Written by: Natalie Pirolli, MS, RDN, LDN | February 28, 2024
There are many misconceptions about eating disorders. Movies and TV shows sometimes poke fun at them making them seem purely superficial and mild and insensitive comments like “I wish I had anorexia” or “I would take an ounce of that self-control” when learning someone has an eating disorder are common not only on TV but in real life.
But in reality, if we saw the extreme physical and psychological pain of a person with an eating disorder, we wouldn’t wish it on our worst enemy.
Eating disorders affect people of all ages, genders, races, sexual orientations, body weights/shapes, etc., and are estimated to impact at least 9% of the US population. That is at the very least because the nature of the disorder itself is secretive, so many individuals do not seek help and suffer with their disorder in silence (it’s estimated less than 1/4 of those affected by an eating disorder will seek treatment). Plus, statistics don’t include those who fall outside of the very specific diagnostic criteria. For example, those who are of “normal” weight in terms of their BMI but meet other criteria for anorexia.
It’s important to note that eating disorders are not a choice and are not so easily treated as the simplified (and insensitive) “can’t you just eat?” mentality. Up to 20% of eating disorder cases will result in death, making it the second most deadly mental illness (opioid overdose is number one). This is especially of concern for teenagers and young adults whose risk for suicide increases up to 32 times with an eating disorder.
And while recovery from an eating disorder is possible, it is usually not without great difficulty. Treatment requires a team of professionals to cover the medical, psychological, and nutritional components at various levels of care from outpatient visits to inpatient hospitalization. Support options are often limited or inaccessible (for example, health insurance does not always cover treatment options or the level of care that would be most beneficial) and unfortunately for many individuals, their eating disorder will become a chronic disease—something they will have to continually deal with on varying levels of severity for life.
This is why prevention is so important. Eating disorders often stem from a mix of genetic and environmental factors, so to help prevent eating disorders, we must focus on reducing the risk factors within our control, like the association of self-worth with eating and exercise habits and/or body weight and shape, promotion of fad diets and fear-mongering nutrition advice, and weight stigmatization to name a few.
Here are some ways you can help to prevent eating disorders:
1. Increase your awareness
Our eating behaviors exist on a spectrum ranging from a healthy relationship with food to disordered eating to clinically diagnosed eating disorders. It's important to know that eating behaviors can easily move along this spectrum—what can start as an interest in health can quickly snowball into disordered eating or a full-blown eating disorder.
Eating disorders differ from disordered eating in that they are clinically diagnosed mental health disorders; they meet the criteria laid out by the DSM-V, a diagnostic tool created by the American Psychiatric Association to diagnose mental health disorders. The DSM-V identifies 5 eating disorders: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, Avoidant/Restrictive Food Intake Disorder, and Other Specified Feeding and Eating Disorder.
However disordered eating without a clinical diagnosis can be just as serious and cause adverse effects on our health. Orthorexia, for example, which is an obsession with healthy eating, is not recognized by the DSM-V. This is more than just being concerned with the nutritional quality of the food you eat, which wouldn’t necessarily be a problem in and of itself. Individuals with orthorexia "become so fixated on so-called ‘healthy eating’ that they actually damage their own well-being and experience health consequences such as malnutrition and/or impairment of psychosocial functioning" as described by NEDA.
Learn more about eating disorders and disordered eating to increase your awareness and knowledge about the environmental triggers, symptoms, and side effects. This will help you to avoid making judgments or assumptions about people’s weight, and eating and exercise habits. It will also help you to recognize when someone around you (a family member, friend, student, client, colleague, etc.) may need help.
Learn more: Websites like NEDA, ANAD, and Eating Disorder Hope are a few helpful resources where you can learn more. NEDA has a great "How Do I Help?" page with resources for parents, healthcare providers, coaches, and more.
2. Challenge diet culture
While eating disorders have been around for a long time, there has been a steady increase since the 1950s in Western cultures—around the same time dieting for weight loss and attention to body weight and shape increased, too. There is certainly a correlation between the rise of diet culture and those impacted by eating disorders. By definition, a diet is a form of disordered eating, so it makes sense how even a diet that is intended to be short-term can snowball into a lifelong eating disorder.
Learn more about the long-term effects of dieting and how diets are designed to fail from their physiological impacts on appetite, body composition, metabolic rate, and hormonal regulation to their mental effects on our mood, mindset, and self-esteem. Increasing our knowledge and identifying where diet culture pops up in our lives (hint: it’s everywhere!) helps us to avoid falling for a diet's too-good-to-be-true claims or its altered "before and after" pictures. And most importantly remember that true happiness and self-worth are typically not achieved from a fad diet.
Learn more: I love the book Just Eat It, an intuitive eating resource that does an excellent job of challenging diet culture. Christy Harrison has some great anti-diet resources like her own book, podcast, and newsletter.
3. Walk the walk & talk the talk
Sometimes we think just posting or sharing advice about body positivity is enough, but that's a bit counterproductive if we're simultaneously judging people based on their appearance and/or punishing ourselves (restricting food/diet, overexercising) for not looking a certain way.
Notice the thoughts or judgments you might have about other people’s body weight and/or shape. Avoid making assumptions about others based on their body or eating habits and practice taking a more nonjudgmental approach (more on how to do this in number 4).
