Who are we missing? Eating Disorders & Minority Mental Health


Minority Mental Health Awareness Month was designated in 2008 to bring awareness to the unique struggles that underrepresented groups face in regard to mental illness in the United States.


Eating disorders can negatively affect almost every aspect of a person’s day-to-day life. They can also be associated with dangerous medical consequences. Recovery is possible though, and these negative effects can be minimized with early intervention and quality treatment. But treatment can’t happen if the people with eating disorders who need the help aren’t identified or supported in seeking that help.

Why do so many people with eating disorders go undetected?

There are many reasons why red flags and warning signs of an eating disorder (ED) might be overlooked.  A major factor being that our current culture normalizes dangerous weight-loss behaviors and promotes body dissatisfaction across the board. As a result, it can be hard to detect clinically significant behaviors in anyone when “everyone” seems to be caught up in a toxic diet culture. But there are other reasons that continue to have repercussions specifically for people in minority groups.

Researchers believe that only 1/3 of the people that meet criteria for an eating disorder ever actually receive treatment.1 

Most of what we know to be true about EDs (or any illness) is based on the existing  research on that topic. Much of the early research about eating disorders was done within populations of people who had already been diagnosed and had accessed treatment. Historically, the majority of people who sought and received eating disorder treatment were wealthy and white.2  Most were also relatively young and female. More and more research was done within this mostly homogeneous treatment-seeking population, and it reinforced misperceptions about who is impacted by eating disorders.

More recently, researchers are doing a better job of capturing representative samples, and advocates worldwide are doing tremendous amounts of work to educate communities   about diversity in eating disorders. Research on the prevalence of eating disorders in diverse communities has revealed a reality in stark contrast to the old stereotypes. For example:

  • Prevalence rates of bulimia nervosa, anorexia nervosa, and binge eating disorder are equal across ethnicities and socioeconomic levels 2,3
  • Prevalence of bulimia nervosa is significantly higher in Latinos and African Americans in comparison to non-Latino whites and Asians.2
  • Girls from a low-socioeconomic status (SES) household displayed a 32% increase in bulimic symptoms compared to girls in middle class households, and a 40% increase relative to girls in high income households.1

It’s clear that people from a variety of backgrounds and across racial and ethnic categories are impacted by serious eating disorders. And yet, we also know that equal and consistent access to treatment remains a problem for marginalized communities. Consider the following:

  • White, Non-Latino, high-SES girls are almost twice as likely to be diagnosed with an ED.1
  • Even though African American girls are more likely to exhibit bulimic behavior, only 0.7% of African American, low SES girls have been formerly diagnosed with an ED.1
  • College students of color are less likely to be diagnosed with an ED compared to white students.3
  • Lower SES students are less likely to receive treatment than students from more affluent backgrounds.3

These findings indicate that the popular perceptions of who is affected by EDs, specifically bulimia nervosa, are only accurate in terms of who is identified and diagnosed, not who is actually impacted. It also tells us that health and mental health providers are not immune from the stereotypes and may be less likely to recognize symptoms or warning signs in their minority patients. As a result, they may then be less likely to provide resources and make appropriate referrals.

Updated research, more thorough training for medical and mental health professionals and diverse outreach is needed across the board so that early intervention can be provided for all who are suffering from these life-threatening illnesses.

What can be done? 

You can help by getting involved in advocacy efforts to advance research and clinical practices for all people impacted by eating disorders. The National Eating Disorders Association (NEDA) and Eating Disorder Coalition (EDC) are two great places to start. If you work in education or health-focused organizations, you can take action to ensure that you and your colleagues receive regular training to enhance cultural competence within your field.

Individually, we should all evaluate whether we perpetuate myths about eating disorders by only sharing images or reading stories told through the lens of young, thin white women. Going forward, be sure to amplify the voices of people of color, men with eating disorders, LGBTQ communities and people in higher weight bodies who have historically not been included in eating disorder narratives. Even just boosting diverse posts and articles on social media can go a long way in helping to change the public perception of EDs and make it a little easier for those who need treatment to receive it, or at least recognize themselves in the coversation.

Tweeting about eating disorders, recovery, body acceptance or non-diet news? Check out: @MelissaDToler / @NalgonaPride / @FoodPsychPod ‏/ @dumplingskin ‏ / @thirdwheelED ‏ / @ASDAH ‏ / @DianneBondyYoga / @StigmaConf ‏ / @jameelajamil ‏ / @RadicalBodyLove / @NEDAstaff / @TFFED

If you think that you (or someone you know) may be struggling with an ED ask for help today. The sooner you connect to resources the sooner you can begin to feel better.  The Center for Eating Disorders is committed to being a safe, welcoming organization for people of all ages, races, ethnicities and genders. Call 410-938-5252 today.


Contributions by:
Avery Madison, Former CED Research Assistant
Avery graduated from Franklin & Marshall College where she earned her Bachelors of Arts in psychology with a minor in Spanish.  In addition to her RA role at The Center, she worked at a counseling center in Lancaster, PA providing one-on-one support for children and adolescents with emotional and behavioral difficulties.  Previously, she has worked as a medical advocate for the YWCA where she provided support to victims/survivors of sexual trauma.  Her past school research projects include examining the relationship between facial mimicry and empathy and between cell phone access and anxiety.


References:

  1. Ham, J., Iorio, D., & Sovinsky, M. (2012). Race, social class, and bulimia nervosa.Human Capital and Economic Opportunity Working Group Working Papers16.
  2. Marques, L., Alegria, M., Becker, A. E., Chen, C. N., Fang, A., Chosak, A., & Diniz, J. B. (2011). Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: Implications for reducing ethnic disparities in health care access for eating disorders. International Journal of Eating Disorders44(5), 412-420.
  3. Sonneville, K. R., & Lipson, S. K. (2018). Disparities in eating disorder diagnosis and treatment according to weight status, race/ethnicity, socioeconomic background, and sex among college students. International Journal of Eating Disorders.

