I probably read too much about eating disorders. Whenever an article related to them pops across my Facebook feed or shows up on Twitter, I click. And there’s a frustrating element of these articles that has begun to grate on me more and more. Every single time someone writes about eating disorders, they have to bring up those “terrifying statistics” about dieting and body dissatisfaction in girls and women. In one article I read last night, the author even went so far as to suggest that “dieting is a gateway drug to eating disorders”.
Now these are of course important concerns. Dieting isn’t a particularly healthy practice most of the time. Women thinking that they should or must be thin is not exactly an ideal state. But where I run into problems is this: a diet is not an eating disorder. Dieting does not lead to developing an eating disorder because an eating disorder is not just an extreme version of a diet or a choice or a lifestyle change. It is a disease. You can’t catch the eating disorders from a diet.
So what is the relationship between diets and eating disorders? Why do people keep throwing into the same sentences as if everyone knows the clear link between them? I can’t help but come from my own perspective and my first thought is that diets and eating disorders belong nowhere near each other. I have never in my life been on a diet. Up until my eating disorder came bearing down full force I had never even imagined restricting my food intake. And when my eating disorder happened, it was never anything like a diet. There may have been a couple of weeks during which I wasn’t aware that I was making destructive choices, but it became quite clear quite quickly.
I get the feeling that I’m not the typical case and that many people experiment with dieting before they fall into a full blown eating disorder. But it is the case that there are many, many people who diet and never develop and eating disorder, and I am evidence that the opposite can be true as well. The deep link that most people seem to assume between the two can be questioned.
And then there’s the evidence. Do we have any evidence that dieting leads to eating disorders, or even that dieting can predict eating disorders? There is evidence that those who diet are about six times more likely to develop eating disorders. We don’t however know whether those who are already predisposed to having an eating disorder are more likely to diet, or whether diets lead to eating disorders. The vast majority of dieters never develop an eating disorder, so there is no certain way to determine whether an increase in dieting will lead to an increase in eating disorders.
“Recent research indicates that 50-80% of the risk of developing AN is genetic (Kaye, 2007). Patients with AN typically demonstrate high levels of anxiety, harm avoidance, and behavioral inhibition (Shaw et al. 1997) – all traits which are heavily influenced by genetics (Cloninger, 1986, 1987, 1988). Perfectionism, obsessionality, and cognitive rigidity, which are also highly heritable, have been identified as risk factors for AN (Kaye et al., 2009). Most patients with AN have exhibited one or more of these traits since early childhood, long before the development of an eating disorder. These traits tend to be exacerbated during bouts of malnutrition and persist long after recovery, albeit to a lesser degree (Kaye, 2007).” Source
There are chemical changes in the brain when we deprive ourselves of food and for those who have the predisposition for an eating disorder, a diet can be the moment that flips the switch as it were. So while there is a relationship between diets and eating disorders, an increase in dieting does not necessarily imply that there will be an increase in eating disorders (unless there were a whole lot of predisposed people running around who never hit any level of nutrition deprivation or stressful circumstances that would have precipitated the illness). It is possible that an increase in dieting would trigger an illness in those with a smaller predisposition, but that’s all speculation.
So we have evidence that dieting does correlate with eating disorders. We have no evidence that it causes eating disorders. There are however many problems with talking about dieting as if it caused eating disorders (beyond the fact that it’s probably not accurate). Especially when the connection is drawn in a sloppy fashion, it implies that eating disorders are on a spectrum with diets and that one can slip from one into the other with ease. The further implication is that eating disorders are a choice, obscuring the reality of the genetic components of eating disorders, as well as the psychosocial aspects (which tend to be less about diet culture and more about individual stresses in someone’s life).
But perhaps worse is that it gives the picture that everyone who has an eating disorder is a chronic dieter, the kind of person who is always belittling themselves, or obsessed with their looks. This leads to the distinct possibility that people won’t get proper diagnosis, treatment, or support. It continues the love/hate relationship with eating disorders that our culture has in which the anorexic does what everyone else does but just does it better, so if you aren’t a model/fashionista/weight obsessed salad eater, you don’t have an eating disorder. And that’s a problem.
I’m not saying that we shouldn’t recognize that diets can predict eating disorders, but it’s not as if that’s not already in common parlance. Let’s spend some time focusing on the things no one thinks of, like a rape, or a bad breakup, or a bad family situation, or any other form of trauma that can easily precipitate a mental illness. Let’s get over the idea that an eating disorder is a part of diet culture, because it’s something else altogether and we know that.