New Ways Media Worsens the Eating Disorder Epidemic

Eating disorders first became classified as psychiatric diagnoses in the 1980’s. The advent of mass media was one clear instigator of widespread dieting, glorification of thinness and, thereby, eating disorders. At that time, magazines and television were the central purveyors of the visual idealization of thinness.

The burgeoning food, diet and exercise industries capitalized on the growing desire for thinness. The powers of capitalism ingrained weight loss as a central tenet and achievement of our society. In the decades since, the industries adapted to changes in media and instilled an even more pervasive and insidious desire for thinness.

Social media is the most obvious example and one that has been explored through the entire eating disorder treatment landscape, this blog included. The images of thinness available on our phones all day long makes magazines seem innocuous. Increasingly, the explosion of content aimed at disempowering social media, such as the body positive movement or fashion ads using all body types, will hopefully have more of an impact in time, but it’s hard to imagine a world where the glorification of thinness is sidelined.

However, there are many new ways media culture continues to make it impossible to avoid the lure of thinness as a source of identity and accomplishment.

The explosion of eating disorder content makes even the process of recovery a new source of identity. The content ranges from personal stories of recovery, plentiful online companies offering help for treatment, clinicians advertising their treatment to forums to discuss all parts of the disorders.

Even when this content is mostly about getting well, the endless of supply of content is counterproductive. The goal of recovery is to stop ruminating about food and weight as the most important things in life. Getting better means these thoughts aren’t central anymore. Endlessly reading about eating disorders online may help someone get well, but they never allow a chance to find other more meaningful parts of life.

Wearable devices that track food, exercise and calories are another technological advance which encourages eating disorders. For many, the eating disorder thoughts now revolve around steps and calories burned. The result is that compulsive exercise has escalated enormously, and many people only allow themselves to eat calories based on what the device prescribes, always under what the person really needs.

Even more alarming, the Apple Watch never puts a cap on the amount of exercise it encourages a person to do. The dangerous success of “closing one’s circles” (accomplishing daily exercise goals) exacerbates compulsive thoughts about movement for anyone with an eating disorder. Because there is no limit on how much exercise is considered reasonable, the device can force someone with an eating disorder to exercise hours and hours in a day. The result is terrifying and truthfully life threatening. Apple needs to think much more carefully about its watch software.

Last the diet industry continues to use developments in social media to reframe dieting as a lifestyle change. Ignoring the endless data that diets don’t work, these companies bombard people with a mixture of guilt and promise in their social media streams. The result is only to reinforce the negative self-image and constant shame about their bodies.

These three examples help explain how the media deepens and worsens the eating disorder epidemic. The goal is a life not focused on weight and body but on the things try at matter most instead of a world which capitalizes on or fears all day long.

The Reasons People with Eating Disorders Receive Subpar Medical Care

Patients with eating disorders worry universally about biased treatment from medical professionals. The prejudice of clinicians across the board leads to poor care, mistaken diagnoses and potentially harmful treatment.

The bias against eating disorders stems from two central issues. First, the ignorance about eating disorders in general is rampant. Second, the prevalence of bias against fat and for thinness reinforces eating disorder myths and limits thoughtful medical care.

Medical professionals learn very little about eating disorders. A lecture or two about eating disorders in training explains the criteria to diagnose these illnesses and a few basic facts about treatment and outcomes. However, for doctors not in the mental health field, this information is not useful at all. In order to be helpful to patients with eating disorders, primary care doctors or medical specialists need to know what to look for in order to recognize and treat common medical consequences of eating disorders.

Cardiologists need to identify low potassium in young people as a sign of Bulimia. For gastroenterologists, delayed gastric emptying not explained by other illnesses is often due to anorexia. Rapid weight gain and loss accompanied by vitamin deficiencies is often a sign of severe periods periods of binging and restricting.

These are only a few examples of the myriad medical issues secondary to eating disorders. Even a basic amount of knowledge can help doctors diagnose eating disorders and treat the resulting symptoms effectively.

The lack of knowledge leads to poor treatment, but the weight bias is just as prevalent and even more destructive to people with eating disorders.

Doctors frequently have a personal bias for thinness and against fat based on their own internal fatphobia. The medical establishment reinforces the purported medical consequences of being fat that doctors exaggerate and use to confirm their own bias.

The result is that doctors assume thin patients must be healthy and that their weight itself is enviable. Similarly, doctors see fat people as unwell with poor health and that weight loss is the only recommendation these patents deserve and need.

So patients with anorexia are told they are not sick, something people with anorexia often use to bolster their own false beliefs about their illness. And patients with Bulimia or binge eating disorder cannot get the medical help they need. Instead, they are always advised to lose weight.

These two facts about medical care for eating disorder patients leads to patients either ignoring medical problems or being too afraid to seek medical care. As a psychiatrist treating people with these illnesses, I see too many patients avoid medical care for treatable illnesses. The results can range from unfortunate to catastrophic.

Because of the increasing prevalence of these illnesses, the medical establishment needs to ensure basic and adequate education for doctors about eating disorders in order to provide care these patients deserve.

How the Pandemic has Changed Eating Disorder Treatment

I have mentioned multiple times how the incidence of eating disorders increased significantly during the pandemic. Several posts also posited possible reasons for this purported increase based on the clinical literature, media and also from my own thoughts.

However, none of this data has taken into account confounding factors in the eating disorder treatment world. Three of these factors may be very pertinent.

First, there has been much more attention paid to people’s mental health during the pandemic. We were all cooped up during much of the first year of the pandemic which meant there were few places to hide. Regular life makes it easier for people with burgeoning eating disorders to hide the progress of the illness from others for a long time. That was not possible at the start of the pandemic.

Second, increased access to care, as described in recent posts, changes the cohort of new therapists. Many more clinicians will have had exposure to eating disorders after working in various treatment programs and thus be more able to diagnose an eating disorder and recommend treatment.

Third, during much of the pandemic, people sought out therapy much more than usual. Practices filled up very quickly. Finding an available therapist was very hard. Treatment programs had waitlists two to three times long as usual. Clinicians starting new practices filled shockingly fast.

So the conclusion that the incidence of eating disorders increased drastically may not be the entire or even the true picture.

The pandemic may have helped usher in a new chapter in mental health treatment in this country. People may seek more help, look for eating disorder treatment sooner and be diagnosed with eating disorders earlier in the illness.

Over time, the changes in diagnosis and treatment might become clearer and give us all a better sense of how the pandemic changed the eating disorder treatment world.