“Like a tree, my body is truly incredible.” – One Student’s Experience with the Love Your Tree Campaign

Love Your Tree (LYT) is a creative arts campaign designed to help students develop positive body image, improved self-esteem and enhanced media literacy skills, all of which can serve as protective factors against the development of eating disorders. Inspired by the work of author and playwright, Eve Ensler, this campaign empowers students of all ages to use art and creativity to challenge harmful appearance ideals and narrow definitions of beauty.

With the 13th annual campaign now behind us, we sat down with Kate Helminiak, a sophomore at Notre Dame Prepatory School to talk about her involvement in LYT and the inspiring poster she created. Her artwork was selected by a panel of health and mental health professionals to be the official poster of the 2019 campaign.

While the Notre Dame Prepatory School art department and school community has been participating in the LYT Campaign for the past 13 years, this was Kate’s first year taking part. Her initial interest began after she attended in a LYT workshop at her school presented by Brianna Garrold, art therapist and LYT facilitator. Kate said that an image of a friend who had struggled with an eating disorder was in her mind during the workshop. After the class viewed examples of LYT student artwork, she remembered her friend’s struggles and how she had worked hard to recover. Kate said this memory, “inspired me to do more” and so, she set out to design a poster based on her friend’s “mindset while she was going through her eating disorder and how she got through it.

The poster Kate ultimately submitted to the campaign depicted the beauty of what the body and mind can do while incorporating the LYT metaphor of the body as a tree. In the poster, which she made using colored pencils, a young girl is sitting down with legs crossed and her hair growing upward and outward like branches towards the sky. She has a reflective quality about her, almost as though she is meditating with the faintest of smiles that seems to convey peace with oneself. During our interview, Kate described the branches as that of a willow tree. To her, the willow tree itself represents how vast and complex our minds can be. In further describing her poster she explained that “none of the branches are the same,” and that “the vines that come down help to shelter our minds.

Everyone who participates in the LYT campaign is encouraged to submit an artist statement with their work. Kate, chose the phrase Like a tree, my body is truly incredible. When asked why she chose this phrase, she stated that the word incredible was a step up from other words she thought about to describe what our bodies can do each day. She wanted to emphasize how amazing and complex a body can be. Kate also explained how the LYT campaign helped her see how negative body image can affect so many students her age. She says, “It opened my eyes to see how long and far eating disorders and mental disorders stretch and how many people are impacted.” She also highlighted how fortunate she and her classmates were to have the opportunity to talk openly about mental health and how helpful it can be to use art to communicate about complex topics like body image.

At the end of each year’s LYT campaign, a special reception is held where students, teachers and families get to see all of the students’ artwork on display. The community exhibit celebrates the diversity of beauty and empowers viewers to embrace and appreciate all bodies while rejecting damaging media messages. When asked about the exhibit Kate stated that her favorite part was seeing and talking to the different students who participated. She said she loved seeing the connection between each student and their art. “It was really interesting to see which student did which poster and how their poster connected to the message they wrote.” This was a common sentiment from the crowd of over 200 who also attended that day.

As our discussion came to a close, Kate expressed gratitude that her poster was selected among more than 300 posters to receive the top award in 2019. She hopes to have more opportunities to advocate for positive body image among her fellow teens in the years ahead.

To learn more about the Love Your Tree campaign and how your school can participate in the 2019-2020 campaign, visit loveyourtree.org or email bgarrold@sheppardpratt.org for more information.


Written by Julie Seechuk, BSW
Social Work & Community Outreach Intern
Julie is currently pursuing her Masters in Social Work at Salisbury University online with an intent to graduate May of 2020.  Julie received her Bachelor’s Degree from Salisbury University in 2015 with a double major in Psychology and Social Work. In addition to pursuing her Masters and interning at The Center for Eating Disorders, Julie also works part-time as a Community Relations Coordinator for a Pediatric Oncology Nonprofit called The Cool Kids Campaign located in Towson, Maryland. During the 2018-2019 school year Julie assisted with resource development, event coordination, social media and website maintenance, community outreach to schools, and The Center’s free weekly support group.

 

Is your school or classroom a body-positive space for students?


It is widely accepted, from preschool to high school, that teachers and school staff play a big part in helping students to develop positive self-esteem. Many of those same teachers may not be aware that one of the most significant factors in an individual’s overall self-esteem is body image. So why does the way we see/think/feel about our bodies matter so much and what does that have to do with our classrooms? Consider the following:

  • 31% of adolescents do not engage in classroom debate for fear of drawing attention to how they look.1
  • 20% of teens say they stay away from class on days when they lack confidence about their appearance.1
  • On days when they feel bad about their looks, 20% of 15 to 17 year old girls will not give an opinion and 16% will avoid school altogether.2
  • A study of more than 11,000 teens found that students who saw themselves as overweight (regardless of actual weight) had lower academic performance than those who did not. This is important because it means the perception of being overweight – likely because of cultural bias and negative stereotypes that come with that – was a more significant determinant of academic performance than medically defined obesity.

If the way kids feel about their bodies impacts attendance, classroom engagement, academic performance and individual self-esteem, it makes a lot of sense for schools to be paying attention to body image.  Below are just a few ways you can work to establish a school environment that is body positive and doesn’t reinforce harmful weight stigma, appearance ideals or the diet mentality.


6 Guidelines for a Body Positive Classroom


Representation matters. 

Do a thorough scan of books, posters and other materials around your classroom. Do they include a wide representation of people with diverse bodies – both in weight and shape but also skin color, gender presentation and physical ability? Will all kids see themselves represented in the positive imagery around your classroom?

If your class involves physical fitness or health messaging, consider whether your resources show kids and adults of all shapes and sizes being active or just thin/muscular people? Are fatter bodies exclusively used in imagery meant to deter or shame people for specific behaviors? If you’re in need of new imagery, check out these inclusive stock fitness photos from The Body Positive Fitness Alliance.

