Eating Disorders and Body Image (PDF)

The Brittany Weixel Endowment Eating Disorders and Body Image  What Are Eating Disorders? Eating disorders are real, complex and devastating conditions that can have serious consequences for health, productivity, and relationships. They are not a fad, phase or lifestyle choice. Eating disorders are serious, potentially life-threatening conditions that affect a person’s emotional and physical health. People struggling with an eating disorder need to seek professional help. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery. Types & Symptoms of Eating Disorders Eating disorders—such as anorexia, bulimia, and binge eating disorder—include extreme emotions, attitudes, and behaviors surrounding weight and food issues. Eating disorders are serious emotional and physical problems that can have life- threatening consequences for females and males. Anorexia Nervosa  Inadequate food intake leading to a weight that is clearly too low.  Intense fear of weight gain, obsession with weight and persistent behavior to prevent weight gain.  Self-esteem overly related to body image.  Inability to appreciate the severity of the situation.  Binge-Eating/Purging Type involves binge eating and/or purging behaviors during the last three months.  Restricting Type does not involve binge eating or purging.  Binge Eating Disorder  Frequent episodes of consuming very large amounts of food but without behaviors to prevent weight gain, such as self-induced vomiting.  A feeling of being out of control during the binge eating episodes.  Feelings of strong shame or guilt regarding the binge eating.  Indications that the binge eating is out of control, such as eating when not hungry, eating to the point of discomfort, or eating alone because of shame about the behavior. Bulimia Nervosa  Frequent episodes of consuming very large amounts of food followed by behaviors to prevent weight gain, such as self-induced vomiting.  A feeling of being out of control during the binge- eating episodes.  Self-esteem overly related to body image. For Students How to Help a Friend with Eating and Body Image Issues If you are reading this handout, chances are you are concerned about the eating habits, weight, or body image of someone you care about. We understand that this can be a very difficult and scary time for you. Let us assure you that you are doing a great thing by looking for more information! This list may not tell you everything you need to know about what to do in your specific situation, but it will give you some helpful ideas on what to do to help your friend.   Learn as much as you can about eating disorders. Read books, articles and brochures.  Know the difference between facts and myths about weight, nutrition, and exercise. Knowing the facts will help you reason with your friend about any inaccurate ideas that may be fueling their disordered eating patterns.  Be honest. Talk openly and honestly about your concerns with the person who is struggling with eating or body image problems. Avoiding it or ignoring it won’t help!  Be caring, but be firm. Caring about your friend does not mean being manipulated by them. Your friend must be responsible for their actions and the consequences of those actions. Avoid making rules, promises, or expectations that you cannot or will not uphold. For example, “I promise not to tell anyone.” Or, “If you do this one more time, I’ll never talk to you again.”  Compliment your friend’s wonderful personality, successes, or accomplishments. Remind your friend that “true beauty” is not skin deep.  Be a good role model in regard to sensible eating, exercise, and self-acceptance.  Tell someone. It may seem difficult to know when, if at all, to tell someone else about your concerns. Addressing body image or eating problems in their beginning stages offers your friend the best chance for working through these issues and becoming healthy again. Don’t wait until the situation is so severe that your friend’s life is in danger. Your friend needs a great deal of support and understanding.   Remember that you cannot force someone to seek help, change their habits, or adjust their attitudes. You can make important progress in honestly sharing your concerns, providing support, and knowing where to go for more information! People struggling with anorexia, bulimia, or binge eating disorder do need professional help. What Should I Say? Tips for Talking to a Friend Who May Be Struggling with an Eating Disorder If you are worried about your friend’s eating behaviors or attitudes, it is important to express your concerns in a loving and supportive way. It is also necessary to discuss your worries early on, rather than waiting until your friend has endured many of the damaging physical and emotional effects of eating disorders. In a private and relaxed setting, talk to your friend in a calm and caring way about the specific things you have seen or felt that have caused you to worry. Step by Step Set a time to talk. Set aside a time for a private, respectful meeting with your friend to discuss your concerns openly and honestly in a caring, supportive way. Make sure you will be some place away from distractions. Communicate your concerns. Share your memories of specific times when you felt concerned about your friend’s eating or exercise behaviors. Explain that you think these things may  indicate that there could be a problem that needs professional attention. Ask you friend to explore these concerns with a counselor, doctor, nutritionist, or other health professional who is knowledgeable about eating disorders. If you feel comfortable doing so, offer to help your friend make an appointment or accompany your friend on their first visit. Avoid conflicts or a battle of wills with your friend. If your friend refuses to acknowledge that there is a problem, or any reason for you to be concerned, restate your feelings and the reasons for them and leave yourself open and available as a supportive listener. Avoid placing shame, blame or guilt on your friend regarding their actions or attitudes. Do not use accusatory “you” statements