The media needs to do its homework

A big part of my job both as a science writer and as a blogger here for ED Bites is to read news articles. For ED Bites, not surprisingly, those articles are generally about eating disorders.

The problem with regularly perusing media coverage of eating disorders is that I am left wanting to stab out my own eyeballs in frustration and despair.

Cases in point:

Anorexia and bulimia are "dramatically" on the rise.

From a story in The Independent about a psychologist who will be speaking about bringing up adolescent girls.

Anorexia and bulimia are also dramatically on the increase: official figures for hospital admissions released last October pinpointed a 16 per cent rise in hospital admissions for eating disorders, and showed that one in every 10 of these admissions was a 15-year-old girl.

"There's plenty to be concerned about," Biddulph says. "Everyone who has a teenage daughter right now sees this, in their child and among their child's friends." The people they blame, he says, are the advertising industry and the media. "They are driving girls' sensibilities and making them miserable. The corporate world has identified them as a new market for products, and is preying on them." 

The article also talked about the "epidemic" of self-harm in the same population. Although I can't talk as much about self-harm prevalence, I can tell you that the interpretation of the official figures for hospital admissions tell us nothing more than that there was an increase in hospital admissions.

Here's what it doesn't mean:
  • There's an increase in the number of cases of eating disorders. Nope. Overall number of cases could have remained the same or even gone down. We don't know, truthfully. It could be that the cases are more severe, or that people are actually being hospitalized more frequently. It doesn't indicate how many ED cases there are that don't actually end up in the hospital.
  • An increase in hospitalization is a terrible thing. If more people being in the hospital means that more people are getting the care that they need, then this is a good thing. 
  • The world has it out for 15-year-old girls. Considering that peak onset for anorexia is puberty (and, at least in the UK, anorexia is the ED that is most frequently hospitalized), it's not surprising that a high number of hospitalized people are aged 15. Neither surprising, nor shocking, if the reporter had done her background research. 
  • There is an epidemic of eating disorders. To get really technical, an epidemic occurs "when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience." (Thanks, Wikipedia). Here's the rub: we don't have any data on the current number of new or existing EDs in the community, so we absolutely CANNOT accurately say if there are more cases than we would expect. Because we don't know how many cases to expect. It's all smoke and mirrors to say there's an epidemic. As far as we know, there's not.
When all else fails, blame the patient.

The results of a coroner's inquest into the death of a young woman from anorexia were reported, and here is what the medical examiner concluded:

Issuing a narrative verdict, Mr Hinchliff said: “She never fully complied with the treatment regime which had a major impact on her physical health and caused her death.”

Because, yes, it was the patient's fault she died, wasn't it?

It wasn't that she didn't comply, it was that she couldn't comply. When you are underweight and malnourished and frightened, facing the thing that scares you more than anything (food) six times a day is often more than a person can tolerate. Most of the time, ED patients do want to get well, they just can't handle the fear and anxiety. The disorder, then, becomes preferable.

The problem is that too many of the organizations that pay for ED treatment (whether it's insurance companies, the NHS, whatever) see weight restoration as the "cure" for anorexia. Nutritional rehabilitation is crucial and needs to happen for recovery, but just because a patient has gained weight doesn't mean that their eating disorder is gone. So people relapse, again and again and again, and everyone barks at them that they can't be helped.

This behavior isn't a choice. We need to stop expecting compliance from ED patients in the beginning of recovery. Treatment providers need to comply with the patient's abilities at his/her particular stage of recovery. That's where compliance needs to happen. It's not--and can't be--the patient's job.

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Anonymous said...

Thank you for writing this out. I read this stuff, too and seethe and want to scream but I'm supposed to be being compliant now and have a couple people on my team who don't quite understand why I'm so upset presently. Compliance at any stage of refeeding/recovery is iffy. It's hard around certain numbers, it's hard at first, it's hard when there is a necessary kcal increase, it's hard close to the end point and on. It's in our heads that this is not okay on any level and it's so scary to people that instead of checking their fears they project them as if the sufferer isn't terrified enough already. Do they think we don't feel that, too?

The epidemic is the absence of care, the constant blame, finger pointing and the boorish level of understanding that makes the status quo what it is. In my opinion, which is admittedly skewed, the media has helped that problem along by focusing on fat phobia and not on EDs that have been around for centuries. I'm freaking sick of *that*, along with the people who write in ways which sensationalize their opinions, not facts.

Forgive my rant and thanks again for actually researching or owning an opinion as such.

hm said...

I wonder sometimes if sub-par dietitians don't push and insist on compliance because keeping you at sub-par recovery gives them a steady income. And it's "your fault" that you can never leave- b/c you can never do things "quite right"- and so you continue to need their help. Forever. Till you die.

But that's probably another subject.

Great post. Sounds like this journalist is jumping on the bandwagon of "BAD MEDIA!!!"- just trying to get in on the recent media frenzy on the topics of photoshopped models and such. Annoying and irrelevant.