Above all, remember that kids who feel good about their bodies, regardless of their weight, are more likely to engage in healthy behaviors and less likely to engage in risky or harmful behaviors like smoking and bingeing.4 To help bring body positivity into your class, add books and resources to your lesson plan or syllabus that promote body acceptance and provoke age appropriate conversations about the natural diversity of bodies. Messaging that focuses on 1) how health behaviors can make us feel, or 2) developing gratitude for the functionality of our bodies as opposed to what they weigh or look like, can promote self-care and confidence. A list of age-specific body positive resources is included at the end of this post – please scroll down to check it out!


Leave all personal diet-talk at the door and enforce that rule with fellow teachers and school staff.

We know that kids are listening to the adults around them even when we don’t think they are. Casual background discussions about cutting out carbs, trying a new “cleanse” or berating oneself for eating a cupcake are not as innocent as you might think. When little ears – or even mature high school ears – overhear their favorite teacher or respected mentor talking about food and bodies in critical or shameful ways they can internalize those messages. There are many reasons why we encourage adults not to introduce kids to dieting, including the fact that kids who diet are up to 18 times more likely to develop an eating disorder.5

Furthermore, there is no long-term evidence that any fad diets like keto, paleo, Whole30, Atkins or otherwise lead to reliable or sustainable weight loss. In fact, diets have been associated with longterm weight gain. Specifically, adolescent girls who diet are at 324% greater risk for obesity than those who do not.6


Normalize the variety of healthy body changes that take place before and during puberty. 

For example, it’s completely normal (and necessary) for a young girls’ body to store up extra fat before she gets her period for the first time. It’s also common for boys and girls to gain weight and fill out just prior to growth spurts in height. Remember this happens at very different times for different kids. If they experience these normal changes as abnormal or bad, it puts them at risk for body dissatisfaction and disordered eating. But If kids (and teachers and parents) can learn to anticipate these changes they may be more likely to trust their bodies as they grow and mature.


Incorporate MEDIA LITERACY into your curriculum.

It doesn’t matter if you teach preschool story time or AP Literature, there are countless opportunities to talk about how to handle cultural messages kids receive about beauty, appearance, health, and weight. The Center for Eating Disorders provides body image and media literacy workshops for educators and parents as well as arts-based campaigns like the Love Your Tree campaign. We also encourage school staff to pursue training in evidence-based prevention programs such as The Body Project and to work with local organizations to incorporate student activism projects that challenge the thin ideal and inspire brands to do better.

 

Weight-based bullying is more common than all other forms of teasing. Establish a policy against weight-based bullying and actively work to reduce body commentary in general.

What’s the difference between a teacher proclaiming “you look amazing! Have you lost weight?” and a student teasing her classmate for “packing on the pounds” over the summer? Not much actually. They both reinforce a negative bias towards larger bodies and establish an unnecessary focus on appearance/size. In our culture it is assumed that saying something one thinks is “nice” about someone’s body is a good thing but praising specific aspects of one’s appearance can be just as detrimental for the school community as a whole because it reinforces the dangerous appearance ideals. Consider the following scenarios:

Malik gets nicknamed “string bean” by the principal because he had a growth spurt and grew much taller and slimmer than his peers. Malik was already feeling self-conscious about his height and knows the principal was just kidding around but now he does everything he can to avoid seeing him in the hallways.

Dean came back to school a size smaller and friends are requesting her “weight loss secrets”. They don’t know she was in treatment for an eating disorder over the summer and has developed heart problems and other health complications as a result.

So what is a school or classroom policy that addresses all of the situations above? Something similar to “We just don’t comment on other peoples bodies” can be the most effective message to dissuade body-talk (praising or teasing) among students and staff.


Encourage colleagues – administrators, school nurses, coaches and physical education teachers – to review the evidence for any interventions they are implementing with regard to weight, health or nutrition. 

Every school should be asking whether there is quality, health-focused research to back up the intervention and does this program have the potential to do more harm than good? The truth is, many of these practices lack research and may have harmful consequences, yet many schools and childcare centers continue to implement them. Examples of such campaigns and curriculums currently include:

  • Publicly weighing kids in gym or health class
  • Giving kids assignments that require them to count calories and track their food
  • Hosting “Biggest Loser” weight-loss competitions among school staff
  • Sending home BMI report cards for students or calculating BMI in class.
  • Shaming kids’ lunch items or teaching very young kids to label food items as good/bad or healthy/junk.

When it comes to BMI report cards, even the Centers for Disease Control (CDC) notes in their report that “Little is known about the outcomes of BMI measurement programs, including effects on weight-related knowledge, attitudes, and behaviors of youth and their families. As a result, no consensus exists on the utility of BMI screening programs for young people.7

There is no indication that providing kids and parents with BMI information leads to any significant behavior change or improved health outcomes. Furthermore, unless safeguards are solidly in place, a risk of harm exists when children are simply told there is something wrong with their body size. Risks for body comparison and weight-based teasing also increase.8

What else are you doing to reduce weight-based teasing and make your classroom a safe place for students of all shapes and sizes? Tweet us @CEDSheppPratt today and share your experiences. 

 


Body Positive Resources:

For School Administrators:

Preschool/Elementary Kids & Parents:

Middle School:

High School/College:


Links to References:

  1. Ignoring it doesn’t make it stop.
  2. Beyond stereotypes: rebuilding the foundations of beauty beliefs.
  3. Perception of Overweight is Associated with Poor Academic Performance in US Adolescents
  4. Does Body Satisfaction Matter? Five-year Longitudinal Associations between Body Satisfaction and Health Behaviors in Adolescent Females and Males
  5. Onset of adolescent eating disorders: population based cohort study over 3 years
  6. Risk Factors for Body Dissatisfaction in Adolescent Girls: A Longitudinal Investigation
  7. A Report on the Facts and Concerns About BMI Screening in Schools

NEDA Congressional Briefing on Eating Disorders

CED Co-Director, Dr. Steven Crawford, among panelists to speak on Capitol Hill

The National Eating Disorders Association (NEDA) in conjunction with the Congressional Mental Health Caucus hosted a Congressional Briefing on Capitol Hill on October 2, 2018. This briefing was held to educate representatives and legislative aides about eating disorders in overlooked populations. Panelists at the briefing included Chevese Turner (moderator), Mike Marjama, Claire Mysko, Janell Mensinger, PhD, and Steven Crawford, M.D.