such as, “You just need to eat.” Or, “You are acting irresponsibly.” Instead, use “I” statements. For example: “I’m concerned about you because you refuse to eat breakfast or lunch.” Or, “It makes me afraid to hear you vomiting.” Avoid giving simple solutions. For example, “If you’d just stop, then everything would be fine.” Express your continued support. Remind your friend that you care and want him/her to be healthy and happy. After talking with your friend, if you are still concerned with their health and safety, find a trusted adult or  medical professional to talk to. This is probably a challenging time for both of you. It could be helpful for you, as well as your friend, to discuss your concerns and seek assistance and support from a professional. Some Don’ts for Those Concerned About a Person with an Eating Disorder By: Michael Levine, PhD and Linda Smolak, PhD 1. Don’t cast a net of awe and wonder around the existence of an eating disorder. Keep the focus on the reality that eating disorders result in:  Inefficiency in the fulfillment of academic, familial, occupational, and other responsibilities.  Misery in the form of food and weight obsession, anxiety about control, guilt, helplessness, hopelessness, and extreme mood swings.  Alienation in the form of social anxiety, social withdrawal, secrecy, mistrust of others, and self-absorption.  Disturbance of self and others through loss of control over dieting, body image, eating, emotions, and decisions. 2. Don’t oversimplify. Avoid thinking or saying things such as “Well, eating disorders are just an addiction like alcoholism,” or “All you have to do is start accepting yourself as you are.” 3. Don’t imply that bulimia nervosa, because it is often associated with “normal weight,” is somehow less serious than anorexia nervosa. 4. Don’t be judgmental, e.g., don’t tell the person that what they are doing is “sick” or “stupid” or “self- destructive.”  5. Don’t give advice about weight loss, exercise, or appearance. 6. Don’t confront the person as part of a group of people, all of whom are firing accusations at the person at once. 7. Don’t diagnose: keep the focus on IMAD (inefficiency, misery, alienation, disturbance) and the ways that the behaviors are negatively affecting the person’s life and well-being. 8. Don’t become the person’s therapist, savior or victim. Do not “promise to keep this a secret no matter what.” 9. Don’t get into an argument or a battle of wills. If the person denies having a problem, simply and calmly:  Repeat what you have observed, i.e., evidence that there is a problem.  Repeat your concern about the person’s health and well-being.  Repeat your conviction that the circumstance should at least be evaluated by a counselor or therapist.  End the conversation if it is going nowhere or if either party becomes too upset. This impasse suggests that the person seeking help needs to consult a professional.  Take any actions necessary for you to carry out your responsibilities.  Leave the door open for further conversations. 10. Don’t be inactive during an emergency: If the person is throwing up several times a day, passing out, complaining of chest pain, or is suicidal, get professional help immediately.  Media, Body Image, and Eating Disorders We live in a media-saturated world and do not control the message. Mass media provides a significantly influential context for people to learn about body ideals and the value placed on being attractive.  Over 80% of Americans watch television daily. On average, these people watch over three hours per day.  American children engage in increasing amounts of media use, a trend fueled largely by the growing availability of internet access through phones and laptops. On a typical day, 8-18-year-olds are engaged with some form of media about 7.5 hours. Most of this time is spent watching television, though children play video games more than an hour per day and are on their computers for more than an hour per day. Even media aimed at elementary school-age children, such as animated cartoons and children’s videos, emphasize the importance of being attractive. Sexually objectified images of girls and women in advertisements are most likely to appear in men’s magazines. Yet the second most common source of such images is the advertisements in teen magazines directed at adolescent girls. Effects of Media There is no single cause of body dissatisfaction or disordered eating. But, research is increasingly clear that media does indeed contribute and the exposure to and pressure exerted by media increase body dissatisfaction and disordered eating.   Numerous correlational and experimental studies have linked exposure to the thin ideal in mass media to body dissatisfaction, internalization of the thin ideal, and disordered eating among women.  The effect of media on women’s body dissatisfaction, thin ideal internalization, and disordered eating appears to be stronger among young adults than children and adolescents. This may suggest that long-term exposure during childhood and adolescence lays the foundation for the negative effects of media during early adulthood.  Black-oriented television shows may serve a protective function; Hispanic and Black girls and women who watch more Black- oriented television have higher body satisfaction.  Pressure from mass media to be muscular also appears to be related to body dissatisfaction among men. This effect may be smaller than among women, but it is still significant.  Young men seem to be more negatively affected by the media images than adolescent boys are.  For Faculty and Students Meeting With and Referring Students Who May Have Eating Disorders By: Michael Levine, PhD and Linda Smolak, PhD 1. No matter how strong your suspicion that a student has an eating disorder, do not make a decision without first speaking privately with the student. If possible, select a time to talk when you will not feel rushed. Ensure sufficient time and try to prevent interruptions. 