Eating Disorders: The Silent Epidemic

Trigger Warning: This story contains discussions of eating disorders, disordered eating, depression, anxiety, and body image. This story also contains images of food.

In January, body image activist Taryn Brumfitt was selected as the 2023 Australian of the Year.

The moment triggered hope that body image and eating disorders may receive more attention.

National charity and industry leader, the Butterfly Foundation, says body image is "formed by the thoughts, feelings, attitudes, and beliefs" people have about their bodies and appearance.

Studies show body image is a lifelong and complex relationship that can lead to a host of other physical and mental health conditions including depression, anxiety, and eating disorders.

According to the Butterfly Foundation, more than one million Australians were affected by eating disorders in 2022, though it’s believed underreporting of these issues is present.

People with eating disorders are more likely to be females, with average onset between ages 12 and 25, though more than one third of eating disorders occur in males.

CHALLENGES OF PREVENTION AND TREATMENT

Many people typically picture emaciated young girls when thinking of eating disorders, but this isn’t always the case.

According to the Butterfly Foundation, almost half of all people with an eating disorder are diagnosed with Binge Eating Disorder, while just 3% have Anorexia Nervosa.

Madeline West from Monash University’s Body Image and Eating Disorders Research Group says this is a common mistake.

“Everyone thinks that Anorexia Nervosa is the only eating disorder and that people who have an eating disorder are going to look a certain way, really low body weight, but that’s absolutely not the case.

“There’s a misconception about who experiences body image concerns regardless of whether it’s tied to an eating disorder or not.

“We know that some of these negative assumptions about people living in larger bodies can actually lead to poor health behaviours, so things like engaging in eating disorder behaviours or restriction or dieting, and that can actually lead to eating disorders as well,” Ms West said.

Ms West says preventing negative body image and eating disorders is difficult but people can start by changing the way they discuss these issues.

“There’s really insidious things in our day-to-day language and how we talk about our bodies, how we talk about other people’s bodies, how we talk about food."

Ms West says treating people with eating disorders can be challenging because patients can be unaware of or unwilling to accept their diagnosis, while complex presentations mean different patients can have widely varying needs.

The geo healthcare divide also continues to provide barriers to treatment for some Australians.

“We know that people that live rurally, it’s really hard for them to access appropriate treatment,” Ms West said.

RELATIONSHIPS WITH FOOD

Caption: Food isn't the enemy, it's crucial to our wellbeing (Photo Credit: Eliza Marlow).

Alex Rodriguez, an accredited dietitian and specialist eating disorder clinician from River Oak Health, a multidisciplinary clinic specialising in food, eating, and weight concerns says a dietitian’s main aim is to help people with eating disorders build a healthier relationship with food and provide nutrition counselling.

But fighting the messages people learn from an early age can be an immense challenge.

Mr Rodriguez says diet culture has been reinforced over generations and has resulted in people and companies promoting specific body image ideals.

These can vary from the thin ideal often promoted to women; while muscular, tall, and lean bodies have been endorsed as the ideal look for males.

“Anybody who doesn’t look like that unfortunately has been deemed to be unhealthy or lazy or have some form of negative moral judgement made about them.

“Weight stigma lies at the roots of diet culture which means that people perpetuate some form of restrictive or rigid or highly specific and inflexible way of eating as being the morally correct or healthily correct way of eating to be able to pursue body image ideals,” Mr Rodriguez said.

Mr Rodriguez says these restrictive diets touted as ‘healthy’ can cause physical, mental, and social harm.

Finance is also a key part of the wider discussion surrounding food and health.

“What about people who can’t afford to access vegetables or haven’t been privileged enough to be educated on the importance of these things.

“Health is related to being financially stable and being able to afford things that are touted as healthy,” Mr Rodriguez said.

Caption: A cost of living crisis has seen the price of groceries skyrocket, making survival a priority over health (Photo Credit: Eliza Marlow).

PARENTAL INFLUENCE KEY

The long-term effects of diet culture mean parents may have their own food struggles, but they’re also key to changing how their children view food.

Mr Rodriguez says it can be helpful to stop labelling food as things like ‘good’, bad’, ‘healthy’, ‘clean’, or ‘junk’.

“These labels encourage people to put food into dichotomies and then that’s either going to create fear and guilt and negative emotions from eating them, at worse it’s going to lead people to carry those into teenhood and have these things reinforced by social media."

Alex says all food is morally neutral and parents should aim to include foods in their children’s diets rather than focusing on excluding certain foods.

“Rather than making comments on how food is going to influence what they look like, trying to make comments on foods that they enjoy, trying to get them involved in the kitchen, trying to ask them how foods make them feel within themselves…” are all preferable ideas.

Caption: Cooking can be a social and creative activity (Photo Credit: Eliza Marlow)

HEALTH POLICY AND EDUCATION SYSTEMS NEED AN OVERHAUL

Dr Jessica Lee from Griffith University’s School of Public Health says both government and fitness industry policies surrounding the promotion of physical activity are too often built around losing weight.

“If someone increases their physical activity, their health outcomes improve regardless of whether they lose weight or not.

“If we can imagine a health promotion campaign around healthy eating and physical activity that was just for everyone… that had no attachment to what people looked like, your BMI category or overweight or obesity, that would be a really good step in the right direction,” Dr Lee said.

Dr Lee says appearance-based messaging can be confusing to those who already look “trim and fit”, as it tells them there’s no incentive for exercising.

It can also be disheartening to individuals who take up physical activity to lose weight, creating disappointment when this doesn’t happen.

Dr Lee says although some progress has been made, the education of health practitioners in specialty areas like the treatment of eating disorders is minimal.

“They’re really not experts in these areas, yet these are the people who we’re relying on as our initial care providers in these really complex conditions, so I think there’s a lot of work to do there in terms of the education of our health professionals around the relationship between health and weight and body image."

Eating disorder presentations rose sharply during the pandemic, with experts suggesting that increase isn’t likely to subside anytime soon.

As a result, demand for more eating disorder services and health professionals who can work in this space is climbing.

Caption: Running doesn't have to be equated with weight loss, it can have numerous other health benefits like boosting your mood and helping you sleep better (Photo Credit: Eliza Marlow).

FORGING NEW PATHS

Ms West says the research team at Monash University is working on digital initiatives for people at different stages of eating disorder presentation.

“We know that health services are really overrun at the moment, particularly with eating disorders there’s not enough to go round."

With resources stretched since the pandemic, the team is trying to bridge the gap between diagnosis and treatment.

“One of the things that we’re working on is an intervention for people that are waiting for treatment and that will be delivered digitally,” Ms West said.

Another project in the works is a chatbot designed to pop up when people are browsing websites like the Butterfly Foundation and direct internet users to helpful resources.

CHANGE ON THE HORIZON

Recovery from an eating disorder can take, on average, between one and six years, while 25% of those diagnosed will experience "severe and long-term illness".

In the May budget, the federal government announced $20 million in funding specifically for programs designed to research and treat eating disorders.

The National Eating Disorders Strategy 2023-2033 was also announced during Body Image and Eating Disorder Awareness Week in September.

The strategy was developed by the National Eating Disorders Collaboration and is designed to “articulate the key components, standards and actions that are required to achieve an effective, equitable and coordinated system of care that meets the needs of people experiencing or at risk of eating disorders and their families/supports and communities”.

That same week, the Queensland Government announced almost $40 million in funding towards new and improved services for people with eating disorders.

Funding was also allocated to growing the eating disorder workforce, with 34 new jobs announced to help respond to increased demand for care and rising waiting times.