Dr.Crawford, co-director at The Center fo Eating Disorders at Sheppard Pratt, began by discussing the different eating disorders and the risks and causes associated with them. He explained the differences in each disorder and the ways someone can help if they notice symptoms of an eating disorder in someone they care about. These include, seeking more information on the subject, locating resources, not focusing on weight, and encouraging the person to seek specialized treatment.

Dr. Janell Mensinger, an Associate Research Professor at Dornsife School of Public Health at Drexel University, presented on eating disorders and population weight. Her presentation focused on people in higher weight bodies and she explained how weight-related harassment is over four times more common than bullying. She stressed that we, as a society, need to shift focus from weight to health and provided research that shows eating disorders and extreme dieting are increasing among people in higher weight bodies.

The next panelist Claire Mysko, CEO of NEDA, spoke about a prevention program called the Body Project. The Body Project is a group-based intervention that helps decrease eating disorder symptoms and body dissatisfaction in high school girls. There are currently 388 trained facilitators for this program across the United States. Mysko also mentioned how NEDA is working on a similar program for young men.

The final panelist was former Seattle Mariners Catcher Mike Marjama who now serves as a NEDA Ambassador. Marjama presented his personal struggle with body dissatisfaction and an intense desire to change his body, which led to extreme behaviors around food and exercise, an eating disorder diagnosis and eventually hospitalization. His treatment and recovery however, led him to a baseball career and renewed appreciation for mindfulness and balance. After retiring he decided to speak openly about his disorder and his story has since been featured on Good Morning America. As an Ambassador for NEDA his goal is to help boys and men see through outdated stereotypes about eating disorders so they can get the help they need.

Eating disorders are one of the most dangerous mental health issues and should not be taken lightly. Unfortunately, they are too often overlooked in people with higher weight bodies, in athletes of all calibers and in traditionally marginalized populations. Our hope is that the information shared in the Oct 2nd hearing will assist legislators in creating policies that not only support prevention and treatment for eating disorders but improve overall public health.

Additional Advocacy Resources:

  • Get involved, learn about state-specific legislative actions and become a NEDA advocate.
  • Read summaries of current legislative actions, read about current initiatives and get involved with advocacy days on Capitol Hill with the Eating Disorder Coalition.
  • You can find out more about The Center for Eating Disorders’ recent advocacy work here.

Written by: Julie Seechuk, Social Work Intern 

NEDA Walk: There are many ways to make a difference


Despite their increasing prevalence, eating disorders receive significantly less funding than other major mental illnesses, and a lot of misinformation still exists about who is impacted and just how serious eating disorders can be. As treatment providers we know that for every person who walks through our doors and receives treatment, many others never get the help they need. We are participating in a NEDA Walk this year to try to help change that. As NEDA shares on their website, there are 30 million great reasons to participate in a walk. If you’re wondering why you should walk, consider the following.

To help raise awareness & restore hope…
Eating disorders are widely misunderstood illnesses, and old stereotypes and myths often prevent people from seeking help. Help fight stigma and shine a light on eating disorders as a serious public health issue.

To help save lives…
Eating disorders are associated with many different short-term and long-term health consequences, some of which are very serious and others that can be fatal. By participating in the NEDA Walk, you’ll be raising funds that support life-saving programs, advocacy efforts, and research initiatives.

To feel less alone…
Eating disorders can be extremely isolating illnesses. When you’re struggling or supporting a loved one with an eating disorder, it’s easy to feel like you’re the only one in the world who is going through it but we promise, you’re not. Participating in a NEDA Walk is a great way to come together as a recovery-focused group and engage as a community in positive change.

While there are countless reasons to participate in a Walk, it’s also extremely important to consider that there may be reasons not to walk too. Given that eating disorders often involve energy deficits and an unhealthy relationship with exercise, it’s important to remind potential walkers that your safety and recovery always need to come first.

Typical NEDA walks are 1- 2 miles in distance but for someone with an eating disorder, significant movement or walking – even a short distance – could be unsafe or contrary to treatment goals. Definitely check in with your treatment providers prior to participation if you’re having any of these symptoms:

  • recent fatigue, weakness or dizziness
  • episodes of fainting, falling or near falls (tripping) in past month
  • muscle cramps, numbness or paresthesia’s (limb falling asleep) in your extremities
  • recent dehydration and electrolyte abnormalities
  • inability to complete a meal without acting on symptoms the morning of the walk

Furthermore, even if you haven’t had the physical symptoms listed above, ask yourself the following questions:

  • Is your motivation to attend the walk driven primarily by a desire to engage in exercise?
  • Have your thoughts about the walk included calculations of distances, steps, calories, etc.?
  • Do your current treatment goals include taking a break from exercise or restrictions on movement?

If the answer to any of those questions is yes, be sure to set parameters with your treatment team around the best and safest way for you to participate. For example, it is important to remember that you can attend a NEDA Walk without doing the walk portion of the event! Bring a lawn chair, listen to the keynote speakers, and cheer on your team. You can also bring a buddy who can help you stay focused on the important aspects of the walk and who can help ensure you’re well-fueled before the event, symptom-free during the event and full of hope throughout the day.

Lastly, it’s 100% OKAY if you can’t attend a walk right now because you’re taking care of yourself. Sometimes self-care means saying no to some things so you can say yes to treatment or recovery. You can always participate by sharing about the cause online – or – use the event day as a catalyst for your own recovery. Locate a local support group, read a book about recovery, or make that call to a therapist you’ve been putting off.

However you choose to participate, remember that you are worth it and you are not alone.

………………

The Center for Eating Disorders at Sheppard Pratt will be joining NEDA and a host of other eating disorder and body image organizations for the Baltimore NEDA Walk on September 30 at Goucher College. Find out more here.

