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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
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
These are just a few of the typical headlines that can be seen on fitness and “health” magazines geared towards men. While there has been fairly widespread awareness cultivated around the media’s negative impact on women’s body image, not as much attention has been paid to how the media targets men and boys with similar body shaming tactics.
Our culture in general, and the media specifically, often pushes women to lose, lose, lose so they can be smaller, thinner and closer to an elusive definition of “perfect” but the opposite message is often being pushed towards men; most advertising and traditional media suggests the male quest for perfection requires they be bigger, stronger and more muscular. Products previously peddled exclusively towards women – hair removal items, weight loss diets, tanning products, and plastic surgery – are expanding their markets by making men take a harder, longer and much more critical look at their own appearance.
A 2016 review of five national studies found that 20 to 40 percent of men were unhappy with some aspect of their looks, including physical appearance, weight, and muscle size and tone. An earlier study found that college aged men who viewed media images of muscular men showed a significantly greater discrepancy between their own perceived muscularity (what they think they look like) and their ideal body (what they feel they should look like). The researchers suggested their results could show that even brief exposure to such idealized images can increase body dissatisfaction in men.
Despite this ongoing push for men to get bigger and stronger, over the last decade we’ve also seen the juxtaposition of thinner versions of masculinity. You can see it when looking at modern male mannequins with impossibly small waists and very slim – yet sculpted – abdomens and legs. Conflicting body ideals abound. So what is the message after all…get bigger, but stay lean? Be muscular, but still fit in those trendy skinny jeans? It’s mind numbing to try and understand, and even more impossible to attain, yet these are the messages that boys are forced to decipher from a very young age and often continue to wrestle with into adulthood and middle age.
Given all of this, it isn’t that surprising a 2014 study of more than five thousand males aged 12 to 18 years found nearly 18 percent of boys are highly concerned about their weight and physique. Of the boys who were highly concerned with their weight, about half were worried only about gaining more muscle, and approximately a third were concerned with both thinness and muscularity simultaneously.
It’s important to note that, as is also the case with females, photoshopped advertisements and a general lack of diversity in the media’s representation of bodies does not in and of itself cause eating disorders. Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating disorder are complex illnesses with genetic and biologic underpinnings. However, environmental triggers such as narrow or unrealistic body ideals in the media can contribute to increased levels of body dissatisfaction which has been identified as a risk factor for eating disorders.
Dealing with unhealthy media messages is something that almost every man will have to deal with. As is also the case with girls and women, the dangers lie in the drastic steps some boys and men may take to try to manage increasing body image anxiety. Guys who are more dissatisfied with their bodies may be more likely to engage in risky weight loss, bulking or sculpting behaviors such as extremely restrictive diets, cleanses, steroids, supplements or excessive exercise. These are unhealthy and potentially dangerous behaviors for anyone. However, in boys and men who are genetically at risk for eating disorders, these types of behaviors can set the stage for an eating disorder, triggering changes in the brain, disrupting metabolic functioning, dysregulating hunger/fullness cues and often worsening body image, mood and anxiety symptoms. Boys and men who have a history of trauma, are involved in sports or careers that promote weight loss and perfection, and those with close family members with a history of an eating disorder are also at higher risk for developing one themselves.
Eating disorders have long been miscategorized as purely a women’s issue, even by some healthcare professionals. As a result it’s quite common for major warning signs like excessive exercise or drastic changes to diet to be overlooked or even congratulated in men. Stigma and stereotypes in the eating disorders combine to make it difficult for men who are stuck in the cycle of disordered eating to break out of it and get help. It is suggested that 25-40% of people with eating disorders are men, yet they only make up about 10% of people seeking treatment.
Talking openly about eating disorders can help minimize shame and embarrassment for males struggling with these issues. At The Center for Eating Disorders at Sheppard Pratt, we’ve been treating men with eating disorders for more than twenty-five years and we’re encouraged by the changes we hear in the conversations more recently. More men have been speaking out locally and using national platforms to raise awareness. In just the last year, Zayn Malik of the band One Direction discussed his struggle with an eating disorder and anxiety, performer/songwriter Matthew Koma wrote a poignant blog about his recovery from anorexia, and Joey Julius, a football player at Penn State, made a series of public statements regarding his decision to seek treatment for binge eating disorder. Their messages all point to a resounding hopefulness stemming from the reality that treatment is available and men can heal from their eating disorders and body dissatisfaction.
So what can you do to help the men in your life?
