Glamorizing Anorexia: A Societal Problem

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If you’re in the eating disorder field or interested in them at all and haven’t heard of “To the Bone,” you’ve obviously been hiding under a rock. The Netflix movie featuring Lily Collins and Keanu Reeves focuses on a young, white girl with anorexia is due to be released on July 14th, 2017.

The movie has already received considerable attention due to concern that it glamorizes eating disorders and because it focuses on anorexia, which already receives more attention than other eating disorders. It also depicts the stereotypical patient with anorexia: a young, white female. In those aspects, it does nothing to push boundaries, to challenge misconceptions, or to educate about the breadth and diversity of eating disorders.

However, that said – and even though those concerns may be validated – I have only watched the trailer and not the movie. So, I will reserve any more judgment until I have watched “To the Bone” in its entirety.

But, the movie raises a more pervasive question. Why do we focus on anorexia? Why do we glamorize anorexia? Society stigmatizes eating disorders broadly, but for the most part, society depicts anorexia as a glamorous disease.

The answer that I can most clearly arrive at is because of our societal idealization of the thin ideal. Most other eating disorders don’t consistently result in thinness, but anorexia in its most stereotypical form, does. And the ideal in our culture is to be thin (albeit this is being challenged increasingly, but still predominant).

I also believe that anorexia is fixated upon also because its behaviors or consequences are commonly endorsed by society and applauded unless the person becomes emaciated.

Eating clean foods or eliminating certain foods? Totally acceptable and rewarded by positive feedback.

Exercising a lot? Shows dedication and routinely applauded unless you are visibly anorexic.

Losing weight? Not even a question, unless your bones are showing.

Fear of being fat? Universally accepted, especially by and for women.

Behaviors associated with bulimia, binge eating disorder, or eating disorders not otherwise specified (EDNOS) do not receive this attention. They should not be glamorized, certainly, but they also require public attention and research so that those suffering do not feel so alone and shamed.

The point society is missing, however, is none of these behaviors associated even with anorexia are glamorous. They are disordered and dangerous. But people are so blinded by the thin ideal and by idolizing people who have the ‘willpower’ to diet or exercise that they ignore the dangers.

At my very thinnest, I remember being asked by a girl at a party how I got my hips so well-defined. And I was horrified, even in my illness, because those were my hip bones, not my hips. This wasn’t the only kind of comment I got, but it is one that stuck with me the most and honestly after the shock wore off, it probably fueled my eating disorder even more because of the positive feedback.

We need societal change if we are going to tackle this. Because it is rooted in thin idealization, weight stigma, and distorted societal beliefs. Is this going to change quickly? Absolutely not. But we must take steps to do so.

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What I should have said

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We all have that feeling. That stay-up-all-night-think-about-what-you-should-have-said feeling. You replay the situation again in your mind and perfect what you would have said had you been good at coming up with speeches off the cuff.

I recently attended the Academy for Eating Disorders’ International Conference on Eating Disorders. This is an amazing conference, and if you haven’t been to one yet, you should. So many of those people have become incredible friends and mentors and it has hard to believe that from knowing one person in 2011 at my first conference, I now know so many.

But I digress.

We had a plenary one afternoon regarding the intersection of eating disorders and obesity and if you’re familiar with the eating disorders field, you can imagine the uproar that most people expected it to be. As a field, we have been reluctant to join with the obesity field for many reasons, some due to understandable differences or misunderstandings.

The three speakers were all very good, but some of them were not as sensitive to aspects that would trigger eating disorders professionals’ dissent as well as people with lived experience. First, one suggested that obesity was an eating disorder or comparable to one. The second speaker aligned more from the eating disorder side and there was much support among the audience. And lastly, the final speaker suggested an addiction model for understanding eating disorders, which many ED professionals strongly resist.

How do I know this? Because there was a conversation going on during the lectures. Social media, and especially Twitter, can be a very useful way to share thoughts and pose questions to others throughout a conference. It keeps the conversation going and allows others who were unable to attend the conference to engage. Used in the right way, it can create a respectful dialogue. And to the most extent, that is what I saw. There were a few who were more militant or reactionary, which can provide needed catharsis, but may not advance the conversation much.

At the end of the talk, the discussant suggested that the two fields needed to work together and that eating disorders experts need to be at the table to help change public policy. An audience member suggested that ED professionals could help take on the dieting industry through policy. There are many benefits to having the two fields work more closely with each other. Another audience member expressed some of the reluctance and dissent that was being felt in the crowd, and it was an extremely brave and necessary thing to do. The colleague questioned how we could achieve these goals without alienating people in larger bodies, perpetuating weight stigma, and damaging people in ED recovery by labeling foods as good or bad or suggesting eating disorders are an addiction.