Hidden Risks for the LGBTQ+ Community, and How You Can Help

 


Every June, Pride month provides an opportunity to share awareness, knowledge and recognition of important issues facing the LGBTQ+ community. It’s a time to celebrate progress while recommitting to challenges that lie ahead. One such challenge among the LGBTQ+ community too often stays hidden: eating disorders.

While eating disorders may happen to anyone, current research suggests that those in the LGBTQ+ community may be at higher risk,1  beginning as early as age twelve.2  In a study of over 35,000 students, gay males were 28 percent more likely to report poor body image, 25 percent more likey to engage in binge eating, and 9 percent more likely to diet frequently compared to heterosexual males.3  What’s important to highlight is how outside influences can act as a trigger for these unhealthy and dangerous behaviors in marginalized populations. For example, daily discrimination among lesbians is associated with increased binge eating.

Let’s take a closer look at stressors that may be unique to the LGBTQ+ community, including those listed by NEDA (The National Eating Disorders Association)and others identified by our patients and therapists.


Unique Stressors Faced by LGBT+ Individuals

  • Fear of rejection after coming out to one’s friends, family, classmates, co-workers and the public
  • Bullying, violence or threats at school, work or online, in some cases resulting in Post Traumatic Stress Disorder (PTSD)
  • Discrimination based on gender identity or sexual orientation
  • Hardship or stress related to identification with a gender that is different than the one assigned at birth
  • Internalized stigma where one begins to believe, internalize and/or act upon negative messages about oneself
  • Homelessness or unsafe homes occur among the LGBTQ+ population, with 42 percent of homeless youth identifying as such6
  • Unrealistic Body ideals within LGBTQ+ peers/community
  • Double minority status wherein one person experiences oppression as a member of more than one minority group (i.e. related to orientation, gender, religion, race or otherwise).


The Transgender Community

Specifically among transgender youth, a 2017 study reported that as many as one in four youths report engaging in at least one disordered eating behavior, with 35 to 45 percent engaging in binge eating or fasting. Experiences of discrimination, harassment, and violence – or enacted stigma – were often linked to greater levels of eating disorder behaviors among trans youth.7

This same study also indicated that there are some protective factors that help buffer enacted stigma from influencing eating habits in trans youth. Social support from family, friends and peers was associated with a lower percentage of trans youth engaging in binge eating. In other words, when family and school connectedness are present in the youth’s life the likelihood of binge eating decreases. In particular, the presence of family support drove the lowest probability of disordered eating.


Showing Support to the LGBTQ+ Community – 8 Ways to Help

Everyone can do their part to help lower risk factors associated with eating disorders in the LGBTQ+ community. The common thread is championing less violence and discrimination and more support and acceptance. Here are eight way you can help:

  1. Know the signs and symptoms of disordered eating and be able to recognize them in a friend, family or peer. Watch this video for an example of how everyday conversations can be a chance to check in and offer support.
  2. Be a listening ear to your LGBTQ+ friends, family and peers and be someone who they can talk to when they are upset or distressed
  3. Respect identity by using preferred gender pronouns (i.e., he/she/they), name, and other terms – when in doubt, use neutral words (i.e., they, partner) or ask about preference
  4. Ask early and specifically about the presence of eating disorder symptoms if you are a health or mental health provider working with LGBTQ+ youth. Early intervention  leads to more positive recovery outcomes but many people don’t disclose disordered eating behaviors unless explicitly asked about them.
  5. Start an LGBTQ+ club at your school or workplace to demonstrate your support and to help spread awareness
  6. Volunteer for LGBTQ+ hotlines, such as the GLBT National Help Center or The Trevor Project
  7. Educate yourself on the relationship between stigma, discrimination and eating disorders and help spread the word about common myths and facts
  8. Remember the power of family connectedness as a protective factor. Create a welcoming home for your family members of all genders and orientations.

If you are a member of the LGBTQ+ community and you think that you may have disordered eating, or just want a judgement-free space to talk, call any of the following hotlines or visit https://www.eatingdisorder.org/letscheckin to take a free online self-assessment and get connected with treatment.


LGBTQ+ and Related Hotline Numbers

  • National Eating Disorder Hotline 1-800-931-2237
  • LGBT National Youth Talkline 1-800-246-PRIDE (7743)
  • LGBT National Hotline 1-888-843-4564
  • Sage LGBT Elder Hotline 1-888-234-SAGE (7243)
  • The Trevor Project (24/7) 1-866-488-7386
  • TrevorText (M-F 3pm-10pm) Text “Tevor” to 1-202-304-1200
  • The National Runaway Safeline 1-800-RUNAWAY (800-786-2929)
  • The True Colors Fund (homelessness) 1-212-461-4401

For more information about eating disorders and treatment options in Baltimore, visit eatingdisorder.org or call (410) 938-5252 for a free phone assessment.


Blog contributions by Catherine Pappano, CED Research Assistant 

You may also be interested in reading:

 


References

  1. Watson, R. J., Adjei, J., Saewyc, E., Homma, Y., & Goodenow, C. (2017). Trends and disparities in disordered eating among heterosexual and sexual minority adolescents. International Journal of Eating Disorders, 50(1), 22-31.

  2. NEDA: Eating disorders in LGBTQ+ populations. https://www.nationaleatingdisorders.org/learn/general-information/lgbtq. Accessed June 22, 2018

  3. French, S.A., Story, M., Remafedi, G., Resick, M.D., & Blum, R.W. (1996). Sexual orientation and prevalence of body dissatisfaction and eating disordered behaviors: A populationbased study of adolescents. International Journal of Eating Disorders, 19(2), 119-126.

  4. Mason, T.B., Lewis, R.J., & Heron, K.E. (2017). Daily discrimination and binge eating among lesbians: a pilot study. Psychology & Sexuality, 8(1-2), 96-103.

  5. NEDA: Eating disorders in LGBT (gay/lesbian/bisexual/transgender) populations. https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/LGBTQ.pdfAccessed October 31st, 2017.

