tag:theconversation.com,2011:/africa/topics/eating-disorders-1880/articlesEating disorders – The Conversation2024-02-06T13:31:20Ztag:theconversation.com,2011:article/2205362024-02-06T13:31:20Z2024-02-06T13:31:20ZDietary supplements and protein powders fall under a ‘wild west’ of products that necessitate caveats and caution<figure><img src="https://images.theconversation.com/files/573557/original/file-20240205-19-q8vbm4.jpg?ixlib=rb-1.1.0&rect=0%2C14%2C4927%2C3272&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dietary supplement labels can be misleading.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/only-natural-for-her-royalty-free-image/1068340648?phrase=dietary%2Bsupplements">Charday Penn/iStock via Getty Images</a></span></figcaption></figure><p>Dietary supplements are a big business. The industry made <a href="https://www.ibisworld.com/industry-statistics/market-size/vitamin-supplement-manufacturing-united-states/">almost US$39 billion in revenue</a> in 2022, and with <a href="https://doi.org/10.1177/1060028019900504">very little regulation and oversight</a>, it stands to keep growing. </p>
<p>The marketing of dietary supplements has been quite effective, with 77% of Americans reporting feeling <a href="https://www.crnusa.org/resources/2022-crn-consumer-survey-dietary-supplements-0">that the supplement industry is trustworthy</a>. The idea of taking your health into your own hands is appealing, and supplements are popular with athletes, parents and people trying to recover more quickly from a cold or flu, just to name a few.</p>
<p>A 2024 study found that approximately 1 in 10 adolescents have used <a href="https://doi.org/10.1001/jamanetworkopen.2023.50940">nonprescribed weight loss and weight control products</a>, including dietary supplements. </p>
<p>Notably, that systematic review found that nonprescribed diet pill use was significantly higher than the use of nonprescribed laxatives and diuretics for weight management. These types of unhealthy weight control behaviors are associated with <a href="https://doi.org/10.1016/j.jadohealth.2005.05.019">both worsened mental health and physical health outcomes</a>. </p>
<p>As a <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/29092">licensed clinical social worker</a> specializing in treating anxiety disorders and eating disorders and a <a href="https://www.acsh.org/profile/katie-suleta">biomedical research director</a>, we’ve seen firsthand the harm that these supplements can do based on unfounded beliefs. The underregulated market of dietary supplements is setting consumers up to be misled and potentially seriously harmed by these products. </p>
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<figcaption><span class="caption">How the use of an over-the-counter herbal supplement took a deadly turn for a lawmaker’s wife.</span></figcaption>
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<h2>The wild west</h2>
<p>The <a href="https://www.fda.gov/food/information-consumers-using-dietary-supplements/questions-and-answers-dietary-supplements">Food and Drug Administration</a> specifies that supplements must contain a “dietary ingredient” such as vitamins, minerals, herbs, amino acids, enzymes, live microbials, concentrates and extracts, among others. </p>
<p>Unfortunately, manufacturers can claim that a product is a supplement even when it doesn’t meet those criteria, such as <a href="https://theconversation.com/popularly-known-as-gas-station-heroin-tianeptine-is-being-sold-as-a-dietary-supplement-with-deadly-outcomes-221379">products containing the drug tianeptine</a>, a highly addictive drug that can mimic the biological action of opioids. Some of these products are labeled as dietary supplements but are anything but. </p>
<p>Products containing <a href="https://theconversation.com/the-dangers-and-potential-of-natural-opioid-kratom-87581?gclid=Cj0KCQiAn-2tBhDVARIsAGmStVk6onJqs6vRIbYthHTDhpjDVyKF812Ks5A3nan-g5kKtZT3Q2Auc9UaAua2EALw_wcB">kratom, a substance with opioidlike effects</a>, which are sold over the counter in many gas stations, <a href="https://www.fda.gov/news-events/public-health-focus/fda-and-kratom#">claim to be herbal supplements but are mislabeled</a>.</p>
<p>Under <a href="https://ods.od.nih.gov/About/DSHEA_Wording.aspx">a 1994 law</a>, dietary supplements are classified as food, not as drugs. This means dietary supplements are not required to prove efficacy, unlike drugs. Regulators also don’t take action on a product <a href="https://sgp.fas.org/crs/misc/R43062.pdf">until it is shown to cause harm</a>.</p>
<p>However, <a href="https://www.fda.gov/consumers/consumer-updates/dietary-supplements">the FDA’s website states that</a> “many dietary supplements contain ingredients that have strong biological effects which may conflict with a medicine you are taking or a medical condition you may have. Products containing hidden drugs are also sometimes falsely marketed as dietary supplements, putting consumers at even greater risk.”</p>
<p>In other words, supplements are regulated as food instead of drugs, even though they can interact with medications and may be laced with hidden drugs not included on the label.</p>
<p>Manufacturers of <a href="https://www.fda.gov/food/food-labeling-nutrition/label-claims-conventional-foods-and-dietary-supplements">dietary supplements can make claims</a> about their products that fall into three categories: health claims, nutrient content claims and claims about the product’s function, structure or both, <a href="https://www.health.harvard.edu/alternative-and-integrative-health/the-arguments-against-dietary-supplements">all without needing to provide supporting evidence</a>.</p>
<p>Misbranding and false advertising <a href="https://doi.org/10.1080/15563650.2022.2036751">are rampant with dietary supplements</a>, including false claims of <a href="https://www.fda.gov/consumers/consumer-updates/products-claiming-cure-cancer-are-cruel-deception">curing cancer</a>, <a href="https://doi.org/10.1001/jamanetworkopen.2022.26040">improving immune health</a>, <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-action-against-17-companies-illegally-selling-products-claiming-treat-alzheimers-disease">improving cognitive functioning</a>, <a href="https://www.fda.gov/consumers/consumer-updates/watch-out-false-promises-some-dietary-supplements">improving fertility</a>, <a href="https://www.health.harvard.edu/staying-healthy/watch-out-for-bogus-supplement-claims">improving cardiovascular health</a> and, of course, <a href="https://dos.ny.gov/news/nys-division-consumer-protection-warns-consumers-health-and-weight-loss-scams">promoting weight loss and weight control</a>. </p>
<h2>The FDA is cracking down</h2>
<p>You can find supplements that claim to be good for just about every health condition, concern or goal, so it should be no surprise that there are supplements marketed for weight loss.</p>
<p>In August 2021, the <a href="https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/questions-and-answers-about-fdas-initiative-against-contaminated-weight-loss-products">FDA cracked down</a> on some of these weight loss products because of the presence of undeclared drugs. For example, of the 72 products recalled, <a href="https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-recommends-against-continued-use-meridia-sibutramine">the drug sibutramine, sold as Meridia</a>, was found in 68 of them. </p>
<p>While the FDA may take further action beyond the recalls, the agency <a href="https://www.fda.gov/drugs/frequently-asked-questions-popular-topics/questions-and-answers-about-fdas-initiative-against-contaminated-weight-loss-products">acknowledged that it is not able to test</a> every weight loss supplement for contamination with drugs.</p>
<p>These crackdowns demonstrate some progress, though several issues remain. Warning label placement, ingredients and beliefs based on misleading or false advertising <a href="https://doi.org/10.1016/j.foodcont.2023.109673">are still highly problematic</a>. </p>
<p>Some weight loss supplements may have FDA warnings on them. Of those that do, <a href="https://doi.org/10.1016/j.pmedr.2021.101504">the disclaimers are rarely displayed</a> on the front of the product label, so consumers are less likely to see them.</p>
<p>Ingredients in weight loss supplements can and do have adverse effects. They have caused people to be <a href="https://doi.org/10.1056/NEJMsa1504267">admitted to the emergency room</a> for cardiovascular and swallowing problems, including in young, seemingly healthy people. </p>
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<figcaption><span class="caption">Dangers may lurk within the ingredients of some dietary supplements.</span></figcaption>
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<h2>Eating disorders</h2>
<p>Mental health concerns and <a href="https://theconversation.com/eating-disorders-among-teens-have-more-than-doubled-during-the-covid-19-pandemic-heres-what-to-watch-for-201067">eating disorders are on the rise</a>. As a result, researchers are examining unhealthy weight control behaviors, including the use of dietary supplements and how accessible they are to adolescents and children.</p>
<p>People who have eating disorders often suffer related health issues such as <a href="https://eatingdisordersreview.com/bone-loss-in-anorexia-nervosa-mechanisms-and-treatment-options/">bone loss, osteoporosis</a> and vitamin deficiencies. In response, their doctors may prescribe dietary supplements like <a href="https://doi.org/10.1097/YCO.0000000000000653">calcium, vitamin D</a> and <a href="http://dx.doi.org/10.1007/978-3-642-45378-6_23">nutritional supplement shakes</a>. But these are not the dietary supplements of concern.</p>
<p>The concern is with supplements that promote weight loss, muscle building or both.</p>
<p>People with eating disorders may be attracted to dietary supplements that claim quick and pain-free weight loss or muscle gain. Additionally, dietary supplement users may struggle with an increase in <a href="https://doi.org/10.1080/10640266.2020.1712637">compulsive exercise</a> or <a href="https://doi.org/10.1016/j.jaac.2018.09.437">other unhealthy weight control behaviors</a>.</p>
<p>Diet pill and supplement use has also been associated with increased risk for <a href="https://doi.org/10.2105/AJPH.2019.305390">developing eating disorders and disordered eating</a>, as well as low self-esteem, depression and <a href="https://doi.org/10.1002/eat.20520">substance use</a>. While dietary supplements do not solely cause eating disorders or disordered eating, <a href="https://doi.org/10.1007/s40519-022-01364-z">they are one contributing factor</a> that may be addressed with preventive measures and regulations.</p>
<h2>The allure of protein powders and fitness supplements</h2>
<p>Protein powders and other fitness supplements also have wide appeal. Research shows that <a href="https://www.statnews.com/2024/01/10/weight-loss-products-adolescents/">girls are more at risk than boys</a> for using weight loss supplements. But a growing problem in boys is <a href="https://doi.org/10.1542/pir.2021-005452">the use of fitness supplements</a> such as protein powder and <a href="https://www.webmd.com/vitamins-and-supplements/creatine">creatine products</a>, a compound that supplies energy to the muscles.</p>
<p>Use of fitness supplements <a href="https://doi.org/10.1016/j.jadohealth.2019.03.005">sometimes signifies a preoccupation</a> with body shape and size. For example, a 2022 study found that protein powder consumption in adolescence was associated with <a href="https://doi.org/10.1016/j.pmedr.2022.101778">future use of steroids in emerging adulthood</a>.</p>
<p>Protein powders make claims of building lean muscles, while creatine boasts providing energy for short-term, intense exercise.</p>
<p>Protein itself is not <a href="https://ods.od.nih.gov/factsheets/ExerciseAndAthleticPerformance-HealthProfessional/">harmful at recommended doses</a>. However, protein powders may contain unknown ingredients, such as <a href="https://www.health.harvard.edu/staying-healthy/the-hidden-dangers-of-protein-powders">certain toxins or extra and excessive sugar</a>. They can also be <a href="https://www.healthline.com/health/childrens-health/protein-powder-for-kids#safety">dangerous when used in excess</a> and to replace other foods that possess vital nutrients. </p>
<p>And while creatine can usually be safely used in adults, overuse can <a href="https://www.verywellhealth.com/creatine-uses-side-effects-and-more-7556683">lead to health problems</a> and is <a href="https://www.npr.org/sections/health-shots/2017/01/02/507478762/is-the-warning-that-creatines-not-for-teens-getting-through">not recommended for minors</a>. Ultimately, the impact of <a href="https://www.nytimes.com/2020/05/21/well/family/teenage-boys-supplements-protein-creatine.html">long-term use of these supplements</a>, especially in adolescents, is unstudied.</p>
<h2>Possible solutions</h2>
<p>One proposed regulation by <a href="https://www.hsph.harvard.edu/striped/">researchers at Harvard University</a> includes <a href="https://doi.org/10.1017/amj.2022.12">taxing dietary supplements</a> whose labels tout weight loss benefits. </p>
<p><a href="https://www.hsph.harvard.edu/striped/out-of-kids-hands/">Another policy recommendation</a> involves banning the sale of dietary supplements and other weight loss products to protect minors from these underregulated and potentially dangerous products. </p>
<p>In 2023, <a href="https://www.hsph.harvard.edu/news/features/new-york-diet-supplements-ban/">New York successfully passed legislation</a> that banned the sale of these products to minors, <a href="https://www.goodmorningamerica.com/wellness/story/bills-seek-ban-sale-diet-pills-children-parents-89945169">while states</a> including Colorado, California and Massachusetts have considered or are considering similar action. </p>
<p>Ultimately, medical professionals recommend that parents and caregivers encourage their children to <a href="https://www.nytimes.com/2020/05/21/well/family/teenage-boys-supplements-protein-creatine.html">get protein and vitamins from whole foods</a> instead of turning to supplements and powders. They also recommend encouraging teens to focus on balanced nutrition, sleep and recovery, and a variety of resistance, strength and conditioning training.</p><img src="https://counter.theconversation.com/content/220536/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although most Americans believe dietary supplements are safe, these products often make health claims that are unproven or downright false.Emily Hemendinger, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical CampusKatie Suleta, PhD Candidate in Medicine and Health, George Washington UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2226052024-02-05T19:09:57Z2024-02-05T19:09:57ZNo more BMI, diets or ‘bad’ foods: why changing how we teach kids about weight and nutrition is long overdue<figure><img src="https://images.theconversation.com/files/573335/original/file-20240205-15-7h4xks.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6803%2C4419&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/education-question-group-children-classroom-raise-2337136275">PeopleImages.com - Yuri A/Shutterstock</a></span></figcaption></figure><p>How many of us recall having to calculate our body-mass index (BMI) as children at school, prompting comparisons of our weight with that of our peers? Or perhaps we remember references to calories and diets in the classroom.</p>
<p>Now, the <a href="https://v9.australiancurriculum.edu.au/teacher-resources/understand-this-curriculum-connection/food-and-wellbeing">Australian curriculum</a> is changing how children and young people are educated about their bodies and what they eat, in a bid to prevent eating disorders. </p>
<p>Hundreds of references to terms including BMI, weight, calories and diets have been <a href="https://www.theage.com.au/national/diets-bmi-and-bad-foods-axed-eating-disorders-prompt-curriculum-overhaul-20240131-p5f1bp.html">removed from school resources</a> by the Australian Curriculum, Assessment and Reporting Authority, replaced with terminology such as “balanced nutrition”.</p>
<p>As a clinical psychologist specialising in the treatment of children and young people with <a href="https://www.australianacademicpress.com.au/books/details/352/Eating_Disorders_A_Practitioners_Guide_to_Psychological_Care">body image and eating disorders</a>, I welcome these changes. Given what we know about the links between weight stigma and the development of eating disorders, they’re long overdue.</p>
<h2>Weight stigma starts early</h2>
<p><a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/weight-stigma">Weight stigma</a> and <a href="https://butterfly.org.au/diet-culture-101/">diet culture</a> are rife in our society. </p>
<p>People will often use words such as “fat” and “guilt” to cast shame over their own or others’ body size and food choices. On the flip side, the latest diets and other weight loss techniques are regularly hot topics of conversation among friends and colleagues.</p>
<p>Evidence shows this sort of talk around children and young people can be <a href="https://pubmed.ncbi.nlm.nih.gov/33079337/">very damaging</a>, in some cases contributing to the development of disordered eating. So in the school environment we need to be especially mindful of the language we use around people’s bodies and food.</p>
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Read more:
<a href="https://theconversation.com/these-3-factors-predict-a-childs-chance-of-obesity-in-adolescence-and-no-its-not-just-their-weight-124994">These 3 factors predict a child's chance of obesity in adolescence (and no, it's not just their weight)</a>
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<p>Children learn about their bodies and nutrition when they start school, and this can be where a lot of misinformation (such as being fearful of certain foods because they’re deemed to be “bad” for us) and stigma begins. Peer teasing for size, weight and shape is common and <a href="https://www.nationaleatingdisorders.org/risk-factors/">increases the risk</a> of a child or young person developing an eating disorder. </p>
<p>I treat many adults who have severe <a href="https://nedc.com.au/eating-disorders/eating-disorders-explained/disordered-eating-and-dieting">eating disorders</a> partly as a result of growing up in a society that overvalues thinness, promotes dieting for weight loss, and shames people who are overweight or obese. Much of this appears to have come from the influences of their schooling.</p>
<h2>Fostering positive body image</h2>
<p>We’ve known for a long time that <a href="https://nedc.com.au/eating-disorders/preventing-eating-disorders/prevention-programs">early intervention</a> through educating our children about well-being and positive mental health strategies is important to reduce the incidence of severe mental health conditions. </p>
<p>For <a href="https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-023-00758-3">eating disorders</a> specifically, positive role modelling by adults around how we talk about our own and others’ <a href="https://researchprofiles.canberra.edu.au/en/publications/no-bodys-perfect-a-helpers-guide-to-promoting-positive-body-image">bodies</a> is crucial. </p>
<p>This can include describing people for their interests and qualities rather than their appearance, and teaching children about gratitude and respect towards each other.</p>
<p>Research shows learning about body acceptance and <a href="https://pubmed.ncbi.nlm.nih.gov/35878528/">appreciation</a> is important for both males and females in developing a positive body image. Those children and young people who have a positive relationship with their bodies and food are much less likely to develop <a href="https://nedc.com.au/assets/NEDC-Resources/NEDC-Resource-Schools.pdf">eating disorders</a>. </p>
<p>Teachers have an important role in educating our children about body respect and having a healthy relationship with their bodies and eating.</p>
<p>This can be achieved through actions including avoiding comments about <a href="https://edfa.org.au/eating-disorders/how-to-prevent-eating-disorders/">people’s appearances</a>, talking about food for its function in our bodies, and not attaching moral values (such as “good” or “bad”) to the foods we eat. Indeed, the curriculum overhaul warns teachers <a href="https://www.theage.com.au/national/diets-bmi-and-bad-foods-axed-eating-disorders-prompt-curriculum-overhaul-20240131-p5f1bp.html">against using these descriptors</a>.</p>
<h2>How to talk about food with kids</h2>
<p>Learning about the importance of feeding our bodies and listening to our body’s needs is important for children.</p>
<p>We need to talk about food for its function in our bodies (such as carbohydrates for energy and fats for our brain). We should talk about foods we eat to help us concentrate and fuel our bodies as well as making us strong and helping us feel well. </p>
<p>The curriculum changes appear to be designed to connect nutrition to physical and mental health in these ways.</p>
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Read more:
<a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">Using BMI to measure your health is nonsense. Here's why</a>
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<p>Food should also be presented as an enjoyable and a social activity (for example, sharing food with others).</p>
<p>Everyone’s appetite is different at different times and that’s OK. Helping children understand how to respond to their appetite and knowing when they’re hungry and full is important, as we know this helps with issues such as restrictive and binge eating, two common <a href="https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders">disordered eating behaviours</a>. </p>
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<img alt="A young girl eats vegetables." src="https://images.theconversation.com/files/573344/original/file-20240205-25-wkdls6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573344/original/file-20240205-25-wkdls6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573344/original/file-20240205-25-wkdls6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573344/original/file-20240205-25-wkdls6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573344/original/file-20240205-25-wkdls6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573344/original/file-20240205-25-wkdls6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573344/original/file-20240205-25-wkdls6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The way we talk to kids about food is important from an early age.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-girl-eating-fresh-green-vegetables-1845587296">Maples Images/Shutterstock</a></span>
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<h2>Everyone has a role</h2>
<p>Hopefully we are on the way to saying goodbye to the harm of <a href="https://nedc.com.au/eating-disorders/eating-disorders-explained/weight-stigma">weight stigma</a> and diet talk in schools. </p>
<p>The biggest challenge is that we live in an appearance-obsessed world with a diet culture and many people have a fixed way of thinking about food and bodies that’s hard to shift. As adults we have to work really hard to be better role models. </p>
<p>While teachers play a crucial role, children also need other adults to go to who make them feel understood and accepted. Being a positive role model means listening to children’s concerns, and being be mindful of the way you talk about yours and others’ <a href="https://www.australianacademicpress.com.au/books/details/219/Positive_Bodies_Loving_the_Skin_Youre_In">bodies</a>, as well as the sort of language you use around eating and food.</p><img src="https://counter.theconversation.com/content/222605/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Vivienne Lewis works for the University of Canberra and runs her own Clinical Psychology practice. </span></em></p>A clinical psychologist who treats young people with eating disorders gives her verdict on changes to the Australian curriculum designed to prevent these mental health conditions developing.Vivienne Lewis, Assistant professor – Psychology, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2215142024-02-01T21:21:20Z2024-02-01T21:21:20ZHow dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders<figure><img src="https://images.theconversation.com/files/572540/original/file-20240131-15-o0m6p8.jpg?ixlib=rb-1.1.0&rect=147%2C78%2C6271%2C4030&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Although semaglutide drugs like Ozempic are indicated to treat Type 2 diabetes, they are increasingly prescribed off-label because of their observed effectiveness at inducing weight loss.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-dieting-weight-suppression-and-even-misuse-of-drugs-like-ozempic-can-contribute-to-eating-disorders" width="100%" height="400"></iframe>
<p>Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or <a href="https://doi.org/10.1016/j.eatbeh.2014.04.010">body image</a>, according to a U.S. study. Globally, millions of people <a href="https://doi.org/10.1111%2Fobr.12466">attempt to lose weight</a> every year with the hope that weight loss will have positive effects on their body image, health and quality of life. </p>
<p>However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101298">Ozempic</a> or <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101765">Wegovy</a>, <a href="https://www.cbc.ca/news/health/ozempic-weight-loss-1.6772021">might be viewed as an appealing “quick fix”</a> alternative to meet weight loss goals. </p>
<p>Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of <a href="https://osf.io/9stq2">developing an eating disorder</a>.</p>
<h2>Weight loss and eating disorders</h2>
<p>Eating disorders are <a href="https://doi.org/10.1002/eat.20589">serious mental health conditions</a> primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting. </p>
<p>Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of <a href="https://doi.org/10.1002/erv.2553">any age, sex, gender or racial/ethnic background</a>, with an estimated <a href="https://nedic.ca/general-information/">one million Canadians</a> suffering from an eating disorder at any given time. Feb. 1 to 7 is <a href="https://nedic.ca/edaw/">National Eating Disorders Awareness Week</a>.</p>
<p>As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms.</p>
<h2>Eating disorders and ‘weight suppression’</h2>
<p>In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy). </p>
<p>Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in <a href="https://doi.org/10.1016/j.bodyim.2023.01.011">men</a>. Importantly, being more weight suppressed has been associated with the <a href="https://doi.org/10.1093/ajcn/nqaa146">onset of eating disorders</a>, including anorexia nervosa and bulimia nervosa. </p>
<p><a href="https://doi.org/10.1007/s11920-018-0955-2">One proposed explanation</a> for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that <a href="https://doi.org/10.3945/ajcn.110.010025">reduce metabolic rate and energy expenditure, and increase appetite</a>, are activated to promote weight gain.</p>
<p>There is growing awareness that <a href="https://doi.org/10.1136/bmj.g2646">weight regain is highly likely following conventional diet programs</a>. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa.</p>
<h2>Ozempic and other semaglutide drugs</h2>
<p>Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called <a href="https://pdf.hres.ca/dpd_pm/00067924.PDF">glucagon-like peptide-1 agonists (GLP-1As)</a>. These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake. </p>
<figure class="align-center ">
<img alt="A white plate with a weight scale in it, with knife and fork, against an orange background" src="https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Popular weight-loss methods, whether they involve pills or ‘crash diets,’ often mimic symptoms of eating disorders.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Although GLP-1As are indicated to treat Type 2 diabetes, <a href="https://www.cbc.ca/news/canada/london/ozempic-off-label-1.6884141">they are increasingly prescribed off-label</a> or being <a href="https://www.bbc.com/news/health-67414203">illegally purchased</a> without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may <a href="https://doi.org/10.1001/jama.2021.3224">slow down or stop over time</a>.</p>
<p>Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as <a href="https://doi.org/10.1016/j.physbeh.2019.112565">weight suppression is associated with reduced GLP-1 response</a>. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As. </p>
<p>Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are <a href="https://doi.org/10.1111/dom.14725">likely to regain most, if not all, weight lost</a> when they stop taking the medication.</p>
<h2>Risks of dieting and weight-loss drugs</h2>
<p>The growing market for off-label weight loss drugs is concerning, because of the exacerbation of <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">weight stigma</a> and the serious <a href="https://doi.org/10.1016/j.jand.2022.01.004">health risks</a> associated with unsupervised weight loss, including developing eating disorders. </p>
<p>Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible <a href="https://doi.org/10.1017/cts.2023.612">impact on growth and development</a>.</p>
<p>Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and <a href="https://doi.org/10.1016/j.eatbeh.2022.101681">increase the risk of developing binge eating problems</a>. </p>
<p>The use of diet pills or laxatives to lose weight has been found to increase the risk of <a href="https://doi.org/10.2105/AJPH.2019.305390">being diagnosed with an eating disorder in the next one to three years</a>. Drugs like Ozempic may also be <a href="https://doi.org/10.1002/eat.24109">misused by individuals already struggling with an eating disorder</a> to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain. </p>
<p>Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, <a href="https://doi.org/10.1002/eat.24116">even if they only lose a moderate amount of weight</a>.</p>
