February 26, 2019
Culture + Society
Gene Beresin and I have worked with individuals struggling with eating disorders, largely girls and young women and their families for years. As the psychiatric director of an inpatient medical stabilization unit for malnutrition, I see the devastating consequences of disordered eating on a daily basis. Not only do eating disorders have the highest mortality rate of any mental illness, but they also create disruption in almost every area of a young person’s life. Restrictive eating and over exercise may lead to fatigue, social withdrawal and isolation, and loss of interest in previously enjoyed activities. In turn, this can negatively affect peer and family relationships, school performance, and ability to participate in hobbies and activities. Hospitalization or intensive treatment may interfere with regular school attendance, time with friends, and participation in activities, particularly those involving sports or other physical activity.
One of the most common questions parents ask is “Why did this happen?” and “Was there anything that could have prevented it?” Of course, there are no easy answers to this question – every family is different, and eating disorders are not caused by any one thing. More likely, they arise in situations encompassing a perfect storm of factors, including things like genetic vulnerabilities, mood and anxiety disorders, family processes, as well as social forces and environmental stress. It isn’t generally helpful to place blame.
Despite advocacy efforts of those stressing body positivity and acceptance of all body types, the thin ideal remains the goal for many in our society. In addition, almost everyone these days has a smartphone, and with it comes constant access to the Internet and to social media.
Digital Media Influence on Body Image
Digital media is perhaps one of the newest and most powerful agents in our culture. It is well established that media has a profound impact on body image. Research has demonstrated that young children and adolescents are particularly vulnerable to identifying with celebrities who are thin. While we have come a long way in our TV shows over the years to include characters with a wide range of body types and sizes, digital media now spans much broader than TV, and is ever present on a daily basis in many of our lives.
Teens and young adults are particularly caught up in the drama of their Instagram, Snap Chat and texting world. Selfie culture encourages focus on physical appearance, and on posting only the most flattering photos. Many social media influencers post photos of their meals and exercise plans each day. Teens may compare their own physical appearance or daily activities to those they see online, not realizing how carefully curated most online presences are. All too often, young people who develop eating disorders report a deliberate change in eating or exercise behaviors triggered by body dissatisfaction or attempts to “be healthy” that then spiral out of control.
What, then, can concerned parents, teachers, coaches, and clinicians do to try to prevent eating disorders in vulnerable kids and teens? Here are some strategies that focus on healthy activity and healthful relationships with food, and for modeling body positive language in front of young people, both in person and in online engagement.
- Avoid trending diets. Many online media outlets – online blogs, commercials and social media forums send unhelpful messages that children and adolescents receive on a daily basis. The diet, fitness, fashion, and “wellness” industries promote the moralization of clean eating and exercise and give conflicting messages about the merits of various diet plans that can be challenging for even the most educated adults to figure out, and many of which are unproven and can be dangerous to health. There are many websites that provide sound advice, videos, and ways of eating in healthful ways, such as the National Eating Disorders Association and Common Sense Media. Parents and young people need guidance to sort out sites and forums that promote health and do not reinforce unhealthy dietary practices.
- Exercise because it feels good. Instead of forced trips to the gym – though they may have friends who post selfie’s after their athletic feats, like completing a triathalon or showing off their muscles in the weight room – encourage kids to engage in regular physical activity by participating in organized sports or hiking, biking, or swimming with friends and family. Focus on the joy of movement, having fun, and prioritizing strength and function rather than enduring exercise to “earn” food or to look a certain way.
- Find a balance with screen time. Balance physical activities with more sedentary, yet enriching, activities such as reading, making art, and playing music. While it is important to limit screen time, it is also essential that parents recognize that it is an important part of many teens’ lives. Don’t be afraid to talk with them about the movies and television shows they are watching, the video games they play, and the things that they see on social media.
- Offer a variety of options. Try serving a wide variety of foods at regular intervals to promote the idea that “all foods fit” in moderation, and to encourage a healthy reliance on hunger and fullness cues. Discourage skipping meals, but also do not force kids to eat when they are not hungry. It is not helpful to restrict them from eating when they are hungry, as deprivation can lead to secretive overeating.
- Monitor language in online posts. Instead of posting a picture of cookie with the caption, “Oh, I was bad today, I didn’t work out, so I shouldn’t have this cookie,” use this caption instead: “Wow, this is delicious, I’m going to savor it.”
- Highlight qualities other than weight or shape. Whether it’s a person you know in real life, or a YouTube celebrity, focus on characteristics other than just physical appearance when describing someone. It’s important for young people to remember that a bright smile, positive attitude, good communication skills, and emotional intelligence go a long way in forming effective relationships!
- Focus on character traits in young kids. When talking with small kids – including commenting on your friends posts of their children online – take an interest in what they’re reading, their hobbies, and topics that interest them rather than talking only about how cute they are. For example, if your friend posts a video of their little girl dressed up as a fairy princess, performing a magical dance, instead of commenting, “What a beautiful princess she is!” consider, “What a beautiful dance – I love her imagination!” It is essential for young children to internalize the message that who you are is more important than what you look like.
- Put the phone down! We are all hostages to digital media. Teens and young adults are often driven by FOMO (fear of missing out), even if it is a chat that contains devastating comments about peers. Adults are not the best role models. For example, in recent research on distracted driving, parents who forbid use of cell phones behind the wheel for their kids, commonly use navigation and music apps, and receive calls themselves when driving. Conversations about the value of spending face time with others or engaging in activities that are non-digital is an important guideline for parents and kids alike.
This is not to say that taking care of oneself and making an effort when it comes to appearance is not important. It’s just not the most important thing. And while we don’t believe it is reasonable or even desirable to ban the use of screen time for our kids, a sound set of principles and awareness of its impact may be a sound measure to prevent and understand its role in the development of eating disorders.
Additional Helpful Links
- Girls on the Run promotes fitness and self-esteem in girls by helping them train for a 5k.
- The National Eating Disorders Association (NEDA) offers a toolkit to help young people become more savvy media consumers.
- The American Academy of Pediatrics maintains a website for parents that has entire sections devoted to nutrition, exercise, and responsible media use, including tips for developing a family media use plan.
- The American Academy of Child and Adolescent Psychiatry’s Facts for Families include tips for social media use in adolescents and information about teen eating disorders.
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