Start by checking in with them. The Let’s Check In campaign is all about empowering individuals, families and communities to talk openly about eating disorders and to strengthen support for individuals of all genders who might feel alone. When it comes to eating disorders, early identification and prompt help-seeking can make a big difference. You can play a role in supporting prevention and recovery from eating disorders simply by educating and preparing yourself.
Know the risk factors and pay attention to any sudden shifts in diet, exercise routine or increased negative comments about themselves or their body. If you’re unsure, the confidential online assessment is a quick tool that can help you gauge whether someone you love might be at risk. Second, if you are seeing increasing warning signs plan to check in with your friend or loved about your concerns and provide them with compassion and resources. A fact sheet, conversation guide and additional resources are available at www.letscheckin.com/.
Regis Aguglia, LCSW-C,
Family Therapist at The Center for Eating Disorders at Sheppard Pratt
Regis Aguglia earned his Masters in Social Work from the University of Maryland in 2010. Prior to joining The Center for Eating Disorders in 2014, Regis provided individual, family and group therapy in outpatient and school-based settings and gained experience treating individuals struggling with substance abuse. As a Family Therapist in The Center’s inpatient and partial hospital programs, Regis works with families to understand the impact of an eating disorder on the family system and helps to strengthen communication, coping skills, nutritional stability and recovery-focused support. Regis also facilitates a number of inpatient therapy groups including dual diagnosis groups for patients with co-occurring substance abuse and a specialty group for boys and men with eating disorders.
At some point during treatment for an eating disorder, most individuals will meet with a Registered Dietitian. One of the many important things you’ll do during those sessions is identify and discuss your personal list of fear foods. This is an important step that allows the dietitian to individualize treatment, help you plan for and overcome obstacles, and work alongside the rest of the treatment team to empower you in your recovery.
What are fear foods?
A fear food, or challenge food, is a term for foods that one finds difficult to incorporate into everyday eating. This term is used for foods that feel scary to eat, often because of negative thoughts or feelings related to the food’s nutrient content. Fear foods can be items or categories of food that one perceives to be “bad” and which, when consumed, might trigger feelings of intense guilt or shame. As a result, people with eating disorders often completely avoid or restrict their fear foods. Sometimes, just being around a particular food or being faced with the possibility of eating it can result in increased anxiety.
For people with anorexia, bulimia or binge eating disorder, these fears and the perception of certain foods as “bad” are often related to anxiety about anticipated weight gain and/or an inability to stop eating the food once they begin. In other words, there tends to be a strong belief that eating a fear food will instantly make you fat or that eating a certain food will make you lose control and overeat.
A person’s list of fear foods might be specific, like ice cream or peanut butter. For others, their fear foods might encompass a whole category like all desserts or fried foods. Someone else’s fear food list might include an entire nutrient group such as carbohydrates. Common fear foods are also items considered by many to be tasty, but may also be labeled as “junk food” in our current culture.
Where do fear foods come from?
Fear foods develop from personal values, attitudes, feelings and even memories associated with a certain food. Messages from the people close to you – family, friends, coaches, teachers, healthcare providers – all play a significant role in determining your thoughts about food and can ultimately influence your (dis)comfort with particular food items.
Fear foods may also stem from a variety of impersonal sources including trending cultural ideas about food, media messages, advertisements or even nutrition information intended to be educational and beneficial. For example, there are multitudes of articles and news stories that include lists of supposedly good vs. bad foods, or foods that are better/worse for health.
Another frequent source of fear or shame related to food is dieting. Given that most diets limit or cut out certain foods, dieters start to believe that the eliminated food is bad. The more diets a person goes on, the more fear foods they are likely to have.
What are some consequences of avoiding fear foods?
- Limited variety and lack of enjoyment in meals
- Social isolation
- Obsessive thoughts about the feared food
- Worsening anxiety
- Increased eating disorder symptoms and heightened risk of relapse
- Prolonged negative relationship with food
People without eating disorders may have fear foods too but the consequences for those with eating disorders are much steeper since we know that limiting variety and continuing to avoid specific foods during recovery raises one’s chances for relapse. Two of our CED dietitians recently wrote in more detail about this topic for our friends at Eating Disorder Hope in a post entitled, The Importance of Incorporating Fear Foods and Challenge Foods in Recovery.
Remember, no single food has the power to make you thin or fat. And, ironically, the avoidance of a food is typically what leads a person to overeat it.