<p>People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.</p><img src="https://counter.theconversation.com/content/221514/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samantha Withnell receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Lindsay Bodell receives (or has previously received) funding from the Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Brain Canada Foundation, and Banting Research Foundation. </span></em></p>The demand for off-label weight loss drugs like Ozempic is concerning, because of the impact on weight stigma and the health risks of unsupervised weight loss, including developing eating disorders.Samantha Withnell, PhD Candidate, Clinical Psychology, Western UniversityLindsay Bodell, Assistant Professor of Psychology, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2180792024-01-31T13:35:29Z2024-01-31T13:35:29ZEating disorders are the most lethal mental health conditions – reconnecting with internal body sensations can help reduce self-harm<figure><img src="https://images.theconversation.com/files/572227/original/file-20240130-29-zz41uv.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An increased disconnect from your body can make it easier to harm yourself, whether by disordered eating or suicide.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/high-angle-view-of-worried-woman-sitting-on-bed-royalty-free-image/1252672806">Maskot/Maskot via Getty Images</a></span></figcaption></figure><p>Did you know that anorexia is the <a href="https://doi.org/10.1002/wps.20904">most lethal mental health condition</a>? One person dies from an eating disorder <a href="https://uncexchanges.org/2020/09/07/every-52-minutes-new-report-released-on-the-social-and-economic-costs-of-eating-disorders-in-the-united-states/">every hour</a> in the U.S. Many of these deaths are not from health consequences related to starvation, but from suicide.</p>
<p>Up to <a href="https://doi.org/10.1001/jamanetworkopen.2019.12925">1 in 5 women and 1 in 7 men</a> in the U.S. will develop an eating disorder by age 40, and <a href="https://doi.org/10.1080/10640266.2023.2196492">1 in 2 people</a> with an eating disorder will think about ending their life. About 1 in 4 people with <a href="https://www.nimh.nih.gov/health/topics/eating-disorders">anorexia nervosa or bulimia nervosa</a> will attempt to kill themselves, and those with anorexia have a risk of death by suicide <a href="https://doi.org/10.1111/j.1600-0447.2010.01641.x">31 times higher</a> than peers without the disorder.</p>
<p>In fact, nonsuicidal self-injury, suicidal ideation, suicide attempts and suicide deaths are <a href="https://doi.org/10.1080/10640266.2023.2196492">all more prevalent</a> among those with any type of eating disorder compared to those without an eating disorder. </p>
<p>Why might that be?</p>
<p>I am a <a href="https://scholar.google.com/citations?user=YZdGYOIAAAAJ&hl=en">clinical psychologist</a> who studies eating disorders and self-harm, and I have spent the past 15 years researching this question. We still don’t have the answer. But new work on perception of the internal state of the body points to some promising possibilities for treatment. And what we’re learning could help anyone improve their relationship with their body.</p>
<h2>Eating disorders and interoception</h2>
<p>To understand why people with eating disorders are at risk of dying by suicide, I first want to ask you to do a little thought exercise. </p>
<p>I’d like you to really think about your body: Think about your hair, face, arms, stomach, chest and legs. What words and feelings come to mind? Are there any things you wish you could change? Feel free to close your eyes and try this out.</p>
<p>I’m guessing as you did this thought exercise, you probably weren’t thinking, “Every part of my body is amazing. Five stars, wouldn’t change a thing!” In fact, many people tend to have pretty <a href="https://theconversation.com/body-image-issues-are-rising-in-men-research-suggests-techniques-to-improve-it-219451">negative and</a> <a href="https://doi.org/10.1002/erv.2201">highly critical thoughts</a> about their bodies.</p>
<p>Here’s another question for you: What do you do with things you don’t like? For instance, what do you do when you encounter someone you dislike, a food you can’t stand or an overwhelming list of chores? Do you care for or accept them? Probably not. Most people tend to avoid, despise or criticize the things they don’t like. This allows them to separate and disconnect themselves from these loathed things.</p>
<p>But when you think negatively about and try to avoid your body, you end up <a href="https://doi.org/10.1016/j.neubiorev.2017.03.017">disconnecting from it</a> and losing the ability to understand what’s going on inside your body. You start to see it not as your body but as an object.</p>
<p>That ability to recognize, interpret and respond to internal signals in your body actually has a name: <a href="https://theconversation.com/interoception-the-sixth-sense-we-use-to-read-hidden-signals-from-our-body-podcast-220863">interoception</a>, also known as the sixth sense. It refers to your ability to recognize, interpret and respond to a variety of bodily sensations, such as emotions, hunger and fullness, temperature and pain. </p>
<p>Interoception can be divided into various components, and <a href="https://doi.org/10.1111/j.1469-8986.1981.tb02486.x">interoceptive accuracy</a>, or how accurately you notice various internal sensations, can be <a href="https://doi.org/10.1016/j.biopsycho.2014.11.004">measured in various ways</a>. These include psychophysiological measures like a heartbeat perception test, which compares a person’s perceived number of heartbeats without taking their pulse to their actual number of heartbeats over a period of time. People with greater discrepancies between their perceived and actual heartbeat counts are thought to be worse at sensing cardiac sensations and thus have worse interoception.</p>
<h2>Interoception and health</h2>
<p><a href="https://www.redslab.org/">My research</a> over the past decade has found that the worse your interoception is, the more disconnected you are from your body and the less aware you are of what’s going on inside it. And the more disconnected you are from your body, the easier it becomes to harm yourself, whether that be through an eating disorder or suicidal behaviors. </p>
<p>Interoception is crucial to understanding and caring for your body. For instance, you need to be able to perceive hunger and fullness in order to properly nourish yourself. If you were unable to perceive pain, you might end up hurting yourself. And you need to be able to understand the emotions you’re feeling in order to respond adaptively to different situations. </p>
<p>Research suggests that interoception is integrally related to mental and physical health, and impaired interoception is considered a <a href="https://doi.org/10.1016/j.bpsc.2017.12.004">risk factor</a> for <a href="https://doi.org/10.1146/annurev-clinpsy-050718-095617">various mental disorders</a>. For example, if you are unable to sense when you’re hungry or full, that could lead to restrictive or binge eating. Conversely, if you are hyperaware of your internal sensations, such as your heart rate and breathing, that could lead to panic disorder symptoms.</p>
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<p>As you lose connection with your body, it becomes easier to harm your body as an object you’ve grown to loathe. Research from my team has found that people who have <a href="https://doi.org/10.1037/abn0000074">attempted suicide</a> have worse interoception than people who haven’t, and people who have <a href="https://doi.org/10.1080/10640266.2018.1418243">attempted suicide multiple times</a> have worse interoception than those who have only attempted suicide once. People with <a href="https://doi.org/10.1111/sltb.12603">more recent</a> <a href="https://doi.org/10.1016/j.psychres.2021.114210">and lethal</a> suicide attempts have worse interoception than those with more distant or less lethal attempts.</p>
<p><a href="https://doi.org/10.1111/sltb.12603">Impairment in interocepton</a> is more strongly associated with suicidal ideation and suicide attempts than other risk factors like hopelessness, gender and post-traumatic stress.</p>
<h2>Reconnecting with the body</h2>
<p>But many people weren’t always this disconnected from their bodies.</p>
<p>I have two young kids who are learning what their bodies can do and are finding their bodies more and more amazing. My 7-year-old son and his friends are delighted when they do gymnastics, standing on one foot or walking across a balance beam. And my daughter, almost 3 now, loves her round tummy: She proudly sticks it out and plays it like a drum. <a href="https://doi.org/10.1016%2Fj.bodyim.2012.09.001">Young kids haven’t yet learned</a> to talk to their bodies in the harsh way many teens and adults do. They haven’t begun to disconnect from their inner senses.</p>
<p>To reduce self-harm, I encourage you to try to regain a sense of connection and care for not only your body but also the bodies of those you love. This isn’t easy, but researchers are studying multiple ways to improve interoception. </p>
<p>For instance, my team has developed a training program to improve interoception called <a href="https://doi.org/10.1111/sltb.12994">Reconnecting to Internal Sensations and Experiences</a>, or RISE. First, we educate participants about interoception and the importance of cultivating awareness of internal sensations for improved mental and physical health. </p>
<p>Then we teach them to bring attention to their muscles through <a href="https://www.healthline.com/health/progressive-muscle-relaxation">progressive muscle relaxation</a> techniques and to <a href="https://theconversation.com/do-you-eat-with-your-eyes-your-gut-or-your-brain-a-neuroscientist-explains-how-to-listen-to-your-hunger-during-the-holidays-217990">hunger and fullness cues</a> through mindful and intuitive eating.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person lying on back with eyes closed" src="https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572239/original/file-20240130-19-zfxw2p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Relaxing the body can help bring attention to sensation from the muscles.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/power-nap-is-just-what-i-need-royalty-free-image/1187591660">Delmaine Donson/E+ via Getty Images</a></span>
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</figure>
<p>After that, we introduce participants to the concept of <a href="https://theconversation.com/8-ways-to-manage-body-image-anxiety-after-lockdown-162224">body functionality</a> by asking them to think of what their bodies can do rather than evaluating their bodies on appearance. For instance, rather than thinking, “I’m getting fat” or “I’m too old” or “I’m too slow,” they can think, “My legs helped get me out of bed today” or “My arms allow me to hug those I love” or “This scar demonstrates my body’s ability to heal.” This is important because body image is <a href="https://doi.org/10.1016/j.bodyim.2019.10.004">linked to multiple aspects</a> of interoceptive awareness.</p>
<p>Finally, we teach participants about recognizing their emotions and changing their behaviors. <a href="https://doi.org/10.1111/j.1467-6494.2011.00717.x">Emotional awareness</a> is a core component of interoception, so we ask participants to think about where they feel those emotions in their body, how they can distinguish between certain emotions, and how they can more effectively respond to stress. </p>
<p><a href="https://www.sapiens.org/culture/kichwa-body-positivity/">Consumer culture</a> doesn’t tend to promote listening to your body, so relearning how to do this may take time and dedicated practice. But I believe the rewards can be literally lifesaving.</p><img src="https://counter.theconversation.com/content/218079/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>April Smith receives funding from the Department of Defense and the National Institute of Health. </span></em></p>Many people with eating disorders die from suicide. Improving perception of internal body states, or interoception, can help everyone better care for their own bodies.April Smith, Associate Professor of Psychological Sciences, Auburn UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2179902023-12-20T13:17:01Z2023-12-20T13:17:01ZDo you eat with your eyes, your gut or your brain? A neuroscientist explains how to listen to your hunger during the holidays<figure><img src="https://images.theconversation.com/files/566694/original/file-20231219-19-9np3p9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2119%2C1414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The particular stressors of the holiday season can make it difficult to listen to your body.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cropped-closeup-photo-of-young-woman-in-red-and-royalty-free-image/1346694165">InspirationGP/iStock via Getty Images</a></span></figcaption></figure><p>The holiday season is upon us, and with it, opportunities to indulge in festive treats. The proverbial saying “you eat with your eyes first” seems particularly relevant at this time of year. </p>
<p>The science behind eating behavior, however, reveals that the process of deciding what, when and how much to eat is far more complex than just consuming calories when your body needs fuel. Hunger cues are only part of why people choose to eat. As a scientist interested in the <a href="https://scholar.google.com/citations?user=F31UkfUAAAAJ&hl=en">psychology and biology that drives eating behavior</a>, I’m fascinated with how the brain’s experiences with food shape eating decisions. </p>
<p>So how do people decide when to eat? </p>
<h2>Eating with your eyes</h2>
<p><a href="https://doi.org/10.1016/j.bandc.2015.08.006">Food-related visual cues</a> can shape feeding behaviors in both people and animals. For example, wrapping food in McDonald’s packaging is sufficient to <a href="https://doi.org/10.1001/archpedi.161.8.792">enhance taste preferences</a> across a range of foods – from chicken nuggets to carrots – in young children. Visual food-related cues, such as presenting a light when food is delivered, can also promote <a href="https://doi.org/10.1126/science.6836286">overeating behaviors</a> in animals by overriding energy needs.</p>
<p>In fact, a whole host of sensory stimuli – noises, smells and textures – can be associated with the <a href="https://doi.org/10.1016/j.tins.2013.01.002">pleasurable consequences of eating</a> and influence food-related decisions. This is why hearing a catchy radio jingle for a food brand, seeing a television ad for a restaurant or walking by your favorite eatery can shape your decision to consume and sometimes overindulge.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566695/original/file-20231219-23-bbv1i7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of person holding plate of gingerbread cookies" src="https://images.theconversation.com/files/566695/original/file-20231219-23-bbv1i7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566695/original/file-20231219-23-bbv1i7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566695/original/file-20231219-23-bbv1i7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566695/original/file-20231219-23-bbv1i7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566695/original/file-20231219-23-bbv1i7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566695/original/file-20231219-23-bbv1i7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566695/original/file-20231219-23-bbv1i7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Your senses feast on food as much as your stomach does.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mixed-race-female-holds-plate-of-gingerbread-royalty-free-image/1360401442">Catherine McQueen/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>However, your capacity to learn about food-related cues extends beyond just stimuli from the outside world and includes the <a href="https://doi.org/10.1146/annurev-psych-122216-011643">internal milieu of your body</a>. In other words, you also tend to eat with your stomach in mind, and you do so by using the same learning and brain mechanisms involved in processing food-related stimuli from the outside world. These internal signals, also called <a href="https://doi.org/10.3389/frym.2021.558246">interoceptive cues</a>, include feelings of hunger and fullness emanating from your gastrointestinal tract.</p>
<p>It’s no surprise that the signals from your gut help set the stage for when to eat, but the role these signals play is more profound than you might expect.</p>
<h2>Trust your gut</h2>
<p>Feelings of hunger or fullness act as important interoceptive cues influencing your decision-making around food. </p>
<p>To examine how interoceptive states shape eating behaviors, researchers trained laboratory rats to <a href="https://doi.org/10.1016/j.peptides.2005.02.014">associate feelings of hunger or satiety</a> with whether they receive food or not. They did this by giving rats food only when they were hungry or full, such that the rats were forced to recognize those internal cues to calculate whether food would be available or not. If a rat is trained to expect food only when hungry, it would generally avoid the area where food is available when it feels full because it does not expect to be fed.</p>
<p>However, when rats were injected with a hormone that <a href="https://doi.org/10.2337/diabetes.50.8.1714">triggers hunger</a> <a href="https://doi.org/10.1152/physrev.00012.2004">called ghrelin</a>, they approached the food delivery location more frequently. This suggests that the rats used this artificial state of hunger as an interoceptive cue to predict food delivery and subsequently behaved like they expected food.</p>
<p>Interoceptive states are sufficient to shape feeding behaviors even in the absence of external sensory cues. One particularly striking example comes from mice that have been genetically engineered to be unable to taste food but nevertheless show preferences for specific foods <a href="https://doi.org/10.1016/j.neuron.2008.01.032">solely by caloric content</a>. In other words, rodents can use internal cues to shape their food-related decision-making, including when and where to eat and which foods they prefer.</p>
<p>These findings also suggest that feelings of hunger and the detection of nutrients is not restricted to the stomach. They also involve areas of the brain important for regulation and homeostasis, such as the <a href="https://doi.org/10.1016/j.cub.2021.06.048">lateral hypothalamus</a>, as well as centers of the brain involved in learning and memory, such as the <a href="https://doi.org/10.1016/j.biopsych.2019.10.012">hippocampus</a>.</p>
<h2>What happens in vagus</h2>
<p>The <a href="https://doi.org/10.1038/nrn3071">gut-brain axis</a>, or the biochemical connection between your gut and your brain, shapes feeding behaviors in many ways. One of them involves the <a href="https://www.ncbi.nlm.nih.gov/books/NBK537171/">vagus nerve</a>, a cranial nerve that helps control the digestive tract, among other things. </p>
<p>The vagus nerve rapidly <a href="https://doi.org/10.1126/science.aat5236">communicates nutrient information</a> to the brain. Activating the vagus nerve can induce a pleasurable state, such that mice will voluntarily perform a behavior, such as poking their nose through an open port, to stimulate their vagus nerve. Importantly, mice also learn to <a href="https://doi.org/10.1016/j.cell.2018.08.049">prefer foods and places</a> where vagal nerve stimulation occurred.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/3Vy6vl8RZrw?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Your gut and brain are intimately connected.</span></figcaption>
</figure>
<p>The vagus nerve plays an essential role in not only communicating digestive signals but also an array of other interoceptive signals that can affect how you feel and behave. In people, vagal nerve stimulation can <a href="https://doi.org/10.1097/01.wnn.0000213908.34278.7d">improve learning and memory</a> and can be used to <a href="https://doi.org/10.1007/s13311-017-0537-8">treat major depression</a>.</p>
<h2>Benefits of interoceptive awareness</h2>
<p>Your body’s capacity to use both external and internal cues to regulate how you learn and make decisions about food highlights the impressive processes involved in how you regulate your energy needs.</p>
<p>Poor interoceptive awareness is associated with a range of <a href="https://doi.org/10.1027/2512-8442/a000062">dysfunctional feeding behaviors</a>, such as eating disorders. For instance, <a href="https://doi.org/10.3389/fnut.2017.00032">anorexia may result</a> when interoceptive signals, such as feelings of hunger, are unable to trigger the motivation to eat. Alternatively, the inability to use the feeling of fullness to dampen the rewarding and pleasurable consequences of eating palatable food could <a href="https://doi.org/10.1016/j.neubiorev.2019.08.020">result in binge eating</a>. </p>
<p>Your interoceptive signals play an important role in regulating your daily eating patterns. During the holidays, many stressors from the outside world surround eating, such as packed social calendars, pressures to conform and feelings of guilt when overindulging. At this time, it is particularly important to cultivate a strong connection to your interoceptive signals. This can help promote <a href="https://theconversation.com/intuitive-eating-a-diet-that-actually-makes-sense-112800">intuitive eating</a> and a more holistic approach to your dietary habits. Rather than fixating on external factors and placing conditions on your eating behavior, enjoy the moment, deliberately savor each bite and provide time for your interoceptive signals to function in the role they are designed to play. </p>
<p>Your brain evolved to sense your current energy needs. By <a href="https://doi.org/10.1016/j.physbeh.2011.06.004">integrating these signals</a> with your experience of your food environment, you can both optimize your energetic needs and enjoy the season.</p><img src="https://counter.theconversation.com/content/217990/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexander Johnson receives funding from the National Institute of Health</span></em></p>You likely know that the sight and smell of food can trigger cravings. But internal cues from your gut and your brain play just as important a role in the decisions you make around food.Alex Johnson, Associate Professor of Behavioral Neuroscience, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168002023-11-27T16:39:57Z2023-11-27T16:39:57ZPsilocybin shows promise for treating eating disorders, but more controlled research is needed<figure><img src="https://images.theconversation.com/files/560977/original/file-20231122-15-kimes4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5760%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Psilocybin is showing promise for treating mental disorders, but cautious optimism is required while researching safe doses.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/psilocybin-shows-promise-for-treating-eating-disorders-but-more-controlled-research-is-needed" width="100%" height="400"></iframe>
<p>Psychedelic research has surged in recent years, sparking enthusiasm among clinicians, investors and the general public. Clinical trials are indicating transformative outcomes for people struggling with <a href="https://doi.org/10.3389/fpsyt.2021.800072">mental illnesses</a> like depression, post-traumatic stress disorder and end-of-life anxiety. </p>
<p>Recently, the spotlight is turning to eating disorders (ED), a group of severe and difficult-to-treat conditions. A survey revealed that <a href="https://doi.org/10.31083/j.jin2003059">70 per cent of people view psychedelic medicine as a promising avenue for EDs</a>, and numerous reports depict positive results. </p>
<p>Media platforms abound with compelling personal stories, from online articles to Netflix documentaries, Reddit threads, TikTok videos and YouTube clips. But the critical question remains: does the scientific evidence align with the hype?</p>
<p>As a doctoral student in the field of neuropsychiatry with a personal interest in EDs, I delved into the literature to assess the evidence for <a href="https://doi.org/10.47626/2237-6089-2022-0597">psilocybin-assisted therapy in ED treatment</a>.</p>
<h2>Long-term management of EDs</h2>
<p>EDs have the highest mortality rate among psychiatric disorders and their <a href="https://doi.org/10.1016/j.jadohealth.2021.07.014">prevalence</a> is on the rise. Treatment usually involves a combination of medication and therapy, but avoidance, drop-out and <a href="https://doi.org/10.1186/1471-244X-13-282">resistance</a> are all too frequent. Many patients go untreated or endure symptoms for life. Overall, we lack treatment options that yield long-term improvements.</p>
<p>While the causes of EDs are diverse, patients often exhibit alterations in brain connectivity and serotonin signalling. <a href="https://doi.org/10.3389/fnins.2020.00043">These changes</a> affect regions involved in body image, mood, appetite and reward, resulting in “<a href="https://doi.org/10.1007/s40519-016-0331-3">cognitive inflexibility</a>.” </p>
<p>This manifests as rigid thought patterns like religious calorie counting, restrained emotions and punishing exercise regimens, among other ED behaviours. Cognitive inflexibility may also be the culprit for treatment resistance itself. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/560978/original/file-20231122-27-kw6xzp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a woman in a red bathing suit with a black bob haircut seen through a distorted lens" src="https://images.theconversation.com/files/560978/original/file-20231122-27-kw6xzp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560978/original/file-20231122-27-kw6xzp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560978/original/file-20231122-27-kw6xzp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560978/original/file-20231122-27-kw6xzp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560978/original/file-20231122-27-kw6xzp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560978/original/file-20231122-27-kw6xzp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560978/original/file-20231122-27-kw6xzp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Body dysmorphia and eating disorders can require long-term treatment and care.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Underlying mechanisms</h2>
<p>It seems that standard treatments do not address the full range of mechanisms underlying EDs. Unlike conventional talk therapy led by therapists, psilocybin therapy uses the psychedelic experience to alter brain activity and foster cognitive flexibility.</p>
<p>Psilocybin, a naturally occurring plant alkaloid found in the Psilocybe genus of mushrooms, was first introduced to western medicine by <a href="https://doi.org/10.1038/s41429-020-0311-8">Indigenous communities</a> in the 1950s. It increases serotonin signalling while reducing the activity of brain networks linked to rigid thinking patterns. These changes are thought to enhance body image, reward processing and relax beliefs, ultimately <a href="https://doi.org/10.1111/acps.13249">catalyzing the therapeutic process</a>. But does clinical evidence support this? Well, somewhat. </p>
<p>A <a href="https://doi.org/10.1016/j.amp.2021.08.004">case study</a> described a woman with treatment-resistant anorexia nervosa who, after two doses of psilocybin, experienced immediate mood enhancement, increased insight into the root of her symptoms and long-term weight resolution. </p>
<p>Another study found that a single dose of psilocybin was <a href="https://doi.org/10.1038/s41591-023-02455-9">safe and tolerable in women with anorexia nervosa</a>, reducing their body image concerns.</p>
<p>In <a href="https://doi.org/10.1097/00004714-199604000-00011">another report</a>, an individual with body dysmorphia responded well to both fluoxetine and psilocybin treatment, but was treatment-resistant to other medications. </p>
<p>Theoretical evidence suggests a role for psilocybin in treating <a href="https://doi.org/10.1016/j.clinthera.2020.10.014">binge eating</a>, <a href="https://doi.org/10.1007/7854_2021_279">compulsive overeating</a> and <a href="https://doi.org/10.3390/bs11060080">food addiction</a>, while also improving symptoms of depression and trauma. However, despite these exciting prospects, numerous limitations temper the results.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-potential-of-psychedelics-to-heal-our-racial-traumas-218233">The potential of psychedelics to heal our racial traumas</a>
</strong>
</em>
</p>
<hr>
<h2>Challenges with conducting research</h2>
<p>The gold standard of evidence for any intervention is the <a href="https://www.unicef-irc.org/KM/IE/impact_7.php">randomized controlled trial (RCT)</a>, where participants are randomly assigned to an intervention or control group, ideally without knowing which they were assigned. The idea is to reduce the impact of individual differences and expectancy bias to truly see if an intervention is effective or not. </p>
<p>However, for psychedelic RCTs, it can be difficult to properly blind participants — hallucinations are a bit of a dead giveaway. </p>
<p>Many studies feature small sample sizes lacking diversity, which limits real-world applicability. While psilocybin has a good safety profile, participants are highly vulnerable during psychedelic experiences. The experience is often ineffable and different for everyone, making the process of informed consent ethically challenging.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/560979/original/file-20231122-27-u5geo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="someone wearing a labcoat and surgical gloves weighs dried mushrooms" src="https://images.theconversation.com/files/560979/original/file-20231122-27-u5geo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560979/original/file-20231122-27-u5geo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560979/original/file-20231122-27-u5geo5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560979/original/file-20231122-27-u5geo5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560979/original/file-20231122-27-u5geo5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560979/original/file-20231122-27-u5geo5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560979/original/file-20231122-27-u5geo5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Researching psilocybin contains challenges because of the unique difficulties in conducting randomized control trials.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It is also crucial to acknowledge “<a href="https://doi.org/10.1177/02698811221133461">excessive enthusiasm</a>” in the field, where researchers’ and participants’ personal use of psychedelics may introduce bias. Among other limitations, we need to be aware of how this impacts the results portrayed in the media. </p>
