The Prevalence of Eating Disorders: And What Role Do We Play in Feeding Them?

Recently I attended a party for a dear friend. It was a well-attended gathering and a wonderful chance to reconnect with old friends from my two decades in Montecito. However, I was gravely concerned at how many women were alarmingly thin. This wasn’t “Oh, I have started to do Pilates” thin. This was, “Is this person chronically ill, or do they have an eating disorder?” thin. I know people can lose weight for many different reasons, often including stress, so I tried to keep an open mind. But there were just so many of them.

While I can normally find humor in everything I write about, this piece is different. Eating disorders are no laughing matter.

Equally disturbing was the number of people who commented on these women’s weight to say how great they looked. Really? Do you genuinely think her sunken cheeks look “great”? Or are you at a loss as to what to say? From my studies, I remember it is often best not to comment on the appearance of someone with an eating disorder at all; unless it is a private sharing with a close friend of your concern for their health. Is this part of the problem, I wondered. Are we, as women, reinforcing the disordered eating with our effusive praise?

I wanted to get an expert’s perspective, so I spoke with Linda Wells, local LCSW (Licensed Clinical Social Worker), therapist, and Certified Eating Disorder Specialist with over 30 years’ experience in the field. I asked her if she has seen a rise in eating disorders over the years, and if so, why she thinks that might be. This is what she shared, “We have seen a rise in eating disorders and disordered eating in Santa Barbara, although with UCSB this has been true for some time. We are seeing more and more clients presenting with an obsessive relationship with weight, shape, and a preoccupation with ‘healthy eating’ – which is now termed Orthorexia. In the past, the average age of female clients were 20 to 30 years of age. However, in the recent past we have seen an increase in women and men of all ages, and girls and boys starting as young as 10 years old, there was also a steep increase in the rates of referrals to higher levels of care during the pandemic. Social media is one of the biggest influences, but Santa Barbara’s proximity to Hollywood and L.A. is another factor. The Eating Disorder field has really grown in the last twenty to thirty years. We have become a lot better at identifying ‘disordered eating’ and ‘Eating Disorders’ and are better at identifying populations who are at higher risk. We have a lot more treatment options as well, including different levels of care now. I am very glad you’re helping to bring this concern to light. This is sadly a very high medical risk diagnosis,
including fatality.”

Let’s start with what is an eating disorder and the distinction between that and “disordered eating.” According to the National Eating Disorder Alliance (NEDA), while there are similarities between the two, there are significant differences as well, “Disordered eating refers to a spectrum of problematic eating behaviors and distorted attitudes towards food, weight, shape, and appearance. Often these behaviors include dieting, skipping meals, fasting, restricting food intake, eliminating specific foods or food groups, binge eating, excessive use of diuretics, laxatives, and weight loss medications, as well as the use of compensatory behaviors (purging, excessive exercising).” And while these patterns of behavior can often be the precursor to an eating disorder, they don’t meet the criteria to be diagnosed as a mental health illness. That threshold is informed in part by the added element of a behavior’s frequency or severity, both of which can propel one further in the direction of an eating disorder diagnosis. 

According to the American Psychiatric Association, eating disorders are “behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions.” These can be very serious conditions and include diagnoses such as anorexia nervosa, bulimia nervosa, binge eating and laxative misuse. At any given time, several million people are affected by this mental health illness, the most common sufferers women between the ages of 12 and 35.

The need for support in this area has grown exponentially over the last decade. Emblematic of the dramatic rise of this therapeutic field may be the Monte Nido eating disorder treatment program. Founded by Carolyn Costin as a single location in Malibu, Monte Nido now has 48 centers across the United States. 

As Wells pointed out, we have seen a rise in this issue in Santa Barbara. She speculated that it could be due to our proximity to Los Angeles and the Hollywood subculture of glamour, where remaining thin seems to typify the pursuit of seemingly ageless beauty. But the end question remains the same. What can we do about it? The number one piece of advice that most professionals offer is to not compliment a worryingly thin person on their appearance. As we have learned recently, it is never a good idea to comment on someone’s weight at all. We live in a diet culture that rewards weight loss, and this preoccupation can often be one of the foundations behind the eating disorder itself. Specifically young men and women are held up to the unrealistic expectations of social media and celebrity. 

According to the National Association of Anorexia Nervosa and Associated Disorders, “Complimenting someone’s appearance is a way of reinforcing that how they look is what’s important about them. If you stop for a moment, you can think of so many other things that are more important than the body or appearance of your loved ones. Comment on style and taste, not the body in the clothes. Mention how happy someone looks, not their weight changes. Bring up the way people make you feel, not how you interpret their health.” This is a much-needed shift in our dialogue, the redirection of the conversation to something much more interesting than our body fat percentage.

If you or someone you care about might have an eating disorder, or is experiencing disordered eating, there are ways to help. The National Eating Disorders Association recommends privately expressing your concern to the loved one in question. The key is gentleness, not judgment, and sticking to “I” statements such as “I am concerned at how often you are working out.” Or “I am worried at how little you are eating.” The idea is to not finger point or diagnose, but to be supportive, do your research, and perhaps have a resource or two to refer them to.

It is estimated that over 10,000 people every year die of eating disorders in the United States alone. That is 1 death every 52 minutes.

For more help, reach out to The National Eating Disorders Helpline at 800-931-2237.