Eating disorders don’t discriminate
When Olivia Broome, a sophomore majoring in advertising, found out that she was a member of the Sadie Hawkins Dance court senior year of high school, she should have been ecstatic.
Instead she was horrified.
“It was supposed to be a great thing, but the ‘ED voice’ kept telling me, ‘You’re going to walk down there to the front of the gym, in front of a thousand people and they’re all going to see how much weight you’ve gained. They’re going to know you’re not well,’ ” Broome said.
For someone who always wanted to “have it all together,” this was terrifying.
Starting the summer before her junior year, and going through her senior year of high school, Broome said she suffered from orthorexia, a disease categorized by overly restrictive healthy eating, and binge eating disorder. Her “ED voice” was the “voice” of her eating disorder; the voice in the back of her mind that kept feeding her lies and kept her from living in the moment.
“If you’re living with an eating disorder, you’re not really living,” Broome said.
Due to underfunded research, confidentiality agreements and other hindrances, there is a lot of discrepancy in eating disorder statistics, but according to the National Eating Disorder Association (NEDA), a support and advocacy organization, approximately 30 million Americans suffer from an eating disorder at some point in their life. They are often linked to or a coping mechanism for, anxiety, depression or trauma and are considered a mental health diagnosis.
Broome, who describes herself as a perfectionist, said her orthorexia had a lot to do with a need to be in control, whereas her binge eating was a loss of control that brought on a lot of fear, panicking, anxiety, frustration and even depression. For Broome, as it is for many, her eating disorder was never about weight or wanting to look good, it was a way of dealing with feelings of worth. It made her feel in control of her life.
The most commonly known eating disorders are binge eating disorder, bulimia nervosa and anorexia nervosa. Dr. Nicole Siegfried, clinical director and certified eating disorder specialist at an eating disorder treatment center in Birmingham, Alabama, called Castlewood of the Highlands, said the list far exceeds that, though. She said that at Castlewood of the Highlands they also treat avoidant/restrictive food intake disorder (ARFID) and compulsive exercise.
There is also other specified feeding and eating disorder (OSFED). Someone diagnosed with OSFED will have problems with eating, but their symptoms will not meet the criteria for an aforementioned diagnosis.
The amount of types of eating disorders is often underestimated, and so too is who it affects.
According to NEDA, eating disorders were once thought to affect only a narrow portion of the population, only one “type” of person. Society has perpetuated the thought that only young, white, affluent females suffer from eating disorders, but that is the farthest thing from the truth.
“Eating disorders know no bounds in terms of age, race, gender and socioeconomic factors,” Siegfried said.
Sheena Gregg, assistant director of nutrition education and health services at the Student Health Center (SHC), has serviced people from all demographics who have eating disorders.
“What we are realizing now in preliminary research is that eating disorders certainly don’t discriminate,” Gregg said.
From her clinical experience, Gregg has come to understand why the stereotype came to be. She said it is a product of inadequate research and depictions in the media. Movies and T.V. shows that feature characters with eating disorders often have those characters be young, white, affluent females.
Broome feels strongly though, that despite what people may say, the media does not cause eating disorders. She said it was never models in magazines that she was comparing herself to, but the “last version of herself,” or real people that she knew or would ride an elevator with.
Broome believes the media reflects what consumers want, not the other way around. She also feels that the media is a really easy scapegoat, but that blaming eating disorders on the media is a hurtful thing because it reduces eating disorders and mental problems to just say “the media is telling you what to do.”
“It makes people [with eating disorders] feel worse,” Broome said. “It makes them feel like drones that are programmed by culture, and I think that people are much more resilient than that.”
Gregg said another reason why the young, white, affluent female stereotype exists is because that is the group that has historically sought treatment.
“That may be part of the reason why health care providers ... typically associate eating disorders with wealthy, Caucasian women, because they are the ones actively going in to seek services,” Gregg said.
Yet, people of all races and ethnic backgrounds can and have suffered with eating disorders. According to NEDA, “the prevalence of eating disorders is similar among Non-Hispanic Whites, Hispanics, African-Americans and Asians in the United States.”
“Eating disorders don’t see race, and they don’t see ethnicity,” said Katrina Velasquez, policy director at the Eating Disorders Coalition, an advocacy organization in Washington, D.C. that works to change policy.
Lauren Smolar, director of Helpline Services, NEDA said that while minority populations suffer from eating disorders, they have less treatment options available to them. She said this is especially true if the patient’s primary language isn’t English, or they’re dealing with other cultural norms – such as different eating behaviors and patterns – that treatment plans may not be used to.
Smolar also said eating disorders are less likely to be recognized in minority populations, explaining that oftentimes minorities are not diagnosed because of the stigma that only white people are affected by eating disorders.
