Education and prevention?

It's nice to think about preventing eating disorders.  I'm not saying we can't do it or we shouldn't try.  But I'm wondering how teaching kids about "loving your body" and the dangers of eating disorders is actually going to help.

In a recent Huffington Post article, therapist Judith Brisman writes:

•Talk about eating disorders and how dangerous they are. Talk about it in the same way you talk about lung cancer and smoking -- or death and drunk driving. It's that dangerous. It can't be ignored.


•Help your kids pay attention to their inner life. What are they feeling inside when they turn to the third batch of cookies, or when they are skipping breakfast and lunch? Be genuinely curious about their fears, thoughts and worries about their body. And educate them! They may not know that skipping breakfast and lunch disrupts metabolism.

•Help your kids be responsible for what they are eating. Allow them snacks. For example, it's okay to eat cake -- but how many times a day? And what should portion size look like? Talk, be curious, instruct and pay attention. Kids need to know that if they get too skinny or become anorexic, they won't be able to be in the school play or on the hockey team. Kids should be as scared of anorexia, binge eating and bulimia as they are of smoking and drunk driving. They also should know that there are many things that can be done to help if they worry they are in trouble with food.

I don't think that these things are bad.  Open lines of communication between parent and child are very important.  And I do think that kids should be taught about eating disorders the same way they are taught about smoking, drunk driving and cancer.

My question is this: do we know that this will actually prevent eating disorders?

I'm guessing that most people who develop an eating disorder today probably know what one is.  I knew eating disorders were dangerous before I got sick, and it didn't really stop me.  One, I thought it would never happen to me. Two, I didn't realize I had anorexia until I was already stuck. 

I wish more kids (and adults!) were taught about the dangers of dieting and that "healthy eating" can go too far.  I want more people to know about exercise--too much and not enough.  I can believe that these things might help.

But explaining to someone how dangerous eating disorders are isn't going to prevent someone from getting sick.  It's like telling someone that cancer can kill you and expecting that this will make cancer rates go down.  It's a nice thought, but that's not how cancer works.  And that's not how eating disorders work, either.

Eating disorders are baffling and scary, and it's probably nice to think that if we just don't complain about our butts and if we tell little Susie and Sammy that EDs can kill, then surely they won't be stupid enough to get sick.  After all, my mother once told me (in all seriousness) that she never thought I would develop an eating disorder because I was smarter than that.  As in, I knew it was dangerous so why would I "dabble" in anorexia?

Because I didn't know I was dabbling in anorexia when I first got sick.  I just wanted to eat "better."  I was actually trying not to get anorexia.  It happened all the same because an eating disorder isn't a choice.  It's not logical.  It's an illness. 

25 comments:

Anonymous said...

I agree with you Carrie! I don't think all this stuff is a bad idea but would it work??? From a mom's eye view, what would have prevented my daughter's anorexia?

Well, if I would have figured out that she had ADHD and an anxiety disorder when she was a young girl and found her some effective treatment-now that might have been preventive because I look upon her anorexia as a complication of those other problems. But I'm not sure how I would have done that as I only see this now as it was I look back with experienced eyes.

azhe'n said...

completely agree. it is an illness. intellect is simply not a factor.
i'm pretty angry with it all right now. i'm pretty angry with me right now. still, i have to remember, i would not be angry with my Gram for having cancer. she did, and i wasn't. i wouldn't.
goes to show that mental illness really is still stigmatized, even now.
i broke a leg badly a few years ago and got it screwed back together. was that my 'fault' too?
no.

Samantha C. said...

excellent points, as always. I think ideally, this sort of thing should be able to act as a screening. It's not that telling people about cancer can prevent it from growing, but that reminding people to do self-exams and know the symptoms can help people get help at earlier stages. In an ideal world, one that DOES teach about the dangers of orthorexia and dieting, I think that's what education should be able to do.

Becca said...