The panelists fielded the question appropriately and respectfully, validating the concerns and stating that this was why ED professionals needed to be at the table … to ensure this didn’t happen.

So, having set the scene, here are my thoughts on what I should have said.

I have been in both the obesity and eating disorders fields and have always felt that they would be more powerful as a united force. I do agree that there are many shared risk factors for both, but I firmly disagree that obesity is a disease or an eating disorder. It is not. It is merely a size categorized by an arbitrary number. Just as thinness is not a disease or an eating disorder, obesity is also not. You can be thin and not have an ED, you can be in a larger body and not have an ED.

However, we live in a society which has caused us to be very out of sync with our eating, with our hunger cues, and we are perpetually hounded by weight stigma and the dieting culture to be thinner and fitter. We know that dieting is one of the main triggers for someone with a genetic predisposition for an eating disorder. We know that higher calorie foods consumed by someone with a genetic predisposition to have a larger body can contribute to that larger body. That is not to say that a thin person can’t eat junk all the time and stay thin. They can. And that is mostly due to genetics. We cannot change that.

By joining with the obesity field, uniting under public policy, we could help to change the food system so that it is more conducive for everyone, no matter their shape, size, or economic status. No food is good or bad, but we are overwhelmed by our food and dieting culture and that is very hard for someone with an eating disorder or someone in a larger body who wants to eat, but feels judged by eating and pressured to restrain.

And here, I need to check my privileges. One of my colleagues has been inspiring in this regard and I think it is something we need to acknowledge more. I am a white, cis-gender, heterosexual female in a thin body. I can say things that a person in a larger body cannot. If I go to a restaurant and eat four hamburgers, I probably won’t get any judgmental stares, whereas a person in a larger body could never get away with that. We all hold weight stigmatizing attitudes to some degree. It is either conscious or subconscious, but it is so pervasive in our society that it is hard to avoid.

Despite these privileges, I also have a unique perspective. I have been on varied points in the size spectrum. I was in a much larger body as a child and adolescent. I was bullied mercilessly. I was judged. I longed to be thin. I thought when I was thin, my life would finally be perfect. And I finally did lose weight. A lot of weight. People were so supportive, so congratulatory. The positive feedback was overwhelming and it fueled my dieting. And then I lost too much weight. And people were judgmental again. I was an anorexic freak, I just needed to eat, I was a problem.

Now in recovery, I can see both sides. I am certainly not suggesting that people with EDs are more judged than people in larger bodies. No, for the most part, people cannot tell who have EDs. Size we can see and society judges and is unaccepting. You have to apologize for who you are when you are larger. You have to try to make yourself small, to fit in. It is unconscionable and it needs to stop.

I also am somewhat on the fence about whether eating disorders can be fully understood as addictions. There are many cases where perceiving substance use or alcoholism as an addiction has alleviated some of the stigma around it. Even the efforts in the ED field to pinpoint genetic underpinnings may have reduced stigma because EDs are beginning to be considered something people can’t necessarily control.

However, does it help us as a field to resist uniting with obesity researchers? I understand the HAES belief that obesity labeling and obesity research is a form of oppression. I do understand that. But can we help educate that field to focus more on health instead of weight? Can they help educate us on how to effect change on a large scale? I remain in awe of how clinicians and researchers change lives and improve the ED field, but also, as a public health professional, I realize what we could do on a broader scale towards prevention if we partnered together.

The American Academy of Pediatrics recently put out guidelines that stated to prevent both obesity and EDs in children and adolescent, we needed to focus on health and not weight. That needs to be the message for all of society. If we let the obesity field self-regulate without our influence, that may not be achieved. With our voices – with all our voices – we could achieve our mutual goal of creating an environment that helps people have healthy relationships with food and their bodies.

And those are my thoughts from 3am one morning, for whatever they are worth. If you read to the end, thank you and I welcome a respectful discussion on any of the topics I addressed.

Changing the dialogue

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A few weeks ago, the American Academy of Pediatrics (AAP) released new recommendations on how to prevent childhood obesity and eating disorders. Yes, that’s right, I said childhood obesity AND eating disorders. They are interrelated and it’s high time we start acknowledging that.

