in behavioral health emergencies. In this period of great uncertainty, individuals reported seeking ways to regain control, often through regimenting meals and by selecting only small portions of low calorie foods. Concurrently, during this time spent alone, without other activities and distractions, individuals turned their undivided attention to social media. In lockdown, away from friends and family, individuals spent more time than ever on social media in an effort to remain connected with the outside world.

As a general trend, early pandemic posts featured ways to avoid the “COVID 15,” or how to eat healthy and stay in shape at home. As individuals were at their most vulnerable, they were encountering posts, videos, and tutorials geared toward managing weight, prescribed tips for preparing healthy meals, and how to exercise from home. Structuring meals, increasing the time spent exercising, and limiting consumption began to trend, fueling concerns that one would gain weight while stuck in lockdown. To help address “unhealthy” media messaging, people should focus on regular virtual hangouts with friends (instead of influencer-strangers), engage in moderate levels of physical activity, and pursue personal hobbies and creative outlets to help dilute the effect of trending “anti-fat” or disordered eating content.

How to #BeTheChange

While widely portrayed in popular culture, eating disorders are vastly mischaracterized, and surrounded by misconception, stigma, and limited understanding. In movies and TV shows, characters with disordered eating habits are often overblown, typecast as villains, or spun like a myth. Often, popular culture helps perpetuate eating disorders: from social media “thinspo” or “fitspo” posts, to celebrity culture, and types of models selected for popular brands. While some national brands are increasingly shifting to size-inclusive clothing options and diverse new models, more must be done to shift the conversation and help break the cycle.

Perpetual misunderstanding and stigma has troubling consequences, leaving many feeling ashamed and hopeless. Recent studies indicate that those with eating disorders are reluctant – and unlikely – to voluntarily seek help. Among a population of 36,000 respondents, only about half reported reaching out for any type of support.

In order to make a difference and #BeTheChange, help advocate for new legislation to expand eating disorders support and coverage, spread the word through local community walks, and help support those who are struggling. More than ever, creating safe spaces for those who are struggling, sharing stories of hope, and dispelling stigma around diagnosis can help individuals feel safe seeking help.

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