If you think you might need assistance reintegrating fear foods or overcoming negative thoughts about food and eating in general, please call The Center for Eating Disorders at (410) 938-5252 for a free phone consultation.
In individuals with different eating disorder diagnoses, or those with co-occurring disorders, fear foods might manifest differently. For example, in individuals with ARFID, anxiety may be related to a fear of choking or to a perceived health consequence of eating the food item. In individuals with PTSD, fear foods may stem from associations with the traumatic experience. In both cases, treatment methods may differ, and the treatment team should take into account the origin and underpinnings of each fear food when providing education and support.
Hannah Huguenin, MS, RD, LDN
Samantha Lewandowski, MS, RD, LDN
Kate Clemmer, LCSW-C
Skin cancer is among the most common forms of cancer in the United States. In fact, over the past three decades, there have been more cases of skin cancer than all other forms of cancers combined.1 Furthermore, a 2014 study published in the Journal of the American Medical Association-Dermatology estimated that more than 400,000 cases of skin cancer each year in the United States may be the result of indoor tanning, with approximately 6,000 of these cases being melanoma, the most deadly form of skin cancer.2
Most people are aware of these risks. Warnings of cancer and other related health problems are broadcast widely, and reminders to slather on sunscreen can be heard from all corners of our pools and beaches. At the same time though, the pressure to acquire the media’s ideal body is strong, and this culturally defined ideal frequently includes obtaining a “luxurious summer glow” or becoming a “bronzed beauty”. For some, the perceived benefits of tanning via sun exposure, or tanning bed, seemingly outweigh those severe health risks and they continue tanning despite the danger. In research on UV exposure, some excessive tanning behavior has even been described as an addiction. Many other people, including 1 in 10 adolescents, opt for what is promoted as the safer option – sunless tanning.
Sunless tanning products (creams, foams, sprays, stains, etc.) are heavily promoted as a viable option for someone looking to achieve a summer glow without assuming the health risks of tanning beds or sun exposure. But is it completely without risk? If we know UV exposure is unhealthy, then why are we spending time and money trying to fake it? It’s a million dollar question with a million dollar answer, or more accurately, a $763 million answer; that’s how much the fast-growing sunless tanning industry was worth in 2014.
Like the bikini body, the elusive summer glow represents an unfair and unrealistic expectation that can contribute to an individuals’ experience of body dissatisfaction. Additionally, trying to change skin color with the use of sunless tanning products can be viewed as a form of body image avoidance. An inability to achieve the tan ideal, or the time and mental resources spent focused on one’s perceived inadequacies, simply magnify negative feelings towards the body. Thus, sunless tanner may help dodge the bullet, so to speak, by avoiding UV rays, but it is not completely harmless. Body dissatisfaction, body image avoidance, and low self-esteem are some of the most well documented risk factors in the development and presentation of eating disorders. Furthermore, studies have found links between general tanning behaviors and unhealthy weight control practices. Consider the following associations:
- Steroid use and unhealthy weight loss strategies were 4x and 2.5x more likely, respectively, among high school males who used indoor tanning, compared to their non-tanning counterparts.3
- Boys who tan were more likely to be trying to lose or gain weight than non-tanners.4
- Female students who engaged in indoor tanning were also more likely to engage in unhealthy weight control practices.5
- A belief that a tan improves appearance is one of the strongest predictors of UV exposure behaviors.6
We know that body dissatisfaction can drive both tanning and unhealthy weight control behaviors. These correlations underscore the point that, despite a lower skin cancer risk, promoting sunless tanning may still be problematic, especially in individuals who struggle or have struggled with body image. Promoting or validating the quest for a tan body has the potential to reinforce negative body image thoughts and perpetuate appearance related obsessions.
It is important to keep in mind that any beauty ideal is carefully crafted and enforced by an industry that profits from the body dissatisfaction it’s “standards” create. Tanning is no different. In fact, it’s important to point out that the tan ideal is just one way that westernized beauty ideals promote insecurity or dissatisfaction across the spectrum of skin colors. The media’s pressure on Caucasian women to be tan occurs concurrently with tactics like whitewashing and digitally lightening the skin (and hair) of women of color in prominent advertisements. Writers at Beauty Redefined unpack the cultural implications of those practices in the post: Beauty Whitewashed: How white ideals exclude women of color.
By creating the narrowest possible margin for beauty, the media essentially convinces everyone their skin is either too light, too dark or some other shade of inadequate. As a result, people who internalize the cultural definitions of beauty feel ‘required’ to purchase some sort of product or service to achieve the ideal, or risk being invisible. As Director Elena Rossini reveals in her masterful documentary The Illusionists, the very same company that promotes tanning products in the U.S., profits off of skin-whitening creams in India.