If that fact bothered you, it is probably also going to bother you that some of the recommendations focus on limiting family or parental weight talk or teasing. Here is an important time for a caveat. I am NOT endorsing parent blaming. Parents are most certainly not to blame for the creation of an eating disorder or for obesity and in fact, parents and families are an essential part of the solution. However, although both eating disorders and obesity are governed in part by genetics, the family context provides a malleable trigger that can be addressed and mitigated.

I am a parent and I have a history of an eating disorder. Understanding that your children are impressionable to what you say or do is not intended to make you feel bad or blamed. Trust me, I believe there is far too much parent-blaming as it is. However, this isn’t saying you’re doing something wrong, this is providing knowledge and insight on how to foster healthier, happier children. And I know many parents (with and without a history of an eating disorder) who are considered how to talk to their child about weight, or how to instill a healthy lifestyle. This is not easy and we parents shouldn’t have to figure it out all on our own.

With those caveats up front, it is important to discuss the content of these new AAP recommendations, because they mark a deviation in the way childhood obesity and eating disorders have been addressed. Specifically they stated that obesity and eating disorder prevention messages should focus on health and healthy behaviors rather than weight. They also provided evidence-based behaviors that are associated with both obesity and eating disorders including:

  1. Dieting – Dieting is a risk factor for both obesity and eating disorders. Dieting in adolescents is the most important predisposing predictor of developing an eating disorder and diets track with overweight and obesity rather than weight loss.
  2. Family Meals – Family meals are protective against both obesity and eating disorders because it allows for a time set aside for food and provides parents an opportunity to model healthy eating. Without family meals, there is more likelihood of obesity and eating disorders among children.
  3. Weight Talk – Comments by family about their own weight or size as well as encouraging children to diet are damaging. Parental weight talk has been associated with child overweight and eating disorders 5 years later. If the focus of the conversation was healthy eating adolescents were less likely to diet or use unhealthy weight control practices.
  4. Weight Teasing – Weight teasing by peers or family members is both common and is correlated with poorer health outcomes for those teased. Males and females who were teased were more likely to use unhealthy weight control measures, binge-eat, and were more likely to be heavy a number of years later.
  5. Healthy Body Image – Body dissatisfaction is a risk factor for both eating disorders and disordered eating as well as dieting which are related to obesity.

These behaviors are all socio-ecological in nature and are therefore malleable triggers that could involve interventions to prevent the health outcomes. So far we do not have effective gene therapy that can prevent these complex diseases, so we have to look at these changeable risk factors and do what we can. We owe it to our children to look into the culture we create as a family and how that might impact them.

 

 

Breaking down Body Shame

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Body shame comes in so many forms and can manifest itself internally or externally. With the many nuances involved in body shame, I thought it time that it was broken down into a more easily-understood graphic.

The types of fat talk are most thoroughly explored, with six distinct types of fat talk identified. Dr. Cynthia Bulik of University of North Carolina has researched fat talk in depth and states that it can be more than just obvious Generic fat talk (“I need to lose weight.” or “This makes me look fat.”, but also more subtle messages that can be equally damaging. Most forms of fat talk are socially-constructed or reinforced, with Comparative, Competitive, Compliment-Fishing, and Can’t-Take-A-Compliment Fat Talk, all of which pit people against each other. Even Silent Fat Talk is socially-influenced; a group of women (or men) share a meal and are guided or guilted by others’ food choices.

But body shaming extends beyond fat talk. There’s self-shame, which doesn’t need any social influence or participation to exist. That’s the shame that happens when you critique yourself in front of the mirror or constantly body-check. Food and body guilt is pervasive also and reinforced socially and through the media. We are made to feel guilty if we eat certain things or do not exercise as often and as much as we ‘should.’ Passing judgment is an area that intersects with weight stigma; we judge people based on their size and draw moral conclusions based on their weight, shape, or size.

All of these areas work in isolation or unison to create a perfect storm of shame, for both ourselves and others. The more we recognize it, the easier we can work to counter it.

Project Harpoon … if the name alone doesn’t offend you

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If you follow body image news as incessantly as I do, you are no doubt aware of Project Harpoon. The despicably-named ‘project’ is dedicated to ‘harpooning’ those it deems to be ‘whales,’ showing how beautiful they would look if only they were thin. I won’t bother pointing out the blatant misogyny in that only women have been target by this ‘campaign.’

