Starving for perfection

Women are bombarded by messages from the media, their peers, and their families that thin is beautiful and that dieting is the way to reach the elusive goal of bodily perfection. Sadly, sometimes these pressures can trigger eating disorders that can have devastating effects, including death. According to the National Eating Disorders Association, as many as 10 million females in the United States suffer from anorexia or bulimia. Since 1987, the organization has sponsored National Eating Disorders Awareness Week, the nation’s largest eating disorders outreach effort, this year running from February 26 through March 4. During the week, BU Nutrition Club and BU Red Cross volunteers will host an eating disorders awareness panel, on Wednesday, March 1, from 7 to 9 p.m. in Room 206 of the Photonics Center. Topics will include the firsthand experience of a student who has suffered from anorexia, the psychological impact of eating disorders, and the media’s influence on body image.

BU Today spoke with Paula Quatromoni, a Sargent College assistant professor of nutrition, about the factors that contribute to eating disorders and whether college students are more vulnerable to developing them.
 
BU Today: What causes eating disorders?
Quatromoni: Eating disorders represent maladaptive coping mechanisms. Any event that requires effective coping strategies can trigger disordered eating when coping skills are weak and support systems are nonexistent. A number of factors can contribute to eating disorders, including chronic dieting, chronic dissatisfaction with weight or appearance, depression, low self-esteem, or some traumatic event, like sexual assault, for instance. Other events that may seem much more benign can also trigger disordered eating for some individuals, such as moving off to college, being cut from an athletic team, being told by a coach to “drop a few pounds,” or being dumped by a boyfriend. For some, eating disorders are an issue of control — trying to take control over food and body weight when other things in life feel out of control. For others, it’s the quest for perfection.

Can eating disorders be genetic? If so, what should you do if someone in your family has had an eating disorder?

Eating disorders are largely learned behaviors. But they can spread within a family because of behaviors, attitudes, and belief systems that are role modeled and perpetuated. If someone in the family has an eating disorder, the appropriate thing to do is to seek family therapy. Eating disorders affect the whole family, not just the individual with the disorder. Family therapy is essential for recovery, especially for an adolescent, but also for adults. For instance, if a mother has an eating disorder, family therapy in addition to individual therapy would be important to minimize the risk of her daughters being affected by the disease as well. Therapy usually involves psychotherapy and nutritional counseling, with appropriate medical intervention as needed.

Why do people with eating disorders see themselves as overweight when in reality they are dangerously thin?

A distorted perception of body image is one hallmark of the disease — it’s what points to the fact that this is a psychological disease. At its core, it’s really not about food and nutrition. It’s about emotional well-being. It’s impossible for a nutritionist to move a client with an eating disorder into a state of recovery and improved nutritional health without the partnership of psychotherapy. There is only so far you can go with nutrition counseling if the client is resistant to changing her behavior because she still clings to a faulty belief system about food, body image, and coping mechanisms.

Why do many girls feel pressure to diet and be thin?

There are so many pressures on girls to be thin. Whatever they are, the pressures are real and they are strong. We can look to the media as an important influence. Skinny, beautiful girls are what you see in magazines and on the fashion runways. The media tell us that skinny is beautiful, skinny is sexy, and skinny is desirable. We also get these messages from our peers. Friends are constantly comparing their bodies, what they ate or didn’t eat, etc. Peers who aren’t necessarily our friends can say cruel and hurtful things about our appearance, our weight, or what we are eating that remain with us when we are emotionally vulnerable. This can chip away at a young girl’s self-esteem and self-image.  Sometimes family pressures can contribute in a major way. The young girl who gets teased by her brother because she is heavy or who gets constantly reminded by her mother that she shouldn’t eat certain foods or whose father comments negatively on her developing body during adolescence can develop eating problems because of these things. That kind of feedback can be devastating to a young girl and can have long-lasting impact.

Are college-aged people especially susceptible to external pressures to be thin?

In general, statistics on the prevalence and the incidence of eating disorders are largely underestimates, because they reflect only those cases that come to our attention or seek treatment. Unfortunately, a lot of eating disorders remain silent and untreated. Yes, data show that college-aged women are more vulnerable to eating disorders than the general public. Some sources refer to the prevalence of eating disorders in college as an epidemic. College is a time of huge life transition. Any dramatic life event, such as moving to a new city, leaving the security of friends and family, the stress of finding new support systems and making new relationships, the stress of academics, a whole new food environment, food available all hours of the day and night, and the dreaded “freshman 15,” can be a trigger for disordered eating.

Rates of eating disorders are also climbing among men, although it is still a condition that affects disproportionately more women than men. Athletes are also more susceptible than the general population to disordered eating. Many believe their performance would be better if they were thinner. Unhealthy eating behaviors and restrictive or ritualistic eating may be modeled by teammates. Many of the things that make elite athletes top performers are among the characteristics that can also predispose them to disordered eating — competitive drive, quest for perfection, a learned ability to train through pain and ignore internal body signals, including hunger.

Why do we need to raise awareness of eating disorders through an initiative like National Eating Disorders Awareness Week?

People don’t know how widespread and how dangerous eating disorders are. The average person doesn’t realize that a major contributor to eating disorders is chronic dieting. They don’t realize that they could develop problematic eating behaviors despite their best intentions just to diet. There are many shades of gray of disordered eating behavior. With awareness, education and health promotion activities, early recognition of warning signs, and timely intervention, eating patterns can be normalized before dangerous behaviors become set and ingrained. In other words, people can be spared years of suffering if we can prevent disordered eating from becoming a clinical eating disorder with irreversible and life-threatening consequences. It’s that serious. We also need to make people aware that help is out there — that they can have credible sources of information in a private and confidential way and have access to trained professionals and support groups. These are the things an awareness week can provide.