There is an urgency to understand the social, psychological, and biological influences on eating disorders: how they develop and what keeps them going. Clinician Anthea Fursland explains why.
It is nearly 40 years since my first professional encounter with eating disorders. The year was 1980 and the place was the Atkinson Morley Clinic at St George’s Hospital in London, where I had the honour to work with Professor Arthur Crisp in the final internship of my Clinical Psychology Masters programme.
In 1980, we had no evidence-based treatments, and there were few clinicians who knew much (anything!) about eating disorders. When I joined the National Health Service in the UK, I soon became the go-to person in my clinic whenever someone was admitted for an eating disorder.
With no evidence-based treatments, I made huge efforts to educate myself, largely through the Women’s Therapy Centre, run by Susie Orbach and Louise Eichenbaum, and I joined a consultation group run by Marilyn Lawrence. I moved to the US, but for the 1980s and much of the 1990s, those of us outside academic institutions were still working in isolation, just doing our best.
More knowledge but …
And here we are in 2019. What has changed? We have a broader understanding of eating disorders and there is more interest in the field, with more people treating those with eating disorders and conducting research. We now have evidence-based treatments, but the effectiveness of these treatments is still unsatisfactory, and a disappointingly low number of clinicians use them.
Plus – our young people are still developing eating disorders. Poor body image is the norm, and one of the most serious concerns reported by youth in Australia, where I have worked for 15 years.
… weight stigma, bullying and shaming are rife
People at both ends of the weight spectrum are shamed. Stemming from a fear of becoming fat and an idealisation of thinness, dieting is the norm. Yet, however much anorexic bodies are idealized by some, anorexia nervosa is more stigmatized than either depression or schizophrenia…because of the perception that it is a lifestyle choice.
Although women have been faced with images of idealized and unattainable bodies for decades, the current onslaught of such images in social media is unprecedented. Our young people are presented with heavily photoshopped images and our boys are being targeted too – now instead of John Wayne, they are shown images of buffed celebrities, which encourages them to, or shames them into, coveting and developing equally perfectly-formed pecs, abs, six-pack and more.
We have more children growing up in large bodies, but they are living in a world where having a large body is vilified and where weight stigma, bullying and shaming are rife. Dieting is the norm and restricting calories in growing children is regarded as health-promoting and seen as protecting them from the negative impact of having a larger body.
Even without a larger body, the messages out there about ‘getting fat’ or ‘being unhealthy’ are so pervasive that recently my skinny six-year-old grand-daughter refused cake at her four-year old cousin’s birthday party because “sugar is bad for you” – a lesson she had learned in school.
We need a paradigm shift in public health messaging
Never have the obesity field and the eating disorders fields been so far apart. I believe that nothing will change until we stop putting kids on diets and setting them up for a lifetime of shame, yo-yo dieting and increasing their risk of developing an eating disorder. We need to educate families, schools, children, general practitioners and all primary care staff – in fact all staff involved in education and health care. What we need to teach them is healthy living, which involves joy in eating, in movement, in sport and in socialising. We do need to get kids off the couch and away from their computers, not by shaming them, but by offering them options that are fun and social.
Eating disorders: We can’t wait
We still have people developing eating disorders. We are allowing too many people with newly-developed eating disorders to go unrecognized, undiagnosed and untreated.
We still have people dying from these conditions. We have too many people living subpar lives because of their debilitating illness.
We know that there is a large genetic component to eating disorders. Genes and underlying personality characteristics predispose someone to develop an eating disorder. Those with a genetic vulnerability will be more likely than their friends to develop an eating disorder after a diet.
Genes load the gun, weight loss pulls the trigger
As Professor Cynthia Bulk explains: “Genes load the gun, environment pulls the trigger.” (I explain it more strongly: “Genes load the gun, weight loss pulls the trigger.”) So – for an eating disorder to develop, we need to have a genetic vulnerability plus environmental stress with weight loss.
And it’s important to remember that ANY weight loss (from illness, depression, or even chemotherapy) can lead to the genes being “switched on”. Epigenetics is the study of the process whereby changes to our biology might cause the genes to be “switched on”, for example by stress and/or inadequate nutritional intake.
We need early intervention
Early intervention is vital. We know that even modest dieting affects brain activity. We know that the sooner we introduce evidence-based treatment and help patients achieve early change (symptom reduction including weight regain where necessary), the more likely they will recover.
If we leave the brain to starve, what results is neurobiological change and the “neuroprogression” that results in a snowball effect which makes recovery harder. There are brain-based reasons for avoiding food or being compulsively drawn to eat, and we need further research to understand the role of the genes, the brain and the gut – so that we can prevent and minimize suffering.
Eating disorders can’t wait. People with eating disorders can’t wait.
About World Eating Disorders Action Day 2019
This year grassroots activists, volunteers, and over 250 organizations in 40+ countries are calling for caregivers to receive support, health care workers to be properly trained, and access to immediate, evidence-based treatment.
Why We Can’t Afford to Wait
- Worldwide over 70 million people are estimated to be affected by an eating disorder,
- Eating disorders have the HIGHEST MORTALITY RATE of any psychiatric illness
- Eating disorders affect people of all genders, sexual orientations, ages, socioeconomic class, abilities, races, and ethnic backgrounds. It is time to take action.
- Good news! When treated EARLY and correctly, eating disorders have the highest and fastest recovery rate!
How to support World Eating Disorders Action Day, June 2, 2019
- Join the movement, show your purple on social media! Use hashtag #ShowUsYourPurple
- Follow conversation on social media. Use hashtags #ShowUsYourPurple #WeDoActNow
- Host or attend an event. See http://www.worldeatingdisordersday.org/2019-events-2/
- Donate. To support the work see http://www.worldeatingdisordersday.org/get-involved/participating-organisations/.
- Discuss eating disorders. Through open, supportive dialogue, we can create change.
E-book release: Come as you are, eating disorders can’t wait
As a Participating Organisation supporting 2019 World Eating Disorder Action Day, The Diary Healerhas released a new ebook, . Stories from around the world illustrate that recovery from an eating disorder IS possible, at every age. The first step, is to seek help. to purchase a copy for $9.97 (AUD) – all profits support eating disorder services.
Anthea has worked for nearly 40 years in the eating disorders field, with previous experience in the UK and the USA. Now living in Perth, Australia, she began the Eating Disorders Program at the Centre for Clinical Interventions (CCI) and is now Director of the Western Australia Eating Disorders Outreach & Consultation Service (WAEDOCS).
Anthea is involved in applied clinical research, service development, supervision, consultation and training (of primary care doctors, mental health practitioners and carers). She has trained and supervised clinicians throughout Australia in CBT-E. She has co-authored many peer-reviewed papers and created a web-based self-help resource.
Anthea serves on the Steering Committee of the National Eating Disorders Collaboration. She is past-president and current executive committee member of the Australia and New Zealand Academy for Eating Disorders (ANZAED). In 2011 she was elected a Fellow of the Academy for Eating Disorders (AED); in 2015 she was awarded the ANZAED Lifetime Achievement Award, and in 2019 she received the AED Outstanding Clinician Award.