  6. NEDA: Eating disorders in LGBT (gay/lesbian/bisexual/transgender) populations. https://www.nationaleatingdisorders.org/sites/default/files/ResourceHandouts/LGBTQ.pdfAccessed October 31st, 2017.

  7. Watson, R. J., Veale, J. F., & Saewyc, E. M. (2017). Disordered eating behaviors among transgender youth: probability profiles from risk and protective factors. International Journal of Eating Disorders, 50,515-522.

Testimony on The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools


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The following written testimony was provided by Steven Crawford, M.D. in advance of the Maryland State Medical Society House of Delegate’s vote on the matter of advocating for the inclusion of eating disorder questions in state and national health monitoring tools. 

Additional information on the position of Dr. Crawford and The Center for Eating Disorders at Sheppard Pratt can be found by reading the following articles: 

Data Collection Critical to Understanding Eating Disorders – Baltimore Sun

30 million people will experience eating disorders — the CDC needs to help – The Hill

More detailed information about resolution 10-18 is linked in the testimony below.

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Testimony of

Steven F. Crawford, M.D., Co-Director
The Center for Eating Disorders at Sheppard Pratt

Before the

MEDCHI, THE MARYLAND STATE MEDICAL SOCIETY HOUSE OF DELEGATES

April 29, 2018

Resolution 10-18 – The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools

My name is Dr. Steven Crawford, and I am pleased to appear today on behalf of The Center for Eating Disorders at Sheppard Pratt.  For nearly 30 years, on a daily basis, I have been involved in clinical care, teaching, and research of life-threatening eating disorders including anorexia nervosa and bulimia. I started my career in at Mercy Center for Eating Disorders, and subsequently I have held leadership positions in psychiatry at St. Joseph Medical Center, and currently, with Dr. Harry Brandt, I co-direct one of the largest hospital based eating disorders programs in the United States at Sheppard Pratt Health System.  I am a member of the Academy For Eating Disorders, a Distinguished Fellow the American Psychiatric Society, and a faculty member of the University of Maryland School of Medicine.

I come before you asking your support of Resolution 10-18 which asks for the “The Inclusion of Questions on Eating Disorders in National and State Youth Risk Assessment Tools.”

In the United States there are an estimated 20 to 25 million people who suffer from anorexia nervosa, bulimia nervosa and related eating disorders.  These illnesses destroy lives and devastate families throughout Maryland.  Anorexia nervosa has the highest death rate and the highest suicide rate of any psychiatric illness.   Further, the eating disorders are unique in that virtually every major organ system in the body can be affected by starvation, poor nutrition, and the dangerous behavioral patterns associated with eating disorders.  Sudden death is not uncommon.

After over two decades of mandatory surveillance of eating disorders signs and symptoms under the CDC’s Youth Risk Behavioral Surveillance System, the Centers for Disease Control (CDC) and state stakeholders voted to remove the mandatory eating disorders surveillance questions in 2015. The questions were removed under the pretense of changing public health priorities.  This, despite growing prevalence of eating disorders, an increasing awareness of their impact and the knowledge that every 62 minutes, someone dies as a direct result of an eating disorder.  Eating disorders should be among the top priorities of CDC because of their high death rate and the evidence that early identification and treatment are essential.

In this resolution, we request support of Med-Chi in advocating to the Maryland Department of Health for the immediate re-instatement of eating disorder questions in any current and future statewide Youth Risk Behavior Surveys (YRBS).  These efforts, if successful, would position Maryland as a national leader in tracking, assessing and mitigating the negative medical, social and financial burdens caused by eating disorders.

Additionally, we are working with the Strategic Training Initiative for the Prevention of Eating Disorders (STRIPED), the National Eating Disorders Association (NEDA), and The Eating Disorders Coalition (EDC) to ensure the eating disorder questions are reinstated on a national level through the CDC surveillance systems.  This resolution additionally asks the MedChi’s American Medical Association (AMA) Delegation ask our AMA to advocate that the CDC reinstate the eating disorder questions into the YRBSS.

It is our hope that the House of Delegates will support this critical initiative by passing resolution 10-18.


UPDATE: On April 29, 2018, the MedChi House of Delegates voted to adopt resolution 10-18.

 

How to Stay Recovery-Focused When Interacting with Triggering Media

In our previous post we discussed a variety of reasons that individuals with eating disorders, especially those in the early stages of recovery, may choose not to watch the Netflix film To The Bone or other films they know could create roadblocks in their continued recovery.

With that said, triggering media has always been around and will always be a part of our society so it’s helpful to know how to navigate it.  Many individuals in long-term recovery or later stages of treatment might feel prepared to watch a film or read a book about eating disorders, despite triggering content. Many of our clinicians have helped to shape such exposure into therapeutic experiences for patients who are ready.  For example, during periods of strong recovery, seeing a film like To The Bone can be an opportunity to reflect on one’s own experience, see things from a new perspective, process lingering eating disorder thoughts or channel anger towards the eating disorder in productive ways.

If you’ve considered all of the options and decide you do want to watch a film about eating disorders, these are a few things to consider that can help you do so in safe and productive ways.

  1. Don’t watch alone. Watch with a support person you can trust and communicate openly with them about how it is impacting you in the moment. You might even consider pausing the show periodically to breathe, reflect and talk.
  2. Time it right. Only watch it when you know you’ll be attending a therapy session or support group within a few days so you can explore your reactions and get help challenging any distorted thoughts or concerns about what you see on screen. If you currently have a lot of other life stressors or you’re in a time of transition (moving, starting school, going through a divorce, etc.) you may want to consider waiting to watch until things settle down.
  3. Challenge the ED thoughts. Consider journaling about aspects of the movie that you find triggering and then refute and challenge the inaccurate, negative or distorted thoughts.
  4. Be an activist. Write a letter to the director of the film or to the editor of a local newspaper regarding what you liked or didn’t like, what was helpful vs. not helpful or what you’d like to see more of when it comes to films about eating disorders. For example, while To The Bone features one person of color and one male in supporting roles, the movie’s star and protagonist is a young, white, upper-middle class woman with anorexia. This doesn’t help to dismantle stereotypes about who is and isn’t impacted by eating disorders. Consider writing a letter that advocates for greater diversity in eating disorder representation or about another aspect of recovery that feels important to you.
  5. Create an escape clause. Allow yourself the option to stop watching at any point throughout the film. Eating disorders can be associated with all-or-nothing thinking so it may feel like once you start the movie you have to finish it, but remember it’s not so black and white. At any point, if you feel triggered or uneasy about what you’re watching, turn it off.
  6. Plan ahead. Decide in advance upon an alternative show to watch or a self-care activity you can do when the film is over (or if you stop watching early) that will help you sustain a more recovery-focused mindset.