<h2>Patient safety</h2>
<p>Over-emphasizing the therapeutic actions of psilocybin or selectively presenting positive results may cause more harm than good. Due to legal restrictions, some patients source psilocybin illegally, without proper safety protocols or medical supervision. While this may reflect a health-care system failure, a proper mindset and environment are vital for a safe and productive session. </p>
<p>The therapeutic actions of psilocybin extend beyond the psychedelic experience; integration with a therapist is key to applying the benefits. Narratives suggesting a single psilocybin experience as a cure-all are dangerous. </p>
<p>Lastly, we need to consider how the financial hype surrounding psilocybin could inflate costs, limiting access to the individuals who need it most. </p>
<p>While excitement about psilocybin-assisted therapy is justified, cautious optimism is essential. We still need to determine the optimal therapeutic framework for EDs and how this can be effectively and ethically provided at large.</p><img src="https://counter.theconversation.com/content/216800/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elena Koning receives funding from the Ontario Graduate Scholarship (OGS) Program. </span></em></p>Can psychedelics assist in recovery from eating disorders? The findings are promising, but patients and doctors need to proceed with caution until there is additional and extensive research.Elena Koning, PhD Student, Centre for Neuroscience Studies, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2174672023-11-16T10:35:15Z2023-11-16T10:35:15ZLord Byron vinegar diet can have a series of harmful health effects<figure><img src="https://images.theconversation.com/files/558799/original/file-20231102-28-1tp153.jpg?ixlib=rb-1.1.0&rect=221%2C115%2C6802%2C4822&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lord Byron on his death bed, by
Joseph Denis Odevaere. </span> <span class="attribution"><a class="source" href="https://es.wikipedia.org/wiki/Lord_Byron#/media/Archivo:Lord_Byron_on_his_Death-bed_c._1826.jpg">Groeningemuseum / Wikimedia Commons</a></span></figcaption></figure><p>Romantic poet <a href="https://es.wikipedia.org/wiki/Lord_Byron">Lord Byron</a> – famed for his rich and expressive portrayal of landscape and human emotions – is considered to be one of the key figures of English literature.</p>
<p>Over the course of his life, however, he suffered from a raft of health problems, ranging from <a href="https://journals.sagepub.com/doi/abs/10.1177/147827159802800109">vertigo, clubfoot and gonhorrea</a> to <a href="https://www.infezmed.it/media/journal/Vol_23_3_2015_16.pdf">malaria</a> and even <a href="https://www.liverpooluniversitypress.co.uk/doi/10.3828/BJ.2003.12">bulimia and anorexia</a>. </p>
<p>The dubious treatment methods of the time were recorded in his writings, including the well known burlesque epic poem <a href="https://ia800301.us.archive.org/27/items/lordbyronsdonjua00byrouoft/lordbyronsdonjua00byrouoft.pdf">Don Juan</a>. Here he mentions the consumption of <a href="https://brill.com/display/book/edcoll/9789004418288/B9789004418288_s002.xml">Epsom salts</a>, which were used as a laxative, or as a muscle relaxer when dissolved in bathwater. They were also combined with other strong diuretics and cathartics to purge the body and induce vomiting.</p>
<h2>Demanding diets</h2>
<p>In his youth, <a href="https://www.liverpooluniversitypress.co.uk/doi/10.3828/bj.2023.7">Byron followed strict diets</a> to avoid the problems suffered by his mother as a consequence of being overweight. At one point, he experimented with consuming only a quarter pound (113g) of meat per day alongside small amounts of wine. </p>
<p>In his later years he turned to vinegar, believing the sour liquid could reduce his appetite. The resulting weight loss was dramatically successful, but it took its toll: dental problems, vomiting and diarrhoea became constant features of his life. He ingested it only with water and rice, as he thought this would enhance its cleansing effects. </p>
<p>As a result of this and other extreme diets, the writer managed to reduce his Body Mass Index (BMI) <a href="https://link.springer.com/chapter/10.1057/9780230611047_7">from 29.7 to 22.1 kg/m² at least twice in his life, in 1806 and in 1822</a>. While in Venice, before his second substantial weight loss, <a href="https://archive.org/details/byronlifelegend0000macc/page/n7/mode/2up">his lawyer reported being troubled by his pale, bloated and sickly appearance</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/555839/original/file-20231025-17-h3m2i1.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/555839/original/file-20231025-17-h3m2i1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555839/original/file-20231025-17-h3m2i1.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=336&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555839/original/file-20231025-17-h3m2i1.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=336&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555839/original/file-20231025-17-h3m2i1.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=336&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555839/original/file-20231025-17-h3m2i1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555839/original/file-20231025-17-h3m2i1.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555839/original/file-20231025-17-h3m2i1.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Lord Byron, on his death bed. Painting by Joseph Dionysius Odevaere (1775-1830).</span>
<span class="attribution"><a class="source" href="https://es.m.wikipedia.org/wiki/Archivo:Lord_Byron_on_his_Death-bed_c._1826.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<h2>Other victims of vinegar</h2>
<p>Byron was not alone in using vinegar for slimming purposes in his time, as various tragic events show. One of the <a href="https://archive.org/details/dissertationsurl00desa">earliest published cases of this</a> involved a French woman called Mademoiselle Lapaneterie in 1773. Worried by her physique and the red colour of her skin, she followed her neighbour’s advice of drinking a small cup of vinegar per day to lose weight and achieve a fairer complexion. </p>
<p>As the doctor Pierre Desault reported, Lapaneterie followed this recommendation for over a month. She saw her weight decrease and her vivid complexion – considered undesirable for women at the time – became paler. However, she soon developed a cough, night sweats, nausea, swollen feet and legs, and diarrhoea, and she eventually died. </p>
<p>A <a href="https://www.gutenberg.org/files/22741/22741-h/22741-h.htm">second case</a> was reported in 1826, two years after Lord Byron’s death. Louise, a young women from Dijon, took to drinking vinegar because “the young people where she lived were making fun of her”. The diet also led her to an early grave. </p>
<p>Despite cases such as these, the commonplace cooking ingredient formed the basis of slimming diets across Europe – especially in France – throughout the 18th century and remained popular until the mid-19th century.</p>
<h2>The serious health effects of drinking vinegar</h2>
<p>In 1998, a group of researchers at the Department of Internal Medicine at the Medical University of Innsbruck (Austria) <a href="https://karger.com/nef/article-abstract/80/2/242/209061">observed that high vinegar consumption can have three main harmful effects</a>:</p>
<ul>
<li><p>Hypocalcaemia: Low levels of calcium in the blood serum, which can cause muscle spasms. </p></li>
<li><p>Hyperreninaemia: Excessive levels of renin (a hormone produced by the kidneys) in the blood. The body’s homeostatic response to this results in high blood pressure and kidney failure.</p></li>
<li><p>Osteoporosis: A condition that weakens bones, making them brittle and more prone to break or fracture.</p></li>
</ul>
<h2>The effects of vinegar on teeth</h2>
<p>In 2012, a <a href="https://pubmed.ncbi.nlm.nih.gov/23373303/">clinical report</a> was published of a 15 year old girl who was suffering from eroded teeth caused by drinking a glass of cider vinegar each day. Curiously, <a href="https://www.jstor.org/stable/48604053">Byron was also troubled by his teeth</a>. He chewed and smoked tobacco in the belief that it would preserve his dental health and, in later years, to stave off hunger. At the end of his life, he still had some white teeth remaining, but they had become somewhat loose. </p>
<p>At least <a href="https://pubmed.ncbi.nlm.nih.gov/25571718/">one study</a> has shown that white vinegar, cider vinegar and hydrogen peroxide can both whiten and weaken teeth. Additionally, in 2016 it was observed that white vinegar may cause greater levels of damage to the hardness and quality of tooth enamel.</p>
<p>However, according to <a href="https://www.quintessence-publishing.com/deu/en/article/840922">a study led by Philipp Kanzow</a>, the presence and severity of these erosive defects also depend on several factors including nutrition, saliva composition, disease and abrasive stress. </p>
<h2>Appetite suppressant</h2>
<p>The slimming effect that Byron attributed to vinegar most likely came from its ability to suppress the appetite. In 1998 <a href="https://www.nature.com/articles/1600572">it was shown</a> that acetic acid – the chemical that gives vinegar its characteristic taste and smell – significantly reduces glucose and insulin response after eating, perhaps due to a reduced digestion rate.</p>
<p>This suggests that the spike in blood sugar levels after a meal can be reduced by consuming vinegar. This is because it causes the body to take longer to digest food, meaning carbohydrates are broken down more slowly.</p>
<p><a href="https://www.liverpooluniversitypress.co.uk/doi/10.3828/bj.2023.7">Our study</a> suggests that Lord Byron’s vinegar diet did help him to lose weight and give him a paler complexion. However, its long term consumption may have contributed significantly to the anorexia nervosa – complicated by episodes of bulimia – from which he suffered.</p><img src="https://counter.theconversation.com/content/217467/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Las personas firmantes no son asalariadas, ni consultoras, ni poseen acciones, ni reciben financiación de ninguna compañía u organización que pueda obtener beneficio de este artículo, y han declarado carecer de vínculos relevantes más allá del cargo académico citado anteriormente.</span></em></p>Lord Byron’s drank vinegar for weight loss, with catastrophic health effects. His eating disorders were reflected across 18th century Europe.Jose Miguel Soriano del Castillo, Catedrático de Nutrición y Bromatología del Departamento de Medicina Preventiva y Salud Pública, Universitat de ValènciaMª Inmaculada Zarzo Llobell, Estudiante de Doctorado en Medicina, Universitat de ValènciaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2151202023-10-30T17:04:07Z2023-10-30T17:04:07ZReplacing frontline workers with AI can be a bad idea — here’s why<figure><img src="https://images.theconversation.com/files/555248/original/file-20231023-21-78v8r3.jpg?ixlib=rb-1.1.0&rect=21%2C7%2C4681%2C2524&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/businesperson-use-customer-service-support-live-1705078873">R. Classen / Shutterstock</a></span></figcaption></figure><p>AI chatbots are already widely used by businesses to greet customers and answer their questions – either over the phone or on websites. Some companies have found that they can, to some extent, replace humans with machines in call centre roles.</p>
<p>However, the available evidence suggests there are sectors – such as healthcare and human resources – where extreme care needs to be taken regarding the use of these frontline tools, and ethical oversight may be necessary. </p>
<p>A recent, and highly publicised, example is that of a <a href="https://www.wsj.com/articles/eating-disorder-chatbot-ai-2aecb179">chatbot called Tessa</a>, which was used by the <a href="https://www.nationaleatingdisorders.org/">National Eating Disorder Association (NEDA)</a> in the US. The organisation had initially maintained a helpline operated by a combination of salaried employees and volunteers. This had the express goal of assisting vulnerable people suffering from eating disorders. </p>
<p>However, this year, the organisation <a href="https://fortune.com/well/2023/05/26/national-eating-disorder-association-ai-chatbot-tessa/">disbanded its helpline staff</a>, announcing that it would replace them with the Tessa chatbot. The reasons for this are disputed. Former workers claim that the shift followed a decision by helpline staff to unionise. The <a href="https://www.npr.org/2023/05/24/1177847298/can-a-chatbot-help-people-with-eating-disorders-as-well-as-another-human">vice president of NEDA cited</a> an increased number of calls and wait times, as well as legal liabilities around using volunteer staff.</p>
<p>Whatever the case, after a very brief period of operation, Tessa was taken offline over reports that the chatbot had issued problematic advice that could have exacerbated the symptoms of people seeking help for eating disorders. </p>
<p>It was also reported that <a href="https://www.npr.org/sections/health-shots/2023/06/08/1180838096/an-eating-disorders-chatbot-offered-dieting-advice-raising-fears-about-ai-in-hea">Dr Ellen Fitzsimmons-Craft and Dr C Barr Taylor</a>, two highly qualified researchers who assisted in the creation of Tessa, had stipulated that the chatbot was never intended as a replacement for an existing helpline or to provide immediate assistance to those experiencing intense eating disorder symptoms. </p>
<h2>Significant upgrade</h2>
<p>So what was Tessa designed for? The researchers, alongside colleagues, had generated an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10053367/">observational study</a> highlighting the challenges they faced in designing a rule-based chatbot to interact with users who are concerned about eating disorders. It is quite a fascinating read, illustrating design choices, operations, pitfalls and amendments.</p>
<p>The original version of Tessa was a traditional, <a href="https://en.wikipedia.org/wiki/Rule-based_system">rule-based chatbot</a>, albeit a highly refined one, which is one that follows a pre-defined structure based on logic. It could not deviate from the standardised pre-programmed responses calibrated by its creators.</p>
<p>Their conclusion included the following point: “Rule-based chatbots have the potential to reach large populations at low cost in providing information and simple interactions but are limited in understanding and responding appropriately to unanticipated user responses”. </p>
<figure class="align-center ">
<img alt="Person using chatbot online." src="https://images.theconversation.com/files/555605/original/file-20231024-29-vdn0vs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555605/original/file-20231024-29-vdn0vs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=385&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555605/original/file-20231024-29-vdn0vs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=385&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555605/original/file-20231024-29-vdn0vs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=385&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555605/original/file-20231024-29-vdn0vs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=484&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555605/original/file-20231024-29-vdn0vs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=484&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555605/original/file-20231024-29-vdn0vs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=484&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">AI chatbots are already widely used to engage with customers or users of a service.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/chatbot-live-chat-customer-help-assistant-1555297907">Tero Vesalainen / Shutterstock</a></span>
</figcaption>
</figure>
<p>This might appear to limit the uses for which Tessa was suitable. So how did it end up replacing the helpline previously used by NEDA? The exact chain of events is under discussion amid differing accounts, but, according to NPR, the hosting company of the chatbot changed Tessa from a rules-based chatbot with pre-programmed responses to one with an <a href="https://www.npr.org/sections/health-shots/2023/06/08/1180838096/an-eating-disorders-chatbot-offered-dieting-advice-raising-fears-about-ai-in-hea">“enhanced questions and answers feature”</a>. </p>
<p>The later version of Tessa was one employing generative AI, much like ChatGPT and similar products. These advanced AI chatbots are designed to simulate human conversational patterns with the intention of giving more realistic and useful responses. Generating these customised answers relies on large databases of information, which the AI models are trained to “comprehend” through a variety of technological processes: <a href="https://en.wikipedia.org/wiki/Machine_learning">machine learning</a>, <a href="https://www.ibm.com/topics/deep-learning">deep learning</a> and <a href="https://www.ibm.com/topics/natural-language-processing">natural language processing</a>.</p>
<h2>Learning lessons</h2>
<p>Ultimately, the chatbot generated what have been described as potentially harmful answers to some users’ questions. Ensuing discussions have shifted the blame from one institution to another. However, the point remains that the ensuing circumstances could potentially have been avoided if there had been a body providing ethical oversight, a “human in the loop” and an adherence to the clear purpose of Tessa’s original design. </p>
<p>It’s important to learn lessons from cases such as this against the background of a rush towards the integration of AI in a variety of systems. And while these events took place in the US, they contain lessons for those seeking to do the same in other countries.</p>
<p>The UK would appear to have a somewhat fragmented approach to this issue. The advisory board to the Centre for Data Ethics and Innovation (CDEI) <a href="https://www.computerweekly.com/news/366553297/UK-government-quietly-disbands-data-ethics-advisory-board">was recently dissolved</a> and its seat at the table was taken up by the newly formed Frontier AI Taskforce. There are also reports that AI systems are already being trialled in London as tools to aid workers – though not as a replacement for a helpline.</p>
<p>Both of these examples highlight a potential tension between ethical considerations and business interests. We must hope that the two will eventually align, balancing the wellbeing of individuals with the efficiency and benefits that AI could provide. </p>
<p>However, in some areas where organisations interact with the public, AI-generated responses and simulated empathy may never be enough to replace genuine humanity and compassion – particularly in the areas of medicine and mental health.</p><img src="https://counter.theconversation.com/content/215120/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Tsagas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Real-world examples suggest we need to be careful using AI for frontline work.Mark Tsagas, Lecturer, Criminal Law, University of East LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2097982023-10-05T12:34:44Z2023-10-05T12:34:44ZThe ‘Zoom effect’ and the possible link between videochatting and appearance dissatisfaction<figure><img src="https://images.theconversation.com/files/551566/original/file-20231002-28-4ctl1.jpg?ixlib=rb-1.1.0&rect=47%2C11%2C7951%2C5288&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Unhappiness with your online appearance can lead to negative thinking and poor body image.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-planning-strategy-with-colleagues-in-meeting-royalty-free-image/1428694074?phrase=videoconferencing&adppopup=true">Morsa Images/Digital Vision via Getty Images</a></span></figcaption></figure><p>The COVID-19 pandemic ushered in a new era of digital connection: In the absence of in-person gatherings, many people instead found themselves face-to-face with their co-workers and loved ones on a screen.</p>
<p>Videoconferencing has provided many benefits and conveniences. However, it isn’t surprising that constantly seeing ourselves on screens might come with some downsides as well.</p>
<p>Prior to the pandemic, studies showed that surgeons were seeing increasing numbers of patients <a href="https://doi.org/10.1001/jamafacial.2018.0486">requesting alterations of their image</a> to match filtered or doctored photos from social media apps. Now, several years into the pandemic, surgeons are seeing a new boom of cosmetic surgical requests related to videoconferencing. In one study of cosmetic procedures during the pandemic, 86% of cosmetic surgeons reported videoconferencing as the <a href="https://doi.org/10.1016/j.ijwd.2021.01.012">most common reason for cosmetic concerns</a> among their patients. </p>
<p>Despite the fact that many aspects of life have returned to some version of pre-pandemic normal, it’s clear that videoconferencing and social media will be with us for the foreseeable future. So what does that mean when it comes to appearance satisfaction and making peace with the image that’s reflected back at us?</p>
<p>For the past 10 years, I have worked as a specialist in <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/29092">obsessive-compulsive disorders, eating disorders and anxiety</a>. Since the pandemic, I, too, have seen increasing numbers of therapy clients reporting that they struggle with appearance concerns related to videochatting and <a href="https://theconversation.com/mounting-research-documents-the-harmful-effects-of-social-media-use-on-mental-health-including-body-image-and-development-of-eating-disorders-206170">social media</a>.</p>
<h2>Zooming in on image and appearance dissatisfaction</h2>
<p>Every person has perceptions and thoughts about their appearance. These can be neutral, negative or positive. We all look at <a href="https://www.discovermagazine.com/mind/how-the-mirror-changed-humanity-forever">ourselves in the mirror</a> and may have even experienced distress while looking at our reflection. </p>
<p>There are a number of factors that may lead to appearance dissatisfaction.
A preoccupation with thoughts, feelings or images of one’s own appearance is linked to the action of <a href="https://doi.org/10.1016/j.brat.2011.05.003">“mirror gazing,”</a> or staring at one’s reflection. Researchers suggest that this type of selective self-focused attention and mirror gazing <a href="https://doi.org/10.1097/PRS.0000000000008031">can lead to negative fixations</a> on specific attributes or minor flaws, which in turn intensify the preoccupation with these attributes. </p>
<p>Other factors that can contribute to appearance dissatisfaction include <a href="https://doi.org/10.1186/s12888-021-03185-3">low self-esteem</a>, <a href="https://doi.org/10.1002/eat.22151">societal beliefs</a> around appearance, <a href="https://doi.org/10.1007/s10964-009-9500-2">peer</a> and <a href="https://doi.org/10.1016/j.bodyim.2009.04.004">parental influences</a>, <a href="https://doi.org/10.1016/j.eatbeh.2017.11.001">temperament</a> and genetic predispositions to <a href="https://doi.org/10.3389/fpsyt.2019.00864">mental health conditions</a>.</p>
<p>Appearance dissatisfaction and negative evaluations of self are associated with <a href="https://doi.org/10.1186/s12888-021-03185-3">depression, lower self-esteem</a>, <a href="https://doi.org/10.1080/08870441003763246">habitual negative thinking</a> and <a href="https://doi.org/10.1177/2056305120912488">increased social anxiety</a>. What’s more, research suggests that these preoccupations can contribute to the <a href="https://doi.org/10.1016/S0005-7894(02)80007-7">development of eating disorders</a> and disordered eating behaviors, such as frequently restricting food intake or exercising without refueling.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Cp8rAkR_mrs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Some people who are unhappy with their Zoom appearance are turning to anti-anxiety medication and even cosmetic surgery.</span></figcaption>
</figure>
<h2>The ‘Zoom’ effect</h2>
<p>With the ubiquity of Zoom meetings, FaceTime calls, selfies and the constancy of documenting our lives on social media, access to our own image can often feel inescapable. And for some people, this can magnify feelings of appearance dissatisfaction that may have been more fleeting before the Zoom era.</p>
<p>Since the pandemic, screen time has increased <a href="https://doi.org/10.1016/j.eclinm.2022.101452">for both adults</a> <a href="https://doi.org/10.1001/jamanetworkopen.2022.56157">and children</a>. What’s worse, recent research suggests that the video and <a href="https://www.liebertpub.com/full/doi/10.1001/jamafacial.2018.0009?ref=dorenato.blog">photo reflections</a> we see of ourselves <a href="https://doi.org/10.1001/jamafacial.2018.0009">are distorted</a>.</p>
<p>Videoconferencing, taking selfies and posting on social media are visually based activities where <a href="https://doi.org/10.1093/asj/sjab257">appearance is often the primary focus</a>. All of them have in common the fact that a person’s image is either live or shared in an immediate manner. Perhaps not surprisingly, these image-based platforms have been significantly associated with <a href="https://doi.org/10.1371/journal.pgph.0001091">appearance dissatisfaction, anxiety, depression and eating disorders</a>. </p>
<p>One study found that those who engaged in more videochatting appearance comparisons, meaning those who looked at others’ appearance during a video call and sized up their own appearance in comparison, <a href="https://doi.org/10.1002/eat.23393">experienced lower appearance satisfaction</a>. This study also found that people who used more photo-editing features on videochat platforms were more likely to compare themselves with others and spend more time <a href="https://doi.org/10.1002/eat.23722">looking at themselves on video calls</a>.</p>
<p>One thing that is unique to videoconferencing is that it allows people to easily <a href="https://doi.org/10.1016/j.paid.2020.110537">compare themselves with others</a> and watch themselves sharing and speaking in real time. A 2023 study found that discomfort with one’s appearance during videoconferencing led to an increased fixation on appearance, which in turn <a href="https://doi.org/10.1016/j.bodyim.2022.12.007">led to impaired work performance</a>. </p>
<p>Researchers also suggest that appearance dissatisfaction is <a href="https://doi.org/10.1089/cyber.2021.0112">associated with virtual-meeting fatigue</a>. The research reports that this could be due to <a href="http://dx.doi.org/10.2139/ssrn.3820035">negative self-focused attention, cognitive overload</a> and anxiety around being stared at or being <a href="https://doi.org/10.1016/j.bodyim.2022.12.007">negatively evaluated based on appearance</a>.</p>
<p>This last point is notable because of the difficulty videochatters have determining where other users are looking. Using the concept of <a href="https://doi.org/10.1111/1467-8721.00039">the “spotlight effect</a>” − our tendency as humans to overestimate how much others are judging our appearance − this difficulty may lead to more anxiety and individuals believing that others are evaluating their appearance during a video call.</p>
<h2>How to combat appearance dissatisfaction in the digital age</h2>
<p>If you find yourself criticizing your appearance every time you hop onto a videoconference call, it may be time to evaluate your relationship with your appearance and seek out help from a qualified therapist. </p>
<p>Here are some questions to consider to help determine whether your thought patterns or <a href="https://theconversation.com/body-dysmorphic-disorder-is-more-common-than-eating-disorders-like-anorexia-and-bulimia-yet-few-people-are-aware-of-its-dangers-195538">behaviors are problematic</a>: </p>
<ul>
<li><p>How much of my day is spent thinking about my appearance?</p></li>
<li><p>What sort of behaviors am I doing around my appearance?</p></li>
<li><p>Do I feel distressed if I do not perform these behaviors?</p></li>
<li><p>Does this behavior align with my values and how I want to be spending my time?</p></li>
</ul>
<p>Another strategy is to be intentional about focusing on what other people are saying in a videoconference instead of peering at your own face. </p>
<p>When it comes to helping others who might be struggling with appearance dissatisfaction, it is important to focus on the person’s innate qualities beyond appearance. People should be conscious of their comments, no matter how well intentioned. Negative comments about appearance have been linked to <a href="https://doi.org/10.1186/s40337-022-00561-6">worsened self-esteem and mental health</a>. When viewing yourself or your peers on video and social media, try focusing on the person as a whole and not as parts of a body. </p>
<p>Reducing screen time can make a difference as well. Research shows that <a href="https://doi.org/10.1037/ppm0000460">reducing social media use by 50%</a> can improve appearance satisfaction in both teens and adults. </p>
<p>When used in moderation, videoconferencing and social media are tools to connect us with others, which ultimately is a key piece in satisfaction and well-being.</p><img src="https://counter.theconversation.com/content/209798/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Hemendinger does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With our faces seemingly everywhere − from Zoom meetings to selfies − more people are developing anxieties about how they appear online.Emily Hemendinger, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2133872023-10-04T09:14:43Z2023-10-04T09:14:43ZEverything Now: eating disorder recovery is treated with sensitivity and nuance in Netflix comedy drama<p>Netflix couldn’t have chosen a more resonant title than <a href="https://www.netflix.com/title/81437049">Everything Now</a> for their new comedy drama series. When I came out of a residential clinic in 2009 for treatment of anorexia, I did a parachute jump, started volunteering and decided to have a baby on my own. Some of these were impulsive – yet heartfelt – attempts to “catch up” on a life that had been passing me by. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/2AWI_F6x-Dw?wmode=transparent&start=1" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Trailer for Everything Now.</span></figcaption>
