Sifting Through Stereotypes for Better Recognition of Eating Disorders

Eating disorders impact diverse people – but if you were to rely on the representations we have available to us around eating disorders, you might assume that they only happen to young, white, cisgender, heterosexual, thin women. While those of us in the eating disorders field in a research and/or clinical capacity are often aware that people who are marginalized along any number of lines, including race, sexual orientation, gender, and more, get eating disorders, the dominant representation of eating disorders remains this very narrow portrait of a person. The problem with this portrait is not that it is not true – people who fit this image do get eating disorders. However, this portrait creates what Chimamanda Ngozi Adiche refers to as a “single story.” It does not leave room for recognition for those whose disorders look different, which can lead to under recognition, misdiagnosis, and a lack of appropriate care for diverse people experiencing eating disorders. 

One of the most serious issues facing us as a field is the lack of training for primary care physicians and others at the front line of recognition for eating disorders. These individuals may only have dominant representations of eating disorders available to them. Resultantly, they might assume that people in larger bodies, men, racialized people, LGBTQ+ people, and otherwise marginalized folks are somehow “immune” to this kind of distress. The implications of this are twofold:

• We need to improve training for “first responders” for eating disorders, including general practitioners, nurse practitioners, teachers, coaches, and more
• We need to broaden our lens on eating disorders to incorporate and represent a wider array of experiences. This means being more proactive in conducting research that is sensitive to and designed with marginalized folks, and making space for stories to accompany the numbers used to inform eating disorder diagnoses and treatments.

Beyond these points, we also need to be working at a societal level for change in which bodies are welcome not only within eating disorder research and treatment settings, but also in society in general. Many of those who don’t fit the stereotype of eating disorders are also facing countless other obstacles in their lives that can make recovery challenging and that can make talking about their experiences of an eating disorder – and recovery – unsafe. Eating disorders are treatable and recovery is possible, but we can do better to build a world where diverse bodies are honoured and welcomed in; this is the kind of world that might make recovery less of an uphill battle against an oppressive cultural current.

The Waterloo Wellington Eating Disorders Coalition is proud to support the 1st World Eating Disorders Action Day. #WeDoAct for systems-level change for eating disorders, today and every day.

-Andrea Lamarre

International No Diet Day: Why Diets don’t work

How often do you think about what you should or shouldn’t eat, or about your body size? For some this may only represent a small percentage of their experience, whereas others describe it as consuming nearly every waking moment of their lives.

Twenty four years ago, Mary Evans Young (a survivor of an eating disorder and bullying), created No Diet Day. Now recognized as International No Diet Day (INDD), May 6 is a date that encourages people to challenge weight prejudices, raise awareness of the ineffectiveness (and risks!) of dieting and to celebrate body size diversity and the health at every size movement.

How will you celebrate INDD? Many people celebrate by eating mindfully and for pleasure, and by engaging in activities that allow them to enjoy their bodies. The Waterloo-Wellington Eating Disorder Coalition is collaborating with local businesses (and universities) to display positive, empowering messages on signs in shop windows and decals in change rooms. Messages include, “Distorted body image comes from a distorted culture”; “Don’t fight your genes, just change your jeans”; and “Your natural weight is your best weight”. Look for the signs this week!

Billions of dollars are spent on the dieting industry yearly. Industry is the key word. Diets are meant to yield profit and despite the research demonstrating the ineffectiveness of dieting many people are currently on a diet. With children and adolescents, dieting and other weight control behaviours increase the risk of physical health concerns, and the development of eating disorders and other mental health issues.1

Why don’t diets work? Dietician, Caroline Valeriote, offers the following facts:

1.     Goal weights for many diets may be unrealistic for you. Diets don’t often take into account your genetic structure, your body type, how much time and effort you can afford to devote to managing lifestyle and food style changes and your overall health.

2.     Diets that promote unrealistic weight loss goals of greater than two pounds per week means the following:

a.     You are eating too few calories and are at risk of becoming deficient in nutrients

b.     You may be feeling tired and hungry and have a difficult time concentrating and making decisions

c.     The rate at which calories are used (metabolic rate) slows down which is not beneficial to your overall health

3.     Diets don’t often promote physical activity which will increase overall muscle tone and overall fitness. Regular physical activity will increase/maintain your metabolic rate.

4.     Diets will often eliminate certain foods and food groups found on Canada’s Food Guide. Diets eliminating these foods or food groups creates unbalanced intake and often does not recommend healthy substitutions.

5.     Diets usually recommend repetition of several foods. Without variety, the diet will be boring and very difficult to adopt for the long term.

6.     Diets likely promote drastic changes to your overall intake. If this is the case, it will be more difficult to follow because you will have to make too many changes.

7.     Diets are not usually monitored by a registered dietitian or medical professional.

8.     Diets likely recommend very low calorie intake making it very difficult to obtain all the macro and micro nutrients your body needs to be healthy.

9.     Diets often recommend special supplements or foods which can be more costly than regular food. Most often supplements are not well researched for their effectiveness and safety. Supplements cannot replace a well-balanced intake.

10.  Often a diet will discourage you from thinking positively about yourself. A positive sense of self-worth increases your motivation to take good care of yourself and your body though healthy food choices.