Media influencing what we perceive as beauty is not exactly a new conversation, but sometimes these ideals become so much a cultural norm that we cease to question them. Just think how often the phrase “you look so tan!” is thrown around as a compliment or “I’m so pale” is delivered as a self-criticism. Great diversity of skills, skin colors, body shapes and sizes is a natural and healthy part of life. Any group who tries to change that, especially for profit, should be met with critical speculation. Just as we attempt to challenge the thin ideal, we should seek to debunk tanning myths and push back against unrealistic or unhealthy expectations. One way to do that is by helping to build families and peer groups that prioritize body positivity and body acceptance.
As individuals, we can push back by refusing to buy-in to a heavily marketed tanning industry that includes outdoor tanning, indoor tanning or pre-packaged tanning. Perhaps the money, time, and mental resources devoted to the quest for a perfect summer glow could be better used elsewhere?
Find out just how much money you could save by expanding the infographic on the right. Then head on over to Twitter or Instagram to tell us what you would do with your savings and how you intend to finish out your #bodypositivesummer free from the grip of body dissatisfaction.
About the Author:
Taylor Sorensen is a rising senior at Trinity College in Hartford, CT where she is majoring in Neuroscience. At Trinity, Taylor is involved in research focusing on the neuronal underpinnings of Autism Spectrum Disorder. She joined The Center for Eating Disorders as a summer intern in both the Research and Community Outreach Departments.
Stern, RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol 2010; 146(3):279-282.
Wehner, MR. International prevalence of indoor tanning: a systematic review and meta-analysis. JAMA Dermatol. 2014 Apr;150(4):390-400. doi: 10.1001/jamadermatol.2013.6896.
Miyamoto J, Berkowitz Z, Jones SE, Saraiya M. Indoor tanning device use among male high school students in the United States. Journal of Adolescent Health. 2012;50:308–310. doi:10.1016/j.jadohealth.2011.08.007. [PubMed]
Demko CA, Borawski EA, Debanne SM, Cooper KD, Stange KC. Use of indoor tanning facilities by white adolescents in the United States. Archives of Pediatriac and Adolescent Medicine. 2003;157:854–860. doi:10.1001/archpedi.157.9.854. [PubMed]
Guy, GP. Et al. Indoor Tanning Among High School Students in the United states, 2009 and 2011. JAMA Dermatol. 2014 May; 150(5):501-511.
Pagoto, SL, Hillhouse, J.Not All Tanners Are Created Equal: Implications of Tanning Subtypes for Skin Cancer Prevention. Arch Dermatol. 2008 Nov; 144(11): 1505–1508.
I went to pick a magazine off the rack the other day at the store, and, just like most people, I am automatically drawn to the headlines highlighted in big, bold capital letters on the front covers.
“Flat Abs, Lean Legs, Firm Butt.”
“Drop XX lbs. Fast.”
“Flat Belly Now!”
“Drop A Jeans Size In XX Days.”
“Sexy Abs Fast.”
You get the point. It is only natural for me, or anyone, to assume that these characteristics are being promoted because they depict beauty, and that sexy is defined as thin, lean, flat, and firm. As we are right in the thick of summer season, and attaining a “bikini body” is at the forefront of peoples’ minds, I picked up one of the magazines and skimmed through it. Thankfully, those magazine headlines don’t effect me in the same way they once did.
I suffered from an eating disorder at the age of twenty. My desire to appear attractive, and be physically fit fully dominated my ability to focus on being healthy. My initial attempt at losing “a few pounds” turned into an obsession with food restriction and excessive exercise. And, it all began in the summertime when I knew I would be in a swimsuit with my friends, and my body was more exposed than in the winter season. Little did I know that my drive to be thin and sexy would lead me down a deep, dark path of depression and anxiety.
I am an athlete. I have always been active and competitive in sports, particularly soccer. Short in height, I needed to have strength in my upper and lower body to be successful. At the time of my eating disorder, however, I lacked size, power, and personality–all attributes that had contributed to my successes on the field. I quickly realized these qualities I once possessed had dissipated and what I thought was making me better, sexier and more confident was actually making me weaker and more insecure.
Fast forward thirteen years.