Gregg has seen this trend too.
“In rural areas where health care providers aren’t treating eating disorders as frequently, [researchers are] noticing that it’s less likely for a health care provider to diagnose a minority individual with an eating disorder because of this stigma,” Gregg said. “If a minority comes in reporting issues of weight changes or problems with eating habits, typically the health care provider doesn’t have the immediate assumption of an eating disorder.”
Men with eating disorders have historically met a similar fate.
Lena Sheffield, interim co-director, National Association for Men with Eating Disorders (NAMED) knows that eating disorders are not gender-specific, but said that official diagnosis is an obstacle for men, since people often don’t suspect eating disorders to be a problem for them.
“People don’t even think to ask [a male about his eating habits] because people just don’t assume that a male could have an eating disorder,” Sheffield said.
According to NAMED, males make up about 25 percent of the population of people with eating disorders. Sheffield notes that that is probably a conservative estimate, considering the lack of adequate research in the field.
Eric Ceballos, writer, advocate and public speaker affiliated with NAMED, suffered with bulimia for roughly three years, starting the summer before his junior year. When he first started noticing a change in behavior and looking up information on eating disorders, he was only finding resources and support groups for females. This made him question whether or not something was actually wrong.
“I started wondering ‘Do I even have an eating disorder? Do men even get eating disorders?’ ” Ceballos said. “I didn’t know what was going on. There were no resources. There was nothing.”
That gap in resources, though shrinking, is still alive today. Smolar said there are fewer treatment centers available that cater to men than there are for women.
Ceballos encourages men struggling with eating disorders who are having a hard time finding treatment or other resources to reach out to NAMED.
While growing up, Ceballos said he was always overweight. He had a passion for attention, but felt that his weight was keeping him from being noticed and fitting in at his high school that was full of privileged, toned teens. Tired of not being seen, Ceballos decided that he would spend the summer before his junior year losing weight.
On the first day of junior year, after the weight had started “melting off,” Ceballos saw an old friend who said, “Wow, you look so good! Keep it up! I’m so proud of you - this is your year.”
Ceballos felt he must be doing something right, noting that if he was getting that much attention after dropping 30 or 40 pounds, imagine how much he would get after dropping 20 or 30 more.
“We praise people who are losing weight,” said Sheffield who knows that this can encourage someone with an eating disorder to continue their habits.
Ceballos continued trying to lose weight, and his eating disorder eventually became all-consuming. He noted that from the second he woke up, until the second he went to bed he was thinking about how much he was consuming, how he would get rid of it, how many calories a certain sport would burn, if a school bathroom was clean enough to throw up in, etc.
“It was mentally draining; there’s no off switch for [an eating disorder],” Ceballos said.
Ceballos attributes part of his struggles with bulimia to be an effect of growing up in an unstable household, noting that when somebody or something wasn’t around to keep him busy, food was always around. He also, like Broome, said it made him feel in control.
“There was all this stuff I couldn’t really control,” Ceballos said. “The only thing in the entire word that I had control over was what I ate, what I put in my mouth and how much I weighed ... weight and muscle mass was something I could control.”
Eating disorders, while they are present in both genders, tend to manifest themselves differently in males than they do in females.
Sheffield said that females tend to be concerned with looking lean and thin when considering body image, but that the same is not true for males.
“With guys it’s not so much the idea of being thin, but are they ‘ripped’ enough, are they muscular enough?” Sheffield said. “There’s pressure [to look that way], but again not everybody’s body type can do that.”
Ceballos agreed, saying that men have become ingrained with the concept that they have to be the “ultimate alpha male.” He feels differently from Broome in regards to the media, commenting on the fact that the only role models men have are the toned athletes and actors in magazines that have the money for trainers and diet regimens.
Ceballos also feels that athletics add a lot of pressure for men, noting that for many sports males are pressured to cut weight.
That pressure often leads to competition at the gym and unhealthy weight loss or weight gain strategies. This can include over exercising or the use of “risky products” that Sheffield said are in the sports market.
Ceballos knows several people in the bodybuilding world who said that they didn’t even realize their over-exercise, substance use, excessively controlled eating and desire to change their bodies was out of the ordinary and indicative of body image issues. This was once again due to the misconception that men aren’t affected by eating disorders, only women.
Because of this misconception, Ceballos said that eating disorders can take a bigger toll on men, because they often take longer to speak up and ask for help.
“They suffer in silence for so long,” Ceballos said.
Ceballos said males do this because of a sense of shame. He said a lot of men feel embarrassed and don’t want to admit to having something that is often thought of as a “girl’s disease.”
Eventually during Ceballos’ time dealing with bulimia, he started losing his hair, looking frail and having mood swings. These changes led his peers and family to believe he had a drug problem.