Do you use these strategies or have other ideas for navigating triggering media safely?  Tweet them to us @CEDSheppPratt and we’ll add to the list. 


You may also be interested in reading: 
To Watch or Not to Watch: That is the Question, Navigating “To The Bone” and other potentially triggering movies about eating disorders

 

 

 

 

 

To Watch or Not to Watch: That is the Question

Navigating “To the Bone” and other Potentially Triggering or Inflammatory Movies about Eating Disorders

Like most things in life there are benefits and risks that come with exposure to media, especially media that depicts sensitive or potentially life-altering subject matter such as eating disorders, suicide or mental health. As you may have already noticed from the controversial conversations about it, the Netflix movie, To the Bone is no different. The film depicts a young woman, Ellen, in the throes of her eating disorder and follows her through the recovery process which the synopsis points out, includes
help from a “non-traditional doctor” played by Keanu Reeves. It may come as no surprise that the main character, Ellen, is a young, white, very thin, upper middle-class woman, and that the particular eating disorder she is dealing with is anorexia nervosa. Hollywood tends to over-rely on this stereotyped depiction of eating disorders, despite the fact that in reality, eating disorders and the people they impact are much more diverse.

As one of the nation’s longest-running providers of evidence-based treatment for children, adolescents and adults with eating disorders we’ve been asked by numerous patients and families in the previous weeks how to handle such a film.  And while To The Bone may be a new film, this is far from a new question.  Over the last several decades, similar questions have been raised in response to documentaries, blogs, fictional books and memoirs written by individuals recovering from eating disorders.

Decades of observing the impact of this type of media has reinforced our recommendation that individuals who are currently struggling with an eating disorder or those who are in the early stages of treatment and recovery don’t typically benefit from watching movies or reading books that display any of the following characteristics:

  • extremely graphic depictions of people engaged in eating disorder symptoms such as bingeing, purging, chewing/spitting, body checking, over-exercising, self-harming or abusing drugs and alcohol
  • detailed descriptions of ED thoughts and behaviors that are left unchallenged, unexplained or are not paired with sufficient education regarding the consequences
  • conversations that include specific numbers such as weights, clothing sizes, calorie counts or repetitions of exercise.

If you notice any of these characteristics in a movie, show or book, it should be a red flag that it might not be a beneficial resource or recovery-focused activity for someone who is currently struggling.

We always look to support popular media that finds a way to raise awareness and stimulate meaningful discussions about eating disorders in safe and non-triggering ways. With that in mind, we went into our own viewing of this newest movie with high hopes and an open mind. Unfortunately, what we found was that To The Bone ultimately ticks off all three of the red flags mentioned above. Furthermore, the film’s depiction of treatment methods and treatment protocols are far from helpful, safe, or accurate.  As a team of specialized professionals, many of whom have spent their entire careers learning about, researching and utilizing evidence-based treatments for eating disorders, this film was, quite frankly, disappointing and at times difficult for our staff to watch.

On the flip side, it did do a good job of illustrating the immense pain and struggle faced by those who are impacted by these illnesses. It also got people talking about an issue that is usually hushed in society despite the fact that eating disorders impact 20-30 million people.  Our hope would be that some viewers of the film gain insight or information that could help them check in with a friend or loved one who is showing warning signs and needs help.

Taking into account both perspectives and the possibility for all the positive and negative impacts, it’s crucial to think  critically about the media introduced to us as communities, families and individuals.

If you are a therapist, a parent, educator or friend of someone with an eating disorder

It’s really important to empower anyone considering watching a film about eating disorders to feel like they can disengage safely and with your support.  Let them know it’s okay to decide not to watch because it has the potential to be harmful for them and their recovery.  This can be a hard but powerful decision because it builds confidence and sets a precedent for recovery-focused decision-making.  How? Today, it might be saying no to a Netflix film that “everyone else is watching and talking about” but tomorrow it could be saying no to a dangerous cleanse that a favorite celebrity is promoting on social media or saying no to a friend that encourages you to step on her bathroom scale. Learning how to say no to such things, even when the societal pressure and internal urges are strong, is imperative for long-term recovery.

If you have an eating disorder or are in recovery from an eating disorder…

If you’re like a lot of our patients, seeing a trigger warning at the start of a film or hearing in advance that it might be detrimental isn’t always a deterrent and might even make the content more intriguing. We’ve heard from some of our patients that they choose to watch the film despite their own reservations and knowledge of the content.  Most of the reactions included versions of the following:

  • I found myself comparing my body to the actress in the film and thinking that maybe I wasn’t deserving of or didn’t really need treatment since I wasn’t as thin as her.
  • I found myself wishing I could go back to my eating disorder.
  • I was tempted to use “a little bit of my ED behaviors” and was reassuring myself I wouldn’t let it get that bad.
  • If she [the actress Lily Collins] can “lose weight safely” for this role after recovering from an eating disorder in real life than maybe I can too.  

Despite what may be positive intentions for this film, it’s important to be realistic about how it actually plays out for the millions of people with eating disorders who watch it. While not everyone will have reactions like these, we think it’s important for individuals and support people to know it’s a possibility that the person who is struggling with an eating disorder may overlook the negative aspects of the eating disorder on screen and only see the perceived positive or glamorized aspects.