I am now 23-weeks pregnant with my third child, and summer has begun once again. My body is larger than it has ever been in my whole life. But so is my heart. I have two little boys, who love to go swimming at our neighborhood pool. It is in this environment that I am forced to make a decision: embrace my features and my body, and enjoy myself and my children; or turn back to my eating disorder and disengage from life and from my family.
Love, family, and happiness now far outweigh a desire to be a certain body type. And, for me, who is not happy, joyful, or lively when I am dieting or focusing on dissatisfaction with my body, I choose to live life.
Life is too short to focus solely on my appearance or socially constructed beauty ideals. I much prefer to enjoy myself, exercise healthily, and concentrate on being the best person, mom, wife, daughter, and friend I can be. That is far sexier than any number on the scale or what I look like in a bikini.
Erin Mandras is a blogger and inspirational speaker at Kick The Scale. She’s also a youth soccer coach in the Baltimore, MD area, and cares for her two young kids (Levi, 4 1/2 and Austin, 2 1/2). Prior to these roles, Erin was a college soccer coach at Michigan State University, Towson University, and Loyola University Maryland, and a former women’s soccer player at Michigan State University. She was born and raised in West Bloomfield, MI, is now married to her wonderful husband, Jon Mandras, and resides in Baltimore.
Wondering how can you start to build a body positive summer for yourself and the people you care about?
Put the magazines down. Better yet, don’t even pick them up. Create your own headlines.
Despite how widespread eating disorders are, many, many misconceptions remain about these illnesses and the people affected by them. These misconceptions are hosted and maintained by a variety of sources including the popular media, opinions of people around you, outdated information online and in textbooks, and by stigma that prevents open and honest conversations that could lead to greater understanding on a more personal level. As a society, it’s important that we move past the stereotypical thinking, not just about eating disorders but about eating and health in general so that we can shift towards non-judgmental attitudes and practices that truly promote well-being. After my time as a Community Outreach intern at The Center for Eating Disorders at Sheppard Pratt, these are the five most surprising facts I thought would be important for my peers and the community to know.
* * *
1. Anorexia and bulimia are not the only eating disorders, nor are they the most prevalent. There are more than just the eating disorders that we hear about through the media. Binge eating disorder, atypical anorexia nervosa, bulimia nervosa of a low frequency and/or limited duration, and Avoidant Restrictive Food Intake Disorder (ARFID) are just a few examples. Some of these diagnoses fall within the category of Other Specified Feeding or Eating Disorder (OSFED), but it is also possible to have an Unspecified Feeding or Eating Disorder. In all of these cases though, eating disorders can take a significant toll on a person’s health and quality of life. It seems the lack of awareness, the sensitivity of these disorders, and the confusing nature of diagnosis for eating disorders have all contributed to the fact that only 1 in 10 people with an eating disorder will get treatment. This is a sobering statistic given that eating disorders have the highest mortality rate of any mental illness and are rarely resolved without professional help. Raising awareness of all the different types of eating disorders and wide variety of symptoms might make it a little easier for individuals who are struggling to see themselves represented and to seek help.
2. Up to 30 million people of all ages and genders suffer from eating disorders. It is true that adolescent females make up a large part of the treatment seeking population, but it’s important to note the role that bias and misinformation, even among medical professionals, can play here. If a person is struggling with an eating disorder and they fall outside of the white, adolescent female stereotype, they are actually less likely to be screened for, correctly diagnosed with, or referred to specialized treatment for an eating disorder. The truth is that eating disorders do not discriminate; people of any race, ethnicity, sexual orientation or socioeconomic status may be affected. These illnesses affect men, women, children, and the elderly. It’s important that health and mental health professionals know this and don’t overlook warning signs in their patients.
3. There is no such thing as a “bad food.” Most of us learn throughout our lifetimes that certain foods are “bad” and others are “good” based on any number of analyses – fat content, calories, food group, process by which it was made, etc. These messages reach us through social pressures, peer groups, family attitudes, commercials, magazines, and just about everywhere we look online. When we’re surrounded by these messages, it is easy to forget that food is just food and gives us energy and can be enjoyed– it doesn’t have to be assigned a moral value. Despite what we are told by the healthy lifestyle bloggers, it is okay, even necessary, to eat bread and pasta. It is okay to get ice cream that isn’t sugar free and to go for the full fat lattes. None of these things influence our self-worth or intrinsic goodness. Disordered thoughts about food are everywhere and will likely continue to be everywhere. Take away the “good” and “bad” labels from the food and you’re one step closer to creating a healthy attitude toward food whether you’re working on recovery from an eating disorder or not.
