It’s talked about a lot. Comments about the size and weight of celebrities abound in tabloid magazines, on television, radio, and within various social media sites. And the comments have a theme. They are too skinny. They appear drastically underweight and sickly. A recent picture showed the normally healthy looking Katie Holmes with her rib bones protruding through her middle section as she frolicked with her daughter poolside. Model Candice Swanepoel was recently criticized for showing up at a Victoria Secret promotional event looking frail and pin-thin.
This is surprising, as Victoria Secret is typically known for images of women with fuller, curvier bodies. But this dynamic is pervasive. The models on the runway are mind blowingly slim as they make their way down the catwalk as noted once again during New York’s’ fashion week. And, of course, most of the images in magazines continue to show models and actresses who are impossibly thin.
And eating disorders are pervasive. Girls as young as eight years old are going on diets, complaining that their stomachs aren’t flat enough and engaging in the worst of dysfunctional eating patterns: starvation, bingeing/purging, overeating followed by restrictive behavior and excessive exercise. But this affliction is not restricted to the young. Women of all ages---literally---are suffering with eating disorders. And it is an invasive, insidious disease. It takes over. Like any addiction. She becomes addicted to keeping her body slim. And obsessed with how, if, and when this will happen.
Like any addict, she thinks about food and her body all day. Just like an alcoholic thinks about alcohol all day—when and if the next drink will come, how much longer she can hold out until the next high. Similarly, females afflicted with eating disorders or eating disorder behavior spend time dreaming up ways to lose weight or to compensate for “bad” eating behavior. She ruminates about what her next meal will be. The thoughts become all consuming. And her life no longer has room for friends, family and career. Not really. The disorder takes over and now her emotional and physical state is in grave danger.
Ironically, eating disorders are not really about food. They are not really about the body. They tend to reside in people that have pre-existing psychic pain. That have trauma, depression, anxiety, sadness…something that gets them to latch on to an eating disorder as a way of managing their feelings. Now, they are not thinking about their sadness or their loneliness. They are thinking about their dress size. And this feels “better” than focusing on the deep-rooted psychological pain that is the underbelly of this disease. Psychological intervention and extended treatment is the only way out.
So why talk about celebrities and models if the cause of this disease is more personal, more family of origin? Because these images exacerbate it. Not cause it. But exacerbate it. And that matters. We have to treat this disease via a multi pronged approach. The first line of defense is always going to be exploring family and psychological dynamics that have contributed to the development of this condition. There is always going to be psychological intervention. Looking for signs in the women in our lives that are suggestive of this struggle: dramatic weight loss, obsession with weight, eating large amounts of food followed by extended period of time in the bathroom (possibly purging), and engaging in excessive exercising after food consumption. These behaviors may be accompanied by tendencies towards withdrawal, isolation, anxiety, sadness or other pervasively negative emotional states. It is indeed critical to intervene and mobilize help if this set of patterns is observed in a loved one. And this is where the focus and responsibility for dealing with the disease primarily lies. Meaning it lies with the individual afflicted (if she is an adult) and/or with the family of the individual afflicted.
But there’s a second line of defense. Or there should be. Society. Can’t we do better by our young girls? And our vulnerable women? And manage the images of these models and actresses so they are not so lauded by the collective and not so promoted by the media? Can’t we seek to balance out these representations with images of healthy women who are focused on mental and physical well-being, not their pants size? It’s not that eating disorders would magically be cured. They wouldn’t. There are still and will always be young girls and women with trauma, sadness, family dynamics that get them to seek a way to escape their feelings.
But if thinness weren’t so prized in our society, maybe they wouldn’t go that way; the way of the eating disorder. They wouldn’t choose that way to escape. And the very life of our girls and women wouldn’t be jeopardized. Because make no mistake about it---eating disorders can be deadly. We want to do all we can to discourage females to choose this way to deal with their psychic pain. And the more the skinny girl is promoted, the more we can predict this will continue.
So let’s really think about it. While clinicians continue to do all they can to treat eating disorders and parents do all they can to encourage healthy self acceptance and body image, can’t the marketers of the world help too? Less underweight women promoted and celebrated. It’s not the answer. But it’s part of the solution.
Dr. Hillary Goldsher is an expert on the topic of eating disorders and has a private practice in Beverly Hills, CA. Please contact her with additional questions or to continue this important dialogue.