If you are struggling with whether or not to watch this film, or engage with any other eating-disorder focused media, remember that it’s okay to say no. At the very least, we encourage you to discuss your decision with a treatment provider or trusted support person.  If you decide together that watching this type of film might actually be beneficial at certain stages of recovery, check out these guidelines for watching safely.

Some of the most important ways to enhance recovery and prevent relapse include: continuing regular contact with treatment providers, following evidence-based recommendations, engaging in regular self-care and creating a home environment that is conducive to your continued healing and recovery. In this case, that might also include creating a Netflix watchlist that doesn’t have anything to do with eating disorders.

Do you have thoughts on the film or the media surrounding it? Join the discussion on our Facebook page.


Written by Kate Clemmer, LCSW-C, Community Outreach Coordinator, The Center for Eating Disorders at Sheppard Pratt

A Conversation with Bailey Webber, Co-Director of THE STUDENT BODY Film – Part 2

In addition to her debut as a filmmaker with The Student Body, Bailey Webber is an up-and-coming public speaker and has appeared as a guest on several television and radio shows. If you missed Part 1 of our conversation with Bailey, you can find it here and you can meet Bailey, along with her father and Co-Director of the film, Michael Webber, on February 26 at The Center for Eating Disorders at Sheppard Pratt


Q&A with Bailey Webber – Part 2

What have been the most common responses or reactions from people who’ve seen The Student Body? Have they all been positive?

BW: For about a year the film has played at film festivals and special premieres and screenings around the country and my dad and I have been fortunate enough to attend many of them and engage with the audiences. This gives us a great idea of how people are responding to the story and information and I’m so happy to say that the reaction has been incredible!

We have had adults stand up and explain that the story has completely changed their perspective on themselves, their kids, and others.  Students have felt empowered to speak up for the first time and share their own experiences, when before they were too ashamed to say anything.  Teachers, doctors and school nurses have thanked us for making the film, have shared their own emotional stories.  We receive emails and phone calls from people around the country, encouraging us to keep getting the message out.  We even have clinics that want to incorporate the film into their patient programs. 

Just this week we spoke with a clinician who has been battling this issue in her own school district for years, but with no success.  Months ago she arranged to bring the film to her city and worked to encourage the community to join her in seeing it.  The screening was last night and she called us immediately after.  She was so excited and explained that the school officials have finally agreed to stop sending out the letters and will be looking for help to approach the issue in a more productive way!  We were all so excited!  It’s such a game changer and it makes me feel so humbled and overwhelmed to see the film is being used as a tool to help bring about change with these issues. 

Do you have any personal advice or a message of hope for kids and teens who’ve been impacted negatively by bullying, BMI report cards or weight teasing?

BW: The biggest thing to know is that you are not alone and your voice does matter.  I also want them to know that things can change, but only if we are willing to speak up and engage.  Along those lines, there are a few things that I suggest to young people:

  1. Always be respectful. Taking a stand, speaking your mind and challenging authority doesn’t mean you have the right to disrespect another person in the process. Otherwise, you’ve just done something wrong yourself!
  2. Find an adult to learn from and help support you. My friend, Maddie, had a strong, smart, loving mother who was willing to stand behind her when she protested. For me, my dad had my back all along the way as I challenged authority at every corner. This can help give you the courage you need when taking on big challenges and getting outside of your comfort zone.
  3. Know your rights. My dad taught me that 90% of having rights is knowing my rights! Learn from an adult what is possible, what actions you can actually take, and what your rights are. Then bravely exercise those rights! Trust me, it feels great!
  4. Use your powerful voice! It’s surprising to learn that many people might feel the same way you do, but everyone is just waiting for someone else to speak up. Well, maybe you should be that “someone”! Start the conversation with your peers, your teachers, your parents and your school board. You’ll be amazed at the change that can happen when you finally choose to use your voice. I’ve experienced this twice in high school and you see it in the film. It’s amazing, it’s simple, and it can really change things for the better. You can do it, too!

What was it like to embark on a project this big with your dad as your partner? Did the two of you learn anything new about each other in the process?

BW: Working alongside my dad was amazing!   Growing up he always taught my sister and me to tackle big and difficult things, to face our fears, and to overcome any disadvantages that we might have rather than use them as excuses.  For me, making this film was an example of all of these things and having my dad mentor and encourage me through the process was everything.

Father/Daughter Filmmaking Duo, Michael Webber & Bailey Webber

In the beginning, he also explained that this was my project and he will be there to equal my effort, but no more.  In other words, if I don’t put in the time, if I don’t do the research, if I don’t do the work, neither will he.  But if I give it everything I have no matter how difficult the obstacles, then he will give his everything too.  We joke about it now because the film became an obsession for me and I would drag him all over the country and spend the next three years helping me make this film.  He even set aside other films he was working on just to help me see this through!

My dad would also assign books for me to read on filmmaking, journalism, writing – and I would read them all!  He would give me lists of films to watch and study and take notes on, and then he would discuss them with me.  He taught me how to edit, how to write for film, how story works and how to build these big story boards to work from as the production evolved.  It was the greatest filmmaking course ever! We had so much fun together and I hope that comes out in the film, especially with the humor that we brought to it.   So for me, the experience has changed me forever.

Who do you think could benefit from attending the screening of The Student Body here in Baltimore on February 26th? What overarching message do you hope they will take away from the event?

BW: Public screenings like this are great for parents, students, teachers, lawmakers, and anyone in the healthcare field.   All of these groups are represented in the film and will benefit from experiencing the other perspectives in the story.  My hope is that people will come away from the film with a greater understanding of the complexity behind obesity and eating disorders and with a new appreciation for the struggles that people have with their weight and body image.


Many thanks to Bailey Webber for taking the time to share about her experience filming The Student Body.  If you’d like to see the film and have a chance to ask Bailey and her dad, Michael Webber, more about their experience, join us in Baltimore on February 26 for a FREE SCREENING in recognition of National Eating Disorders Awareness Week. Attendance is free but space is limited – RSVP Today!

The Student Body

Read More: A Conversation with Bailey Webber, Co-Director of THE STUDENT BODY – Part 1