4. Fat talk is harmful for everyone. Body dissatisfaction can be a significant risk factor for the development of eating disorders. Negative thoughts about one’s body are not easily extinguished and most people with eating disorders continue to struggle with these thoughts during their recovery process. Talking about diets, comparing body sizes, complimenting weight loss, or just generally talking negatively about body shape or weight can be very triggering and can even contribute to relapse. But it’s not just people with eating disorders who are harmed by fat talk. Whether it is self-directed or directed at a friend or a stranger, focusing on weight/size as a measure of worth or beauty brings everyone down. It probably seems completely normal for someone to say “you look great, have you lost weight?” or for a co-worker to mention she’s not eating carbs because she’s afraid it will make her fat. But it doesn’t have to be normal. When fat talk happens, consider how you might turn it around to be positive and helpful instead of feeding into the negativity. Could you change the subject completely, educate your friend about the dangers of fat talk, or simply model mindful eating behaviors? You can also remind your friends of all the reasons why you care about them that have nothing to do with what size they wear.
5. You really can’t tell whether or not someone has an eating disorder simply by looking at them. People with eating disorders look very much like everyone else – completely diverse. As stated earlier, this includes diversity in age, gender and race but also diversity in weight and size. The phrase, “you don’t look like you have an eating disorder” is not only misleading but also can be extremely detrimental to individuals seeking support. Eating disorders can affect low weight, average weight, and high weight individuals. Unfortunately, many people delay seeking treatment based on an assumption that their health is not at risk unless they are drastically under or overweight. In general, weight is a very poor predictor of one’s current health. If you are engaging in disordered eating behaviors and experience frequent negative thoughts about your body, it doesn’t matter what size you are, your health is at risk and you deserve support and treatment.
For more information about different types of eating disorders and treatment visit eatingdisorder.org.
If you’re concerned that you or a loved one may be exhibiting signs of an eating disorder, you can take the confidential online self-assessment to find out more.
In honor of National Eating Disorders Awareness Week 2016 (Feb. 21-27), we asked body acceptance activist and eating disorder recovery advocate, Melissa Fabello to share her thoughts on some essential eating disorder awareness topics. If you missed it, you can find her thoughts on self-care, perfectionism and dieting in Part I.
Below, in part II she opens the door to important conversations about body neutrality and intersectionality, and she also shares the one thing she wants people struggling with eating disorders to know about recovery.
Q & A with MELISSA FABELLO: Part II
Q: You recently wrote an awesome list of 50 body acceptance resolutions for 2016. In that list you introduce body neutrality as an alternative goal when body positivity feels like too much pressure. What did you mean by that?
MF: There are so many aims of the body acceptance or body positivity movement that I love. I have found so much comfort, joy, and support within those communities, and I am forever grateful to them for that. I’ve also found some missteps that I think need correcting, one of which being the push for everyone to feel beautiful and to love their bodies. I think that’s a lovely goal, and I also think it’s too lofty for reality.
Because the truth is that no one loves their body every single day – no one. Part of how body image works is that it can shift and that we all have good days, and we all have bad days. Mostly, when we have healthy body image, we simply see our body for what it is without ascribing any meaning to it whatsoever, and we exist, full of acceptance, in that body. To me, that’s what body neutrality is about. It’s about acknowledging and accepting our body as is, rather than pushing ourselves to have extreme feelings about it either way.
And I like to think of it as an option – not an alternative to the mainstream body acceptance movement. I like to think of it as something that someone can choose to work toward, if that goal feels more realistic than one of unconditional love. Perhaps, even, I like to think of it as a stop on the train toward a more loving relationship with our bodies. I just think that pushing people to love their bodies can backfire if it creates another standard to live up to.
Q: In all of your writing and in advocating for individuals with eating disorders, you take great care to acknowledge the true diversity of those who are impacted. From gender to age to race and socioeconomic status, why is it so important to you to highlight these marginalized voices in your work?
MF: Intersectionality – the understanding that intersecting social identities exist, a term that was coined by Kimberlé Crenshaw – is an absolute must in any and all work, I believe, but especially in work that stems from feminism. The ways in which we’re impacted by society differ, based on our identities. As a queer woman, for example, I experience life differently than a straight woman or a queer man. As a white woman, I experience life differently than a woman of color or a white man. Our positionality within the complicated web of identity matters because it affects how we move through this world. This is true in regards to body image and eating disorders, too.