Ceballos let them believe that.
“I was so ashamed,” Ceballos said. “I let people think that I was a drug addict because I would rather them think that of me than that I was a boy with a ‘girl’s disease.’ ”
Ceballos thinks the idea that eating disorders are a “girl’s disease” is a product of the idea that girls take longer to get dressed and do their hair and makeup. This leads to the assumption that females care more about their appearance, and would thereby be more likely to have a disease that is linked to body image. He said there is a classic stigma of men being able to throw on a shirt and jeans, go out the door and be fine: that they don’t have to look in a mirror.
“There’s the idea that it doesn’t matter what we look like because we’re men and we’re macho and we don’t care about ‘that girly stuff,’ ” Ceballos said.
If a guy starts caring about his appearance, he will often be deemed girly, Ceballos said. This is due to the thought that only girls feel embarrassed about their bodies and get insecure about how they look.
People will start questioning the man’s sexuality as well.
“[I’ve heard people say things like] ‘Oh, well that guy cares what he looks like, he’s embarrassed about his body, he’s a pussy or a faggot,’ ” Ceballos said.
The idea that only gay men care about their appearance, have body image issues and suffer from eating disorders is not uncommon.
It is also not true.
“It’s not only gay males [that eating disorders are affecting],” said Sheffield who has dealt with this misconception often.
While gay men and other members of the LGBTQ+ community are affected by eating disorders, so are straight men.
Various studies show that members of the LGBTQ+ community are more at risk for, and have higher rates of, eating disorders, but it is important to understand that this is not because of their sexuality. Sexuality does not cause eating disorders, and eating disorders do not pick and choose which sexualities they affect.
According to NEDA, the increase among the LGBTQ+ community is due to the “myriad of unique stressors LGBT-identified people experience.” This can include coming out, anxiety-inducing harassment in schools or the workplace, depression, low self-esteem, and unhealthy coping mechanisms such as substance abuse. NEDA describes these things as common co-occurring conditions which can contribute in the development of an eating disorder.
People also mistakenly believe that eating disorders have physical symptoms that people can see, when in fact anorexia nervosa is the only eating disorder associated with being underweight, and thereby the only one that can be seen. According to Siegfried, anorexia nervosa is the least common eating disorder.
“I think there is this myth that you can recognize if someone has an eating disorder by looking at them, when for the majority [of people] you’d never know [they] had an eating disorder,” Siegfried said. “Eating disorders come in all shapes and sizes”
Broome understands this, and said she didn’t look like she had an eating disorder when she was in high school. She said she looked normal.
“You don’t have to look sick to be sick,” Broome said.
Broome, while she is young, white and female, does not fall into the affluent category of the stereotype. Broome is from a middle class family and said that money affects so much when it comes to eating disorders, and that eating disorders can and will affect people whether or not they can “afford” to have it.
Broome said treatment was very expensive. Insurance usually does not cover eating disorder treatment, and so Broome who had to pay for services out-of-pocket. Eventually she had to stop going because she ran out of money, but at that point she said she was in a much better state and had “enough tools in her toolbox” to work toward recovery. She said there are charities that help pay for eating disorder treatment, but that she wasn’t at a “certain level of ‘bad enough” in order to receive such funds.
“I was able to function, but I was miserable and it was completely consuming me, but I wasn’t sick enough to [get help from those charities],” Broome said.
Broome said it is hard to find financial help, especially in high school. She added that it may be easier for college students to find help due to the services available to them like the SHC and the Counseling Center.
Eating disorders don’t discriminate based on socioeconomic factors, and neither do they based on religion. Smolar said eating disorders can affect someone of any religion, though their effects may differ based on observance levels and the tenants of certain religions. For instance experts note that fasting rituals in religions can exacerbate a person’s eating disorder issues, or put them at a higher risk for getting an eating disorder.
According to Eating Disorders Victoria (EDV), an organization that hopes to break the stigmas surrounding eating disorders, fasting is not harmful in and of itself, “but can be triggering to people at risk of an eating disorder, in the stages of an eating disorder or in recovery, and may intensify and accelerate eating disorder symptoms.”
Recent research has also shown that a large population of women in the ultra-Orthodox Jewish community suffer from eating disorders.
NEDA attributes this to a preoccupation with food in the Jewish culture, and reluctance to acknowledge illness and seek help, due to both mental health stigmas, and a fear that doctors will not understand their way of life.They also say that eating disorders may be used as a coping mechanism in ultra-Orthodox communities.
“It is perceived as more ‘socially acceptable’ than other behaviors such as drug abuse,” said a NEDA article entitled “Eating Disorders in the Jewish Community.”