</figure>
<p>This sense of things moving on while you have been trapped in the depths of an eating disorder is probably even more potent in the <a href="https://theconversation.com/eating-disorders-among-teens-have-more-than-doubled-during-the-covid-19-pandemic-heres-what-to-watch-for-201067">intensified temporal rhythms of teenage years</a>. </p>
<p>As Mia Polanco (Sophie Wilde), the 16-year-old protagonist of Everything Now, asks as the school bus conversation jostles around her: “Fuck. How can I have missed so much in seven months?” </p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/friends-with-benefits-what-a-sex-and-relationship-therapist-wants-you-to-know-210854utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Friends with benefits – what a sex and relationship therapist wants you to know</a></em></p>
<p><em><a href="https://theconversation.com/girl-math-may-not-be-smart-financial-advice-but-it-could-help-women-feel-more-empowered-with-money-211780?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">‘Girl math’ may not be smart financial advice, but it could help women feel more empowered with money</a></em></p>
<p><em><a href="https://theconversation.com/why-are-photo-dumps-so-popular-a-digital-communications-expert-explains-210486utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Why are ‘photo dumps’ so popular? A digital communications expert explains</a></em></p>
<hr>
<p>Everything Now is a thoughtful, sensitive and entertaining journey through Mia’s experience of teenage life following her discharge from the eating disorder inpatient unit she has been confined to for seven months. </p>
<h2>The image of eating disorders</h2>
<p>White, middle-class girls with anorexia have long since dominated the representation in film and TV. But eating disorders cut across ethnic boundaries. </p>
<p>Although there can never be any simple correlation between popular media representations of eating disorders and reality, they play a role in shaping wider understandings of eating problems. This includes who might be affected by them. As a result, this under-representation contributes to a culture in which people from minority ethnic backgrounds are under-diagnosed and <a href="https://www.emerald.com/insight/content/doi/10.1108/17465721211236363/full/html">less likely to access treatment</a>. </p>
<p>Everything Now should be praised for recognising that it’s not just white, middle-class girls who experience eating disorders.</p>
<p>Also, a significant part of the early plot focuses on Mia’s crush on a female student. Historically, clumsy assumptions have supposed that LGBTQ+ girls and women are <a href="https://www.tandfonline.com/doi/epdf/10.1080/19419899.2011.603349?needAccess=true">somehow more “protected”</a> from eating issues than their heterosexual counterparts. This has long since been challenged. <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/eat.23830">Research</a> has shown that sexual minorities may be more at risk due to the complex relationships between oppression, gender identity and sexuality. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-male-character-on-heartstopper-has-an-eating-disorder-thats-more-common-than-you-might-think-211912">A male character on Heartstopper has an eating disorder. That's more common than you might think</a>
</strong>
</em>
</p>
<hr>
<h2>Nuanced representation</h2>
<p>Everything Now is one of the first TV shows about eating disorders that did not make me cringe. It is sensitive, carefully researched and it resonated.</p>
<p>The show does a good job of exploring the complexities of recovery – a long and uncertain process that is rarely depicted, perhaps because it is seen as less arresting than the descent into the illness. </p>
<p>Switching between flashbacks of her time in the clinic and her present life at school and home, Mia’s voiceover communicates her struggles and anxieties. It also shows how difficult it is to navigate other people’s perceptions of recovery. Her grandmother, for example, bakes her a coconut sponge to welcome her home, to which Mia internally exclaims: “You’ve got to be fucking kidding me.” </p>
<p>Her grandma then pinches her cheek and says: “You look so wonderful, so healthy.” The implied link between flesh and healthiness can make such <a href="https://recoverywarriors.com/look-healthy-difficult-comments/">comments</a> a minefield for people in recovery.</p>
<p>Mia aims to throw herself back into adolescence, but the series poignantly explores her new status as an insider and outsider – how she is irrevocably changed by her eating disorder. </p>
<p>As the camera pans over the nibbles and drinks at a party she asks: “How can they just eat and drink? How am I 16 and I can’t just do that?” This captures the way spontaneity with food and drink becomes utterly unimaginable, not only during the throes of an eating disorder but during the pressures, regimens and routines of a recovery meal plan. </p>
<h2>Representing recovery</h2>
<p>The voiceover is particularly good at showcasing the disjuncture between Mia’s eagerness and how her eating disorder pulls the brake: “Shots, OK. At least I can track what’s in that. Maybe I can skip something tomorrow. I need to show them I’m better. That I can be normal.” She is both present and not present – one of her peers yet so separate.</p>
<p>Everything Now depicts positive moments of recovery too, in ways that are touching and insightful. As Mia walks to school for the first time, she reflects on “All the everyday beauty I forgot how to see – and all the things I get to rediscover now.” </p>
<p>While the eating disorder has made the everyday strange (the snacks and drinks at the party seem impossible) it has also made the everyday more beautiful. The scene reminded me of a quote from a student in sociologist Paula Saukko’s 2008 book <a href="https://sunypress.edu/Books/T/The-Anorexic-Self">The Anorexic Self</a>: “I used to be able to see the sky, but now I only think about food.” </p>
<p>Everything Now is an original, heartwarming and insightful story of learning to see the sky again.</p>
<hr>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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</figcaption>
</figure>
<p><em>Looking for something good? Cut through the noise with a carefully curated selection of the latest releases, live events and exhibitions, straight to your inbox every fortnight, on Fridays. <a href="https://theconversation.com/uk/newsletters/something-good-156">Sign up here</a>.</em></p>
<hr><img src="https://counter.theconversation.com/content/213387/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Su Holmes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The series should be praised for recognising that it’s not just white, middle-class girls who experience eating disorders.Su Holmes, Professor of TV Studies, University of East AngliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2026222023-09-18T02:15:17Z2023-09-18T02:15:17ZWhat does having a ‘good relationship with food’ mean? 4 ways to know if you’ve got one<figure><img src="https://images.theconversation.com/files/548446/original/file-20230914-29-s25lth.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6568%2C4375&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Travelling on a train recently you couldn’t help but overhear two women deep in conversation about a mutual obsession with food, including emotional triggers that pushed them towards chocolate and pizza. </p>
<p>They shared feeling guilty about a perceived lack of willpower around food and regularly rummaging through the fridge looking for tasty treats to help soothe emotions. Both lamented not being able to stop and think before eating. </p>
<p>Their discussion was a long way from talking about physiological requirements for food to fuel your body and meet essential nutrient needs. Instead, it was highly emotive. </p>
<p>It got me thinking about the meaning of a healthy relationship with food, how a person’s eating behaviours develop, and how a “good” relationship can be nurtured. Here’s what a “healthy” food relationship can look like.</p>
<h2>What does a ‘good relationship with food’ mean?</h2>
<p>You can check whether your relationship with food is “<a href="https://www.rwapsych.com.au/blog/what-does-a-healthy-relationship-with-food-and-eating-look-like/">healthy</a>” by seeing how many items on this list you tick “yes” to. Are you:</p>
<ol>
<li><p>in tune with your body cues, meaning you’re aware when you are hungry, when you’re not, and when you’re feeling full? </p></li>
<li><p>eating appropriate amounts and variety of foods across all food groups, at regular intervals so your nutrient, health and wellbeing needs are met?</p></li>
<li><p>comfortable eating with others and also eating alone?</p></li>
<li><p>able to enjoy food, without feelings of guilt or it dominating your life?</p></li>
</ol>
<p>If you didn’t get many ticks, you might need to work on improving your relationship with food.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-youre-on-a-diet-is-half-the-problem-heres-how-to-be-a-mindful-eater-99207">Thinking you're 'on a diet' is half the problem – here's how to be a mindful eater</a>
</strong>
</em>
</p>
<hr>
<h2>Why does a good relationship with food matter?</h2>
<p>A lot of “no” responses indicate you may be using food as a coping mechanism in response to <a href="https://pubmed.ncbi.nlm.nih.gov/36863205/">negative emotions</a>. The problem is this <a href="https://pubmed.ncbi.nlm.nih.gov/36839185/">triggers the brain’s reward centre</a>, meaning although you feel better, this behaviour becomes reinforced, so you are more likely to keep eating in response to negative emotions.</p>
<p>Emotional eating and bouts of uncontrolled eating are more likely to be associated with <a href="https://pubmed.ncbi.nlm.nih.gov/36863205">eating disorder symptoms</a> and with having a worse quality diet, including lower intakes of vegetable and higher intakes of nutrient-poor foods. </p>
<p>A review of studies on food addiction and mental health found healthy dietary patterns were associated with a lower risk of both disordered eating and <a href="https://pubmed.ncbi.nlm.nih.gov/29368800/">food addiction</a>. Higher intakes of vegetables and fruit were found to be associated with <a href="https://pubmed.ncbi.nlm.nih.gov/35586735/">lower perceived stress</a>, tension, worry and lack of joy in a cohort of more than 8,000 Australian adults. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548442/original/file-20230914-19-tdxta1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man eating burger" src="https://images.theconversation.com/files/548442/original/file-20230914-19-tdxta1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548442/original/file-20230914-19-tdxta1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548442/original/file-20230914-19-tdxta1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548442/original/file-20230914-19-tdxta1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548442/original/file-20230914-19-tdxta1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548442/original/file-20230914-19-tdxta1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548442/original/file-20230914-19-tdxta1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Constantly thinking about food throughout the day can spell an unhealthy relationship with food.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/s/photos/binge-eating">marcel heil/Unsplash</a></span>
</figcaption>
</figure>
<h2>How to develop a healthy food relationship</h2>
<p>There are ways to improve your relationship with food. Here are some tips:</p>
<p><strong>1. keep a ‘food mood’ <a href="https://nomoneynotime.com.au/ebooks-meal-plans-more/nmnt-food-and-mood-diary">diary</a>.</strong> Writing down when and where you eat and drink, whom you’re with, what you’re doing, and how all this makes you feel, will give you personal insights into when, what and why you consume the things you do. This helps increase awareness of emotions including stress, anxiety, depression, and factors that influence eating and drinking.</p>
<p><strong>2. reflect on what you wrote</strong> in your food mood diary, especially “why” you’re eating when you eat. If reasons include stress, low mood or other emotions, create a distraction list featuring activities such as going for a walk or listening to music, and put it on the fridge, noticeboard or in your phone, so it’s easy to access.</p>
<p><strong>3. practise <a href="https://pubmed.ncbi.nlm.nih.gov/28848310/">mindful eating</a>.</strong> This means slowing down so you become very aware of what is happening in your body and mind, moment by moment, when eating and drinking, without making any judgement about your thoughts and feelings. Mindless eating occurs when you eat without thinking at all. Being <a href="https://www.headspace.com/mindfulness/mindful-eating">mindful</a> means taking the time to check whether you really are hungry, or whether it’s “eye” hunger <a href="https://theconversation.com/health-check-six-tips-for-losing-weight-without-fad-diets-52496">triggered by seeing food</a>, “nose” hunger triggered by smells wafting from shops or cafes, “emotional hunger” triggered by feelings, or true, tummy-rumbling hunger. </p>
<p><strong>4. learn about <a href="https://nomoneynotime.com.au/hacks-myths-faqs/healthy-eating-why-caring-about-the-foods-you-eat-is-worth-it">your nutrient needs</a>.</strong> Learning why your body needs specific vitamins and minerals and the foods they’re in, rather than just mentally coding food as “good” or “bad”, can help you drop the guilt. Banning “bad” foods makes you want them more, and like them more. Mindfulness can help you gain an <a href="https://pubmed.ncbi.nlm.nih.gov/24035461/">appreciation of foods that are both</a> pleasing and nourishing.</p>
<p><strong>5. focus on getting enjoyment from food.</strong> Mindless eating can be reduced by focusing on enjoying food and the pleasure that comes from preparing and sharing food with others. One <a href="https://pubmed.ncbi.nlm.nih.gov/24035461/">intervention</a> for women who had concerns about dieting and weight control used workshops to raise their awareness of food cues that prompt eating, including emotions, or being in places they normally associate with eating, and also sensory aspects of food including taste, touch, smell, sound and texture. It also aimed to instruct them in how to embrace pleasure from social, emotional and cultural aspects of food. The intervention led to a reduction in overeating in response to emotional cues such as sadness and stress. Another <a href="https://pubmed.ncbi.nlm.nih.gov/33347469/">review</a> of 11 intervention studies that promoted eating pleasure and enjoyment found promising results on healthy eating, including better diet quality, healthier portion sizes, healthier food choices and greater liking of healthy foods. Participants also reported healthy food tasted better and got easier to cook more often at home.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548443/original/file-20230914-9125-jy3lz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pizza slices with hands reaching for them" src="https://images.theconversation.com/files/548443/original/file-20230914-9125-jy3lz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548443/original/file-20230914-9125-jy3lz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548443/original/file-20230914-9125-jy3lz1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548443/original/file-20230914-9125-jy3lz1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548443/original/file-20230914-9125-jy3lz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548443/original/file-20230914-9125-jy3lz1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548443/original/file-20230914-9125-jy3lz1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sharing and enjoying food with others improves our relationship to food.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/s/photos/sharing-food">klara kulikova/Unsplash</a></span>
</figcaption>
</figure>
<h2>Where to get help to improve your relationship with food</h2>
<p>A healthy relationship with food also means the absence of <a href="https://www.healthdirect.gov.au/eating-disorders">disordered eating</a>, including binge eating, bulimia and anorexia. </p>
<p>If you, or someone you know, shows <a href="https://www.rwapsych.com.au/blog/what-does-a-healthy-relationship-with-food-and-eating-look-like/">signs suggesting disordered eating</a>, such as regularly using restrictive practices to limit food intake, skipping meals, food rituals dictating which foods or combinations to eat at specific times, binge eating, feeling out of control around food, secret eating, inducing vomiting, or use of diet pills, follow up with a GP or health professional.</p>
<p>You can get more information from <a href="https://insideoutinstitute.org.au/about-us">InsideOut</a>, an Australian institute for eating disorders. Try their online <a href="https://insideoutinstitute.org.au/for-myself">food relationship “check-up”</a> tool.</p>
<p>The <a href="https://butterfly.org.au/">Butterfly Foundation</a> also has specific resources for <a href="https://butterfly.org.au/back-to-school-a-body-image-and-mental-health-guide-for-parents-and-children/">parents</a> and <a href="https://butterfly.org.au/">teachers</a> and a helpline operating from 8am to midnight, seven days a week on 1800 334673.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-a-balanced-diet-anyway-72432">What is a balanced diet anyway?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/202622/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins AO is a Laureate Professor in Nutrition and Dietetics at the University of Newcastle, NSW and a Hunter Medical Research Institute (HMRI) affiliated researcher. She is a National Health and Medical Research Council (NHMRC) Leadership Fellow and has received research grants from NHMRC, ARC, MRFF, HMRI, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, WA Dept. Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute, Dietitians Australia and the ABC. She was a team member conducting systematic reviews to inform the 2013 Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.</span></em></p><p class="fine-print"><em><span>Tracy Burrows is a Professor in Nutrition and Dietetics at the University of Newcastle, NSW and a Hunter Medical Research Institute (HMRI) affiliated researcher. She is a National Health and Medical Research Council (NHMRC) Emerging Leader Fellow and has received research grants from NHMRC, ARC, HMRI, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, WA Dept. Health, Meat and Livestock Australia. She has consulted to the Sax Institute, Dietitians Australia, Diabetes Victoria. </span></em></p>Thinking about food all day, feeling guilty when you eat, not knowing when you’re actually hungry: these could be signs you need to work on your relationship with food.Clare Collins, Laureate Professor in Nutrition and Dietetics, University of NewcastleTracy Burrows, Professor Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2119122023-08-22T20:07:29Z2023-08-22T20:07:29ZA male character on Heartstopper has an eating disorder. That’s more common than you might think<figure><img src="https://images.theconversation.com/files/543857/original/file-20230822-38016-v420lw.jpg?ixlib=rb-1.1.0&rect=20%2C30%2C3355%2C1650&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://media.netflix.com/en/only-on-netflix/81059939/assets/eyJpZCI6IjM3MGU2Y2MwLTA5MmItMTFlZS1hYjdhLTBlYzdkMTlhM2U3ZCIsIm5hbWUiOiJIZWFydHN0b3BwZXJfUzAyX1RlYXNlcjIuanBnIn0=">Netflix</a></span></figcaption></figure><p>Season two of the series <a href="https://www.imdb.com/title/tt10638036/">Heartstopper</a> on Netflix brings out an issue that is often hidden – male eating disorders. Centred on two teenage boys in love, the show helps bust the common perception that eating disorders are only seen in girls and women. </p>
<p>In one episode of the series, based on a series of graphic novels, Nick asks Charlie about his eating because he is becoming worried about him. Charlie responds, saying</p>
<blockquote>
<p>Some days I’m fine and other days I control it. I used to do it a lot last year when everything at school was really bad. Sometimes it feels like the only thing I can control in my life.</p>
</blockquote>
<p>Although under represented in research, <a href="https://nedc.com.au/eating-disorders/eating-disorders-explained/eating-disorders-in-males/">statistics</a> indicate one third of people with an eating disorder are male and <a href="https://www.missionaustralia.com.au/publications/youth-survey/2618-youth-survey-2022-report/file">body image in boys</a> is a major concern. Eating disorders affect mental and physical health. Shame and stigma are among the reasons people who identify as male <a href="https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00543-8">don’t seek help</a>. </p>
<h2>A range of disorders</h2>
<p><a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00864/full">Body dissatisfaction</a> comes from not liking one’s size, shape and weight and leads some boys and men down the dangerous path to <a href="https://nedc.com.au/eating-disorders/eating-disorders-explained/body-image/">an eating disorder</a>. </p>
<p>An <a href="https://www.eatingdisorders.org.au/eating-disorders-a-z/eating-disorders-explained/">eating disorder</a> is an unhealthy relationship with one’s body and eating and includes such disorders as anorexia nervosa (fear of weight gain and deprivation of food), bulimia nervosa (which typically involves eating large amounts and then purging) and binge-eating disorder. </p>
<p>Binge-eating disorder is the most common of these for both males and females. It <a href="https://www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/binge-eating-disorder-men">involves</a> a preoccupation with eating, often rapidly, an amount of food much greater than someone would eat in a short amount of time, to the point of feeling uncomfortable. Disgust with oneself often follows in the aftermath.</p>
<h2>What drives it</h2>
<p>This obsession with one’s body and its <a href="https://nedc.com.au/eating-disorders/eating-disorders-explained/body-image/">perceived faults</a> comes from our society’s obsession with appearance particularly around a person’s weight, size and shape.</p>
<p>Male media images promote an idealised body that is often <a href="https://www.sciencedirect.com/science/article/abs/pii/S174014452030437X?casa_token=ePw-Tcht4hoAAAAA:ICTulL_wHHWg6aWGzTMe3d_yFyAZgHPeSptJ3wEKoAdoAW-4tB-v276f6lueG3cCYHfd2qpn">unattainable</a>. Seeing one’s own body as inferior in comparison can lead to attempts to <a href="https://www.mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes/syc-20353603">change it</a>. </p>
<p>Over <a href="https://nedc.com.au/eating-disorders/types/co-occurring-conditions/">half those diagnosed</a> with an eating disorder also receive a diagnosis for at least one psychiatric disorder such as depression, anxiety disorders (including obsessive-compulsive disorder), post-traumatic stress disorder and personality disorders. This makes treatment even more complex.</p>
<p>Other factors involved in the development of an eating disorder can be parental or peer teasing about appearance, especially about weight. Poor self esteem, a need for control (as articulated by Heartstopper character Charlie), experiencing sexual trauma and identity disturbance are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8355094/">drivers</a>. Eating disorders are more common for <a href="https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00327-y">LGBTIQ+ people</a>. </p>
<hr>
<iframe width="100%" height="577" src="https://www.youtube.com/embed/ScNbNi2BTs0" title="Joe Locke:"Eating disorders on TV are scary, #heartstopper shows it's going to be okay & gives hope"" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen=""></iframe>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-i-work-with-people-with-eating-disorders-i-see-many-rules-around-good-and-bad-foods-but-eating-is-never-that-simple-188803">When I work with people with eating disorders, I see many rules around 'good' and 'bad' foods – but eating is never that simple</a>
</strong>
</em>
</p>
<hr>
<h2>Dangerous methods</h2>
<p>Boys and men may engage in dieting and other weight-loss methods to try and <a href="https://theconversation.com/body-image-issues-affect-close-to-40-of-men-but-many-dont-get-the-support-they-need-179046">change or control their body</a>. They may also exercise excessively. Some may even turn to drugs to try and alter their body. </p>
<p>They can become consumed by thoughts about their body to the detriment of their schooling, socialising, work, family life and physical health, not to mention the financial impact. </p>
<p>Eating disorders are detrimental to a person’s <a href="https://healthtalk.org/eating-disorders/physical-symptoms">physical health</a> with increased risk of injury due to over exercising, rotting teeth due to purging, osteoporosis due to calcium loss and unstable hormones. They can be deadly, causing heart attack, malnourishment, liver and kidney issues, gastrointestinal disturbances, loss of fingers and toes due to poor circulation, as well as <a href="https://butterfly.org.au/news/suicide-up-to-31-times-more-likely-for-people-with-an-eating-disorder/">death by suicide</a>. </p>
<h2>Getting help early</h2>
<p>Early intervention is the key to <a href="https://www.australianacademicpress.com.au/books/details/289/No_Bodys_Perfect_A_helpers_guide_to_promoting_positive_body_image_in_children_and_young_people">fostering a positive body image</a> and self-esteem in young males. This involves recognition by parents, teachers and peers of unhealthy talk about and behaviour towards one’s body and eating. </p>
<p><a href="https://www.nationaleatingdisorders.org/warning-signs-and-symptoms">Warning signs</a> might include skipping meals, excessive time spent on grooming, social avoidance, body consciousness and appearing sad and anxious. Education in schools about eating disorders helps young people understand what eating disorders are and normalises help-seeking. </p>
<p>As adults, we need to be aware our talk about dieting and comments about people’s bodies is influential. So is modelling healthy eating and exercising behaviour. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/Cn08n63sQwI/?utm_source=ig_embed\u0026ig_rid=b656fc66-f3f9-40da-91ba-343fdd7b6b7f","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/some-ozempic-users-say-it-silences-food-noise-but-there-are-drug-free-ways-to-stop-thinking-about-food-so-much-208467">Some Ozempic users say it silences 'food noise'. But there are drug-free ways to stop thinking about food so much</a>
</strong>
</em>
</p>
<hr>
<p>Doctors and health professionals need to be better educated on warning signs and what to look out for in their male patients and clients. Teachers and parents can <a href="https://www.australianacademicpress.com.au/books/details/352/Practitioner_Guide_to_Psychological_Care_for_People_with_Eating_Disorders">learn more</a> and be on the look out for signs too. </p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1002/erv.2959">Early intervention</a> is backed by evidence but help often comes too late. People who get help early, particularly in their adolescent years <a href="https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-023-00758-3">when eating disorders often first start</a>, have a good success rate with the right treating team. This usually consists of a doctor, psychologist, dietitian and psychiatrist. </p>
<p>Families and people with eating disorders can find treatments and support in both the <a href="https://butterfly.org.au/">public and private sectors</a>. <a href="https://www.cbte.co/what-is-cbte/a-description-of-cbt-e/">Enhanced cognitive behavioural therapy</a> is usually used. It involves changing destructive behaviours and thoughts around the body, self and eating so a person can become healthier and happier. <a href="https://www.eatingdisorders.org.au/wp-content/uploads/2019/04/EDV-Family-Based-Treatment.pdf">Family-based approaches</a> for children and adolescents are also used to counter behaviour such as food refusal. Of course, as with many mental health conditions, more <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/70-million-for-eating-disorders-and-childhood-mental-health">funding for more support services</a> is needed. </p>
<p>If you or someone you know may be suffering from an eating disorder getting help fast is important before the eating disorder really takes hold. If you are worried about a friend, talk to an adult, such as a teacher or school counsellor. Starting a conversation with someone to ask them if they’re OK, how they are feeling and showing a non-judgmental attitude is also key. The character of Nick <a href="https://www.youtube.com/watch?v=fQ3XXeCpYjc">models this</a> well on Heartstopper. </p>
<p>Education about and becoming more aware of this issue and knowing how to get help is critical. As is reducing the <a href="https://www.nationaleatingdisorders.org/blog/stigma-surrounding-men-eating-disorders">stigma</a> often associated with male eating disorders. </p>
<p><em>If this article has raised issues for you, consider contacting the <a href="https://butterfly.org.au/">Butterfly Foundation</a> on 1800 33 4673 or Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/211912/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vivienne Lewis is a Clinical Psychologist working with people of both genders with eating disorders. She has recently written a book to assist health professionals and trainees working in this field called Eating Disorders – A practitioner’s guide to psychological care.