- Caroline Valeriote, RD and Carrie Pollard-Jarrell, MSW RSW

For more information on eating disorders, body dissatisfaction and the problems with dieting, visit: http://nedic.ca/know-facts/statistics

Medical Complications: Part 1

As many as 600,000 to 900,000 Canadians meet diagnostic criteria for an eating disorder. 80% of these individuals are women and girls. Eating Disorders also affect men and boys. Weight is not always the clinical marker of an eating disorder. People that have normal weights can also have an eating disorder. Eating disorders, such as Anorexia Nervosa, Bulimia Nervosa, Other Specified Feeding and Eating disorders, Binge Eating Disorders are serious illnesses that can be deadly. Individuals can develop life threating medical complications and often have other debilitating illness. The devastating symptoms of an eating disorder lead to serious consequences and risks to an individual’s mental and physical health and can compromise other parts of their lives such as personal relationships, current and future education and employment and overall quality of life. The mortality rate for individuals struggling with anorexia nervosa is estimated between 10-15% and Bulimia Nervosa is about 5%.

Health Consequences of Anorexia Nervosa

The body is denied the essential nutrients that it needs to function normally. There may be depletion of nutrition stores, vitamins, minerals, electrolytes or malabsorption. The body attempts to accommodate this by slowing all of its normal processes to conserve energy which can result in medical consequences such as:

·       Slowing of the heart rate and lowering of the blood pressure; symptoms such as chest pain, heart palpitations, irregular beats or arrhythmias, shortness of breath or edema

·       Muscle loss and weakness. The heart is also a muscle so it is affected significantly and can cause heart failure, heart arrhythmias, cardiac arrest and death

·       Severe dehydration can occur which can cause the kidney function to be altered

·       Liver function alteration

·       Decreased metabolic rate

·       Poor healing and alteration in immune system functioning

·       Bone mineral density loss or osteoporosis which can result in dry, brittle bones with poor bone healing or mineralization

·       Fainting, fatigue and overall weakness can be caused by poor nutrition, anemias, dehydration, low blood pressure, slow heart rate or other heart problems

·       Hair loss is very common, dry skin is also very common, development of lanugo or a downy layer of hair all over the body can develop in the body’s attempt to keep itself warm

·       Intolerances of the body to cold or marked sweating or hot flashes

·       Loss of menstrual cycle or amenorrhea, irregular menses, loss of libido, infertility

·       Gastrointestinal effects such as pain, bloating, acid reflux, constipation or hemorrhoids

·       Seizures, memory loss, poor concentration, insomnia, depression, anxiety, obsessive behaviours, self-harm, suicidal ideations or attempts

Health Consequences of Bulimia Nervosa

Many of the above consequences can be present in Bulimia Nervosa. The recurrence of binging and purging can affect the digestive system and can also lead to electrolyte and chemical imbalances in the body affecting the heart and other major organs. Some of these include:

·       Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death

·       Electrolyte imbalances and loss of potassium, sodium and chloride because of purging behaviours can also lead to dehydration

·       Possible rupture of the esophagus or inflammation or erosion or ulceration of lining from vomiting

·       pancreatitis

·       Changes in the gastrointestinal system, diarrhea, constipation, incontinence and chronic problems with the misuse of laxatives

·       Tooth decay, dental enamel erosion, discoloration, loss of teeth, gum recession or oral lesions, lacerations from the stomach acids during frequent vomiting

·       Parotid gland enlargement

Health Consequences of Binge Eating Disorder

Many of the associated clinical risks are similar to the health risks of obesity and they can include:

·       Hypertension

·       Dyslipidemia or high cholesterol and triglycerides

·       Heart disease as a result of elevated cholesterol and triglyceride levels

·       Development of type II diabetes

·       Gallbladder disease

·       Development of varicose veins

·       Hiatal hernia

·       Arthritis, sciatica or other mobility issues related to the wear and tear on major joints

Eating disorders are complex illnesses that can have harmful consequences on an individual and impact their physical health. They do not discriminate about any body system. They can compromise all regulatory systems of the body including the immune system, digestive system, skeletal system, cardio vascular system and reproductive system.  The effects on physical health can occur rapidly or may deteriorate over a longer period of time. Chronic illnesses can be a direct outcome from the harmful effects of an eating disorder. Some medical complications can resolve quickly as an individual recovers from their eating disorder and others such as osteoporosis can have lasting effects. However recovery is possible and is also complex requiring nutritional, psychological and often vocational or relational treatment.

Written By: Catherine Miller

References:

Mehler, Philip & Anderson, Arnold (2010). Eating Disorders: A guide to medical care and complications, 2nd edition.

Report of the Standing Committee on the Status of Women: Eating Disorders Among Girls and Women in Canada (November 2014) Available at: http://www.parl.gc.ca/content/hoc/Committee/412/FEWO/Reports/RP6772133/feworp04/feworp04-e.pdf

Putting Eating Disorders on the Radar of Primary Care Providers (CWEDP-2010) Available at https://www.haltonhealthcare.on.ca/site_Files/Content/Documents/PDFs/Eating_Disorders_Tool.pdf

Eating Disorders, Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders, 2nd edition (AED Report 2012) Available at: http://www.aedweb.org/web/downloads/Guide-English.pdf