February is National Eating Disorders Awareness Month, and as such it is an optimal time to consider eating disorders, their impact on our society and what we can do to support our youth, who are especially vulnerable to these disorders. Supporting a healthy body image at an early age is critical in avoiding the development of eating disorders.
The statistics regarding the prevalence of eating disorders are sobering. The National Eating Disorders Association estimates that 20 million women and 10 million men in the United States will demonstrate a clinically significant eating disorder at some time in their lives.
Eating disorders are a group of attitudes, emotions and behaviors surrounding weight and eating that can lead to significant health issues, including death. These disorders include anorexia nervosa (self-starvation and excessive weight loss resulting in an unhealthy weight), bulimia nervosa (a cycle of binge eating and compensatory behaviors to decrease the impact of the binge eating), binge eating (frequent binge episodes without compensatory strategies) and an eating disorder, not otherwise specified (causes significant impairment, but doesn’t meet criteria for another eating disorder).
While the etiology of eating disorders is still under investigation, genetics play a role. Individuals who have a first-degree relative with an eating disorder are five to six times more likely than the general population to develop one. In addition, certain disorders, such as anxiety and depression, seem to co-occur with eating disorders, although which comes first is hard to delineate.
In addition, new research suggests a neurobehavioral cause. Researchers at the Eating Disorders Treatment and Research Program at UC San Diego found that a faulty reward response system in the brain may explain why healthy eaters experience a dopamine rush when eating sugary foods while anorexics experience anxiety.
The diagnosis of eating disorders has been rising for many decades. Since 1930, there has been a significant increase in the number of women ages 15 to 19 diagnosed with anorexia every decade, and the incidence of bulimia in 10- to 39-year-old women tripled between 1988 and 1993. The age of diagnosis is also decreasing, with a 119 percent rise between 1999 and 2006 for children age 12 or younger hospitalized for eating disorders.
There has been a growing awareness that males also suffer from these disorders, with statistics showing that today 33 percent of adolescent males report engaging in unhealthy behaviors to control their weight. Eating disorders impact all races, with similar prevalence rates among non-Hispanic whites, Hispanics, African-Americans and Asians in the United States, with the exception that anorexia nervosa is more prevalent in non-Hispanic whites.
The burgeoning rate of eating disorders may be attributable, in part, to better awareness and recognition of the disorders, but in large part may be the result of the pressure our media put on people to conform to a certain image. The “ideal” image, represented by models as beauty contestants, has shrunken significantly over the past several decades. For example, the average body mass index (BMI) of Miss America winners has decreased from around 22 in the 1920s to 16.9 in the 2000s, far below the “normal” BMI range of 18.5 and 24.9. Likewise, the muscularity of the “ideal” male as depicted by the media has greatly increased from 1970 to today.
Female models of today are thinner than before and further away from the average American woman’s measurements. Twenty years ago, the average runway model weighed 8 percent less than the average American female, yet today the average model weights 23 percent less than the average American woman. In fact, while the average American woman is 5 feet 4 inches tall and weighs 140 pounds, the recent Miss America winner is 5 feet 11 inches tall and weighs 117 pounds.
The disparity between the real and ideal is greater than ever before and can lead to anxiety and stress about how one’s body measures up. This incongruence can be particularly upsetting to children, teens and young adults who are just getting comfortable in their bodies and may be very influenced by the media.
The media’s pull on young girls can be seen in the statistic that 69 percent of American elementary-age girls who read magazines say that the pictures influence their concept of the ideal body shape, and 47 percent say the pictures make them want to lose weight.
While unrealistic media images are not the only culprits in the development of eating disorders — genetic and neurobiological factors have been shown to play an important role — these unattainable prolific images can act as a trigger for vulnerable youth. Even though it is unlikely that we will be able to effect significant changes in the way the media portray the “ideal” body type, we can exert influence over how children feel about their bodies.
Research has shown that body dissatisfaction at an early age is predictive of unhealthy eating and eating disorders later in life. Dissatisfaction with one’s body begins early, with 42 percent of first- through third-graders indicating that they want to be thinner, 81 percent of third-graders reporting they are “afraid” of being fat and 25 percent of elementary-age girls indicating that they are “often” on diets.
While not all of the children who are dissatisfied with their bodies at a young age will develop eating disorders, they will likely engage in compensatory strategies, such as dieting or binging, that can put them at risk for a future eating disorder. Of concern is the fact that 35 percent of “normal dieters” progress to pathological dieting, and of these dieters, 20 to 25 percent develop partial or complete eating disorders. Thus, supporting a healthy body image at an early age is critical in avoiding behaviors that can open the doors to disordered eating.
Supporting the development of a healthy body image and troubleshooting around the first signs of dissatisfaction with one’s body can be a significant step in curtailing the development of eating disorders. Because most eating disorders develop in adolescence and young adulthood, parents, family members and teachers may be the first line of defense. The following techniques can support the younger generation in building a positive body image and avoiding the pitfalls of disordered eating.
» Be a good role model. Children and teens often mirror the attitudes that parents express about heir body image. Embrace a more accepting and loving view toward your body while avoiding critical statement about your body or others.
» Focus on a healthy lifestyle instead of a thin body. Reinforce the notion of health as linked to proper eating and activity as opposed to a certain weight on the scale or a certain size of clothes.
» Demonstrate moderation in your approach to food and exercise. Focus on supporting your child in developing a balance in how they approach exercise and eating. Avoid gimmicks to burn many calories or restrict many calories, as these are short-term fixes that always backfire and lead to greater body dissatisfaction.
» Teach children about the media and how the ideal image is not necessarily healthy or attainable. Look for teachable moments to show children that the images they see on television or in print are often not accurate depictions of the person and are not attainable for the majority of the population.
» Emphasize other qualities over appearance. Ensure that you reinforce children for areas other than their appearance and encourage their efforts.
» Focus on health as a family activity. Engage with your children in healthy activities such as walks, hikes and healthy eating instead of other activities.
» Don’t be afraid to talk about eating and disordered eating. Bringing concerns or observations out into the open can start an important dialogue about these disorders that are often shrouded in secrecy.
» Consult with a professional to gain information or address concerns. Think of this as a team activity and engage a nutritionist or other specialists when questions or problems arise. Consulting with a specialist (nutritionist or therapist trained in eating disorder treatment) provides information that can help a young person better understand a concept and can move the decision away from a power struggle between a child and parents to a situation of an expert presenting factual information.