</span></em></p>Although under represented in research, about one third of people with an eating disorder are male. Netflix show Heartstopper explores this in season two.Vivienne Lewis, Assistant professor – Psychology, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2073222023-07-05T20:05:54Z2023-07-05T20:05:54ZWhy eating disorder treatments only work half the time, according to a psychologist<figure><img src="https://images.theconversation.com/files/530809/original/file-20230608-29-mrpuo8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-male-therapist-working-teenage-girl-2193299341">Shutterstock</a></span></figcaption></figure><p>No single treatment will work for all people with eating disorders. Even the most highly researched evidence-based treatment may work for some people, but less so for others. When such treatments do not work, it can provoke anxiety.</p>
<p>As part of <a href="https://doi.org/10.1186/s40337-019-0235-5">our research</a>, we spoke with one mother who was supporting her teenage daughter through anorexia nervosa. When current treatments were not working, the mother told us: </p>
<blockquote>
<p>We don’t really know what else we can do.</p>
</blockquote>
<p>But there may be other treatment options for people like her daughter. The issue is they’re not always available on Medicare.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/binge-eating-is-more-common-than-anorexia-or-bulimia-but-it-remains-a-hidden-and-hard-to-treat-disorder-192596">Binge eating is more common than anorexia or bulimia – but it remains a hidden and hard-to-treat disorder</a>
</strong>
</em>
</p>
<hr>
<h2>Medicare provides a menu of options</h2>
<p>In Australia, changes to Medicare mean people diagnosed with an eating disorder <a href="https://www.servicesaustralia.gov.au/eating-disorder-treatment-and-management-plans?context=20">may be eligible for</a> up to 40 sessions with a psychologist and up to 20 sessions with a dietitian a year. </p>
<p>This is a remarkable recognition of how eating disorders such as anorexia, bulimia or binge eating <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575017/pdf/coip-33-521.pdf">impact people’s lives</a>, and for those who care for them. </p>
<p>This also recognises how difficult it can be to <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2017.02273/full">recover</a> from an eating disorder. This is particularly when aspects of the eating disorder are acceptable to the person, and become their way of dealing with the slings and arrows of life.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1190142197859049472"}"></div></p>
<p>Medicare provides <a href="https://insideoutinstitute.org.au/medicare/for-health-professionals">several options</a> for psychological interventions to treat eating disorders that are backed by research evidence. </p>
<p>These treatments include <a href="https://pubmed.ncbi.nlm.nih.gov/30520532/">family-based treatment</a> for adolescent eating disorders and <a href="https://pubmed.ncbi.nlm.nih.gov/30188385/">cognitive behavioural therapy</a> for adult eating disorders.</p>
<p>Such interventions work in the long term for <a href="https://doi.org/10.1002/wps.20465">around</a> <a href="https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-023-00801-3">half</a> of people. </p>
<p>So what about the other half?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-i-work-with-people-with-eating-disorders-i-see-many-rules-around-good-and-bad-foods-but-eating-is-never-that-simple-188803">When I work with people with eating disorders, I see many rules around 'good' and 'bad' foods – but eating is never that simple</a>
</strong>
</em>
</p>
<hr>
<h2>It’s not just about evidence</h2>
<p>Think about <a href="https://psycnet.apa.org/record/2019-34830-000">psychotherapy</a> – also known as talking therapy – as a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832531/">three-legged stool</a>.</p>
<p>One leg of the stool is the research evidence. Another is the clinician’s expertise. The third leg is preferences of the person having treatment. We need all three if the stool is to stay upright and the psychotherapy has a chance of working.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/531842/original/file-20230614-29-sipiun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Yellow three-legged stool against yellow background" src="https://images.theconversation.com/files/531842/original/file-20230614-29-sipiun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/531842/original/file-20230614-29-sipiun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/531842/original/file-20230614-29-sipiun.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/531842/original/file-20230614-29-sipiun.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/531842/original/file-20230614-29-sipiun.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/531842/original/file-20230614-29-sipiun.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/531842/original/file-20230614-29-sipiun.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Think of psycotherapy as a three-legged stool.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/yellow-three-legged-chair-on-background-2182268591">Tharin kaewkanya/Shutterstock</a></span>
</figcaption>
</figure>
<p>The current Medicare system allows clinicians to draw from the first leg – the research evidence. This works for some.</p>
<p>Then there’s the second leg, the clinician’s expertise. One welcome development is through the Australian & New Zealand Academy for Eating Disorders <a href="https://connected.anzaed.org.au/treatmentproviders/">credential</a> for professionals treating eating disorders.</p>
<p>What is less recognised in the current Medicare system, however, is the importance of the therapeutic relationship, such as whether the clinician works in a <a href="https://onlinelibrary.wiley.com/doi/10.1002/wps.20912">person-centred way</a> that takes into consideration the person’s preferences. </p>
<p>This could be tailoring treatment to the person’s unique needs, instilling hope for their recovery, and seeing the person as more than just the eating disorder. Think of these as the third leg of the stool. </p>
<p>These second and third legs help explain why even gold-standard, research evidence-based treatments do not work for everyone.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-many-people-have-eating-disorders-we-dont-really-know-and-thats-a-worry-121938">How many people have eating disorders? We don't really know, and that's a worry</a>
</strong>
</em>
</p>
<hr>
<h2>What else could work?</h2>
<p>There are many psychological treatments for eating disorders that don’t have research evidence to back them. We cannot necessarily dismiss them as not working. They may have not yet been extensively researched. These <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6897497/pdf/nihms-1056078.pdf">emerging treatments</a> need more research evidence, <a href="https://www.mja.com.au/journal/2023/219/3/current-approaches-recognition-and-management-eating-disorders">including</a> which treatments work, for whom, and when. </p>
<p>Emerging treatments include those based on <a href="https://www.researchgate.net/publication/49705468_The_Application_of_Mindfulness_to_Eating_Disorders_Treatment_A_Systematic_Review">mindfulness</a>. These <a href="https://link.springer.com/article/10.1007/s12671-019-01216-5">may involve</a> people learning not to judge their thoughts and feelings as right or wrong, or good or bad. Instead, this therapy allows them to observe these thoughts and feelings by focusing on the present moment.</p>
<p>Others include <a href="https://iris.unito.it/bitstream/2318/1700926/1/2017_Eye%20Movement%20Desensitization%20and%20Reprocessing%20%28EMDR%29%20and%20eating%20disorders.pdf">therapies</a> <a href="https://www.cambridge.org/core/journals/advances-in-psychiatric-treatment/article/sensorimotor-approaches-to-trauma-treatment/D89DECA6078BBCF28669E8F76090197C">that address</a> both the eating disorder and adverse and traumatic life events, including the experience of the eating disorder itself.</p>
<p>We are also interested in, and are currently researching, <a href="https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-022-00636-4">narrative therapy</a>. This explores aspects of the person that have been lost to the eating disorder, such as a valued sense of oneself. Reclaiming these aspects can give the person freedom to live a life no longer dominated by the eating disorder. </p>
<p>Until emerging treatments have more extensive research evidence, the Medicare system needs to mention them as valid treatment pathways when facilitated by experienced practitioners. This is particularly important if the most widely researched interventions do not work for someone.</p>
<p>Including emerging therapies, however, does not mean anything goes. To work out which of these emerging therapies might be eligible for Medicare funding in the future, we need greater consultation with people living with eating disorders, and the clinicians who treat them, to learn which emerging treatments work in practice.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-makes-a-good-psychologist-or-psychiatrist-and-how-do-you-find-one-you-like-120981">What makes a good psychologist or psychiatrist and how do you find one you like?</a>
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</p>
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<h2>Join our study</h2>
<p>We are conducting a small study on narrative therapy for anorexia nervosa. This involves 40 sessions over 12 months to be conducted at Western Sydney University.</p>
<p>If you want to know more about participating in the study, email us at narrative@westernsydney.edu.au</p>
<hr>
<p><em>If you (or someone you know) needs care for an eating disorder, see your GP to be assessed for a Medicare <a href="https://www.servicesaustralia.gov.au/eating-disorder-treatment-and-management-plans?context=20">Eating Disorder Plan</a>. For support and more information about eating disorders, contact the <a href="https://butterfly.org.au">Butterfly Foundation</a> on 1800 33 4673 or <a href="https://kidshelpline.com.au">Kids Helpline</a> on 1800 551 800. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.</em></p><img src="https://counter.theconversation.com/content/207322/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Janet Conti is affiliated with Western Sydney University as an Associate Professor of Clinical Psychology. She also works part-time in private practice as a Clinical Psychologist. She is currently a co-researcher in two research projects funded by the Butterfly Foundation and the Australian and New Zealand Academy of Eating Disorders (ANZAED).</span></em></p><p class="fine-print"><em><span>Tania Perich is affiliated with Western Sydney University as an Senior Lecturer in Psychology. She also works part-time in private practice as a registered psychologist.</span></em></p>When it comes to treating people with eating disorders, we may need to look more widely than what studies tell us work.Janet Conti, Associate Professor of Clinical Psychology, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2084672023-06-29T20:01:22Z2023-06-29T20:01:22ZSome Ozempic users say it silences ‘food noise’. But there are drug-free ways to stop thinking about food so much<figure><img src="https://images.theconversation.com/files/534228/original/file-20230627-19-26ek8k.jpg?ixlib=rb-1.1.0&rect=441%2C12%2C3648%2C2133&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/thirsty-woman-standing-front-fridge-drinking-2199248609">Shutterstock</a></span></figcaption></figure><p>“<a href="https://www.nytimes.com/2023/06/21/well/eat/ozempic-food-noise.html">Food noise</a>” or thinking about food constantly is not helpful to anyone’s mental health and wellbeing. </p>
<p>When we become obsessed with any one line of thought (in this case, food), we can become consumed by it and it’s very hard to think about anything else. This can be very distressing. </p>
<p>Some people taking the diabetes drug Ozempic for weight loss have <a href="https://www.nytimes.com/2023/06/21/well/eat/ozempic-food-noise.html">reported</a> a sudden silencing of food noise and cravings. But there are other ways to maintain a healthy balance when it comes to our internal food monologue. </p>
<h2>One track thinking</h2>
<p>Thinking about food constantly is a common feature of an eating disorder. Indeed one of the main <a href="https://butterfly.org.au/eating-disorders/eating-disorders-explained/">criteria</a> for diagnosis of eating disorders is a preoccupation with the weight, shape and size of one’s body. A person may use control, or lack of control, of food to bring their body in line with how they perceive it should look. </p>
<p>A person with anorexia nervosa severely restricts their food intake to the point where their body is starving. As a result of this deprivation, their brain <a href="https://doi.org/10.1016/S0002-8223(96)00161-7">constantly thinks</a> about food.</p>
<p>People with binge eating disorder and bulimia nervosa are also consumed by thoughts of food <a href="https://doi.org/10.1016/j.appet.2009.03.005">including</a> when they’ll eat, what they’ll eat, obtaining food and where they’ll eat it. </p>
<p>But it’s <a href="https://eating-disorders.org.uk/information/the-effects-of-under-eating/">not just</a> those with eating disorders who can be obsessed with food. If we are dieting, undereating, restricting our intake of food or overeating, we can be consumed by thoughts about food.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/Cn08n63sQwI","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>An easy fix?</h2>
<p>As a clinical psychologist, I have treated many clients and helped people with eating disorders who can not stop thinking about food. They have often tried medications and drugs to try and stop <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312901/">ruminating</a> over food, <a href="https://doi.org/10.1017/S1461145711000460">usually to no avail</a>. </p>
<p>Or they are prescribed medications to reduce appetite, in the case of binge eating and obesity. These might work and help the person lose large amounts of weight, only for them to put it all <a href="https://www.healthline.com/health-news/weight-regain-after-stopping-ozempic">back on again</a> when they stop taking the drug.</p>
<p>Weight loss drugs should only be used under <a href="https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss-drugs/art-20044832">medical supervision</a> and some diet pills <a href="https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity">can affect</a> the heart, breathing, blood pressure and brain. </p>
<p>Ozempic (and similar drug Wegovy) use the ingredient semaglutide drug to <a href="https://theconversation.com/ozempic-helps-weight-loss-by-making-you-feel-full-but-certain-foods-can-do-the-same-thing-without-the-side-effects-201870">induce feelings</a> of being full or satisfied. Side effects of semaglutide <a href="https://www.tga.gov.au/sites/default/files/auspar-semaglutide-201030-pi.pdf">can include</a> nausea, bloating, constipation and diarrhoea.</p>
<p>So, it’s important to work on developing a healthy relationship with food and your body. Often a combination of psychological therapy and seeing an accredited dietitian is needed. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ozempic-helps-weight-loss-by-making-you-feel-full-but-certain-foods-can-do-the-same-thing-without-the-side-effects-201870">Ozempic helps weight loss by making you feel full. But certain foods can do the same thing – without the side-effects</a>
</strong>
</em>
</p>
<hr>
<h2>Working out what’s driving it</h2>
<p>With clients, I start by working on what’s driving the food obsession. Is it due to eating too little? Not eating regularly enough? Having strict rules and what you can and can’t eat? </p>
<p>It’s important to establish regular and adequate eating so your body and brain are well-fuelled and you can make sensible decisions around the food you consume. </p>
<p>Our biology ensures that when we are hungry we will <a href="https://theconversation.com/chemical-messengers-how-hormones-make-us-feel-hungry-and-full-35545">think about obtaining food</a> for survival. It can make us anxious or “<a href="https://theconversation.com/health-check-the-science-of-hangry-or-why-some-people-get-grumpy-when-theyre-hungry-37229">hangry</a>” and it can be hard to concentrate or focus on anything else but food. Then when we eat, our brain stops sending messages to eat and we can focus again. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534229/original/file-20230627-23-wfx2kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman bites bread with topping" src="https://images.theconversation.com/files/534229/original/file-20230627-23-wfx2kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534229/original/file-20230627-23-wfx2kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534229/original/file-20230627-23-wfx2kc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534229/original/file-20230627-23-wfx2kc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534229/original/file-20230627-23-wfx2kc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534229/original/file-20230627-23-wfx2kc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534229/original/file-20230627-23-wfx2kc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Eating well and regularly can help us develop a healthier relationship with food.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-restaurant-cozy-warm-sweater-wholesome-1914593563">Shutterstock</a></span>
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</figure>
<p>The <a href="https://ceed.org.au/resources_links/raves-a-step-by-step-approach-to-re-establishing-normal-eating/">RAVES model</a> of eating is used for people with eating disorders to help them be in tune with their body, respond to its needs and establish healthy behaviours. It’s about helping a person understand where their food rules have come from, debunk myths around eating and dieting, and challenge unhelpful ways of thinking about food. </p>
<p>Many people with and without eating disorders have <a href="https://theconversation.com/when-i-work-with-people-with-eating-disorders-i-see-many-rules-around-good-and-bad-foods-but-eating-is-never-that-simple-188803">food rules</a> around what they can and can’t eat, when and how much and this just sets us up to be obsessed with food. Once you allow yourself to eat when you’re hungry, stop when you’re full and have the foods you enjoy, you free your brain to think about things other than food and eating. </p>
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Read more:
<a href="https://theconversation.com/when-i-work-with-people-with-eating-disorders-i-see-many-rules-around-good-and-bad-foods-but-eating-is-never-that-simple-188803">When I work with people with eating disorders, I see many rules around 'good' and 'bad' foods – but eating is never that simple</a>
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<h2>A healthy food mindset</h2>
<p>A person who has a healthy relationship with food listens to their body’s needs. They don’t have food rules around what they can and can’t eat and they feel comfortable in their body. </p>
<p>They can reject media and advertising around dieting and idealised bodies and they are respectful of their body. When I work with clients we work on listening to your body, respecting its needs and treating it well. This is called having a <a href="https://www.australianacademicpress.com.au/books/details/219/Positive_Bodies_Loving_the_Skin_Youre_In">positive body image</a> and is an important part of treatment for people with body image and eating issues. </p>
<p>It is often a person’s perception of their body that influences their eating. Learning to accept your physical self as well as treating the body well, with good nutrition, builds a <a href="https://www.nationaleatingdisorders.org/learn/general-information/ten-steps">positive body image</a>. </p>
<p>If you are concerned about your relationship with food or your body, seeing your GP for a referral to a psychologist or dietitian is advised. <a href="https://butterfly.org.au/?gclid=Cj0KCQjw7uSkBhDGARIsAMCZNJuqKyBW0wInQwCp3fMyLn6xcft6NrLdVZdiuouauwoKJm_Xq9L0BV8aArGYEALw_wcB">The Butterfly Foundation</a> is also a great source of support for information on eating disorders. </p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CnVSr--qisn","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p><img src="https://counter.theconversation.com/content/208467/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vivienne Lewis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s important to establish regular and adequate eating so your body and brain are well-fuelled and you can make sensible decisions around the food you consume.Vivienne Lewis, Assistant professor – Psychology, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2080622023-06-21T14:53:54Z2023-06-21T14:53:54ZEating disorders and self-harm rose among teenage girls during the pandemic – new UK study<figure><img src="https://images.theconversation.com/files/533124/original/file-20230621-29-qag769.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6720%2C4466&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/teen-depression-concept-stressed-indian-teenage-2018791433">Prostock-studio/Shutterstock</a></span></figcaption></figure><p>Evidence tells us the COVID pandemic and measures put in place to contain the virus negatively affected the mental health of adolescents and young people in the UK and elsewhere. One <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2782796">review study</a> published in August 2021 estimated that the global prevalence of children and adolescents with depression and anxiety had doubled since the start of the pandemic.</p>
<p><a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61141-0/fulltext">Self-harm</a> and <a href="https://www.dovepress.com/the-epidemiology-of-eating-disorders-genetic-environmental-and-societa-peer-reviewed-fulltext-article-CLEP">eating disorders</a> typically start during adolescence or early adulthood. As well as being major health issues, both are coping mechanisms that often indicate <a href="https://onlinelibrary.wiley.com/doi/abs/10.1521/suli.2007.37.4.409">underlying psychological distress</a>.</p>
<p>In a <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(23)00126-8/fulltext">new study</a>, we found that GPs in the UK recorded a large rise in eating disorder diagnoses and self-harm episodes among teenage girls in the first two years of the pandemic.</p>
<p>The study was conducted jointly by the University of Manchester, Keele University, the University of Exeter and the <a href="https://mcpin.org/">McPin Foundation</a>, a mental health research charity. We also worked with an advisory group of young people with lived experience of mental health difficulties, as well as parents and carers.</p>
<h2>Comparing predictions and observed case numbers</h2>
<p>We used data from the <a href="https://cprd.com/">Clinical Practice Research Datalink</a>, a database of anonymised primary care electronic health records. We included over 9 million patients aged ten to 24 (both males and females) from 1,881 general practices across the UK.</p>
<p>We calculated the monthly incidence rates of eating disorder diagnoses and self-harm episodes from January 2010 through to March 2022. Based on data from the ten years preceding the pandemic, and using statistical models, we predicted what the rates of eating disorders and self-harm would be had the pre-pandemic trends continued. We then compared the rates actually observed in March 2020 until March 2022 with these predictions.</p>
<p>In the two years after the onset of the pandemic, we found that eating disorder diagnoses were 42% higher than would be expected for girls aged 13–16, and 32% higher for girls aged 17–19. There was little difference between observed and expected incidence for the other age groups.</p>
<p>The increase in rates of self-harm was also greatest among girls aged 13–16, 38% higher than expected. There was no evidence of an increase in self-harm in females in the other age groups.</p>
<p>Among males, the rates of eating disorders and self-harm were lower than, or close to, the expected rates across all age groups.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/people-with-eating-disorders-saw-their-symptoms-worsen-during-the-pandemic-new-study-140487">People with eating disorders saw their symptoms worsen during the pandemic – new study</a>
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<p>In the ten years before the pandemic, eating disorder diagnoses in females were more common among those from less-deprived areas than those from more-deprived communities. This socioeconomic difference widened following the onset of the pandemic. Since March 2020, eating disorder diagnoses for females living in the least-deprived communities were 52% higher than expected, compared with 22% higher for those in the most-deprived areas.</p>
<p>In contrast, self-harm rates before the pandemic were higher for those in the most-deprived compared with the least-deprived areas. Since March 2020, self-harm incidence for females in the least-deprived areas was 31% higher than expected, while there was no significant difference between observed and expected incidence for those in the most-deprived areas, therefore narrowing the pre-pandemic gap.</p>
<h2>Limitations and possible explanations</h2>
<p>Our study is large, but episodes of self-harm that were not treated by health services were not captured in our data, so the rise in self-harm incidence might have been even greater than we observed. However, it’s also possible that cases of self-harm not coming to the attention of services might have exhibited a different pattern.</p>
<figure class="align-center ">
<img alt="A teenage girl sits on the floor against her bed." src="https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533126/original/file-20230621-19-vbgdqm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eating disorders and self-harm can indicate underlying psychological distress.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/frustrated-sad-teen-girl-child-sitting-2292976519">DimaBerlin/Shutterstock</a></span>
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<p>Previous studies have reported increased hospital admissions and presentations to emergency departments for <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2783854">self-harm</a> and symptoms of <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2798255">eating disorders</a> among teenage girls during the COVID pandemic. Our study complements these findings. </p>
<p>The reasons for the increase in eating disorder diagnoses and self-harm episodes among teenage girls are likely to be complex and could be due to a combination of factors. These include <a href="https://link.springer.com/article/10.1007/s12144-022-03651-5">social isolation</a>, anxiety resulting from changing routines, disruption to education, unhealthy <a href="https://www.mdpi.com/1660-4601/19/16/9960">social media influences</a>, and increased awareness of mental health difficulties. </p>
<p>It’s also pertinent to note that youth mental health had been deteriorating even in the years <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03235-w">before the pandemic</a> in the UK, though at a less substantial rate of change.</p>
<p>The greater increases in eating disorders and self-harm among female teenagers living in less-deprived areas, relative to those in more-deprived areas, may reflect differences in service provision and access to clinical care between these areas.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/melatonin-use-may-reduce-self-harm-in-young-people-research-shows-202895">Melatonin use may reduce self-harm in young people, research shows</a>
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</em>
</p>
<hr>
<h2>What next?</h2>
<p>The substantial rise in eating disorder diagnoses and self-harm episodes among teenage girls highlights an urgent need for intervention. Early identification of mental health difficulties in children and young people by primary care clinicians (including GPs, nurses and psychologists) is extremely important, as this facilitates timely access to treatment. </p>
<p>Potential barriers to help-seeking, including <a href="https://bjgp.org/content/71/711/e744">fear of stigma</a> and concerns about long waiting lists to access services, need to be tackled. Given the current pressures on the NHS in both primary and specialist care, our study emphasises the need for sufficient capacity in mental health services to meet growing demand.</p><img src="https://counter.theconversation.com/content/208062/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pearl Mok receives funding from the National Institute for Health and Care Research. </span></em></p><p class="fine-print"><em><span>Alex Trafford does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We analysed the primary care records of more than 9 million young patients across the UK.Pearl Mok, Research Fellow, Centre for Pharmacoepidemiology and Drug Safety, University of ManchesterAlex Trafford, Research Associate in Epidemiology, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2061702023-06-07T12:25:05Z2023-06-07T12:25:05ZMounting research documents the harmful effects of social media use on mental health, including body image and development of eating disorders<figure><img src="https://images.theconversation.com/files/529888/original/file-20230602-15-ynda6h.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5742%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The hours spent – and the content viewed – by teens on social media can lead to depression, anxiety and body image issues.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cell-phone-break-up-royalty-free-image/483933372?phrase=upset+teenager+on+phone&adppopup=true">Mixmike/E+via Getty Images</a></span></figcaption></figure><p>Media influences and conventional beauty standards have long plagued society. </p>
<p>This issue took on new urgency in May 2023 when the <a href="https://www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf">U.S. surgeon general issued a major public advisory</a> over the <a href="https://www.nytimes.com/2023/05/23/health/surgeon-general-social-media-mental-health.html">links between social media and youth mental health</a>. </p>
<p>Research shows that images of beauty as depicted in movies, television and magazines <a href="https://doi.org/10.1037/0021-843X.103.4.836">can lead to mental illness</a>, issues with disordered eating and <a href="https://doi.org/10.1093%2Fpch%2F8.5.287">body image dissatisfaction</a>. </p>
<p>These trends have been documented <a href="https://doi.org/10.1037/0033-2909.134.3.460">in women</a> <a href="https://doi.org/10.1521/jscp.2008.27.3.279">and men</a>, in the <a href="https://doi.org/10.1016/j.jadohealth.2018.10.096">LGBTQ+ community</a> and in <a href="https://www.hsph.harvard.edu/striped/wp-content/uploads/sites/1267/2022/10/Real-Cost-of-Beauty-Report-10-4-22.pdf">people of different racial</a> and ethnic backgrounds. </p>
<p>Experts have long suspected that social media may be playing a role in the growing <a href="https://www.nytimes.com/2022/04/23/health/mental-health-crisis-teens.html">mental health crisis in young people</a>. However, the surgeon general’s warning is one of the first <a href="https://www.nytimes.com/2023/05/23/health/surgeon-general-social-media-mental-health.html">public warnings supported by robust research</a>.</p>
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<figcaption><span class="caption">The U.S. surgeon general says the youth mental health crisis is the ‘defining public health challenge of our time.’</span></figcaption>
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<h2>Social media can be toxic</h2>
<p>Body dissatisfaction among children and adolescents is commonplace and <a href="https://doi.org/10.3389%2Ffpsyg.2023.1037932">has been linked to</a> decreased quality of life, worsened mood and unhealthy eating habits. </p>
<p>As an <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/29092">eating disorder and anxiety specialist</a>, I regularly work with clients who experience eating disorder symptoms, self-esteem issues and anxiety <a href="https://news.cuanschutz.edu/news-stories/how-does-social-media-affect-our-mental-health">related to social media</a>. </p>
<p>I also <a href="https://doi.org/10.1016/S2215-0366(23)00116-5">have firsthand experience with this topic</a>: I am 15 years post-recovery from an eating disorder, and I grew up when people were beginning to widely use social media. In my view, the impact of social media on diet and exercise patterns needs to be further researched to inform future policy directions, school programming and therapeutic treatment. </p>
<p>The mental health of adolescents and teens has been <a href="https://www.cdc.gov/nchhstp/dear_colleague/2020/dcl-102320-YRBS-2009-2019-report.html">declining for the past decade</a>, and the <a href="https://doi.org/10.1016%2Fj.psychres.2023.115082">COVID-19 pandemic contributed to worsening youth mental health</a> and brought it into the spotlight. As the mental health crisis surges, researchers have been taking a <a href="https://cuanschutz360.buzzsprout.com/1991131/10641970-how-does-social-media-affect-our-mental-health">close look at the role of social media</a> in these increasing mental health concerns.</p>
<h2>The pros and cons of social media</h2>
<p>About 95% of children and adolescents in the U.S. between the ages of 10 and 17 are <a href="https://www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf">using social media almost constantly</a>.</p>
<p>Research has shown that <a href="https://www.commonsensemedia.org/sites/default/files/research/report/2021-coping-with-covid19-full-report.pdf">social media can be beneficial</a> for finding <a href="https://doi.org/10.2196/26011">community support</a>. However, studies have also shown that the use of social media contributes to social comparisons, unrealistic expectations and <a href="https://doi.org/10.1001/jamapsychiatry.2019.2325">negative mental health effects</a>. </p>