Completely agree with you, Carrie.
I certainly was well-educated about healthy eating and eating disorders as a kid (I grew up on a very balanced diet), and although I went to the same arts boarding high school as Wasted's Marya Hornbacher, I can't recall ever being anywhere NEAR disordered. Until around sophomore year of college, I never gave food a second thought. I liked it, it fed me, it was something people did.

My ED behaviors started then, beginning to insinuate themselves slowly into my life. It wasn't until the ED truly took over in ways I could not ignore did I even know I HAD one! Eating disorders, at least for me, are not about "eating healthy," "knowing the dangers," and "celebrating our bodies." They are symptoms of deeper psychological issues that manifest themselves in physical ED behavior.

Education's good, but we can't hope to cure EDs through this kind of knowledge alone.

hm said...

I come from a family riddled with ADHD, OCD, anxiety, depression, ED. We've pretty much all got the fun genes here.

My sweet, beautiful little niece, a cheerleader, decided a year or so ago that she was getting too fat. She started exercising more, eating less. She started withdrawing, feeling faint during cheer practice, establishing rigid rules about what she could eat and when. She was teary eyed and calling herself fat in spite of dropping significant weight in a short amount of time.

I was still in the dark about my own disorder in a lot of ways, but I could see it creeping up in her. I did try to educate her on nutrition, on her body's needs, on how her thoughts and insecurities were being exacerbated by her poor nutritional choices. She didn't get it. She's a smart kid- but she couldn't hear it.

So instead, I educated her mother, my sister. My sister asked her coaches and the person who checked them in at Curves and recorded their weights and my concerns were validated beyond doubt. My sister took the bull by the horns. Began sitting with her at every meal. Monitoring every bite. Took her to a therapist. And told her that if she lost any more weight, she'd pull her out of school and put her in a hospital.

My niece was back to normal within about a week.

The whole episode lasted maybe a month, if even that.

Now she never got to that emaciated point- we caught her right at the beginning of what could have been an eating disorder. We stopped the disordered behaviors before they developed into a full blown disorder. But I think it's interesting that, even at the very beginning, she was unable to hear rational arguments against her behaviors.

She is a very logical little girl- she talks to me about all kinds of things- relationships, drugs, sex, friends, faith- everything. She listens to grown up opinions and takes them into consideration, and makes logical, mature choices with her life.

But when she started losing weight, she lost her logic. That's scary.

I think, if anything, education is necessary not so much b/c it might pull a kid entrenched in an ed out of a hole- b/c I don't think eds are rational and therefore do not respond to rational argument- but b/c it will open kids' eyes to what's going on around them- to what their friends might be doing- what their little sisters or brothers might be doing- what their OWN kids might do someday.

Yes, please, educate the kids. Educate the public. Let everyone know what eds are and that they are dangerous. So that we can protect EACH OTHER. So we can be rational for someone else who is slipping and maybe isn't.

I have something else to say but this post is getting too long...

hm said...

Ok, this quote:

"Help your kids pay attention to their inner life. What are they feeling inside when they turn to the third batch of cookies, or when they are skipping breakfast and lunch? Be genuinely curious about their fears, thoughts and worries about their body. And educate them! They may not know that skipping breakfast and lunch disrupts metabolism."

Ok, ok, I get it, talk to your kids. But if you leave it at that, you're an idiot. Asking them how they feel when they skip breakfast and lunch is... STUPID. At least, it's stupid if that's where you leave it. Here's how a conversation like that would have gone w/me at that age:

Mom: "How do you feel when you don't eat breakfast or lunch?"

me: "I did eat lunch." [lie]

Mom: "Oh... but I didn't see you eat breakfast. How did you feel about that?"

me: "I just didn't have time this morning. I took a granola bar in the car." [lie]

Mom: "Oh... ok. You didn't eat dinner with us though. How did you feel about that?"

me: "Good. I wasn't hungry. I'll eat something later." [lie, lie, lie]

How about: Take the kid to a therapist. Take the kid to a doctor. "Out" them. Have them weighed, monitored, and treated. Refeed them.