We talk a lot about the thin ideal in our work – and that’s a very real, valid concern. We talk less, though, about how our beauty ideals are also centered on whiteness, on a heteronormative idea of gender roles, on access to money, on youth, and many other intersections. The further that we get away from the ideal, the more suffering we may experience as a result, and the more pressure we may feel to approximate those ideals. And I think that when we center the most marginalized – the people furthest from that ideal – in our work, then we help more people. When our work focuses on white, middle class, cis women, for example, then those are the only people that we help.
The eating disorder field has long focused its efforts on a very specific population, and I think it’s far past time to admit that and to work actively to eradicate the ways that that focus perpetuates systems of oppression like white supremacy and classism, among others. Different voices need to be centered because different experiences exist and have been ignored.
Q: Who do you think could benefit from attending your presentation, Adventures in Self-Care: Everyday strategies for nurturing an imperfect recovery in the real world?
MF: I think that anyone could, honestly! It’s been my experience that conversations around self-care can be difficult to have because so few people practice it. I’m going to talk a lot about what self-care means and why it’s important, but I’m also going to give ideas on how to start cultivating more self-care practices in your life – in ways that are easy and practical. I think that anyone who feels like sometimes life is overwhelming and they need some “me” time could benefit from this conversation – and isn’t that everyone?
Q: Lastly, what is the one thing you would want to tell someone who is struggling with an eating disorder and may be feeling ambivalent, hopeless, overwhelmed by or resistant to the prospect of recovery?
MF: I want them to know that those are very real and valid feelings to have. I want them to know that we’ve all come up against that at some point or another. And I want them to know that one of the biggest obstacles to recovery is believing that it’s one huge accomplishment that looks a certain way. It’s not. Recovery is about a whole bunch of tiny successes that lead you to a healthier, happier place – defined by you. Recovery is in your reach because you get to decide what it looks like and how to get there. But first, you need to take the first step of believing (even skeptically!) that it’s a possibility. And it is. I promise you that it is.
Many thanks to Melissa Fabello for taking the time to share her passionate and thoughtful responses. If you’d like to hear more from Melissa, join us in Baltimore on February 21 to help kick-off National Eating Disorders Awareness Week. Don’t forget to RSVP. Space is limited.
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Adventures in Self-Care…Everyday strategies for nurturing an imperfect recovery in the real world (PDF)
You can find Part I of our Q&A with Melissa here.
If you’ve ever seen one of her YouTube videos than you probably already know Melissa Fabello is a talented and passionate activist. She also writes boldly and beautifully about eating disorder recovery, body image, diet culture and a host of other important issues. In advance of National Eating Disorders Awareness Week and her presentation in Baltimore on February 21, we asked Melissa to share her thoughts on why self-care is not self-ish, the intersection of eating disorders and perfectionism, and her experience with recovery in a society obsessed with dieting. We are honored to share her responses with you below.
Q&A with MelissA Fabello – Part I
Q: A lot of people assume self-care to be synonymous with personal hygiene or the daily chores of living. This can sound like a pretty boring topic. Given that you will be in Baltimore on February 21 to discuss the Adventures in Self-Care as part of National Eating Disorders Awareness Week, can you explain more about what self-care really is and why it’s something we should be talking about?
MF: To start, I would actually argue that self-care should, indeed, be a daily chore of living. It should be an intentional practice that we partake in – every single day – in order to take care of ourselves. It really can be as simple as getting the right amount of sleep, drinking enough water, or eating a meal that fuels your body. It’s finding ways to insert self-care into those daily chores of living, which in turn, creates a life that may feel a bit more adventurous.
And when I say “adventurous,” I don’t necessarily mean thrill-seeking, but rather, simply, more livable. And what is more of an adventure than life itself? Self-care puts you in the position to live life more fully and to experience it more broadly because it cultivates your self-awareness and forces you to consider what makes you the happiest.
Self-care, really, is just any set of practices that are nourishing to you – physically, emotionally, and spiritually. Those practices can be preventative (like taking care of your physiological and mental health needs to the best of your ability every day), and they can also be intervention methods (think: calling out sick just to spend the day taking a bubble bath and reading novels). But the point is that they are necessary to all of our lives, but especially necessary when we’re in eating disorder recovery.
Q: We often hear from patients who fear that engaging in self-care is a selfish act. How would you respond to someone worried about being, or being perceived as, selfish?