They state that they are aiming to make “your outsides look like what you really are on the inside,” but with shaming captions such as “from blocking the view to enhancing it” and “from buttercake to mini cupcake,” they are not fooling anyone into thinking their motives are altruistic. Neither does their hashtag #thinnerbeauty. This is fat-shaming and body-shaming, pure and simple. Perhaps the most appalling one I have seen so far is where someone actually photoshops down a Health At Every Size poster that says “I stand against teaching kids to hate their bodies. Hate ≠ health.” Way to miss the message, Project Harpoon.

I debated whether to include a few images; my uncertainty was based on 1) not wanting these pictures to be more widespread, and, 2) feeling that the images could help accentuate my point by seeing the extent to which people will go with fat-shaming. The latter one, so please see below.

Now I admit there was a time that I would have agreed with this. I was a heavier child even into high school until I had been shamed so much that I decided to lose weight. Unfortunately, I had a genetic predisposition to anorexia which was triggered by the diet. And immediately following that time when my eating disorder reigned, I wanted to rid myself of every ‘before’ picture. I distanced myself from that girl so much that when I look back even now, all my memories are if I am seeing myself as if a stranger; I cannot see those memories through my own eyes.

The problem with this was that I was a nice person. There was nothing wrong with that girl. She was heavier but that did not make a moral point about her. Yes, she didn’t eat as well or exercise as much as she could have, but others didn’t either and remained thin. But she felt inferior because society made fun of her. She nearly died in order to become the ‘after’ picture, lost friends to have the ‘ideal’ body, became less patient, less caring, and less happy.

What Project Harpoon is doing is taking women who are proud of their bodies, like plus-sized models, and telling them they should not be proud of their bodies until they radically change themselves. Being healthy does not mean being thin and you should embrace yourself and your body as you are.

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Thinner Beauty or Project Harpoon is a reddit group where people photoshop overweight women to be thin

Thinner Beauty or Project Harpoon is a reddit group where people photoshop overweight women to be thin

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Not an easy road

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Recovery from an eating disorder is grueling work that strains you emotionally, physically, and socially as you work to combat internalized rules that have dictated your everyday life for so long. But ridding oneself of body shame and not giving in to a society that perpetuates it, is just as difficult, albeit in different ways.

I am trying to eradicate the blame and shame from my life, and just as recovery happened slowly and in spurts, so will this. Even when not saying anything, sometimes the thoughts still go through my head especially on days when taking care of my little one means that I haven’t gotten exercise, or put on makeup, or done my hair. In some ways, it is liberating to know those are secondary to caring for my baby, but there is still some guilt that lingers, telling me that I could have done more.

I think some of us also speak the shame and blame because it frees us from the messages berating us in our head. Putting voice to them is cathartic, but also damaging to ourselves and others. We cannot keep them pent in, but cannot let them out. Instead, we must learn to dissolve those thoughts from within before they can haunt us or hurt others.

I’d be interested in hearing some examples of how you combat the internal thoughts.

Everywhere we look

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The day has dawned, my baby has slept, and the world seems fresher and more hopeful. We all have days like yesterday and as several wise sources have told me, we are only human and being human is messy. It certainly is, and on those messier days, we just have to push through and pretend its some kind of sadistic mud run. So many of us, eating disorder, recovered, or just a struggling human, turn to self-hatred, blame, and guilt when things go wrong. And we all just need a reminder that we sometimes can’t control all that goes wrong, but we can control how we respond to it and whether we treat ourselves with compassion as we get through it.

That said, my challenge continues and although days like yesterday make it difficult not to be positive about myself, I am still dedicated to eradicating body shaming from my life. Even in the last few days, I have been made ever more aware of the ubiquity of body shame and food and body related guilt. A good friend aware of my challenge sent me this wonderfully telling picture the other day.

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“Reduced guilt” as if we should feel guilty about fueling our bodies. This package was also right next to Shells with Brie and asparagus entree with the tag line: “Sinfully rich and worth every bite.”

Our society makes us fight this internal battle between ‘treating’ ourselves and feeling guilty afterwards. Fast food and high calorie meals are rampant and yet the diet industry in this country is a 60 (yes sixty!) billion dollar enterprise. It is a tug of war between telling us to eat and guilting us into fad diets and grueling workouts. Neither is good for our bodies and the roller coaster ride we give them is so damaging.

There is no place for guilt in eating. There is no place for shame in our bodies. We all get one body to take us through this life, to bear the greatest joys and sadness the world has to offer. And in the end, we will all wear our battle scars proudly, knowing that we have lived life to the fullest. And there is no shame in that.