THEN ask them about their feelings as you SUPPORT THEM THROUGH TREATMENT.

OF COURSE parents should care how their kid feels. Duh. But no one would advise a parent to talk to a kid about their feelings if they felt a tumor under their skin. They'd say TAKE THEM TO A FUCKING DOCTOR. That's number one. Then, of course, they'd say to support them throughout their treatment, love on them, talk to them, listen to them, be there for them. But getting help is the first priority.

Cathy (UK) said...

"I was actually trying not to get anorexia. It happened all the same because an eating disorder isn't a choice. It's not logical. It's an illness."

Thank you Carrie :)

I developed AN in 1977 when there was no internet, no constant talk of EDs in the media, no general societal obsession with body image... and the only magazines I had ever read were kid's comics, like 'Beano'. I was a geek child; not a child who desired to look like a 'skinny celebrity'. I had never heard of EDs and neither had my parents or friends.

For these reasons I am convinced that AN comes from within a person; i.e. that certain people are inherently susceptible - and that all the cultural stuff we emphasise nowadays is simply a 'red herring'. The main things that indicated my inherent susceptibility to AN was my obsessionality, perfectionism, attention to detail and OCD.

Sure, once an ED has already established itself, in a person who is inherently susceptible, the person becomes acutely aware of environmental issues that relate to their ED. This is a SYMPTOM of their illness; not the cause. They compare their size to other people (and if their are no media images for comparison or calibration they 'use' real live people). They become obsessed and ritualised.

The idea that we can prevent EDs by encouraging people to 'love their bodies'; by praising 'curvey, real women'; by telling kids that media images have been digitally altered; by removing skinny Pepsi cans from the environment... is, IMO, pure baloney. So too is saying 'don't do anorexia; it's really bad for you'.

It just doesn't happen that way. People don't get AN by 'trying' to get it.

Of course, when we live in the 21st Century it's easy to attribute EDs to our culture; but IMO our culture is merely a mediating factor - that may make recovery more difficult.

Katie said...

I agree too. I volunteer for an ED charity and when my views on prevention are questioned I always say that I don't believe they CAN be prevented, not entirely - but that accurate information and proper support can make an enormous difference in early intervention, like hm showed with the example of her niece. I go into schools and universities to talk about eating disorders with the aim of educating people so they can spot the signs in their friends and family members. I am aware that I might be addressing people WITH eating disorders too, and I hope that I can give them some hope that recovery is possible, but really it's the general public I'm interested in getting the knowledge to.

No discussion of the dangers ever made a difference to my behaviours either, but I do think that some mention should be made, because people don't tend to think that eating disorders are all that dangerous. I've known/heard of a couple of people this year who have died because no one took their illness seriously until they were literally at death's door. So I will carry on discussing the dangers of EDs in the hope of getting through to the people who support those with EDs, not those with EDs themselves.

Cathy (UK) said...

Sorry, typo:

I meant 'there' not 'their' in my comment above in the sentence:

"...and if there are no media images for comparison or calibration they 'use' real live people..."

Briony said...

I actually disagree. Obviously, you can't prevent all eating disorders with education (we're all warned about drugs again and again in schools, but people still become addicts). But I do think that better education could reduce the rates at which they develop- look at how much smoking has decreased in recent years, and rates of drinking are apparently falling too with the increased focus on alcohol abuse. These things will probably never disappear completely, I know, but any reduction can only be a good thing.

In schools now, there's already quite a lot of focus on 'healthy eating'. As far as I experienced this, there was a lot of focus on obesity and cutting down on fats- plenty of people in the class didn't realise that fats were an essential nutrient. Eating disorders were touched upon- but only very briefly, and with the usual 'emaciated girl in knickers'-style picture. It sort of gave the sense that EDs weren't a 'real' concern in the same way as obesity. I know that this makes sense since they're relatively rare, but they are still a concern for a significant proportion of people. I think it would have been nice if it was made clear that eating disorders *do* affect normal, smart people- not just vain rich girls who want to look like celebrities. Would this have prevented my disorder? I doubt it, but maybe, just maybe, I would have thought twice before embarking on a 'diet' when I knew I was a perfectly healthy weight and shape.

