Treating Eating Disorders Requires Attention to Media Influence on Diverse Populations

Social media trends can subtly encourage eating disorders, especially in groups not traditionally thought to be at risk

By Emily Kim

If someone you know is experiencing disordered eating or experiencing any of the risks mentioned below, discussing your concerns with them or contacting CAPS at Emory is a great place to start. Any type of disordered eating must be evaluated by a professional. 

Call CAPS at 404-727-7450 or schedule online by going to https://counseling.emory.edu and requesting an initial phone consultation to talk to a mental health professional about your concerns. You can also make an appointment with a primary care provider at Student Health Services and discuss your concerns with them.

In the United States alone, almost 30 million Americans will have an eating disorder at some point in their lifetime. Each year, 10,200 deaths are a direct result of eating disorders — one every 52 minutes.

“Globally, around 10% of the population will experience an eating disorder in their lifetime. And yet, eating disorders are profoundly misunderstood,” says Cheri Levinson, MD, associate professor at the University of Louisville and director of its EAT (Eating Anxiety Treatment) Laboratory.

“Eating disorders can affect anyone, and you can’t tell if someone has an eating disorder just by looking at them,” says Elizabeth Neri, a licensed clinical social worker currently working at Emory University’s Counseling and Psychological Services. 

She explained that eating disorders are influenced by a number of intersecting factors: genetics, biology, thoughts, beliefs, and behaviors. External factors such as our families, culture, gender expectations, peers, media, and socioeconomic status also impact our relationship with food and our bodies. 

Furthermore, eating disorders vary based on severity and presentation. However, the most common types of eating disorders are anorexia nervosa, bulimia nervosa, binge eating disorder, and “other specified feeding or eating disorders” known as OSFED. Most of these eating disorders consist of individuals experiencing restrictive food intake or recurrent episodes of binge eating, plus an underlying belief that their self-worth is based on their weight, shape, and ability to control eating. Physically, eating disorders can risk heart health, bone and hormone impacts, gastrointestinal problems, metabolic changes, and impacts on the brain.

“Most often we see people with anxiety disorders, PTSD, and OCD, and so, when you’re treating an eating disorder, you really are treating not just an eating disorder, but also co-occurring with psychological issues that come along with the co-occurring psychological issues,” says Levinson. According to her research, from 55 percent to 97 percent of people diagnosed with an eating disorder receive a diagnosis for at least one more psychiatric disorder. 

Death by suicide is significantly more prevalent in eating disorder populations compared to the general population. Recent research has found that individuals with anorexia are 31 times more likely to attempt suicide than individuals from the general population, and the suicide rate for individuals with bulimia is 7.5 times higher than that of the general population. 

According to Levinson, people with eating disorders are most times extremely secretive about their behaviors and the severity of the disorder can go undetected by friends, family, and even professionals for extended periods of time. However, through treatment with a licensed mental health professional trained in eating disorders, recovery is possible. 

“If you only take 2 points from this, I think it’s important to realize that eating disorders can affect people of all genders, sexual orientations, races, and ethnicities, and so, therefore, it’s important for the media to represent this diversity in eating disorders,” says Dr. Jason Nagata, a pediatrician based in San Diego, California. 

Nagata brings up two important points – diversity and media. As he wrote in Current Opinion in Psychiatry in 2020, self-reported lifetime eating disorders in the LGBTQ+ population, especially transgender men, transgender women, and gender-expansive (non-binary) people, are higher than cisgender people.  

“Particularly in transgender youth and young people, there may be additional distress secondary to gender norms,” says Nagata. Additionally, most eating disorder research is done on females, when the masculine body ideal has also become increasingly large and muscular. 

The New York Times reported in 2022 on emerging concerns over “bigorexia,” in which a muscular individual experienced themself as small and skinny, despite being muscular. Although eating healthfully and exercising daily may be considered good for the body, young men have been seen fainting at the gym because they overexerted themselves and did not consume enough calories to sustain their workout. Such situations are overlooked because social media glamorizes the overconsumption of protein and men with “Dorito Physiques,” a term that first appeared as a Tumblr hashtag, implying the shoulder-waist ratio of a triangular Dorito. The term went viral, attracting massive attention to celebrities, models, and fitness stars with idealized #DoritoBod bodies. 

This underlines how mass media — including news, entertainment, and social media — play a crucial role in the dissemination of health information, and shaping our attitudes towards public health issues, including weight stigma. 

According to Levinson, weight-biased media content such as over-representing thin individuals, using weight-related humor, and spreading misinformation about the causes of being overweight and having obesity, can reinforce negative attitudes.

“Be mindful of language – sometimes without even realizing we use language that is not helpful,” says Levinson. She recommends avoiding toxic language, such as labeling foods as “bad,” “good,” or “clean,” or commenting on people’s body size or shape, while describing bodies in neutral terms and learning to appreciate the amazing things they can do can do. 

“Be supportive and grateful towards ourselves and what our bodies can do ,” she says. For those struggling, she adds: “Above all, our role is to listen, be patient, and let them know that help is available.” 

National Eating Disorders Association (NEDA) Awareness week is an annual campaign to promote eating disorder awareness and provide hope for those in recovery. In 2023, NEDA week started on Monday, February 27^th and ended on Sunday, March 1^st. According to NEDA, this year’s theme was “It’s Time for Change.¹”