Most importantly, be sure to take a look at your own relationships with food, exercise, and your body. Do they need some support? Learning to accept and appreciate our bodies not only helps to improve our self-esteem and self-worth but also sets a positive example for our kids, students, clients, family members, etc. Treating our body with respect by nourishing ourselves with nutrient-dense and enjoyable foods, moving in ways that bring us joy, and taking care of our physical and mental health helps send the message that it's important to care for our bodies and that they are worthy of love and respect.
Be sure to speak about your body with respect—both to yourself and to others. When you catch yourself having a negative body image day, notice what else may be going on and causing you to feel down, anxious, irritable, out of control, etc. Your body is usually not to blame. It can also help to remind yourself of all that your body allows you to do and that you are so much more than the number on the scale or the tag of your pants.
Remember the way you treat and talk about yourself not only impacts you but those around you, too (more on that in number 5).
4. Learn more about Health at Every Size
Health at Every Size is a movement that supports people of all sizes in adopting healthy behaviors, with the focus being on health and not weight or size alterations. It recognizes that social, economic, genetic, and environmental influences are the main determinants of our health status and that body weight/shape and fat mass can be influenced by these factors, but are not the sole determinants of our health.
This can be tough to accept when we've been taught that our weight or BMI is what largely determines our health status. But the research is there—when we take the emphasis on weight/BMI out of the picture, it helps promote size acceptance, self-esteem, and long-term health behaviors, while decreasing the likelihood of weight-cycling and preoccupation with food, weight, and exercise (which is a huge risk factor for eating disorders).
Learn more: Some of my favorite resources include Body Respect (quick read), Health at Every Size (longer read), and not to toot my own horn but, these two blogs of mine: Health at Every Size: Taking Weight Out of Wellness, Health at Every Size: Common Questions Answered. : )
5. Promote body positivity & acceptance
Be a positive influence on your children, friends, coworkers, clients, followers, etc. Unlearn diet culture's harmful messages and avoid promoting them to others. For example, avoid associating morality, e.g.“good” or “bad,” with foods and eating habits. Even if we are not explicitly saying to our kids “You’re bad if you eat Oreos,” they can pick up on this message if we shame talk ourselves for enjoying Oreos or if we call Oreos “garbage,” “toxic,” “fattening” in front of them. Try to use a more neutral voice with food recognizing that it’s important to eat the nourishing ones we enjoy and to have some fun ones too.
Be mindful of spreading the message that "thinner is better," or that weight loss is always a good thing that should be praised and weight gain is never good and should be corrected. It's been reported that 42% of girls in the 1st to 3rd grade want to be thinner and 81% of 10-year-olds are afraid of being fat. We start picking up on these messages from a young age! We can do our part by not promoting them. Plus, we don’t know if someone’s weight loss is a result of their battle with an eating disorder, or if their weight gain was a result of healing their relationship with food and their body. We’re meant to be different shapes and sizes—when we accept this it can help us stop comparing, judging, and giving into or promoting diet culture.
Notice what you follow on social media and how it makes you feel. Unfollow the accounts that promote diet culture and start following ones with a more positive, inclusive approach. Exposing ourselves to diverse body types can help us develop body acceptance and practice non-judgment. If your relationship with food and body image needs some work, trying to be a more positive influence in this diet-culture-focused world can actually help you to be more positive with and accepting of yourself, too.
We can promote health and well-being without promoting diet culture or contributing to weight stigmatization. We just need to be mindful of how our message may be received.
Learn more: The Body Positive and NEDA are helpful online resources and here is a list of some body positive Instagram accounts. The Body Project has also been shown to help prevent eating disorders in at-risk populations.
6. Speak up
We’re prone to think of that textbook image of an extremely thin person when we think about eating disorders, but not even 6% of people with eating disorders are classified as “underweight.” So instead of thinking “Their eating disorder can’t be that bad” or “They must be doing better because their weight is normal/higher,” keep in mind that we never know a person’s whole story, and certainly don’t know any more about a person because of their weight or shape.
If an eating disorder cannot be prevented, early intervention is the next best thing to help increase the likelihood that an individual will recover. The sooner a person with an eating disorder gets help, the better the outcome. If you suspect someone needs help, reach out privately in a nonjudgmental, supportive, and empathetic way. Here are a couple of helpful tools from NEDA: an eating disorder screening tool and a resource for how to approach someone with an eating disorder.
Putting it into practice
I realize these are all easier said than done. It’s going to take time to learn to reject diet culture and appreciate and accept our own bodies before we can confidently promote these things to our kids, students, clients, etc. But that doesn’t mean we can’t start working on them now. By being mindful of our own judgments and beliefs and practicing being a positive influence in this weight-obsessed world, we can get to a place of diet-culture freedom while helping others get there along the way.
I still have times when I have to challenge that diet culture voice in my head and what it says about my body, diet, and exercise habits, too. It takes time, but writing about it and promoting it with my clients and on social media has helped me tremendously.
Help spread the message: if you found this blog helpful, like it (click the heart below), share it on social media, or email it to a friend!
You can also learn more about my non-weight-focused approach to health and well-being by subscribing to my newsletter or reaching out to work together.
Sources:
1. NEDA
2. ANAD
3. UC Berkeley
4. Eating Disorder Hope
Additional Eating Disorder Resources:
For Practitioners (books):