We Still Don’t Know What an Eating Disorder Looks Like
Eating disorders affect people of all backgrounds, at all weights. To tackle them, we first need to reframe the way we think and talk about them.
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Eating disorders have been on the rise for years, but during the pandemic, there was a drastic increase in diagnoses and disordered behaviors. Psychologist Lisa Damour wrote in the New York Times that the combination of high anxiety, lack of structure, and fewer outlets for energy and time created the perfect storm for this rise in disordered behaviors among teens. The same has proved true for adults, as eating disorder treatment centers are at capacity and therapists have long waitlists for new patients, NPR reported in May.
In 2021, it’s easier than ever to spot the hypocrisy around how we think and talk about eating disorders. The CDC and mainstream outlets like the New York Times continue to spread fatphobic messages, warning against fatness and weight gain. Today publishes stories about how pandemic anxiety has exacerbated disordered eating, while simultaneously running pieces that glorify overexercise and strict dieting (both of which are disordered eating behaviors, according to the National Eating Disorders Association). As life settles back into a new kind of normal, we should take the opportunity to broaden our view of who is affected by eating disorders, and learn how to talk about them—and food and bodies in general—in a way that’s helpful without being triggering.
A Worsening Problem
A 2019 review published in the American Journal of Clinical Nutrition found that roughly 7.8 percent of the world’s population will have an eating disorder in their lifetime, more than double the number from just 15 years ago. Another 2020 study published in Eating Behavior found the prevalence among American women to be even higher, at more than 13 percent. And while there’s not yet a huge amount of data on how the pandemic has affected these numbers, countless health experts say that they’ve seen a rise in both eating disorders and the severity of disordered behaviors since stay-at-home orders began last March.
This makes sense. Whitney Trotter, a dietitian, registered nurse, and activist who works primarily with BIPOC communities, explains that oftentimes, eating disorders are a coping mechanism. “I treat eating disorders as a trauma response,” she says. Many people who live in marginalized bodies, or who deal with the constant stress and uncertainty of job insecurity, poverty, or abuse, use disordered eating behaviors as a way to feel some sense of control over their bodies and their lives. In a time of such universal uncertainty, it’s no surprise that so many people are turning to unhealthy coping mechanisms like extreme restriction, over-exercise, and bingeing as a way to feel like they’re in control.
Of course, that sense of control is always short-lived. Climber Kai Lightner explains in this Outside piece that his own eating disorder was born out of a desire to be a more competitive (lighter) athlete, but eventually took a huge physical toll. Champion obstacle course racer Amelia Boone admits that she downplayed her own eating disorder for years, ashamed that, as an athlete known for her grit, she couldn’t get a handle on it herself.
Many people with eating disorders appear healthy and high-functioning. Dori Bowling-Walters, an eating disorder therapist and senior director of admissions at the Eating Recovery Center in Chicago, explains that many of her patients are at the top of their class, or working a great job. They’re also totally consumed by their disorder, but people don’t notice because they don’t look sick. Or worse, others mistake disordered behaviors for discipline and dedication.
Most People Don’t Look the Part
Too often, we don’t worry about someone’s relationship with food and body unless they’re visibly emaciated, or they’ve lost a significant amount of weight in a short time. But this is a complete misunderstanding of what eating disorders actually look like. Many people think only of anorexia nervosa (extreme food restriction, very low body weight, and disturbed body image) and bulimia nervosa (repeated bingeing and purging, usually through vomiting or overexercise). But eating disorders encompass a much wider range of behaviors, including food restriction and/or obsession without weight loss, extreme picky eating, and binge eating. And only about six percent of people with diagnosed eating disorders fall into the underweight body mass index category, while the rest are classified as normal, overweight, or obese.
There’s also the issue of diversity when it comes to how eating disorders are portrayed. While more high-profile men, transgender people, and people of color (like Lightner) have started talking about their experience with eating disorders, the vast majority of these stories still come from young white women, like NEDA spokesperson Iskra Lawrence, and Taylor Swift. Trotter says that this is a huge problem—BIPOC communities experience similar rates of eating disorders, but because there’s no conversation about it, people are far less likely to seek or admit they need help. Bowling-Waters also adds that eating disorders affect people of all ages, despite the myth that it’s primarily young people at risk.
The worsening of eating disorders during the pandemic is in part due to this limited understanding of what these disorders look like and who they affect. Instagram has policies that shield young people from posts about weight loss, but adults are encouraged to lose their quarantine 15. We celebrate body positivity and acceptance when it’s centered around relatively thin people, but criticize it when it’s coming from fat people.
And of course, there’s the fact that most of us have spent far more time than usual on social media in the past 16 months. “You can go on social media whenever you want and stare at ‘perfect’ bodies,” Bowling-Waters says. And when you’re not surrounded by as many real-life bodies, these photoshopped images that display a tiny fraction of the population start to seem normal—which makes some people feel like they have to engage in extreme restriction or other disordered behaviors just to fit in.
It’s Time to Change the Conversation
There isn’t a quick and easy way to prevent eating disorders. But there is so much we can do to reframe the way we think and talk about them. On a large scale, we can end the cultural panic about quarantine (or any other) weight gain. It’s stigmatizing to anyone in a fat body, and it’s triggering for anyone with or at risk of an eating disorder. On an individual level, we can be deliberate about not complimenting weight loss or expressing “concern” over someone’s weight gain. In sports, we can focus on an athlete’s performance and wellbeing instead of obsessing about their weight. And overall, we can stop praising thinness as the end-all, be-all of wellbeing and happiness. We’re talking about a huge cultural shift, and that will take time and work—but if we can pull it off, we can decrease the risk of eating disorders and make help more accessible to those who need it.