<p>In addition, those who have <a href="https://www.apa.org/topics/social-media-internet/health-advisory-adolescent-social-media-use.pdf">preexisting mental health conditions</a> tend to spend more time on social media. People in that category are more likely to <a href="https://doi.org/10.1177/1461444817694499">self-objectify</a> and <a href="https://doi.org/10.1016/j.eatbeh.2012.06.003">internalize the thin body ideal</a>. Women and <a href="https://doi.org/10.1371/journal.pgph.0001091">people with preexisting body image concerns</a> are more likely to feel worse about their bodies and themselves after they spend time on social media.</p>
<h2>A breeding ground for eating disorders</h2>
<p>A recent review found that, as with mass media, the use of social media is a risk factor for <a href="https://doi.org/10.1371/journal.pgph.0001091">the development of an eating disorder</a>, body image dissatisfaction and disordered eating. In this review, social media use was shown to contribute to negative self-esteem, social comparisons, decreased emotional regulation and idealized self-presentation that negatively influenced body image.</p>
<p>Another study, called the <a href="https://www.dove.com/us/en/stories/campaigns/social-media-and-body-image.html">Dove Self-Esteem Project</a>, published in April 2023, found that 9 in 10 children and adolescents ages 10 to 17 are exposed to toxic beauty content on social media and 1 in 2 say that this has an impact on their mental health. </p>
<p>Eating disorders are <a href="https://theconversation.com/eating-disorders-among-teens-have-more-than-doubled-during-the-covid-19-pandemic-heres-what-to-watch-for-201067">complex mental illnesses</a> that develop because of biological, social and psychological factors. Eating disorder hospitalizations and the need for treatment have dramatically <a href="https://doi.org/10.1001/jamapediatrics.2022.4346">increased during the pandemic</a>.</p>
<p><a href="https://doi.org/10.1001/jamanetworkopen.2021.34913">Some reasons for this</a> include isolation, food scarcity, boredom and <a href="https://doi.org/10.3389/fpsyg.2023.1139261">social media content</a> related to weight gain, such as the “<a href="https://doi.org/10.1016/j.bodyim.2021.04.002">quarantine15</a>.” That was a reference to the weight gain some people were experiencing at the beginning of the pandemic, similar to the “freshman 15” belief that one will gain 15 pounds in the first year of college. Many teens whose routines were disrupted by the pandemic turned to eating disorder behaviors for <a href="https://doi.org/10.2196/26011">an often-false sense of control</a> or were influenced by family members who held unhealthy beliefs around food and exercise. </p>
<p>Researchers have also found that increased time at home during the pandemic <a href="https://www.luriechildrens.org/en/blog/social-media-parenting-statistics/">led to more social media use by young people</a> and therefore more exposure to toxic body image and dieting social media content. </p>
<p>While social media alone will not cause eating disorders, <a href="https://www.hsph.harvard.edu/striped/wp-content/uploads/sites/1267/2022/10/Real-Cost-of-Beauty-Report-10-4-22.pdf">societal beliefs about beauty</a>, which are amplified by social media, can contribute to the development of eating disorders. </p>
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<figcaption><span class="caption">According to a report from the Centers for Disease Control and Prevention, 42% of high school students say they feel ‘persistently sad’ and ‘hopeless.’</span></figcaption>
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<h2>‘Thinspo’ and ‘fitspo’</h2>
<p>Toxic beauty standards online include the normalization of cosmetic and surgical procedures and pro-eating-disorder content, which promotes and romanticizes eating disorders. For instance, social media sites have promoted trends such as “thinspo,” which is focused on the thin ideal, and “fitspo,” which perpetuates the belief of there being a perfect body that can be achieved with dieting, supplements and excessive exercise.</p>
<p>Research has shown that <a href="https://doi.org/10.1186/s40337-019-0246-2">social media content encouraging “clean eating</a>” or dieting through pseudoscientific claims can lead to obsessive behavior around dietary patterns. These unfounded “wellness” posts <a href="https://doi.org/10.1016/j.childyouth.2020.105659">can lead to weight cycling, yo-yo dieting</a>, chronic stress, body dissatisfaction and higher likelihood of <a href="https://doi.org/10.1177/1461444818821064">muscular and thin-ideal internalization</a>.</p>
<p>Some social media posts feature <a href="https://doi.org/10.3390/ijerph18042186">pro-eating-disorder content</a>, which directly or indirectly encourages disordered eating. Other posts promote deliberate manipulation of one’s body, using harmful quotes such as “nothing tastes as good as thin feels.” These posts provide a false sense of connection, allowing users to bond over a shared goal of losing weight, altering one’s appearance and continuing patterns of disordered eating. </p>
<p>While young people <a href="https://www.dove.com/us/en/stories/campaigns/real-cost-of-beauty/thestats.html">can often recognize and understand</a> toxic beauty advice’s effects on their self-esteem, they may still continue to engage with this content. This is in part because friends, influencers and <a href="https://doi.org/10.1016/j.bodyim.2022.03.007">social media algorithms</a> <a href="https://doi.org/10.1007/s10964-012-9898-9">encourage people</a> to follow certain accounts. </p>
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<figcaption><span class="caption">Not all teens are on social media.</span></figcaption>
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<h2>How policy changes could help</h2>
<p><a href="https://scrippsnews.com/stories/legislators-target-social-media-to-combat-eating-disorders/">Legislators across the U.S.</a> are proposing different <a href="https://www.pbs.org/newshour/health/new-state-laws-aim-to-tackle-surge-in-eating-disorders">regulations for social media sites</a>. </p>
<p>Policy recommendations include increased transparency from social media companies, creation of higher standards of <a href="https://www.apa.org/topics/social-media-internet/health-advisory-adolescent-social-media-use?">privacy for children’s data</a> and <a href="https://doi.org/10.1177/0098858819849990">possible tax incentives and social responsibility initiatives</a> that would discourage companies and marketers from using altered photos.</p>
<h2>Phone-free zones</h2>
<p>Small steps at home to cut down on social media consumption can also make a difference. Parents and caregivers can <a href="https://www.luriechildrens.org/en/blog/social-media-parenting-statistics/">create phone-free periods</a> for the family. Examples of this include putting phones away while the family watches a movie together or during mealtimes. </p>
<p>Adults can also help by modeling healthy social media behaviors and encouraging children and adolescents to focus <a href="https://www.dove.com/us/en/dove-self-esteem-project/help-for-parents/social-media/social-media-filters.html">on building connections and engaging in valued activities</a>. </p>
<p>Mindful social media consumption is another helpful approach. This requires recognizing what one is feeling during social media scrolling. If spending time on social media makes you feel worse about yourself or seems to be causing mood changes in your child, it may be time to change how you or your child interact with social media.</p><img src="https://counter.theconversation.com/content/206170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Hemendinger does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research shows that social media, with it endless promotion of unrealistic standards of beauty, has had a negative impact on millions of young people.Emily Hemendinger, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1987312023-05-05T12:14:36Z2023-05-05T12:14:36ZMindfulness, meditation and self-compassion – a clinical psychologist explains how these science-backed practices can improve mental health<figure><img src="https://images.theconversation.com/files/521937/original/file-20230419-16-ly31ug.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7951%2C5304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Studies show that consistent meditation practice is key.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/peace-relax-and-happy-mindset-of-a-woman-from-royalty-free-image/1421420537?phrase=meditation%20sitting%20in%20chair&adppopup=true">pixdeluxe/E! via Getty Images</a></span></figcaption></figure><p>Mindfulness and self-compassion are now <a href="https://www.forbes.com/sites/payout/2017/09/29/mindfulness-is-more-than-a-buzzword-a-look-at-the-neuroscience-behind-the-movement/?sh=55bb4905372f">buzzwords for self-improvement</a>. But in fact, a growing body of research shows these practices can lead to real mental health benefits. This research – ongoing, voluminous and worldwide – clearly shows <a href="https://doi.org/10.1371/journal.pone.0191332">how and why these two practices work</a>. </p>
<p>One effective way to cultivate mindfulness and self-compassion <a href="https://doi.org/10.1016/j.jpsychores.2016.11.006">is through meditation</a>. </p>
<p>For more than 20 years, as a <a href="https://www.seattleu.edu/artsci/about/directory/profile/rachel-turow.html">clinical psychologist, research scientist and educator</a>, I taught meditation to students and clinical patients and took a deep dive into the research literature. My recent book, “<a href="https://www.penguinrandomhouse.com/books/706228/the-self-talk-workout-by-rachel-goldsmith-turow-phd/">The Self-Talk Workout</a>: Six Science-Backed Strategies to Dissolve Self-Criticism and Transform the Voice in Your Head,” highlights much of that research. </p>
<p>I learned even more when I evaluated <a href="https://doi.org/10.1080/10503307.2021.1878306">mental health programs</a> and <a href="https://www.insidehighered.com/advice/2023/01/04/how-teach-practicable-mental-health-skills-classroom-opinion">psychology classes</a> that train participants in mindfulness and compassion-based techniques. </p>
<h2>Defining mindfulness and self-compassion</h2>
<p>Mindfulness means purposefully paying attention to the present moment with an attitude of interest or curiosity rather than judgment. </p>
<p>Self-compassion involves being kind and understanding toward yourself, even during moments of suffering or failure. </p>
<p><a href="https://doi.org/10.1016/j.cpr.2011.04.006">Both are associated</a> with <a href="https://doi.org/10.1037/a0025754">greater well-being</a>.</p>
<p>But don’t confuse <a href="https://doi.org/10.1111/j.1467-6494.2008.00537.x">self-compassion with self-esteem</a> or self-centeredness, or assume that it somehow lowers your standards, motivation or productivity. Instead, research shows that self-compassion is <a href="https://doi.org/10.1177/0146167212445599">linked with greater motivation</a>, <a href="https://doi.org/10.1080/15298868.2013.763404">less procrastination</a> and <a href="https://doi.org/10.1007/s12671-020-01566-5">better relationships</a>.</p>
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<figcaption><span class="caption">Could mindfulness meditation be the next public health revolution?</span></figcaption>
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<h2>Be patient when starting a meditation practice</h2>
<p>I didn’t like meditation – the specific practice sessions that train mindfulness and self-compassion – the first time I tried it as a college student in the late ‘90s. I felt like a failure when my mind wandered, and I interpreted that as a sign that I couldn’t do it. </p>
<p>In both my own and others’ meditation practices, I’ve noticed that the beginning is often rocky and full of doubt, resistance and distraction. </p>
<p>But what seem like impediments can actually enhance meditation practice, because the mental work of handling them builds strength.</p>
<p>For the first six months I meditated, my body and mind were restless. I wanted to get up and do other tasks. But I didn’t. Eventually it became easier to notice my urges and thoughts without acting upon them. I didn’t get as upset with myself. </p>
<p>After about a year of consistent meditation, my mind seemed more organized and controllable; it no longer got stuck in self-critical loops. I felt a sense of kindness or friendliness toward myself in everyday moments, as well as during joyful or difficult experiences. I enjoyed ordinary activities more, such as walking or cleaning. </p>
<p>It took a while to understand that anytime you sit down and try to meditate, that’s meditation. It is a mental process, rather than a destination. </p>
<h2>How meditation works on the mind</h2>
<p>Just having a general intention to be more mindful or self-compassionate is unlikely to work.</p>
<p>Most programs shown to make meaningful differences <a href="https://doi.org/10.1037/pas0000268">involve at least seven sessions</a>. Studies show these repeated workouts <a href="https://doi.org/10.3389/fpsyg.2018.00668">improve attention skills</a> and <a href="https://doi.org/10.2147/PRBM.S31458">decrease rumination, or repeated negative thinking</a>. </p>
<p>They also <a href="https://doi.org/10.1016/j.invent.2016.10.001">lessen self-criticism</a>, which is <a href="https://doi.org/10.1016/j.jad.2018.12.069">linked to numerous mental health difficulties</a>, including <a href="https://doi.org/10.2147/PRBM.S31458">depression</a>, <a href="https://doi.org/10.1002/cpp.1918">anxiety</a>, <a href="https://doi.org/10.1002/eat.23284">eating disorders</a>, <a href="https://doi.org/10.1348/014466509X479771">self-harm</a> and <a href="http://doi.org/10.1002/eat.23284">post-traumatic stress disorder</a>.</p>
<p>Meditation is not just about sustaining your attention – it’s also about <a href="https://doi.org/10.1016/j.janxdis.2011.03.013">shifting and returning your focus</a> after the distraction. The act of shifting and refocusing cultivates attention skills <a href="https://doi.org/10.2147/PRBM.S31458">and decreases rumination</a>.</p>
<p>Trying repeatedly to refrain from <a href="https://doi.org/10.1016/j.cpr.2016.10.011">self-judgment during the session</a> will train your mind <a href="https://doi.org/10.1016/j.invent.2016.10.001">to be less self-critical</a>. </p>
<p>An interconnected group of brain regions called <a href="https://www.psychologytoday.com/us/basics/default-mode-network">the default mode network</a> is <a href="https://doi.org/10.1073/pnas.98.2.676">strikingly affected by meditation</a>. Much of this network’s activity reflects repetitive thinking, such as a rehash of a decadeslong tension with your sister. It’s most prominent when you’re not doing much of anything. Activity of the default mode network is <a href="https://doi.org/10.1093/scan/nsv132">related to rumination, unhappiness</a> and <a href="https://doi.org/10.1016/j.biopsych.2011.02.003">depression</a>. </p>
<p>Research shows that just one month of meditation <a href="https://doi.org/10.1016/j.neuroimage.2017.01.044">reduces the noise of the default mode network</a>. The type of meditation practice <a href="https://doi.org/10.1073/pnas.1112029108">doesn’t seem to matter</a>.</p>
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<figcaption><span class="caption">Don’t be discouraged if your mind wanders as you meditate.</span></figcaption>
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<h2>Establishing the formal practice</h2>
<p>A common misconception about mindfulness is that it’s simply a way <a href="https://doi.org/10.1177/1534735417699514">to relax or clear the mind</a>. Rather, it means intentionally paying attention to your experiences in a nonjudgmental way. </p>
<p>Consider meditation the formal part of your practice – that is, setting aside a time to work on specific mindfulness and self-compassion techniques. </p>
<p>Cultivating mindfulness with meditation often involves focusing on paying attention to the breath. A common way to start practice is to sit in a comfortable place and bring attention to your breathing, wherever you feel it most strongly. </p>
<p>At some point, probably after a breath or two, your mind will wander to another thought or feeling. As soon as you notice that, you can bring your attention back to the breath and try not to judge yourself for losing focus for five to 10 minutes. </p>
<p>When I was just getting started meditating, I would have to redirect my attention dozens or hundreds of times in a 20-to-30-minute session. Counting 10 breaths, and then another 10, and so on, helped me link my mind to the task of paying attention to my breathing.</p>
<p>The most well-established technique for cultivating self-compassion is called loving-kindness meditation. To practice, you can find a comfortable position, and for at least five minutes, internally repeat phrases such as, “May I be safe. May I be happy. May I be healthy. May I live with ease.” </p>
<p>When your attention wanders, you can bring it back with as little self-judgment as possible and continue repeating the phrases. Then, if you like, offer the same well wishes to other people or to all beings.</p>
<p>Every time you return your focus to your practice without judging, you’re flexing your mental awareness, because you noticed your mind wandered. You also improve your capacity to shift attention, a valuable anti-rumination skill, and your nonjudgment, an antidote to self-criticism. </p>
<p>These practices work. Studies show that brain activity during meditation results in less <a href="https://doi.org/10.1186/s13030-019-0145-4">self-judgment, depression and anxiety</a> and <a href="https://doi.org/10.1016/j.janxdis.2011.03.013">results in less rumination</a>. </p>
<p>Mindfulness also occurs when you tune into present-moment sensations, such as tasting your food or washing the dishes.</p>
<p>An ongoing routine of formal and informal practice can transform your thinking. And again, doing it once in a while won’t help as much. It’s like situps: A single situp isn’t likely to strengthen your abdominal muscles, but doing several sets each day will. </p>
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<figcaption><span class="caption">When thoughts pop up during meditation, no worries. Just start again … and again … and again.</span></figcaption>
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<h2>Meditation reduces self-criticism</h2>
<p>Studies show that <a href="https://doi.org/10.1037/pas0000268">mindfulness meditation</a> and <a href="https://doi.org/10.1016/j.invent.2016.10.001">loving-kindness meditation</a> reduce self-criticism, which <a href="https://doi.org/10.3389/fpsyt.2020.00147">leads to better mental health</a>, including lower levels of <a href="https://doi.org/10.1037/ccp0000040">depression</a>, <a href="https://doi.org/10.1007/s10488-021-01170-2">anxiety</a> and <a href="https://doi.org/10.1016/j.psychres.2018.03.007">PTSD</a>. After an eight-week mindfulness program, participants experienced <a href="https://doi.org/10.1186/s13030-019-0145-4">less self-judgment</a>. These changes were linked with decreases in depression and anxiety.</p>
<p>One final point: Beginning meditators may find that self-criticism gets worse before it gets better. </p>
<p>After years or decades of habitual self-judgment, people often judge themselves harshly about losing focus during meditation. But once students get through the first few weeks of practice, the self-judgment begins to abate, both about meditation and about oneself in general. </p>
<p>As one of my students recently said after several weeks of mindfulness meditation: “I am more stable, more able to detach from unhelpful thoughts and can do all of this while being a little more compassionate and loving toward myself.”</p><img src="https://counter.theconversation.com/content/198731/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Goldsmith Turow does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many studies show that consistent meditation practice lowers depression, anxiety and self-criticism.Rachel Goldsmith Turow, Adjunct Assistant Professor in Population Health Science and Policy, Seattle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2010672023-03-31T12:23:17Z2023-03-31T12:23:17ZEating disorders among teens have more than doubled during the COVID-19 pandemic – here’s what to watch for<figure><img src="https://images.theconversation.com/files/517032/original/file-20230322-419-qse5vl.jpg?ixlib=rb-1.1.0&rect=30%2C46%2C5129%2C3380&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The traditional assumption that eating disorders primarily affect affluent white women has led to stigma, stereotyping and misunderstanding. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asia-woman-feeling-sad-in-the-bedroom-royalty-free-image/1324460530?phrase=eating%20disorders%20in%20teens&adppopup=true">toondelamour/E+ via Getty Images</a></span></figcaption></figure><p>The COVID-19 pandemic has been <a href="https://doi.org/10.1016/j.jaac.2022.12.026">associated with worsening mental health</a> among teens, including increasing numbers of patients with eating disorders. In fact, research indicates that the number of teens with eating disorders <a href="https://doi.org/10.1001/jamapediatrics.2022.4346">at least doubled during the pandemic</a>. </p>
<p>This is particularly concerning given that eating disorders <a href="https://doi.org/10.1001/archgenpsychiatry.2011.74">are among the most deadly</a> of all mental health diagnoses, and teens with eating disorders are at <a href="https://doi.org/10.1016/j.copsyc.2017.08.023">higher risk for suicide</a> than the general population.</p>
<p>While experts don’t know exactly why eating disorders develop, studies show that <a href="https://doi.org/10.23750/abm.v93i3.13140">body dissatisfaction and desire for weight loss</a> are key contributors. This can make conversations around weight and healthy behaviors particularly tricky with teens and young adults.</p>
<p>As an <a href="https://profiles.umassmed.edu/display/30628475">adolescent medicine doctor</a> <a href="https://www.researchgate.net/scientific-contributions/Sydney-M-Hartman-Munick-2175760133">specializing in eating disorders</a>, I have seen firsthand the increases in patients with eating disorders as well as the detrimental effects of eating disorder stereotypes. I regularly work with families to help teens develop positive relationships with body image, eating and exercise.</p>
<p>Understanding the signs of a possible eating disorder is important, as studies suggest that timely diagnosis and treatment leads to <a href="https://doi.org/10.1002/eat.22840">better long-term outcomes</a> and to better chances of full recovery. </p>
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<figcaption><span class="caption">Excessive dieting and withdrawal from friends are two signs of disordered eating.</span></figcaption>
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<h2>Eating disorders defined</h2>
<p>Eating disorders, which <a href="https://doi.org/10.1038/s41380-021-01161-7">often start in adolescence</a>, include <a href="https://www.allianceforeatingdisorders.com/anorexia-nervosa/">anorexia nervosa</a>, <a href="https://www.allianceforeatingdisorders.com/bulimia-nervosa/">bulimia nervosa</a>, <a href="https://www.allianceforeatingdisorders.com/binge-eating-disorder/">binge eating disorder</a>, <a href="https://www.allianceforeatingdisorders.com/other-specified-feeding-or-eating-disorders/">other specified feeding and eating disorders</a> and <a href="https://www.allianceforeatingdisorders.com/avoidant-restrictive-food-intake-disorder-arfid/">avoidant restrictive food intake disorder</a>. Each eating disorder has specific criteria that must be met in order to receive a diagnosis, which is made by a professional with eating disorder expertise.</p>
<p>Research suggests that up to 10% of people will develop <a href="https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/">an eating disorder in their lifetime</a>. Medical complications from eating disorders, such as low heart rate and electrolyte abnormalities, <a href="https://doi.org/10.1186/s40337-023-00759-2">can be dangerous and result in hospitalization</a>, and malnutrition can affect growth and development. Many of the patients I see in clinic show signs of paused puberty and stalled growth, which can influence bone health, adult height and other aspects of health if not addressed quickly.</p>
<p>Teens are also at risk for disordered eating behaviors such as intentional vomiting, caloric restriction, binge eating, overexercise, the use of weight loss supplements and misuse of laxatives. </p>
<p>A recent study estimated that 1 in 5 teens may <a href="https://doi.org/10.1001/jamapediatrics.2022.5848">struggle with disordered eating behaviors</a>. While these behaviors alone may not qualify as an eating disorder, they may predict the <a href="https://doi.org/10.1016/j.jada.2006.01.003">development of eating disorders later on</a>.</p>
<p>Treatment methods for eating disorders are <a href="https://www.aedweb.org/resources/about-eating-disorders/treatment-options">varied and depend on multiple factors</a>, including a patient’s medical stability, family preference and needs, local resources and insurance coverage. </p>
<p>Treatment can include a team consisting of a medical provider, nutritionist and therapist, or might involve the use of a specialized eating disorder program. Referral to one of these treatment methods may come from a pediatrician or a specialized eating disorder provider.</p>
<h2>Unpacking misconceptions and stereotypes</h2>
<p>Traditional ideas and stereotypes about eating disorders have left many people with the impression that it is mainly thin, white, affluent females who develop eating disorders. However, research demonstrates that anyone can develop these conditions, regardless of age, <a href="https://doi.org/10.1016/j.eatbeh.2018.11.004">race</a>, <a href="https://doi.org/10.1186/s40337-022-00720-9">body size</a>, <a href="https://doi.org/10.1016/j.jadohealth.2015.03.003">gender identity</a>, <a href="https://doi.org/10.1007/s11920-017-0801-y">sexual orientation</a> or <a href="https://doi.org/10.1002/eat.22846">socioeconomic status</a>. </p>
<p>Unfortunately, stereotypes and assumptions about eating disorders have <a href="https://doi.org/10.1186/s40337-022-00730-7">contributed to health disparities</a> in screening, diagnosis and treatment. Studies have documented negative eating disorder treatment experiences among <a href="https://doi.org/10.1016/j.eatbeh.2021.101517">transgender and gender-diverse</a> individuals, <a href="https://doi.org/10.1002/eat.23402">Black and Indigenous</a> people and those <a href="https://www.nytimes.com/2022/10/18/magazine/anorexia-obesity-eating-disorder.html">with larger body size</a>. Some contributors to these negative experiences include lack of diversity and training among treatment providers, treatment plans without cultural or economic nutritional considerations and differential treatment when a patient is not visibly underweight, among others. </p>
<p>Contrary to popular assumptions, studies show teen boys are <a href="https://doi.org/10.1097%2FMOP.0000000000000911">at risk for eating disorders as well</a>. These often go undetected and can be disguised as a desire to become more muscular. However, eating disorders are just as dangerous for boys as they are for girls.</p>
<p>Parents and loved ones can play a role in helping to dispel these stereotypes by advocating for their child at the pediatrician’s office if concern arises and by recognizing red flags for eating disorders and disordered eating behaviors.</p>
<h2>Warning signs</h2>
<p>Given how common disordered eating and eating disorders are among teens, it is important to understand <a href="https://www.medainc.org/resources-2/about-eating-disorders/">some possible signs</a> of these worrisome behaviors and what to do about them.</p>
<p>Problematic behaviors can include eating alone or in secret and a hyperfocus on “healthy” foods and distress when those foods aren’t readily available. Other warning signs include significantly decreased portion sizes, skipped meals, fights at mealtime, using the bathroom immediately after eating and weight loss. </p>
<p>Because these behaviors often feel secretive and shameful, it may feel difficult to bring them up with teens. Taking a warm but direct approach when the teen is calm can be helpful, while letting them know you have noticed the behavior and are there to support them without judgment or blame. I always make sure to let my patients know that my job is to be on their team, rather than to just tell them what to do.</p>
<p>Teens may not immediately open up about their own concerns, but if behaviors like this are present, don’t hesitate to have them seen at their pediatrician’s office. Following up with patients who have shown signs of having an eating disorder and promptly <a href="https://www.nationaleatingdisorders.org/where-do-i-start-0">referring them to a specialist</a> who can further evaluate the patient are crucial for getting teens the help they may need. Resources for families <a href="https://www.feast-ed.org/">can be helpful</a> to navigate the fear and uncertainty that can come along with the diagnosis of an eating disorder.</p>
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<figcaption><span class="caption">Many misconceptions exist about eating disorders, including that they are about vanity or that people should just be able to stop.</span></figcaption>
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<h2>Focus on health, not size</h2>
<p>Research shows that <a href="https://doi.org/10.1097/MOP.0000000000000910">poor body image</a> and <a href="https://doi.org/10.23750/abm.v93i3.13140">body dissatisfaction</a> can put teens at risk for disordered eating behaviors and eating disorders. </p>
<p>Parents play an important role in the development of teens’ self-esteem, and research demonstrates that <a href="https://doi.org/10.1186/s40337-022-00561-6">negative comments from parents</a> about weight, body size and eating are associated with eating disorder-type thoughts in teens. Therefore, when talking to teens, it <a href="https://doi.org/10.1001/jamapediatrics.2013.78">can be beneficial</a> to take a weight-neutral approach, which <a href="https://doi.org/10.1002/ncp.10885">focuses more on overall health</a> rather than weight or size. I unfortunately have had many patients with eating disorders who were scolded or teased about their weight by family members; this can be really harmful in the long run.</p>
<p>One helpful strategy is to incorporate lots of variety into a teen’s diet. If doable, trying new foods as a family can encourage your teen to try something they haven’t before. Try to avoid terms such as “junk” or “guilt” when discussing foods. Teaching teens to appreciate lots of different kinds of foods in their diet allows them to develop a healthy, knowledgeable relationship with food. If you’re feeling stuck, you may want to ask your pediatrician about seeing a dietitian.</p>
<p>It’s important to remember that teens need <a href="https://doi.org/10.1111/nyas.13330">a lot of nutrition</a> to support growth and development, often more than adults do, and regular eating helps avoid extreme hunger that can lead to overeating. Letting teens listen to their bodies and learn their own hunger and fullness cues will help them <a href="https://doi.org/10.1007/s40519-020-00852-4">eat in a healthy way</a> and create healthy long-term habits.</p>
<p>In my experience, teens are more likely to exercise consistently when <a href="https://health.gov/our-work/nutrition-physical-activity/move-your-way-community-resources/campaign-materials/materials-kids-and-teens#videos">they find an activity</a> that they enjoy. Exercise doesn’t need to mean lifting weights at the gym; teens can move their bodies by taking a walk in nature, moving to music in their rooms or playing a pickup game of basketball or soccer with a friend or sibling. </p>
<p><a href="https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm">Focusing on the positive things</a> exercise can do for the body such as improvements in mood and energy can help avoid making movement feel compulsive or forced. When teens are able to find movement that they enjoy, it can help them to appreciate their body for all it is able to do.</p><img src="https://counter.theconversation.com/content/201067/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sydney Hartman-Munick does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Eating disorders in teens are common and dangerous, and parents and loved ones play a crucial role in helping to both identify concerning behaviors and promote healthy ones.Sydney Hartman-Munick, Assistant Professor of Pediatrics, UMass Chan Medical SchoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2010532023-03-22T17:18:30Z2023-03-22T17:18:30ZOlder people have eating disorders too – but they’re a largely ignored group<p>Josie (not her real name) has bulimia. She is prescribed steroids to manage a lung condition and heart failure and has gained a significant amount of weight as a result of using the drugs. Her body mass index (BMI) is over 35, which is in the obesity range. She was referred to the Community Mental Health Team because she had returned to her GP, concerned about her low mood, anxiety and difficulty walking. </p>
<p>Josie saw the team physiotherapist because she was at risk of having a fall and was avoiding leaving the house. She was also assessed by a clinical psychologist – a specialist in eating disorders. The psychologist asked Josie about her weight, shape and eating concerns. This was the first time her eating disorder has been diagnosed despite years of fasting, binge eating, and using diet pills and laxatives.</p>
<p>Josie is 69 years old. She is a member of the invisible population of older adults with an eating disorder.</p>
<p>She was sexually and physically abused in her early life and hated how big she felt when around others – particularly men. </p>
<p>Josie had been taking laxatives since she was 19 and kept her BMI between 23 and 27, that is, between a healthy weight and overweight. She had sought help from her GP many times but was told that the local eating disorder service only accepted people with a BMI below 17. Josie was told that she was “too big” to get help.</p>
<p>Now she is desperate about the lack of control she has in regulating her weight and has resorted to eating just one meal a day. She perceives her symptoms of water retention and stomach bloating as fat and so she has started restricting her eating again, which then triggers binge eating. </p>