2. Roommates or friends should select the person who has the best rapport with the student to do the talking. Unless the situation is an emergency or otherwise very negative for many people, confrontation by a critical group without professional guidance should be avoided. 3. In a direct and non-punitive manner, indicate to the student all the specific observations that have aroused your concern. Allow the student to respond. If the student discloses information about problems, listen carefully, with empathy, and non-judgmentally. 4. Throughout the conversation, communicate care, concern, and a desire to talk about problems. Your responsibility is not diagnosis or therapy, it is the development of a compassionate and forthright conversation that ultimately helps a student in trouble find understanding, support, and the proper therapeutic resources. 5. If the information you receive is compelling, communicate to the student:  6. Your tentative sense that he or she might have an eating disorder. 7. Your conviction that the matter clearly needs to be evaluated. 8. Your understanding that participation in school, sports, or other activities will not be jeopardized unless health has been compromised to the point where such participation is dangerous. 9. Avoid an argument or battle of wills. Repeat the evidence, your concern, and if warranted your conviction that something must be done. Terminate the conversation if it is going nowhere or if either party becomes too upset. This impasse suggests the need for consultation from a professional. 10. Throughout the process of detection, referral, and recovery, the focus should be on the person feeling healthy and functioning effectively, not weight, shape, or morality. 11. Do not intentionally or unintentionally become the student’s therapist, savior, or victim. Attempts to “moralize,” develop therapeutic plans, closely monitor the person’s eating, adjust one’s life around the eating disorder, or cover for the person are not helpful. 12. Be knowledgeable about community resources to which the student can be referred. In discussing the utility of these resources, emphasize to the student that, since eating problems are very hard to overcome on one’s own, past unsuccessful attempts are not indicative of lack of effort or moral failure.  13. Faculty should arrange for some type of follow-up contact with the student. If you are often involved with students with eating disorders, consultation with a professional who specializes in eating disorders may be needed. For Coaches and Student Athletes Tips for Coaches: Preventing Eating Disorders in Athletes Compiled by: Karin Kratina, PhD, MPE, RD, LD 1. Take warning signs and eating disordered behaviors seriously! Cardiac arrest and suicide are the leading causes of death for people with eating disorders. 2. If an athlete is chronically dieting or exhibits mildly abnormal eating, refer her or him to a health professional with eating disorder expertise. Early detection increases the likelihood of successful treatment; left untreated the problem may progress to an eating disorder. 3. De-emphasize weight by not weighing athletes and eliminate comments about weight. Instead, focus on other areas in which athletes can improve performance. For example, focus on strength and physical conditioning, as well as the mental and emotional components of performance. 4. Don’t assume that reducing body fat or weight will enhance performance. While it  may lead to improved performance, studies show this does not apply to all athletes. It is not uncommon for individuals attempting to lose weight to develop eating-disorder symptoms, which can physically weaken the athlete. Performance should not be at the expense of the athlete’s health. 5. Instruct coaches and trainers to recognize signs and symptoms of eating disorders (weight loss, fatigue, over-training, refusal to eat with the team, frequent injuries, etc.) and understand their role in prevention. Eating disordered individuals often hide their symptoms out of shame and embarrassment. 6. Provide athletes with accurate information regarding weight, weight loss, body composition, nutrition, and sports performance to reduce misinformation and to challenge unhealthy practices. NEDA also has listings of local professionals who can help educate the athletes. 7. Emphasize the health risks of low weight, especially for female athletes with menstrual irregularities or amenorrhea. Risks include low bone density, lowering of immunity and auto-immune illnesses. The athlete should be referred for medical assessments in these cases. 8. Understand why weight is such a sensitive and personal issue for many women. Eliminate derogatory comments or behaviors about weight-no matter how slight. Celebrate the athlete for talents and strengths beyond the physical; work on developing body, mind and spirit. If there  is concern about an athlete’s weight, the athlete should be referred for an assessment to a professional skilled in diagnosing and treating eating disorders. 9. Do not automatically curtail athletic participation if an athlete is found to have eating problems, unless warranted by a medical condition. Consider the athlete’s health, physical and emotional safety, and self-image when making decisions regarding an athlete’s level of participation in his/her sport. 10. It is essential for coaches and trainers to explore their own values and attitudes regarding weight, dieting, and body image, and how their values and attitudes may inadvertently affect their athletes. They should understand their role in promoting a positive self-image and self-esteem in their athletes. Remember, if athletes do not take care of their bodies, they risk losing their athletic careers at a very young age. Athletes and Eating Disorders What Coaches, Trainers, Parents and Teammates Need to Know Involvement in organized sports can offer many benefits, such as improved self-esteem and body image, and encouragement for individuals to remain active throughout their lives. Athletic competition, however, can also be a factor contributing to severe psychological and physical stress. When the pressures of athletic competition are added to an existing cultural emphasis on thinness, the risks