Eating disorders: who is really at risk?

By Adriana Ramos Calvo

Eating disorders (EDs) are a type of deadly and surprisingly common psychiatric disorders. The most common variants are bulimia nervosa, anorexia nervosa and binge-eating disorders, but many more, however, are also diagnosed on a daily basis all around the world (Lutter, 2017). According to the National Eating Disorder Association (NEDA), eating disorders are “serious but treatable mental and physical illnesses that can affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes, and weights”. The risk factors for these disorders can be divided into three categories: biological, psychological and sociocultural. These risk factor can interact differently in different patients, which can suffer from the same disease but have very different experiences and symptoms (National Eating Disorders Association, 2018). 

The first category of risk factors is the one classified as biological. These include individuals who have a history of dieting and other weight control methods which can lead to the development of binge eating patterns. In the same lines, burning off more calories than those consumed and therefore maintaining a negative energy balance, either through dieting, illnesses, growth spurs or intense training can have similar consequences. Furthermore, having a first degree relative, including siblings or parents, who suffer from an eating disorder or other mental health conditions can stimulate the development of EDs. On the other hand, the psychological factors that can lead to these diseases include self-oriented perfectionism, which causes unrealistically high self-expectations, behavioral inflexibility and body image dissatisfaction. The concept of ‘body image’ encompasses how a person feels both about and in their body, and while it is fairly common to dislike one’s appearance, those who suffer from EDs are more likely to present higher levels of dissatisfaction. Moreover, research has shown that two thirds of the patients diagnosed with anorexia also showed signs of anxiety disorder before the development of their ED, including social phobia, OCD (obsessive-compulsive disorder) and generalized anxiety. Social risk factors are the most abundant.  Weight stigma, which is sometimes referred to as weight-based bias or weight discrimination, is the discrimination based exclusively on someone’s body size and, sadly, is a part of everyday life and therefore is one of the most important triggers for the development of eating disorders (Isa Robinson Nutrition, n.d.).  Dieting and food restriction tendencies are also increased by the idea of the “ideal body”, which leads to an appearance ideal internalization that, together with the previously defined weight stigma, can lead to bullying or teasing. Being bullied or teased, especially about body size, has been defined as an emerging risk factor in EDs. As many as 60% of those affected by these conditions have suffered from bullying in the past. Other risk factors, such as limited social networks, historical trauma and acculturation are also crucial (National Eating Disorders Association, 2018).

In a recent study carried out in the Ciudad Real Hospital in Spain, that aimed to identify family, psychopathological, and social variables that might predict the development of EDs in the 2 years following the experiment, at age 13 and 15, 1076 individuals completed questionnaires for the screening of abnormal eating attitudes, psychiatric morbidity and family dysfunction. 159 possible cases of eating disorders, as well as 150 controls, were assessed with standardized interviews (SCAN). The results of this study showed that prevention should focus on self-esteem as a protective factor for body dissatisfaction, which was once again proved to be a key predictor of eating disorder development. The study conducted by Beato-Fernández et al. also indicated that further investigation is necessary to determine the significance of family perception (Beato-Fernández et al., 2004).

Another study performed by Jacobi et al. aimed to identify the women at highest risk of developing an ED within a high-risk sample (i.e., high shape and weight concerns) by examining the risk factors and their interactions across time periods.  In relation to the college-age high-risk cohort, depression was one of the risk factors with the highest potency, since neuroticism and negative emotionality have both been confirmed to be predictors of eating disorders and disturbances. Furthermore, a history of negative comments about eating, weight and shape from a family member, coach or teacher was significantly more widespread in ED sufferers compared to their healthy counterparts (Jacobi et al., 2011). In conclusion, if we, as a society, stopped commenting on young women’s bodies, they would stop thinking one of their most valuable assets is their physical appearance, and this would lead to a decrease in eating disorder development. More often than not, when someone loses weight, they receive praise and congratulations. These comments may be intended to be well-meaning but can end up being damaging and problematic, since they reinforce the idea that in order to be worthy, we must occupy the smallest space possible. In other words, as body dissatisfaction has been shown to be one of the greatest risk factors for eating disorder development, a protective approach towards self-esteem should be taken as a preventive step (Beato-Fernández et al., 2004).

References:

  • Beato-Fernández, L., Rodríguez-Cano, T., Belmonte-Llario, A. and Mart�nez-Delgado, C. (2004). Risk factors for eating disorders in adolescents. European Child & Adolescent Psychiatry, [online] 13(5), pp.287–294. Available at: https://link.springer.com/article/10.1007/s00787-004-0407-x.
  • Isa Robinson Nutrition. (n.d.). What Is Weight Stigma? [online] Available at: https://isarobinsonnutrition.co.uk/blog/weight-stigma [Accessed 13 Mar. 2021].
  • Jacobi, C., Fittig, E., Bryson, S.W., Wilfley, D., Kraemer, H.C. and Taylor, C.B. (2011). Who is really at risk? Identifying risk factors for subthreshold and full syndrome eating disorders in a high-risk sample. Psychological Medicine, 41(9), pp.1939–1949.
  • Lutter, M. (2017). Emerging Treatments in Eating Disorders. Neurotherapeutics, 14(3), pp.614–622.
  • National Eating Disorders Association. (2018). What are Eating Disorders? [online] Available at: https://www.nationaleatingdisorders.org/what-are-eating-disorders.

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