The first thing I thought of when I read that more people are being hospitalized was, good, that means eds might be coming out of the closet and more people might be getting help. Can't imagine there are more eds. It's not they're contagious. Just more people maybe are taking notice, being careful, looking out for their kids.

hm said...

*It's not LIKE they're contagious... I meant to say.

kelsey w. said...

THANK YOU! I am reluctant to tweet articles because it seems that they are forever skewing the results. I tweet for @BHNDPG and so I am moving more towards just sharing the actual research paper - then they can make their own opinons. So frustrating - especially when they start blaming the patients. Big IGNORANT stamp on their foreheads :)

Anonymous said...

One thing my psychiatrist said to me was that social pressures and norms didn't cause EDs per se. However, these pressures might make it easier for the ED to take over rather than some other abnormal coping strategy. 50 years ago I may have been a closet alcoholic. I certainly moved from self-harming (which was very visible and much harder to get away with) to the ED.

kazehana said...

I think you're getting hung up on the minutae of data gathering. I work in kindergarten & have for a little over a decade now. What I can tell you from my day to day interactions with children ages 4-6 over that decade is that more little girls come in to kindergarten worrying about being fat, not wanting to eat bread, refusing to eat things they think might be "fattening" and wondering if they look bad when their tummies are round or better when they suck them in.

You can nitpick the media all you want, but it doesn't change the fact that the obsession with looks/weight/sex appeal that dominates media affects the women who become mothers to these little girls. And while the mothers might not have EDs, their self-image preoccupation becomes a disease they feed to their daughters via osmosis. Hearing mom obsess about carbs, calories, cardio, abs, etc is how they form their perceptions of what is & isn't normal & acceptable behavior.

Dieting becomes their preset mode of eating right from the start. And if any of these pre-pubescent girls has the neurological, biological predisposition towards ED, then they will naturally already be closer to that brink than they would have been before.

While you don't appreciate the lack of scientific finesse the media is showing while reporting this upswing in hospital admittances for ED, how is more awareness a bad thing? More awareness leads to more accountability, not less.

Media as a reflection of society is imperfect. I feel like your attraction to & insistence on a scientifically pure, numerically perfect way of parsing the data is a facet of your own perfectionism.

Fiona Marcella said...

I agree that the media does need to do its homework, but at least in the case of the second report it, and the rest of us, could do with a bit more help from the medical establishment. It wasn't the newspaper which stated that the patient was at fault for being non-compliant, it was the coroner. Apparently her local mental health service "compiled a report stating the support and treatment of her was right “despite the conclusion”" Hmmm - either they've been badly misquoted or they have lost faith in their ability to care for their own patients.

Anonymous said...

Its a bit like treating someone with cancer just because they have done the course of treatment doesnt mean the cancer is gone away, its always there ready to rear it's ugly head.As someone who is suffering for over 20 years i have done the inpatient hospital programme whose emphasis was on putting on the weight and yes i did gain weight and i was totally compliant, did what i was told but inside me the ed was whispering over my shoulder just wait until you get out of here and we can be together again. Sometimes i wonder what planet the professionals are on as the same way they tell someone who is trying to loose weight due to obesity they say the slower you loose it the easier it is for your body to maintain and that its not recommended to loose it too quickly. I imagine then would it not make sense then to gain the weight at a level that the patient is comfortable with instead of expecting them to eat double what any normal person would eat just so they can look like they are making progress because the scales are going up at every weigh in. At least i know for me the whole thought of change and the loss of control is freaking me out sometimes i feel that i will just stay the way i am its easier than facing your fears after being like this for so long i dont know any other life .......

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Carol Lee said...

I couldn't agree more, i have to say that the media has something to so with it. Look at TV, magazine, they all promote thinness. I hope that there is an effective bulimia rehab for those affected individuals, most of them are usually teens.

rootsbyastream said...

Good article! As a former ED girl I love sharing my story and more on health and overcoming ED's.

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the Weather in Anorectica said...

I don't know but I can tell you back in 1981 when I first got sick (after 13 years of picky eating) I'd never picked up a fashion rag, and I didn't start cutting until I was in my 30's. My early home life was chaotic and I did become a model, but I certainly don't believe I got AN because of the 'rents, and when I was working in Paris I was the odd one out. In an industry of glamazons I was often too small for the sample sizes!

the Weather in Anorectica said...

"We need to stop expecting compliance from ED patients in the beginning of recovery."


the Weather in Anorectica said...

Far be it from me to deny that the media can impart the notion that restricting is a good idea and that restriction can catalyze the emergence of a latent ED.

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I wonder often in the event that sub-par dietitians never press as well as insist on compliance since holding you back in sub-par recovery gives them a reliable income. And "your fault" that you can in no way leave- b/c you cant ever perform items "quite right"- so you always will need their own help. Permanently. Till you runescape gold

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About Me

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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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