<p>Josie told the psychologist that she is now avoiding taking steroids because she is worried about putting on weight. She also worries about being judged and won’t leave the house for fear that the neighbours will see how “big” she has become.</p>
<h2>Not recognised</h2>
<p>When Josie’s symptoms began in the early 1970s, eating disorders were not commonly recognised and treatment was in its infancy. Talk therapy for common mental health problems and trauma was also rarely available in the NHS. </p>
<p>Bulimia nervosa was not recognised as a mental health disorder <a href="https://scholarblogs.emory.edu/ant331spring2021/2021/04/01/history-of-bulimia-nervosa/">until 1980</a> when it gained an entry in the third edition of the “psychiatrists’ bible”: the Diagnostic and Statistical Manual III (DSM-III).</p>
<p>In the 1950s and 60s, during Josie’s formative years, people’s views of mental health were very different to now, and so were the ways of dealing with psychological distress. </p>
<p>This, paired with our tendency to make assumptions about people over a certain age, that they won’t experience eating disorders and that the focus of discussions and consultations with doctors will be on physical health rather than mental health, means older people with eating disorders are not noticed, diagnosed or treated.</p>
<p>Since Josie’s early experience, and even in the years since eating disorders were taken seriously, the diagnostic criteria for eating disorders have improved, but progress has been slow. For example, the need for the absence of menstruation to fulfil the diagnostic criteria for anorexia remained in place as late as 2013 (<a href="https://en.wikipedia.org/wiki/DSM-5">DSM-V</a>). </p>
<figure class="align-center ">
<img alt="A doctor taking a patient's blood pressure." src="https://images.theconversation.com/files/515183/original/file-20230314-2366-hbzdsh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/515183/original/file-20230314-2366-hbzdsh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/515183/original/file-20230314-2366-hbzdsh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/515183/original/file-20230314-2366-hbzdsh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/515183/original/file-20230314-2366-hbzdsh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/515183/original/file-20230314-2366-hbzdsh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/515183/original/file-20230314-2366-hbzdsh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">GPs are more likely to focus on physical health than mental health in older patients.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-checking-blood-pressure-patient-1347015317">Brian A Jackson/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Ageism</h2>
<p>New diagnostic criteria have broadened since DSM-V, but we still don’t hear about eating disorders in older people. Ageism may be at the centre of this.</p>
<p>Research into eating disorders tends to exclude older people. Researchers looking to study interventions for people with eating disorders tend to recruit participants from social media or from eating disorder clinics – meaning older adults are largely ignored. Consequently, guidelines for interventions are based on evidence for what works in a younger cohort.</p>
<p>The most common eating disorders are binge-eating disorder, bulimia and anorexia. There is very little research on eating disorders in people over 50. These disorders are not routinely screened in general practice and therefore not reported in NHS data. </p>
<p>Older people with eating disorders are likely to fall into one of three groups. One, people like Josie with a long-standing eating disorder (one that has probably never been treated). Two, people who have had a relapse of a prior eating disorder. And three, people who have developed a problem later in life. </p>
<p>Eating disorders are linked to <a href="https://www.nm.org/healthbeat/healthy-tips/anorexia-and-your-heart">cardiovascular disease</a> and <a href="https://theros.org.uk/information-and-support/osteoporosis/causes/anorexia/">osteoporosis</a>, among other health problems. Screening and treating these disorders can prevent these long-term effects and ultimately save the NHS significant time and money. Surely, as a minimum, people like Josie should not be discriminated against because they were born in the wrong era or because their BMI is “not low enough”. </p>
<p><em>Josie is Suzanne’s patient</em></p><img src="https://counter.theconversation.com/content/201053/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Older adults find it hard to get help for eating disorders.Louisa Shirley, Clinical Lecturer, University of ManchesterSuzanne Heywood-Everett, Visiting Lecturer, Clinical Psychology, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1955382023-03-09T13:39:49Z2023-03-09T13:39:49ZBody dysmorphic disorder is more common than eating disorders like anorexia and bulimia, yet few people are aware of its dangers<figure><img src="https://images.theconversation.com/files/513001/original/file-20230301-20-5yrxjp.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C8231%2C4644&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Those with body dysmorphic disorder often check themselves – and their perceived defects.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-with-bdd-body-dysmorphic-disorder-royalty-free-image/1360144717">Stevica Mrdja/EyeEm via Getty Images</a></span></figcaption></figure><p><em><a href="https://theconversation.com/el-trastorno-dismorfico-corporal-es-mas-frecuente-que-los-trastornos-alimentarios-como-la-anorexia-y-la-bulimia-pero-pocas-personas-son-conscientes-de-sus-peligros-202290">Leer en español.</a></em> </p>
<p>While eating disorders have been <a href="https://doi.org/10.1177/01454455870114005">widely publicized for decades</a>, far less attention has been given to a related condition called <a href="https://bdd.iocdf.org/about-bdd/">body dysmorphic disorder, or BDD</a>. </p>
<p>Body dysmorphic disorder is often hidden from public view due to the shame people feel about one or more parts of their body, yet it is a devastating, debilitating psychological condition. People with the disorder suffer from obsessive thoughts and repetitive behaviors related to their appearance.</p>
<p>Whereas people with eating disorders might view their underweight body as too fat, those with body dysmorphic disorder see themselves as ugly or disfigured even though they appear normal or attractive to others.</p>
<p>Body dysmorphic disorder is more common in both men and women than bulimia or anorexia. About <a href="https://doi.org/10.1017/s1092852900016436">2.5% of women and 2.2% of men</a> in the U.S. meet the criteria for body dysmorphic disorder – that’s higher than the prevalence of generalized anxiety disorder, schizophrenia or bipolar disorder in the general population.</p>
<p>For comparison, at any point in time, bulimia is seen in <a href="https://www.nationaleatingdisorders.org/statistics-research-eating-disorders">roughly 1.5% of women and 0.5% of men</a> in the U.S., and anorexia in <a href="https://www.nationaleatingdisorders.org/statistics-research-eating-disorders">0.35% of women and 0.1% of men</a>.</p>
<p>We are a team of communication and mental health researchers and clinicians from <a href="https://feartocourage.com/about-dr-eva-fisher/">Colorado State University Global</a>, <a href="https://faculty.medicine.hofstra.edu/2313-fugen-neziroglu">Hofstra Medical School</a> and the <a href="https://psychiatry.utoronto.ca/faculty/jamie-feusner">University of Toronto</a>. One of us, Eva Fisher, lived with the disorder for almost 15 years before getting help and recovering. My book, titled “The BDD Family,” provides insights into my <a href="https://feartocourage.com/thebddfamily-book/">daily struggles with body dysmorphic disorder</a> along with information about diagnosis and treatment. </p>
<p>In our view, body dysmorphic disorder needs to be better understood and publicized so that more people suffering from the condition can be properly diagnosed and treated. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/MpLWQVv9k84?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Body dysmorphic disorder often involves a fixation on a single feature, like the shape or size of one’s nose, a mole or the shape or curvature of a certain part of the body.</span></figcaption>
</figure>
<h2>Comparison between BDD and eating disorders</h2>
<p>People with body dysmorphic disorder and those with eating disorders share similar negative emotions such as shame, disgust and anger about their appearance. They also engage in some similar behaviors, such as mirror checking, taking photos to check themselves, seeking reassurance from others about their appearance, and using clothing to camouflage or conceal perceived defects.</p>
<p>People who suffer from these disorders commonly avoid places and activities due to self-consciousness about their appearance. In addition, those with eating disorders and body dysmorphic disorder may lack the knowledge that <a href="https://doi.org/10.1016/j.psychres.2012.03.023">their body image beliefs are distorted</a>.</p>
<p>Depression is common in people with body dysmorphic disorder, and they have a <a href="https://doi.org/10.1017/S0033291720002998">higher rate of suicidality</a> than those with eating disorders, including thoughts about committing suicide and suicide attempts. Although both eating disorders and body dysmorphic disorder can be severe and life-threatening, people with body dysmorphic disorder on average <a href="https://doi.org/10.1016/j.bodyim.2009.03.001">experience more impairment in daily functioning</a> than those with eating disorders.</p>
<h2>A personal view</h2>
<p>My (Eva’s) body dysmorphic disorder symptoms started at age 16. Some causes could have been childhood bullying and perfectionism about my appearance. I would obsess about the shape and size of my nose for more than eight hours a day and constantly <a href="https://www.youtube.com/watch?v=UUkZGSIYcEw&t=23s">compare my appearance</a> to models in fashion magazines. </p>
<p>I was convinced that others were judging me negatively because of my nose, which I perceived to be fat and ugly. I hated my nose so much that I didn’t want to get married or have children because I feared they would inherit it.</p>
<p>Even after getting plastic surgery at age 18 to make my nose thinner, I still hated it. This is a very common outcome for people with the disorder who undergo cosmetic surgery procedures. </p>
<p>Research indicates that 66% of people with body dysmorphic disorder have <a href="https://doi.org/10.1016/S1740-1445(03)00003-2">received cosmetic or dermatological treatment</a>. However, even when people feel better about one part of their body after surgery, the <a href="https://doi.org/10.1093/med/9780190254131.003.0030">image obsession often moves</a> to <a href="https://global.oup.com/academic/product/body-dysmorphic-disorder-9780190254131?cc=ca&lang=en&">one or more other body parts</a>. </p>
<p>Some patients will have multiple procedures on the same body part. Other people are so disappointed by the results of their surgery that <a href="https://doi.org/10.1093/med/9780190254131.003.0013">they want to commit suicide</a>. </p>
<p>Tragically, many people with body dysmorphic disorder think about killing themselves, and others attempt to take their own lives. Approximately 80% of people with body dysmorphic disorder <a href="https://doi.org/10.1093/med/9780190254131.003.0013">experience lifetime suicidal ideation</a>, and 24% to 28% have attempted suicide. Often, they are young men and women who feel so hopeless about their perceived appearance defects that suicide seems like the only way to end their suffering.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/iYwfIhJY8TY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Body dysmorphic disorder carries a high risk of suicide, and sometimes pursuing dermatological solutions can make the issues worse if the person isn’t satisfied with them.</span></figcaption>
</figure>
<h2>When appearance concerns become problematic</h2>
<p>So how is body dysmorphic disorder different from normal appearance concerns? Researchers have found evidence that while <a href="https://doi.org/10.1177/1073191119879241">appearance dissatisfaction can range in severity</a>, there is a distinct group of people with much higher appearance concerns, many of whom likely have the disorder. They feel much worse about their appearance than those with normal appearance concerns and experience greater anxiety, depression, shame and self-disgust about some aspects of their appearance.</p>
<p>About one-third of people with the disorder <a href="https://doi.org/10.1093/med/9780190254131.003.0006">obsess about their perceived flaws</a> for one to three hours a day, nearly 40% for three to eight hours a day and about a quarter for more than eight hours a day. Most people with body dysmorphic disorder know they spend <a href="https://global.oup.com/academic/product/body-dysmorphic-disorder-9780190254131?cc=ca&lang=en&">too much time thinking about their appearance</a>, but others with the condition mistakenly believe that it’s entirely normal to worry about their appearance for hours every day. </p>
<p><a href="https://doi.org/10.1093/med/9780190254131.003.0006">Common body dysmorphic disorder behaviors</a> include, from most to least common:</p>
<ul>
<li><p>camouflaging the perceived defects with clothing and makeup</p></li>
<li><p>comparing one’s appearance to others </p></li>
<li><p>checking one’s appearance in mirrors and other reflective surfaces</p></li>
<li><p>seeking cosmetic treatments such as surgery and dermatology</p></li>
<li><p>repeatedly taking photos to check one’s appearance</p></li>
<li><p>seeking reassurance from others about the perceived flaw or convincing others that it is unattractive </p></li>
<li><p>touching the perceived flaw</p></li>
<li><p>excessively changing clothes</p></li>
<li><p>dieting and skin picking to improve appearance</p></li>
<li><p>engaging in excessive exercise, including excessive weightlifting</p></li>
</ul>
<h2>Discovering the causes of body dysmorphic disorder</h2>
<p>The exact causes of body dysmorphic disorder are unknown. Possible developmental causes include <a href="https://doi.org/10.1017/s0033291711002741">genetic factors</a>, <a href="https://doi.org/10.1016/j.psychsport.2007.10.002">childhood bullying</a> and childhood teasing about appearance and competency, as well as <a href="https://doi.org/10.1016/j.comppsych.2021.152256">childhood maltreatment and trauma</a>. Other factors that could play a role include growing up in a family with an <a href="https://www.scientificamerican.com/article/imagined-ugliness/">emphasis on appearance</a>, perfectionist standards concerning appearance and exposure to <a href="https://doi.org/10.1176/appi.ajp.159.10.1788">high ideals of attractiveness</a> and beauty in the mass media. </p>
<p>Common personality traits among people with body dysmorphic disorder include perfectionism along with shyness, social anxiety, low self-esteem and <a href="https://doi.org/10.1016/j.cpr.2005.04.012">sensitivity to rejection and criticism</a>. </p>
<p>Researchers have found that people with the disorder may have abnormalities in brain functioning. For instance, one study found that people with body dysmorphic disorder, as well as those with anorexia, have an <a href="https://doi.org/10.1017/S0033291715000045">information processing bias</a> toward more detailed visual information rather than viewing images globally – in other words, seeing the trees rather than the forest. This suggests that abnormalities in the brain’s visual system could contribute to the distortions that those with body dysmorphic disorder and anorexia experience.</p>
<h2>Effective treatments</h2>
<p>Fortunately, there are effective treatments for people with body dysmorphic disorder. Cognitive behavioral therapy and medication <a href="https://doi.org/10.4103/psychiatry.IndianJPsychiatry_528_18">are both used to treat the disorder</a>. </p>
<p>During cognitive behavioral therapy, therapists work with patients to help them modify intrusive thoughts and beliefs about physical appearance and to eliminate problematic behaviors associated with body image, such as mirror checking and reassurance seeking. </p>
<p>Medications called selective serotonin reuptake inhibitors, or SSRIs, such as Prozac and Zoloft can <a href="https://doi.org/10.3928%2F00485713-20100701-05">reduce or eliminate cognitive distortions</a>, depression, anxiety, negative beliefs and compulsive behaviors. They can also increase levels of insight and improve daily functioning. </p>
<p>I (Eva) worked with a psychologist and psychiatrist to combat the depression and anxiety caused by my appearance concerns. Fortunately, both the <a href="https://bddfoundation.org/beating-bdd-podcast-27">medication and therapy</a> were effective in reducing my negative feelings and compulsive behaviors. </p>
<p>Two years after I started treatment, my symptoms lessened and became manageable. Today I facilitate <a href="https://feartocourage.com/bdd-resources/bdd-support-group/">two online support groups</a> and encourage people to learn more about the disorder. Group members provide support and comfort to others who understand their daily struggles. They also share advice about getting help for this common but little known body image disorder. </p>
<p>More information about diagnosis and treatment for body dysmorphic disorder is available on the <a href="https://bdd.iocdf.org/">International OCD Foundation BDD</a> site.</p><img src="https://counter.theconversation.com/content/195538/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eva Fisher works for Colorado State University Global. She is affiliated with the International OCD Foundation.</span></em></p><p class="fine-print"><em><span>Fugen Neziroglu is affiliated with OCDNY, IOCD, ADAA. She has receved funding from Bio Haven Pharmaceutical Company. </span></em></p><p class="fine-print"><em><span>Jamie Feusner receives funding from the National Institutes of Health and the Klarman Family Foundation. He is affiliated with NOCD, Inc. </span></em></p>About a quarter of those with body dysmorphic disorder attempt suicide or struggle with ideas of suicide. Fortunately, medication and therapy have proved highly effective at treating the disorder.Eva Fisher, Communication Faculty Member, Colorado State University GlobalFugen Neziroglu, Clinical Assistant Professor of Psychiatry, School of Medicine, Hofstra UniversityJamie Feusner, Professor of Psychiatry and Clinician Scientist at the Centre for Addiction and Mental Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2006812023-02-28T21:44:19Z2023-02-28T21:44:19ZEating disorders are deadly: What are they, who’s at risk, and what can be done about it<figure><img src="https://images.theconversation.com/files/512744/original/file-20230228-2348-obo37h.jpg?ixlib=rb-1.1.0&rect=164%2C67%2C4767%2C2919&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More than 100,000 Canadians are diagnosed with an eating disorder every year.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/eating-disorders-are-deadly--what-are-they--who-s-at-risk--and-what-can-be-done-about-it" width="100%" height="400"></iframe>
<p>Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder are serious health risks, and can be life-threatening. They are also <a href="https://www.doi.org/10.1037/0021-843X.116.2.422">common</a>, especially among teenage girls.</p>
<p><a href="https://www.doi.org/10.1097/YCO.0000000000000739">More than 100,000 Canadians</a> over the age of 15 are diagnosed with an eating disorder each year. Onset usually occurs <a href="https://doi.org/10.1016/j.chc.2014.08.003">between ages 14 and 19</a>. In fact, eating disorders are the third most common chronic illness among teens. </p>
<p>Adolescence is also when eating disorders have the greatest negative effects on health. <a href="https://doi.org/10.1016/S0140-6736(09)61748-7">Five per cent of the general population</a> in North America will suffer from an eating disorder in their lifetime, but few people seek treatment. The prevalence of eating disorders and struggles to access help highlight the need to increase awareness and <a href="https://doi.org/10.3390%2Fnu13082834">decrease stigma</a>. </p>
<h2>Causes and risk factors</h2>
<p>The greatest risk factor for eating disorders is sex. Eating disorders occur <a href="https://www.doi.org/10.1037/0003-066X.62.3.181">10 times more often in females</a> than in males. However, genetic, biological, psychological and cultural factors all affect the development of an eating disorder. </p>
<ul>
<li><strong>Genetics:</strong>
Specific <a href="https://doi.org/10.1038/npp.2011.108">genes have been linked to anorexia and bulimia</a>, and studies of twins suggest eating disorders are very heritable genetic diseases, with rates estimated between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3010958/">50 per cent and 83 per cent</a>. People may be more likely to inherit an eating disorder if their mother was <a href="https://www.doi.org/10.1001/archpsyc.63.1.82">exposed to stressors or complications</a> shortly before or after birth. </li>
</ul>
<figure class="align-center ">
<img alt="A paper cutout of a woman icon reflected much larger in a mirror" src="https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512745/original/file-20230228-2070-jyl1wo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Individuals with body dysmorphic disorder (who obsess over perceived flaws in their body) are at increased risk for developing eating disorders.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<ul>
<li><p><strong>Biology:</strong>
<a href="https://doi.org/10.1016/S0140-6736(09)61748-7">Biological factors</a> such as abnormalities in brain structure or chemistry can cause eating disorders. Developmental disorders such as autism or ADHD affect one-fifth of those with anorexia. Mood disorders such as depression or anxiety are associated with binge eating disorder and bulimia. </p></li>
<li><p><strong>Psychology:</strong>
Eating disorders are more common in people with perfectionism, obsessive compulsive traits, avoidant coping methods and anxiety. People who often have <a href="https://doi.org/10.1002/eat.22300">negative emotions, low self-esteem and who worry or stew on those problems</a> are at risk of eating disorders, as are people who are dependent and sensitive to failure. Individuals with body dysmorphic disorder (who obsess over perceived flaws in their body) are also likely to develop eating disorders.</p></li>
<li><p><strong>Society and culture:</strong>
Eating disorders are <a href="https://doi.org/10.1111/j.1460-2466.2000.tb02856.x">more common in cultures</a> that value thinness. <a href="https://doi.org/10.1002/eat.22459">Societies with unrealistic body ideals</a> (both in shape and size) encourage people to negatively compare their body to others and have poor self-esteem. Those societies also encourage a culture of criticism and bullying around weight. <a href="https://doi.org/10.1002/(SICI)1099-0968(199712)5:4%3C270::AID-ERV212%3E3.0.CO;2-3">Abuse, neglect or general adversity</a> increases the risk of developing an eating disorder.</p></li>
</ul>
<p>Unfortunately, eating disorders can be self-propelling. Eating disorders change the way you perceive food and body shape. Starvation also shrinks the brain and causes problems such as rigidity, emotional dysregulation and social difficulties that maintain the illness. The effects of starvation are particularly exaggerated during adolescence because it is a period of growth and vulnerability.</p>
<h2>Health effects</h2>
<p>Eating disorders are chronic, distressing and impede one’s ability to function. They <a href="https://doi.org/10.1002/eat.22105">increase risk</a> of depression, anxiety disorders, obsessive compulsive disorders, personality disorders, substance abuse, morbidity and future obesity. </p>
<figure class="align-center ">
<img alt="Empty candy and snack food wrappers" src="https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512746/original/file-20230228-22-fwrcra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People with binge eating disorder often suffer from weight stigma, noticeable cycles of weight changes, clinical obesity and depression.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>People with eating disorders are <a href="https://doi.org/10.1016/j.psychres.2014.05.002">six times more likely</a> to die than the general population, and <a href="https://doi.org/10.1016/j.genhosppsych.2014.01.002">five times more</a> likely to attempt suicide. In fact, anorexia has an <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1107207">especially high mortality rate compared to other psychiatric illnesses</a>. </p>
<p>Eating disorders can also have consequences later in life because of their effects on the skeleton (for example, growth retardation and osteoporosis), reproductive system and brain. </p>
<ul>
<li><strong>Anorexia nervosa</strong></li>
</ul>
<p><a href="https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia">People with anorexia experience</a> hormonal changes, heart problems, electrolyte imbalances, decreased fertility, loss of bone density, anemia and suicidal ideation. Some of these effects can be deadly. </p>
<p>Without enough calories, the body is forced to slow its processes to conserve energy. As such, people with anorexia often complain of stomach cramps, constipation, acid reflux, slow heart rate, swelling in extremities, menstrual irregularities, difficulty functioning, dizziness, sleep disturbances and impaired immunity and healing. </p>
<p>Nutritional deficits can cause dental problems, dry skin, dry and brittle hair and nails, thinning hair and muscle weakness. </p>
<p>People with anorexia are often cold and develop fine hair on their body to help conserve heat. They are also <a href="https://doi.org/10.1016/j.chc.2014.08.003">often hyperactive (exercise too much), and if so</a>, can suffer higher relapse rates, younger age of onset, more severe psychopathology, lower BMI, higher dissatisfaction with their body and lowered response to treatment.</p>
<ul>
<li><strong>Bulimia nervosa</strong></li>
</ul>
<p>Since bulimia is characterized by periods of both binge eating and periods of purging or starvation, people with bulimia experience many of the same consequences of anorexia. <a href="https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia">In addition, they often have</a> noticeable changes in weight or experience fluid retention. </p>
<p>As a result of induced vomiting, they may have cuts and calluses across the top of finger joints, swelling around salivary glands, esophagus damage and cavities or tooth discoloration. </p>
<p><a href="https://doi.org/10.1016/S0140-6736(09)61748-7">Bulimia is associated with</a> self-harm, substance abuse, miscarriages, suicide and impulsive behaviours.</p>
<ul>
<li><strong>Binge eating disorder</strong></li>
</ul>
<p>People with <a href="https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed">binge eating disorder often suffer from</a> weight stigma, noticeable cycles of weight changes, clinical obesity and depression. They are <a href="https://www.doi.org/10.1001/2013.jamapediatrics.12">nearly twice as likely</a> to become overweight or obese compared to the general population, and have double the risk of developing severe depression.</p>
<h2>Treatment</h2>
<p>Despite how common, chronic and challenging eating disorders are, few people seek treatment. <a href="https://doi.org/10.1002/14651858.CD000562.pub3">Treatment is effective</a>, though. Many behavioural, psychological and physical effects of starvation clear up once weight is gained and brain mass restored. </p>
<p>For anorexia, an approach that tackles medical, nutritional, social and psychological aspects is recommended. For bulimia and binge eating disorder, <a href="https://doi.org/10.1002/14651858.CD003385">cognitive behavioural therapy</a> (which involves identifying, challenging and changing unhelpful thought patterns) has been shown to be effective, as has medication such as the stimulant <a href="https://doi.org/10.1016/j.euroneuro.2021.08.001">Vyvanse</a> (lisdexamfetamine). </p>
<p>Eating disorders are serious conditions that can endanger health, but there are effective treatments. There is hope. Increasing awareness of eating disorders helps break the stigma and encourages people to get help.</p>
<p><em>This is a corrected version of a story originally published on Feb. 28, 2023. The earlier story stated the mortality rate for anorexia was approximately 10 per cent. It now states that anorexia has an especially high mortality rate compared to other psychiatric illnesses.</em></p><img src="https://counter.theconversation.com/content/200681/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Simon Sherry receives funding from the Social Sciences and Humanities Research Council of Canada. He also owns CRUX Psychology, a private practice in psychology.</span></em></p>The mortality rate of people with eating disorders is six times higher than the general population, and they are five times more likely to attempt suicide. However, few people seek treatment.Simon Sherry, Clinical Psychologist and Professor in the Department of Psychology and Neuroscience, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1973242023-02-01T16:23:31Z2023-02-01T16:23:31ZArfid: genetics a major factor in this little-known eating disorder – new research<figure><img src="https://images.theconversation.com/files/507550/original/file-20230201-6871-vyv5pl.jpg?ixlib=rb-1.1.0&rect=0%2C16%2C5509%2C3741&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The little-known eating disorder Arfid usually develops in childhood.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/no-vegan-diet-concept-teen-girl-1633521040">Tatyana Soares/ Shutterstock</a></span></figcaption></figure><p>An <a href="https://onlinelibrary.wiley.com/doi/10.1002/erv.2964">estimated 1-5%</a> of the world’s population suffer from an eating disorder that few people are even aware exists. Known as <a href="https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/arfid/">avoidant restrictive food intake disorder</a>, or Arfid for short, the condition is an extreme form of restrictive eating – which, if left unchecked, can have a severe impact on a person’s life and health. </p>
<p>Despite how serious Arfid is, we still know very little about what causes it – making it difficult to develop effective treatments. But in the first twin study ever conducted of Arfid, our team has now revealed that <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2801119">genetic factors</a> play a major role in its development.</p>
<p>This research brings us one step closer to understanding the causes of Arfid – and hopefully someday finding better ways of treating the condition.</p>
<p>Arfid was <a href="https://childadolescentpsych.cumc.columbia.edu/articles/arfid-what-you-need-know-about-eating-disorder#:%7E:text=The%20term%20ARFID%20was%20introduced,of%20Mental%20Disorders%20was%20published">first defined as an eating disorder in 2013</a>. People with the condition consume an extremely limited variety of food or a very low amount of food (or both). But compared with people with other eating disorders – such as anorexia nervosa – this food restriction is not driven by body dissatisfaction or the desire to lose weight. </p>
<p>Instead, people may restrict the foods they eat due to sensory aversion to certain tastes, smells and textures, low appetite, as well as traumatic eating experiences – such as choking on food and fear of gastrointestinal pain. This restriction is so extreme that it leads to weight loss, vitamin and mineral deficiencies, and can affect a person’s daily life.</p>
<p>Arfid affects <a href="https://onlinelibrary.wiley.com/doi/10.1002/eat.23424">as many males as females</a>, whereas other eating disorders – such as anorexia nervosa and bulimia nervosa – occur more often in <a href="https://doi.org/10.1097/YCO.0000000000000282">girls and women</a>. Also, in contrast to other eating disorders, Arfid usually develops in early childhood.</p>
<h2>Twins and genetics</h2>
<p>We know that other eating disorders are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803116/">moderately-to-highly influenced</a> by a person’s genetics. It’s therefore highly likely that genetic factors may also partly explain why some people develop Arfid and others do not.</p>
<p>We wanted to find out to what extent, so we looked at something called “<a href="https://theconversation.com/explainer-what-is-heritability-21334">heritability</a>” – a complex concept that measures the proportion by which differences in people’s characteristics are explained by differences in their genes.</p>
<p>To estimate the heritability of any characteristic, we can use the <a href="https://www.gu.se/en/gnc/twin-method">twin method</a>. This makes use of the fact that identical twins share all of their genes, whereas non-identical twins on average share 50% of the genes that make people different from each other.</p>
<p>In addition, as twins grow up in the same environment at exactly the same time, we can rule out that influences of this shared environment cause any differences between them (as might happen with ordinary siblings of different ages).</p>
<p>We then compare the similarity of a certain characteristic between identical twins to its similarity between non-identical twins. The degree to which identical twins are more alike gives us an estimate of the heritability of this characteristic. </p>
<figure class="align-center ">
<img alt="A young boy refuses to eat food from a fork. He looks disgusted." src="https://images.theconversation.com/files/507555/original/file-20230201-3038-m50apm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/507555/original/file-20230201-3038-m50apm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/507555/original/file-20230201-3038-m50apm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/507555/original/file-20230201-3038-m50apm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/507555/original/file-20230201-3038-m50apm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/507555/original/file-20230201-3038-m50apm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/507555/original/file-20230201-3038-m50apm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">According to new research, Arfid might be the most heritable eating disorder.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-feeding-picky-eater-son-335893970">Ground Picture/ Shutterstock</a></span>