I didn't set out to develop an eating disorder, but when I first started to 'eat healthily' it certainly wouldn't have occured to me that you could eat 'too healthily' or even that it was possible to lose to much weight. I was really, really lucky that my mum recognised I had a problem so soon. I think that a lot of parents wouldn't have been so quick on the uptake, though- another area why this sort of education would help.

kushika said...

I believe schools, colleges, etc. should focus on where to go for help. I had no idea where to go for help and found it terrifying to go to my GP so would have wished for more information on what to do once you have an ED. And although such talks may not have prevented me becoming ill, perhaps it would have prevented my friends from believing it was a choice, or that my ED was contagious, and perhaps would have helped them to understand what terrible disease I was going through and not bully me or take advantage of the fact I could not attend all of my lessons.

trimomremade said...

I was incredibly informed about eating disorders. Didn't help one bit. Other than knowing when I was waist deep what I was in. I think the point about educating resources is probably even better. I always felt like there were so few places to seek help. The process incredibly challenging. People's perception of the disease as not serious. It definitely prolonged the illness past my teenage years.

LJS said...

Education may not prevent onset of EDs directly, but I think it can make a big difference in outcomes. If good information becomes common knowledge, parents and friends will see the signs sooner, even if those who are sick cannot.

And that "good information" should include the biology/neurology of eating disorders, which Judith Brisman's article unfortunately does not mention, focusing instead on "this culture of severely distorted eating and body image".

Awareness of the science of these diseases will go a long way towards enabling parents, friends, guidance counselors etc to have open and practical discussions without the shadow of bad-parenting stigma and other issues that cause people to stay silent due to shame and fear.

Unerstanding the biology of an ED can also give those who have been sick a cognitive tool to help prevent relapse. In our house, my daugher grew up knowing that her grandmother had to have a no-nonsense attitude towards her diet due to diabetes. Whatever was going on in "the distorted culture", grandma moderated her food and exercise to keep her blood sugar stable - and lived an active life till age 86 thanks to that attitude. My daugher is beginning to understand her AN in the same way - she cannot let herself get malnourished because her particular biology/brain will go haywire if she gets too skinny.

BTW, this blog and its links have been a trememdous help in our family's education about the science of AN. Carrie, you should write a book! :)

FantasyGirl said...

I don't think the education is a bad idea, I just wonder if it will work. I'm sure my mom thinks that there are a whole bunch of things she could have done to prevent it, but I don't think there is.

I completely agree with you.

Abby said...

I read this too and was thinking these same things. Obviously it's important to teach kids about EDs but like you I knew what one was. And my mom actually said a very similar thing to me as well. I even knew as I started starving myself that I was developing anorexia. I just didn't care at the time.

Anonymous said...

I actually believe that an activity aimed at prevention started my unhealthy thinking. When I was in middle school I remember watching a video about eating disorders and wanting one. Years later I realized what a terrible mistake that was, but I wasn't scared by prevention efforts. Research shows scary prevention doesn't work in general, including Dare and other drug programs. But scare tactics may be all we have to prevention. I think teaching people moderation and to cope with feelings in healthy ways will ultimately help most.

Dana Udall-Weiner said...

This is an excellent post, and you articulate many questions that run through my head all the time.

Yes, eating disorders are an illness, and it's likely that biological underpinnings play a part. But it is no coincidence that the prevalence has skyrocketed in our media-saturated culture. So there are clearly some environmental factors involved, too. Eating disorders often occur when people lack tools to assert themselves, and to deal with internal turmoil. So talking to kids is important, as is helping them build skills to deal with real life problems in a constructive way. Prevention should be multi-pronged in order to be effective, but it's probably unrealistic to think that it will entirely obliterate eating disorders. They are too complex for that.