The documentary “Hungry to be Heard” says another reason for the prevalence may be due to pressures to be thin that ultra-Orthodox women feel because of the arranged marriages that take place in the community.
Smolar said that there are resources for Orthodox Jewish patients, saying that they are now seeing treatment centers that have specialized treatment and kosher meal plans.
“There are also therapists that specialize in that demographic and understand that there are cultural expectations and pressures [in the ultra-Orthodox community],” Smolar said.
Not only do eating disorders recognize a separation between church and who they effect, there is also a separation between age and effect. To them age is but a number.
“Eating disorders can happen at any point in life,” Smolar said, disregarding the stereotype that they only occur in adolescence and adulthood.
Gregg said that in her clinical experience she has serviced someone with an eating disorder as young as seven and as old as 68.
Among the elderly, Smolar said there are people who develop an eating disorder later on in life even though they never struggled with eating before, ones who had an eating disorder and it came back, as well as patients who had eating disorders when they were younger, but they were never actually dealt with,so they continued to struggle throughout their lives.
Velasquez, who is a proponent for early identification of eating disorders, said that 90 percent of the warning signs that someone will develop an eating disorder are there by age 14.
While this does not necessarily mean the person will have the eating disorder at 14, or that someone who doesn’t display warning signs at age 14 can’t develop an eating disorder later on, catching warning signs or the eating disorder early on is important.
Siegfried encourages people who are aware of eating problems to get treatment sooner rather than later.
“The sooner you get treatment the better the prognosis is,” Siegfried said.
For those seeking treatment who aren’t young, white, affluent females, that stereotype is a barrier, according to Smolar. She said people who don’t fit into that category have a harder time feeling comfortable opening up to getting treatment and to disclosing the concerns that they have.
As a member of an underrepresented eating disorder community, Ceballos said he understands that it can be hard to find resources and to feel comfortable speaking up. He also knows how easy it is to think you are the only one dealing with this issue, but wants people to know what that they’re not. He wants them to never be embarrassed of what they’re going through, know that there are resources out there and to speak up.
“I always tell people to speak up, even if their voice shakes,” Ceballos said.
It wasn’t easy for Ceballos to speak up at first, he admits to being afraid , but he now says that speaking up was what ultimately saved his life.
“I don’t know if you want to call it a mental breakdown, or a mental breakthrough, but something in me was like, ‘You know what? I can’t do this anymore ... I need help,’ ” Ceballos said.
Broome found it to be hard at first too. Since the root of her eating disorder was based in a need for control, it was hard for her to admit that she was no longer in control, and that she needed help. She was private throughout her eating disorder, but has since then become open about sharing her story and being a voice for those who haven’t found theirs yet. She speaks out because she thinks people can learn from each other, and she knows how crucial support is.
“I think the more stories you hear about people who have, not gotten control of their eating, but who have gotten freedom from it – where that’s not the central thing they’re thinking about anymore – I think the more positive stories there are, the more people will realize a) if [they have] a problem and if their life is being consumed by something, and b) [that they should be] more empathetic to themselves and other people,” Broome said.
Once people speak up, Siegfried understands that seeking treatment can seem daunting, and that a lot of people have skepticism around whether or not they can get better. She wants people to know though, that research shows that full and sustained recovery is possible and that research shows that people with eating disorders don’t struggle with them their whole lives.
Ceballos doesn’t know if that is true, admitting that while he is better, he doesn’t know if he will ever be fully healed.
“I still have my days,” Ceballos said. “... I think this will be something that I always deal with in the back of my mind.”
Broome admits to having her days too. She acknowledges that some people say you never recover, and some say you do. She doesn’t know which is true, but ultimately identifies with the latter. She considers herself to be recovered, partly because she said no one wants to view themselves as “broken in a way.”
“But I don’t think people with an eating disorder are broken, I just think they are a little lost,” Broome said.
Broome said it has taken a lot of energy and willpower, but that by giving herself space and time to reflect, journaling, loving herself and giving herself a break, she has found herself again.
“After you found enough light through having that recovery toolbox and having that support and knowing what’s going on to you and going like ‘This is ok! I’m not broken, it’s just my challenge that I have to work through and everyone has different challenges,’ and releasing that shame, that is when recovery starts to happen,” Broome said.
Broome views recovery as a kind of gift - one that forced her to know herself and be her own best friend.
“After recovery most people are able to not only accept their bodies, but love their bodies, which is in many cases much more than the average person in our society is able to do,” Siegfried said.
Ultimately Broome said people have messes; eating disorders are just one of them. Having messes is not part of being a certain age, race, gender, socioeconomic class or religion, that is part of being human.
“Everyone has messes, messes are really beautiful, and they shape who we are as people way more than our successes,” Broome said.