</figcaption>
</figure>
<p>In order to estimate the heritability of Arfid, we began by looking at data from the <a href="https://ki.se/en/research/the-swedish-twin-registry">Swedish Twin Registry</a>, which has tracked the health of just under 34,000 twins. First, we combined data from parental questionnaires and registered clinical diagnoses to identify children with Arfid. We then applied the twin method, finding that the heritability of Arfid was 70-85%. This means that whether the children had Arfid or not was between 70-85% explained by differences in their genes. </p>
<p>This places Arfid among the most heritable of mental disorders. In comparison, the heritability of <a href="https://doi.org/10.1001/jamapsychiatry.2018.3652">autism is estimated to be 79-84%, and that of ADHD is 76-89%</a>. Moreover, the heritability of Arfid is higher than that of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803116/">anorexia nervosa (48-74%), bulimia nervosa (55-61%), and binge-eating disorder (39-57%)</a>, suggesting that Arfid might be the most heritable eating disorder. </p>
<h2>Hope for treatments</h2>
<p>Findings like this can help reduce stigma and blame around mental disorders such as Arfid and other eating disorders. A person does not choose to develop Arfid – and similarly, a parent does not cause their child to develop it.</p>
<p>However, the fact that the heritability of Arfid is less than 100% also shows it’s not only the genes that make someone likely to develop the disorder. Other factors, such as choking very badly on food or severe allergic reactions, can trigger this eating disorder to develop.</p>
<p>Our findings also suggest that genetic studies have a huge potential to help us understand the causes of Arfid. This is what our next study will aim to do.</p>
<p>At the moment, treatments for Arfid using <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8375627/">cognitive behavioural therapy</a> and <a href="https://www.sciencedirect.com/science/article/pii/S1551714422003627?via%3Dihub">family-based therapy</a> are being developed. However, these methods usually focus on symptoms, instead of the underlying causes of the eating disorder.</p>
<p>We also still don’t know how well these treatments work. But a better understanding of what causes Arfid, including its underlying biology, will help us to develop better treatments.</p><img src="https://counter.theconversation.com/content/197324/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Dinkler receives funding from the Mental Health Foundation (Fonden för Psykisk Hälsa, 2022) and the Fredrik and Ingrid Thurings Foundation (2021-00660).</span></em></p>An estimated 1-5% of people globally suffer from avoidant restrictive food intake disorder.Lisa Dinkler, Postdoctoral Researcher in Psychiatric Epidemiology, Karolinska InstitutetLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1970122023-01-18T13:38:33Z2023-01-18T13:38:33ZKicking off the new year by cleansing your body with a detox diet? A dietitian unpacks the science behind these fads<figure><img src="https://images.theconversation.com/files/503325/original/file-20230105-12-sxz5c4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7988%2C5329&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A healthy diet – with plenty of fruits, vegetables and whole grains – is one key to a healthy body.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-woman-making-healthy-smoothie-for-breakfast-royalty-free-image/1237890164?phrase=juicing&adppopup=true">Oscar Wong/Moment via Getty Images</a></span></figcaption></figure><p>Detox diets are often touted as a way to cleanse the body after the excess food and drinks that come with the holidays. These diets promise quick results and can particularly entice people around the new year, when there tends to be a renewed focus on health and lifestyle habits. </p>
<p>There are <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">a few different types of detox diets</a>: fasting, juice cleanses, eating only certain foods, using dietary commercial detox supplements or “cleansing” the colon with enemas or laxatives. </p>
<p>Most of these diets have a few things in common: They are short-term and aim to eliminate allegedly toxic substances from the body. Typically, these diets include a period of fasting followed by an extremely restrictive diet for a number of days. </p>
<p><a href="https://www.linkedin.com/in/taylor-grasso-rdn-ld-mpp-d-214747a2/">As a registered dietitian</a>, I have seen clients attempt detox diets and experience a slew of negative side effects, including developing a negative relationship with food. </p>
<p>Research shows that there is little evidence to <a href="https://doi.org/10.1111/jhn.12286">support the use of detox diets</a> and that they are not needed anyway. The body is well-equipped to eliminate unwanted substances on its own, without expensive and potentially harmful supplements sold by the nutrition and wellness industry. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/DESCcjSQSKY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Doing a cleanse doesn’t “clean your pipes” – and it may do harm.</span></figcaption>
</figure>
<h2>About toxins</h2>
<p>What are toxins – and how do they get into the body in the first place? </p>
<p>Internal toxins <a href="https://en.wikipedia.org/wiki/Toxin">include natural byproducts</a> created by the body during metabolism, such as lactic acid, urea and waste from the gut microbes. </p>
<p><a href="https://www.atsdr.cdc.gov/csem/exposure-history/Organ-Systems-Are-Affected.html">External toxic exposures</a> enter the body through eating, drinking, breathing or penetration of the skin. These can come in the form of air pollutants, food or water contaminated with chemicals or heavy metals, household products such as laundry detergent and even beauty products like facial cleansers, body wash and makeup.</p>
<p>The body’s built-in detoxification system includes the liver and kidneys, with assistance from the lungs, lymphatic system, digestive tract and skin. Briefly, the liver breaks down harmful substances, which are then filtered out through the kidneys. The digestive tract also expels them through bowel movements. </p>
<p>But our bodies aren’t always functioning optimally. That’s why a proper diet and improved lifestyle behaviors, such as increased exercise and sleep, may have a significant – and positive – impact on the body’s detoxification system.</p>
<p>Having a diverse microbiome and an <a href="https://www.healthline.com/nutrition/improve-gut-bacteria#TOC_TITLE_HDR_11">abundance of healthy gut bacteria</a> also helps to rid the body of harmful substances. Fermented foods such as kefir, sauerkraut and cultured dairy products can benefit gut health. These foods contain <a href="https://www.healthline.com/nutrition/11-super-healthy-probiotic-foods">probiotics</a>, which are the beneficial bacteria that live in your gut. </p>
<p>Another category, called <a href="https://www.eatingwell.com/article/2059033/best-and-worst-foods-to-eat-for-gut-health/">prebiotic foods</a>, are also beneficial for gut health. They provide nutrition and energy for the healthy probiotics in the gut and are high in fiber. Examples of prebiotic foods are whole grains and fruits and vegetables, particularly bananas, greens, onions and garlic. </p>
<h2>The potential harms of detox diets</h2>
<p>Through glossy and pervasive advertising, detox diets perpetuate <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">a quick-fix mindset about weight and body image</a> rather than promote lifestyle changes that are sustainable for a lifetime. </p>
<p>Although proponents claim that detox diets and juice cleanses lead to weight loss, improved liver function and overall better health, research shows <a href="https://doi.org/10.1111/jhn.12286">they have little to no effect</a>. What’s more, they can <a href="https://www.nutritionletter.tufts.edu/healthy-eating/weight-mgmt/detox-dilemma/">lead to side effects</a>, including headaches, fatigue, weakness, fainting and irritability. However, studies show there is some evidence that certain foods and spices, such as coriander, may <a href="https://doi.org/10.1111/jhn.12286">enhance the body’s natural detoxification pathways</a>.</p>
<p>According to the Academy of Nutrition and Dietetics, other foods that may give the body’s own detox system a boost include cruciferous vegetables like broccoli and Brussels sprouts, berries, artichokes, garlic, onions, leeks and green tea. Eating adequate amounts of lean protein may also benefit the body’s natural system by <a href="https://www.eatright.org/health/wellness/diet-trends/whats-the-deal-with-detox-diets#">maintaining adequate levels of glutathione</a>, the body’s master detoxification enzyme, or catalyst. Glutathione is an enzyme produced by the liver that is <a href="https://www.webmd.com/vitamins/ai/ingredientmono-717/glutathione">involved in numerous processes</a> within the body including building and repairing tissues, assisting in the natural detoxification process and improving immune system function.</p>
<p>A handful of clinical studies have shown increased liver detoxification with a commercial detox diet or supplements, but these studies have <a href="https://doi.org/10.1111/jhn.12286">flawed methodologies and small sample sizes and are often done on animals</a>. In addition, supplements are <a href="https://www.fda.gov/consumers/consumer-updates/it-really-fda-approved#">not regulated by the U.S. Food and Drug Administration</a> as food and drugs are. They can be put on the shelf without full evaluation of ingredients or proven efficacy, except in rare cases in which supplements are tested by a third party. </p>
<p>In fact, some commercial supplements have raised so many health and safety issues that the FDA and the Federal Trade Commission <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">have taken legal action against the companies that make them</a> to remove their products from the market. </p>
<p>Some detox diets and programs can have serious side effects, particularly those including laxatives or enemas, or those that restrict intake of solid foods. These approaches can lead to <a href="https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know">dehydration, nutrient deficiencies and electrolyte imbalances</a>. </p>
<p>In addition, diets that severely restrict certain foods or food groups <a href="https://doi.org/10.1007/s11894-017-0603-8">usually don’t lead to lasting weight loss</a>.</p>
<p>Instead, these types of diets often put the body into “<a href="https://doi.org/10.1038/ijo.2010.184">starvation mode</a>.” That means that rather than burning calories, your body holds on to them to use as energy. </p>
<p>Doing that repeatedly over a long period can <a href="https://doi.org/10.1038/ijo.2010.184">lead to a chronic decrease in metabolism</a>, which means that the number of calories you burn at rest may slowly decrease over time. This can make it more difficult to lose weight and balance blood sugar. It can also leave people more susceptible to chronic metabolic conditions such as cardiovascular disease and diabetes. </p>
<figure>
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<figcaption><span class="caption">There’s very little evidence that detox diets remove harmful substances from your body.</span></figcaption>
</figure>
<h2>A healthy lifestyle, without the detox diet</h2>
<p>Focusing on sustainable lifestyle shifts can make a huge difference – and unlike a detox diet, actually work. </p>
<p>Number one, <a href="https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/">eat a balanced diet</a>. Aim to eat mostly whole grains, lean protein choices, fruits and vegetables of many colors, low-fat dairy, nuts and seeds. This way, you’re getting a variety of nutrients, antioxidants and a good amount of fiber. </p>
<p>Number two, <a href="https://www.eatright.org/health/essential-nutrients/water/how-much-water-do-you-need">hydrate</a>. For women, the <a href="https://www.eatright.org/health/essential-nutrients/water/how-much-water-do-you-need">recommended daily water intake by the Academy of Nutrition and Dietetics</a> is 11½ cups; for males, it’s 15½ cups. However, you get about 20% of that total from food, which leaves nine cups for women and 13 cups for men as the daily recommended water intake. This is comparable to 4½ 16-ounce water bottles for women and 6½ 16-ounce water bottles for men. </p>
<p>Lastly, move your body in a way that you enjoy. The more you enjoy being active, the more likely it will become a routine. Aim for at least 150 minutes, or 2½ hours of <a href="https://www.cdc.gov/physicalactivity/basics/adults/index.htm#:%7E">moderate-intensity physical activity every week</a>. </p>
<p>Focusing on these types of long-term, sustainable healthy habits is the key to weight loss and overall health and wellness.</p><img src="https://counter.theconversation.com/content/197012/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Taylor Grasso consults for Simply Healthy, LLC and CU Anschutz Health and Wellness Center. </span></em></p>Detox diets and cleanses supposedly clear the body of allegedly toxic substances. But the evidence suggests otherwise.Taylor Grasso, Registered Dietitian, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952872022-12-13T19:52:51Z2022-12-13T19:52:51ZWhat Taylor Swift’s ‘Anti-Hero’ controversy can tell us about fatphobia in feminist politics<figure><img src="https://images.theconversation.com/files/499101/original/file-20221205-26-y57tja.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3600%2C2457&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Taylor Swift was accused of fatphobia over her 'Anti-Hero' music video.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Taylor Swift recently <a href="https://www.nbcnews.com/think/opinion/taylor-swift-should-not-remove-fatphobic-scene-anti-hero-video-rcna54617">removed a scene</a> from her music video, <a href="https://www.youtube.com/watch?v=b1kbLwvqugk"><em>Anti-Hero</em></a>, after several <a href="https://www.vice.com/en/article/gvzx94/fat-positive-activists-explain-what-its-really-like-to-be-fat">fat positivity activists</a> across social media accused the <a href="https://twitter.com/fatfabfeminist/status/1583523413221867520">scene of being fatphobic</a>. </p>
<p>In the scene, Swift’s two selves, the real her and her “anti-hero” character, are in a bathroom. As Swift’s real self stands on a weighting scale, her anti-hero persona peers downward and the word “FAT” appears on the scale. Swift’s face appears disgusted. The scene earned <a href="https://www.bbc.com/news/entertainment-arts-63414044">considerable backlash online</a>. </p>
<p>In response to the video, fat positive therapist <a href="https://twitter.com/theshirarose/status/1583500955818942470?s=20&t=c8ETpLI4xoWvF_vCOR4R0g">Shira Rosenbluth</a> posted on Twitter:</p>
<blockquote>
<p>Taylor Swift’s music video, where she looks down at the scale where it says “fat,” is a shitty way to describe her body image struggles. Fat people don’t need to have it reiterated yet again that it’s everyone’s worst nightmare to look like us.</p>
</blockquote>
<h2>White celebrity feminism</h2>
<p>As white feminist scholars committed to anti-racist and decolonial practices who work on divisions within feminist politics as they appear in art practices, this is far from an isolated incident of one artist. It reveals divisions about fat positivity within <a href="https://www.simonandschuster.ca/books/White-Feminism/Koa-Beck/9781982134426">white feminism</a>. </p>
<p>White feminism is not just an identity, it is a structure. As women’s studies scholar <a href="https://www.boldtypebooks.com/titles/kyla-schuller/the-trouble-with-white-women/9781645036883/">Kyla Schuller</a> writes, it “attracts people of all sexes, races, sexualities and class backgrounds, though straight white middle-class women have been its primary architects.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Taylor Swift wearing white on a weighting scale in a bathroom. Her alter-ego looks down at the scale." src="https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=605&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=605&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=605&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=760&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=760&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=760&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Scene from Taylor Swift’s music video ‘Anti-Hero’. The video was edited to remove the word ‘fat’ after Swift was accused of fatphobia.</span>
<span class="attribution"><a class="source" href="https://www.youtube.com/watch?v=b1kbLwvqugk">(YouTube/Taylor Swift)</a></span>
</figcaption>
</figure>
<p>Fat activists have worked to take <a href="https://www.penguinrandomhouse.ca/books/197420/fat-so-by-marilyn-wann/9780898159950">power away from the term “fat”</a> and use it as a neutral descriptor. Swift does not believe she is fat, but is illustrating internalized fatphobic messages. According to Swift, fame and public scrutiny of her body was <a href="https://www.buzzfeednews.com/article/annehelenpetersen/taylor-swift-miss-americana-disordered-eating-body-image">a major contributor to her eating disorder</a>.</p>
<p>Some have raised concerns that Swift’s removal of the scene from the video <a href="https://www.rollingstone.com/music/music-news/taylor-swift-anti-hero-video-fat-controversy-1234619554/">watered down</a> her feminist message. But how does removing the term “fat” water down a specifically feminist message unless fat is seen to be a feminist issue? </p>
<p>This suggests that fat becomes a feminist issue only in the context of the harms of eating disorders from a white woman’s perspective, within market-friendly celebrity feminism. </p>
<p>Fat activists are criticizing Swift’s video and response for reproducing a depoliticized and individualistic strain of feminism that <a href="https://theconversation.com/how-neoliberalism-colonised-feminism-and-what-you-can-do-about-it-94856">ignores the racial, colonial, ableist and socioeconomic problems</a> behind issues such as eating disorders.</p>
<p>Swift has been able to deflect criticism with the support of fans and media writers who have jumped to her defence to protect her image. </p>
<h2>Erasure of others’ experiences</h2>
<p><a href="https://twitter.com/Stoppp_looking/status/1585481003820515330?s=20&t=fnbDCVDMktV5VWSOIRbrhA">Online responses</a> to fat activist critique is telling. Swift’s defenders dismiss and demonize fat activists, aligning them with stereotypes of <a href="https://rowman.com/ISBN/9780739114872/The-Embodiment-of-Disobedience-Fat-Black-Womens-Unruly-Political-Bodies">fat women as unruly</a>. </p>
<p>As feminist scholar <a href="https://doi.org/10.1177/1367549420985852">Alison Phipps</a> argues, white feminism is an identity deeply invested in victimization, suffering and injury. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1584963631271538688"}"></div></p>
<p>Swift’s silence and her angry defenders reveal a complicity in reproducing <a href="https://nyupress.org/9781479886753/fearing-the-black-body/">white supremacist fatphobia</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A book cover featuring a naked fat black woman." src="https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=930&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=930&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=930&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1169&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1169&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1169&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Body is Not an Apology by Sonya Renee Taylor.</span>
<span class="attribution"><span class="source">(Penguin Random House)</span></span>
</figcaption>
</figure>
<p>The rhetoric erases the fatphobia experienced by <a href="https://www.marieclaire.com/celebrity/lizzo-kanye-west-body-shaming/">Black women</a> and other racialized people. As author <a href="https://www.penguinrandomhouse.com/books/565139/the-body-is-not-an-apology-second-edition-by-sonya-renee-taylor/">Sonya Renee Taylor writes</a>, “From LGBTQIA bodies, to fat bodies, to women’s bodies, we live under systems that force us to judge, devalue, and discriminate against the bodies of others.”</p>
<p>White feminism upholds the idea that <a href="https://www.publicaffairsbooks.com/titles/andi-zeisler/we-were-feminists-once/9781610397735/">feminism is about individual empowerment</a>, letting artists off the hook of answering for the injustices reiterated in their art. Moments like this come up <a href="https://theconversation.com/mask-or-no-mask-stop-using-fat-people-in-political-cartoons-176631">regularly in feminist politics</a> and rejecting a fat activist critique is a missed opportunity for coalition. It reinforces the power of white feminism to gatekeep. </p>
<h2>Feminism and eating disorders</h2>
<p>This division between feminism and fat activism often revolves around conceptualizing the harms of eating disorders. <a href="https://www.ucpress.edu/book/9780520240544/unbearable-weight">Feminists have argued that eating disorders do not exist in a social or cultural vaccuum</a>, but this argument has stopped short at fat acceptance. Fat positivity requires grappling with how our culture is obsessed with thinness, and how it reviles fatness as a way of enforcing and <a href="https://doi.org/10.18574/nyu/9780814728758.003.0007">maintaining bodily hierarchies</a>.</p>
<p>Swift’s video echoes many <a href="https://www.youtube.com/watch?v=uJOQOVAoQ9g">other white feminist artists who work out their bad body feelings in public as a way of processing harms of a negative body image</a>. </p>
<p>A running theme in Swift’s work is to <a href="https://doi.org/10.1080/07494467.2021.1976586">mock media misogyny</a>. Since distancing herself from authentic country storytelling, she has moved to a pop persona that <a href="https://doi.org/10.1080/19392397.2019.1630160">relishes in her “zany” flaws</a> and talks about the “real person” underneath the persona to remain relatable. Here, fatphobia is a personal flaw rather than a <a href="https://doi.org/10.1007/978-3-030-95935-7_6">systemic social issue</a>. </p>
<p>White feminist responses to fat activist critique reveal the limits of fat positivity in feminism. Women’s studies professor <a href="https://digitalcommons.uri.edu/jfs/vol1/iss1/13/">Talia Welsh articulates how mainstream feminism is of two minds</a>:</p>
<blockquote>
<p>[The feminist] ability to reject the demonization of fat in one context and to accept fat’s negative status in another is based in the idea that one view of fat (the bad one) arises from sexism and that the other (the good one) arises from a concern about health. It is wrong to equate a woman’s value with her looks, but it is acceptable to encourage that same woman to lose weight if it would augment her health. </p>
</blockquote>
<p>Swift’s permission to express fatphobia in terms of it being detrimental to her health upholds her victim status, thereby centring a thin woman’s pain in discussing fatphobia. </p>
<p>The message received is: feeling positive about one’s body is good, but that good has limits, it is only for those with thin bodies. </p>
<p>Swift has no doubt been the target of beauty culture’s critique, but that culture cannot be divorced from its <a href="https://nyupress.org/9781479886753/fearing-the-black-body/">capitalist, colonial and white supremacist roots</a>. In identifying fatphobia as primarily about women’s looks, Swift and others obscure the <a href="https://www.penguinrandomhouse.com/books/670607/belly-of-the-beast-by-dashaun-harrison/">structural and material oppression experienced by fat people</a></p>
<p>These divisions in feminism will continue so long as white feminism claims fatphobia as its issue to both define and individually resist.</p><img src="https://counter.theconversation.com/content/195287/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>By only discussing fatphobia in the context of eating disorders, Taylor Swift illustrates how deeply individualized and depoliticized white feminism is.Kristin Rodier, Assistant Professor of Philosophy, Athabasca UniversityHeather McLean, Assistant Professor, Environmental Studies and Human Geography, Athabasca UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1905872022-12-02T12:21:56Z2022-12-02T12:21:56ZBinge-eating disorder is more common than many realise, yet it’s rarely discussed – here’s what you need to know<p>Television personality, author and hair stylist Jonathan Van Ness recently shared on social media his struggles with his eating and weight after “years of feeling out of control with food”. He described suffering from binge-eating disorder – an eating disorder characterised by consuming large amounts of food with a sense of feeling out of control.</p>
<hr>
<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/binge-eating-disorder-is-more-common-than-many-realise-yet-its-rarely-discussed-heres-what-you-need-to-know-190587 &bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p><em>You can listen to more articles from The Conversation, narrated by Noa, <a href="https://theconversation.com/us/topics/audio-narrated-99682">here</a>.</em></p>
<hr>
<p>Binge-eating disorder is perhaps the most common eating disorder out there, affecting between <a href="https://doi.org/10.1097/YCO.0000000000000750">0.6-2.3% of people worldwide</a>. It’s estimated that it may occur two to three times more frequently than anorexia nervosa – and some evidence suggests that <a href="https://doi.org/10.1093/ajcn/nqy342">cases are on the rise</a>. Yet, despite how common it is, many people still aren’t aware the condition exists. In fact, many people with binge-eating disorder <a href="https://doi.org/10.1016%2Fj.mayocp.2019.02.030">don’t even realise they have it</a>, meaning they don’t receive a diagnosis <a href="https://doi.org/10.1016/j.biopsych.2018.03.014">until their 30s or 40s</a>.</p>
<p>Given the harm that can come from the condition, awareness raised by people like Van Ness can help more people get the help they need – instead of suffering for years alone.</p>
<hr>
<figure class="align-right ">
<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
</figcaption>
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<p><em><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life.</em></p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/body-image-issues-affect-close-to-40-of-men-but-many-dont-get-the-support-they-need-179046?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Body image issues affect close to 40% of men – but many don’t get the support they need</a></em></p>
<p><em><a href="https://theconversation.com/why-the-body-positivity-movement-risks-turning-toxic-189913?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Why the body positivity movement risks turning toxic</a></em></p>
<p><em><a href="https://theconversation.com/why-many-women-with-autism-and-adhd-arent-diagnosed-until-adulthood-and-what-to-do-if-you-think-youre-one-of-them-179970?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Why many women with autism and ADHD aren’t diagnosed until adulthood – and what to do if you think you’re one of them</a></em></p>
<hr>
<p>Here’s what else you need to know.</p>
<h2>Feeling out of control</h2>
<p>The thing that sets binge-eating disorder apart from occasional overeating or periods of emotional eating is a sense of feeling out of control when eating, or if it interferes with your daily life.</p>
<p>Some other signs of binge-eating disorder include:</p>
<ul>
<li>Eating until feeling uncomfortably full,</li>
<li>Eating large amounts of food, even when not hungry,</li>
<li>Eating more quickly than normal, </li>
<li>Feelings of disgust, low mood, or guilt after eating.</li>
</ul>
<p>With the proper support, it’s often possible to identify binge-eating disorder before serious problems develop. It’s important to catch it early, as it can lead to a <a href="https://doi.org/10.1038/s41572-022-00350-0">range of health problems</a>, such as obesity, type 2 diabetes and high cholesterol. </p>
<p>Other <a href="https://doi.org/10.1002/eat.23004">mental health problems</a> are also common, with up to 70% of sufferers reporting mood disorders – such as depression – or anxiety. Around <a href="https://doi.org/10.1186/s12916-019-1352-3">one-quarter of people</a> with binge-eating disorder have attempted suicide. Binge-eating disorder can have a major effect on a person’s daily life, with people reporting <a href="https://doi.org/10.1002/eat.23211">poorer performance in school</a> and <a href="https://doi.org/10.1016/j.pmedr.2014.12.002">lower employment rates</a>. </p>
<p>A tragic irony with the under-recognition of binge-eating disorder is that it’s a highly treatable condition. Most people will be recommended psychological treatments, such as <a href="https://www.nice.org.uk/guidance/ng69/chapter/Recommendations#treating-binge-eating-disorder">cognitive behaviour therapy</a>, which can help them understand the factors that trigger their binge eating, and also help them learn healthier eating habits and coping mechanisms. Psychological treatments <a href="https://psycnet.apa.org/doi/10.1037/ccp0000358">can be highly effective</a> both in helping people stop binge eating, and in improving symptoms of other mental health conditions they may have – such as depression.</p>
<figure class="align-center ">
<img alt="A therapist speaks with a young woman." src="https://images.theconversation.com/files/498233/original/file-20221130-12-97pakg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498233/original/file-20221130-12-97pakg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498233/original/file-20221130-12-97pakg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498233/original/file-20221130-12-97pakg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498233/original/file-20221130-12-97pakg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498233/original/file-20221130-12-97pakg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498233/original/file-20221130-12-97pakg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Therapy can be very effective in helping people who are struggling.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-crying-obese-woman-opening-female-695123587">SeventyFour/ Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1037/ccp0000358">Drug treatments</a> (such as antidepressants) have been found to be useful in reducing binge eating. However, these carry a <a href="https://doi.org/10.7326/M15-2455">risk of adverse effects</a> (such as headaches, insomnia, nausea and fatigue) and are, on average, less effective than psychological therapy. </p>
<p>Another <a href="https://doi.org/10.1002/eat.23463">key element</a> in recovering from an eating disorder is learning to change your relationship with food. In his Instagram post, Van Ness said that this played a big part in helping him overcome his binge eating. He said some of the things he learned to do included prioritising time to eat and planning his meals. </p>
<h2>Getting help</h2>
<p>While several factors are often at play when it comes to binge-eating disorder, symptoms are usually triggered by negative events or emotions – such as feeling bored, sad, or anxious – or physiological triggers, such as being hungry. People with binge-eating disorder may also find it more difficult to <a href="https://doi.org/10.1016/j.neubiorev.2014.12.008">regulate their emotions</a>, which can lead to vicious cycles of low mood and binge eating.</p>
<p>Some tell-tale signs that you might be <a href="https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/types/binge-eating-disorder/">developing a problem with binge eating</a> can include changes in eating behaviour (such as buying lots of food or eating even if you aren’t hungry) and spending a lot of time thinking about food. Binge eating is not an enjoyable experience and often people feel scared, ashamed or guilty about their symptoms, making it particularly difficult to talk about these experiences.</p>
<p>If you think you may have a problem with binge eating, speak with your GP <a href="https://www.nhs.uk/mental-health/conditions/binge-eating/overview/">as soon as possible</a> so they can refer you to a specialist. Although this can feel daunting, <a href="https://www.beateatingdisorders.org.uk/get-information-and-support/get-help-for-myself/going-to-the-doctor/">preparing in advance can help</a>. Consider what you might say, what you’re worried about and what questions you have. You may want to bring a friend for support. </p>
<p>If you know someone who might have a problem with binge eating, it can be helpful to have an honest, non-judgemental conversation with them <a href="https://www.beateatingdisorders.org.uk/resource-index-page/guide-for-friends-family/">about your concerns</a>. Consider trying to understand why they might be struggling and encourage them to seek support.</p>
<p>Despite the honest accounts of people like Van Ness, binge-eating disorder remains an often overlooked and under-treated illness. Barriers exist for both patients and professionals, and it has been suggested that binge-eating disorder can be <a href="https://theconversation.com/insatiable-an-unhelpful-portrayal-of-binge-eating-disorder-101684">oversimplified in the media</a>. Misrepresenting the illness and talking about it less than other problems can make it more difficult for sufferers to come forward. Increasing awareness of binge-eating disorder will help those affected – not only by encouraging them to seek treatment, but also by reducing stigma.</p><img src="https://counter.theconversation.com/content/190587/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Jenkins works for a service providing evidence-based treatments for people with eating problems, including binge-eating disorder.</span></em></p>Television personality Jonathan Van Ness is the latest celebrity to speak candidly about their struggles with the condition.Paul Jenkins, Associate Professor of Clinical Psychology, University of ReadingLicensed as Creative Commons – attribution, no derivatives.