Jess@atasteofconfidence said...

I agree. I don't think it is at all a bad thing, but prevention is difficult. I don't think I grew up in a bad environment at all in terms of eating, but I still developed disordered eating.

MissBlueBird88 said...

I very VERY much agree with pretty much everything on this post. I can really relate to your point of view and especially the last 2 paragraphs.

Dawn said...

There has to be a balance somewhere right? I knew about ED, I wasn't "trying" to become anorexic, I still did. For me though loving my body had little to do with it. For me it was much more the euphoria of skipping a meal. It was like drugs, it made me feel high and numb to my pain. Before I knew it, it was an addiction. BUT, that said, if my parents had been more educated or observant, they might have seen the warning signs when I was a teenager. Maybe they could have helped me get help. But they lived in a world where nothing bad could happen to their family and where all our problems were only perceived not real. I doubt they could have prevented it, but just like one would notice with a drug addiction, I wish they had noticed with a food addiction. Maybe, just maybe, if they had been educated it wouldn't have been nearly 2 decades later when I finally sought help, because my husband recognized my need for real help. Just a thought. It isn't preventive, but can be helpful.

Anonymous said...

@ Dana: Prelevance of true anorexia nervosa has not skyrocketed. It remains roughly the same, as far as I know (far under 1% of the population)
Body dissatisfaction/depression, EDNOS or excessive dieting behaviour triggered by diets, all these things may be linked to the obsession with weight and appearance in our culture. Certainly dieting can trigger anorexia nervosa. But it is (neuro)biological illness. It has nothing to do with magazines and celebrities.
Hopefully Cathy will have something helpful to say, I know she's very knowledgeable about this.

Carrie Arnold said...

@Briony,

I think we actually agree far more than we disagree. You're right--kids do need to learn things like media literacy and what healthy amounts of exercise are and things like that. I think these things would be tremendously helpful in preventing disordered eating and some eating disorders.

My objection to the article was that teaching kids that eating disorders are dangerous will prevent them from getting an ED isn't right (from my viewpoint).

So I think we do actually agree on most points! :)

sarah said...

Thank you! I got my eating disorder before I knew what was going on. And I also call it illogical. It drives me NUTS when people want to try anorexia or another ED.

Sia Jane said...

I would be interested to know how you felt about the following... it is something I posted the other day.
I work with a great deal of men and women, of all ages and the majority support the idea of prevention, not cure.
If we can prevent the final trigger (namely societal issues) then
perhaps numbers can be reduced.
By society I mean the fashion industry (all walks beyond the catwalk campaign) I mean ongoing work within abuse (NSPCC and Barnardo's campaigns) the work of B-eat (the EDAW 2011 report and ongoing education on body image and self-esteem to young people with companies such as Dove)
I believe that a tripartite of issues can cause eating disorders...
These include a complex interweave of biological, psychological and social factors.
I think it was Criminal Minds that said something about the biology being the gun (predisposition, tolerance, genes, serotonin receptors, hereditary, obsessiveness and perfectionism), psychology being the bullets in the gun (personality, behaviour, emotion, motivation, low self esteem), and society being the pulling of the trigger (literally the "trigger") and these social triggers being vast - invalidating environments, troubled family life, emotional/physical/sexual abuse, bullying, cultural norms, societal pressures to be "thin," definitions of beauty.

If, we can maybe help those 'triggering' instances with education and awareness, maybe, the illness can remain, how do I say, there but not realised.

Just thoughts... :)

Anonymous said...

I personaly dont think that teaching kids to be afraid of an ED would work. When I was a kid, I was Mary-Kate and Ashley Olsens' biggest fan( no joke I had calendars posters movies everything). When I found out about mary-kate's Anorexia I locked myself inthe bathroom and cried. I literally prayed to God that I would never get that problem...it's ironic cuz I got it alright. I was scared out of my mind about it, but I still got it.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote



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