MF: That’s a real concern, and it needs to be validated as such. We live in a culture that’s driven by capitalism, and the number one value held by capitalism is that of productivity. Have you ever slept in because your body needed rest, but then berated yourself for not getting up early enough to start in on your housework? Or have you ever taken a much needed day off to marathon your favorite TV show, but then felt bad that you didn’t work on your school work, even though you hadn’t taken a day off in two weeks? That guilt is the product of believing that our worth is tied up in how productive we are.
This is especially difficult for women. In our society, men are frequently defined by what they do out in the world. Women, though, are judged by how they take care of others. As such, women’s moral development, according to Carol Gilligan, is all about how we understand ourselves in relation to other people. Women, in particular, are taught that taking care of ourselves and putting ourselves first is not only a selfish act, but even an immoral one. And that’s just straight up sexist.
One small shift we can make is to redefine what “productivity” means to us. I have an ex-girlfriend who was a hustler, trying to make it in the music business. As such, every day when we talked, she’d ask me, “What did you do today?” or “What did you accomplish today?” And sometimes that really overwhelmed me – because what if I didn’t “do” or “accomplish” anything? But the truth is that even if what I did that day was laugh while playing with my cat, or if what I accomplished was taking a trip to the bookstore for fun, then I’ve been productive. I’ve produced something: self-care. I think we need to remind ourselves that taking care of ourselves is an accomplishment.
Q: Perfectionism is one of several genetic traits that have been identified by research to be associated with an increased risk for the development of eating disorders. From your experience and observation, how does the topic of self-care intersect with tendencies toward perfectionism?
MF: I like to think of myself as a recovering overachiever, although I still fall back into those old habits sometimes. Again, in a culture where we’re taught to value our productivity, it can be hard not to fall into perfectionism as a way to prove our worth. But the truth is that we need to learn to be okay with the fact that none of us is perfect, that we’re all going to make mistakes.
One of the most valuable pieces of self-care advice I’ve received lately is that of learning to be okay with “good enough.” I’m one of those people who, when I give 75%, will feel guilty and ashamed for not giving 100%. What happens that’s interesting, though, is that no one can ever tell that I didn’t give something my all. As far as they can tell, I gave 110% because what I did was absolutely, positively awesome. Learning to be okay with “good enough” means giving something a shot, but not letting it run our lives, and feeling comfortable with the amount of attention that we were able to give something.
Part of self-care is being able to say, “I can’t (or don’t want to) work on this anymore because it’s possible that continuing to do so will damage my mental health. So I’m done now.” And that means letting go of the idea that we – and everything associated with us – has to be perfect.
Q: Another risk factor for eating disorders stems from the emotional and physiological consequences of dieting. What other impacts do you see from a culture that markets diets as a valid form of self-care and a path towards self-acceptance?
MF: I’ll be honest: The day that I actively decided to go through weight restoration was the day I realized that I could never be both thinner and happy. I could only ever be one of the two. I could spend every second of every day counting, measuring, and restricting in an attempt to achieve self-acceptance through (what I thought was) self-improvement, or I could attempt to apologize to my body and recreate a healthy relationship with food and within that freedom, find happiness. That concrete realization – that I couldn’t work toward a “better” body and experience day to day happiness – was a huge shift for me.
A spoken word poem that I really love, “When the Fat Girl Gets Skinny” by Blythe Baird, has a line in it that says: “This was the year of eating when I was hungry without punishing myself / And I know it sounds ridiculous, but that sh– is hard.” And it is. It is hard. Because we live in a culture that is so focused on dieting as, like you said, “a valid form of self-care and a path towards self-acceptance” that deciding to go against that grain and to seek validation and happiness from elsewhere is a radical act. And make no mistake: Giving up diet culture is a radical act, both personally and politically. Our culture thrives on making us feel small, weak, and less-than. Rebelling against that pressure, declaring that you will not be contained, and saying “no” to everything that our culture and media want us to believe? That is an incredibly courageous act.
Be sure to check out Part II of our discussion with Melissa in which she delves into body image and the concept of intersectionality as it relates to eating disorders.
Melissa A. Fabello, M.Ed. is a body acceptance activist, sexuality scholar, and patriarchy smasher based in Philadelphia. She is currently a managing editor of Everyday Feminism, as well as a doctoral candidate at Widener University, working toward a PhD in Human Sexuality Studies. Melissa has worked closely with The National Eating Disorders Association, The Representation Project, and Adios Barbie on campaigns related to body image, eating disorders, and media literacy. Find out more about Melissa and her work at melissafabello.com.