FOR those unfamiliar with eating disorders, the issue can seem confusing, illogical and even trivial.
Most of us enjoy three meals per day. Why might someone end up in a situation whereby their relationship with food involves restriction, overeating, purging, over exercising and other risky behaviours?
The reality is that eating disorders are not primarily about food or weight and they are a coping mechanism, with both physical and psychological components. The expression of negative emotions — in a constructive way — is challenging for people with eating disorders. It is difficult to determine the precise causes. It is often an accumulation of factors, sometimes bullying or trauma, along with what are described as ‘windows of vulnerability’ ranging from life transitions, age, biology, puberty or a change that leaves a person feeling overwhelmed.
A common misconception is that eating disorders are the domain of young women from the Western world. The difficulty with myths is that they can become a shorthand, knee jerk response to a complex problem.
Eating disorders occur at all weights and have been documented in China, Japan, Korea, South America and the Middle East. Figures from Our World in Data, University of Oxford, indicate that 16 million people worldwide had anorexia and bulimia nervosa in 2017. This, of course, does not account for the less well-known binge eating disorder, avoidant restrictive food intake disorder (ARFID) or other specific feed or eating disorder (OSFED).
A 2019 study from the American Journal of Clinical Nutrition found that the prevalence of eating disorders more than doubled between 2000-2018. We don’t know why this is the case, diagnostic criteria and manuals were updated during this time. Changes in hospital admission figures often attract much comment. Whether those increases are due to better recognition or reflect more people are coming forward, is unknown.
The information deficit is real. Approximately 200,000 studies have been published on depression, compared to 15,600 on eating disorders. Internationally, the funding of eating disorders research falls far behind with just US$1 per affected individual, compared to Alzheimer’s $239, autism US$109, and schizophrenia research at a rate of US$69 per person, respectively. The implications of this are that we cannot currently describe all of the intricacies of eating disorders because there are many unanswered questions. Without a substantial body of research we cannot adequately design and assess treatment or develop a full suite of resources needed to tackle eating disorders.
Whilst the previously noted figures and information seem bleak, the situation is not hopeless, it continues to evolve. In 2019 Professor Cynthia Bulik highlighted findings from the Anorexia Nervosa Genetics Initiative (ANGI), noting that although there is genetic component to eating disorders, ‘genetics are not destiny’. There is further cause for optimism as future genetics research will include other eating disorders.
A question arose recently as to which country has the best recovery rates. Recovery is usually looked at by treatment approach or service rather than location. Recovery from an eating disorder is possible, but it has no set definition and no universal pathway. Published this January, research by Dr Una Foye, King’s College London, examined recovery centred discussions on the popular online platform, Reddit. The findings suggest recovery can be thought of as a process that involves stages and not one defined by stopping certain behaviours. This is important since recovery is not merely a lack of symptoms, or a final clinical outcome. Each person’s recovery goals are individual. Another aspect raised in the study was a sense of freedom. That is, freedom from negative emotions such as guilt and from compulsion and preoccupation. Being able to connect to others played a motivational role in recovery and also emerged as social support, notably captured in a comment where the ‘world opens up’. For the reader without experience of eating disorders it may seem puzzling to connect the word ‘freedom’ to the issue.
People with experience of eating disorders have written books, performed plays about their experiences and participated in media interviews or podcasts. Anyone who has been through the experience will likely tell you they wouldn’t wish it on anyone else, nor would their family, it challenges family bonds and relationships.
A common thread in eating disorders is communication, including a dialogue that facilities feedback. Ultimately, we must work across disciplines, listen to people with personal experience, carers and parents. In Ireland, the HSE is focusing on implementing its Model of Care for Eating Disorders to transform how services are delivered in Ireland.
March 2 to 8 marks Eating Disorders Awareness Week. For more information about eating disorders, see www.bodywhys.ie
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