The question of how to prevent eating disorders is a complicated one. Eating disorders have been on the rise for years, and a lot needs to change if we want to reverse that trend.
To be clear: eating disorders aren’t a new problem. One review found that the lifetime prevalence of eating disorders (that is, the number of people worldwide who will have an eating disorder in their lifetime) rose from 3.5 percent in the early 2000s to 7.8 percent in 2018. That means that eating disorders have more than doubled in the past 20 years. In some studies, particularly those of American women, that number is closer to 14 percent.
And, yes, some of this increase might just be due to the fact that we’re more aware of eating disorders now than we were 20 years ago. Diagnostic criteria is clearer and a bit more all-encompassing these days, which is a good thing because it means more people can get the help that they need. But still, the increase is frightening.
The pandemic has caused a huge spike in eating disorders.
Several small studies and a few big surveys all come to the same conclusion: The pandemic has made existing eating disorders worse. And, disordered eating has increased even among people without diagnosed eating disorders.
The New York Times published an article last week titled, “Eating Disorders in Teens Have ‘Exploded’ in the Pandemic.” It’s written by a psychologist who works with teenagers, who points out that calls to the National Eating Disorder Association’s hotline are up 40 percent since last March, and attributes this to a combination of isolation, uncertainty and lack of structure, and stress. She explains that many high-achieving teenagers who would normally pour their ambition into school or extracurriculars likely turned their attention to controlling their eating habits and body size when school and extracurriculars got taken away. And, she blames Instagram. In regular times, we’re constantly surrounded by other real-life bodies. Alone in a pandemic, most of the bodies we’re seeing are perfectly posed and edited on social media.
All the fearmongering about weight gain is also to blame.
Of course, the all of the messages about the “Quarantine 15” and “how not to gain weight during the pandemic” are also to blame. A comment published in The Lancet Child and Adolescent Health pointed out that “the pandemic has highlighted the profound schism that exists between the fields of obesity and eating disorders.”
Essentially, public health officials aren’t thinking at all about how to prevent eating disorders. They’ve doubled down on weight loss and “anti-obesity” messaging during the pandemic. (And they were already talking a LOT about these things.) But there’s tons of evidence showing that this DOESN’T WORK to promote weight loss. And, that it actually increases the likelihood of eating disorders and disordered eating behaviors.
How to prevent eating disorders? There are a things you can do to help.
Frankly, it can be tough to drown out all the messages demonizing food and weight gain and encouraging dieting and weight loss. But those messages aren’t going away anytime soon. Public health experts just don’t take eating disorders seriously. But that doesn’t mean that they’re not serious. If you’ve lived with one, or know someone who has, you understand that they’re typically all-consuming (and in some cases, life-threatening). They really, really diminish a person’s quality of life, as well as their health. It’s time we get serious about how to prevent eating disorders.
1. Understand that eating disorders aren’t just about food and body size.
Yes, eating disorders manifest as eating and weight control behaviors. But at their core, they’re about so much more than that. They’re about feeling a sense of control (which is part of why they’re so rampant in this time of uncertainty). Wanting to fit in. For people living in larger bodies, eating disorders often start as doctor-recommended diets. Even full-on eating disorder behaviors (like eating dangerously few calories or severely over-exercising) might be praised by doctors and loved ones as an attempt to “get healthy.” In thinking about how to prevent eating disorders, we need to recognize that currently, our culture promotes disordered behavior.
2. Reduce the stigma around eating disorders.
We often see eating disorders as vain. Many people think of them as just an obsession with appearance, instead of realizing that they’re diseases with complex causes and symptoms. There’s also a common misconception that they primarily affect one type of person: a white, thin, young, wealthy, high-achieving female. (Even eating disorder researchers have historically assumed this; most studies look at white, college-aged women.)
Really, anyone might have an eating disorder, and it’s not because they’re vain. Instead of brushing them off as an “it’s all in your head” problem, let’s start encouraging people to seek help without shame. (And, let’s make that help more accessible to everyone.)
3. Realize that eating disorders exist in people of all weights.
Some people with eating disorders might lose extreme amounts of weight and become visibly emaciated. But that’s not always the case; some might lose extreme amounts of weight but still appear “normal” weight, and others might struggle with severely disordered behaviors (restricting, bingeing, purging) without any drastic visible weight changes.
4. Don’t comment on other people’s weight or body.(No complimenting weight loss or shaming weight gain.)
You probably wouldn’t compliment someone on their visible weight loss if they looked emaciated, because you’d worry about them having an eating disorder. Let’s start applying that logic to everyone, no matter what their body looks like. First, you never know just from looking at someone how the weight loss happened; even if they’re in a larger body, they could be starving themselves, or purging, or over-exercising. Second, complimenting weight loss implies that they look better in their newly smaller body than they did before. When they regain the weight they lost (which the vast majority of people will do), they’ll remember the weight loss compliments and feel like a failure. They might even avoid you, for fear that you’ll judge their body.
5. Stop going to great lengths to control your own eating habits and body weight.
The truth is that there’s a fine line between “disordered eating” and an eating disorder. (Actually, it’s more of a slippery-slope-grey-area; disordered eating behaviors can quickly become an eating disorder as they start to consume more of your time and energy.) The National Eating Disorders Association (NEDA) cites dieting and weight management behaviors as a major risk factor for eating disorders.
To be clear: How you choose to eat is up to you. If you want to diet, that’s absolutely your right. But if you choose to do so, it’s only fair that you understand the risks. Diets typically don’t work. Making certain foods off-limits almost always leads you to wanting that food even more, and maybe even obsessing over it. Strictly controlling your food intake just makes you feel obsessed and out of control around food. It’s not normal to think about food 24/7; if you stop dieting and trying so hard to control your weight, you’ll almost certainly starting thinking about food a lot less. If you’re wondering how to prevent eating disorders, start by examining your own beliefs.
Giving up dieting isn’t just about preventing an eating disorder in yourself.
The people around you notice the way you talk about your body, and the way you act around food. If you’re a parent, your children will internalize your ideas about food and bodies. If you’re always talking badly about your body (or other people’s bodies!) around friends, they’ll likely assume that you’re judging their bodies and eating habits just as harshly. Heck, even complimenting friends on the size of their bodies can have negative consequences. Someone else listening might wonder why you’re complimenting one body over others. The person being complimented may feel badly if and when they gain some weight, worrying that you won’t think the same way about them anymore.
The short of it is that there are so many things we can do in our daily lives to combat eating disorders.
It’s not up to you to solve the world’s problems. And again, how you choose to eat and treat your body is entirely up to you. But if you’re as alarmed by the continued rise in eating disorders as I am, know that you’re not powerless. Sure, the media will continue to glorify certain bodies, and public health officials will continue to shame anyone whose weight is above a certain (arbitrary) threshold. And yes, this same thinking is engrained in all of us. (Don’t beat yourself up if you’ve internalized the idea that you should be smaller. Or if you’ve complimented people on weight loss. Or even if thought of truly giving up diets and accepting your body seems impossible. We’ve all been there.)
We can all do better to reject the things that are causing this rapid rise in eating disorders. Acknowledge that eating disorders are a real problem, not just a “vanity thing.” Reduce the stigma around them and make it OK for people to seek help. Validate the fact that eating disorders affect people of all weights, and stop outwardly glorifying certain body types over others.
And, we can take steps to practice what we preach. By learning to respect our own bodies, we set an example for those around us to do the same. When we realize that all bodies are equally deserving of respect, we make ourselves a safe space for people of all shapes and sizes. That goes so, so far when it comes to the question of how to prevent eating disorders.