Dieting: A Gateway Drug to Eating Disorders

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.

 

More About Skeptech: Individual and Societal Responsibilities

So at the conference this weekend we spent a fair amount of time talking about censorship because hey, we were talking about the internet and censorship had to come up at some point or other. Zach Weinersmith (edited because I fucked up Zach’s last name. Sorry) of SMBC gave a talk about comics as a natural experiment in censorship and argued that we should have no censorship (except maybe yelling fire in a crowded theater) particularly of art, because art needs to reflect life, and the best art reflects ALL of life, not just the pretty parts.

We also talked some about Reddit and the r/jailbait fiasco. Some people argued that the subreddit never should have been shut down, because protecting free speech is more important and we should be able to talk about illegal activities if we so choose. Should we be able to shut down the r/trees (edited because apparently the subreddit about marijuana is called r/trees. Way to confused me guys) thread simply because marijuana is illegal?

These are all really important concerns, and I am most certainly a free speech advocate. However I tend to think that our morality should be more about harm than about rights. I don’t think we should do away with the concept of rights entirely because it’s incredibly important for the safety of minorities, but in general when you have to invoke a “right” to justify a harm, you’re doing something wrong. Something that was rarely brought up in these discussions was at what cost do we allow completely unrestrained free speech. Because there certainly are harms. Zack Weinerstein made the argument that with this unrestrained free speech, we now have the most tolerant generation in history, so it’s no big deal that certain parts of the internet are steaming cesspits of hate. But that completely overlooks the damage that that hate directly does to the people who have to witness it. We may be “more tolerant” of women, but if a woman gets harassed every time she logs on to her favorite website, that is a harm.

And in addition to that, what do we really mean by “more tolerant”? A lot of these websites normalize horrific behavior by arguing that they are tolerant. They say that cat-calling a woman is no big deal, that African-Americans are just practicing reverse racism, that slurs are simply free speech, but that they think everyone should be equal. This is lip service to tolerance. But if we can actively see online through their writings for all the world to see that they treat other people like shit, clearly they aren’t tolerant. And they normalize that behavior.

For some reason, this conference seemed to focus entirely on personal responsibility in terms of free speech. You might be exposed to any number of things, but it’s your job as a responsible human being to not be influenced by any of it if you don’t want to be (apparently). But here’s the thing: societies have responsibilities too. As skeptics, we should know by now that NO ONE is immune to the influences of society. All of us internalize the messages that get sent to us, no matter how hard we try to resist (hello eating disorder that reeks of internalized misogyny. How are you today? Oh you’re all my fault because I should have just made a better personal decision? Thanks). It has been well-documented how easy it is to influence people. And when you’re constantly bombarded with certain images and certain messages, there’s only so much personal choice that you have. That limits the amount of personal responsibility you can have.

Media has to be responsible for the messages it sends. Now I don’t necessarily think this should lead to government censorship of unpleasant topics. As a lot of people said, ignoring things doesn’t make them go away, and often bringing them out into the open can help us deal with them. I’m honestly less worried about some of the unpleasant topics and far more worried about some of the glamorized topics. Take for example binge drinking. We see binge drinking all the time on TV held up as fun and awesome and hilarious and completely normal. If someone has a predisposition for alcoholism, can we hold them completely responsible if they fall into the trap of alcoholism when they are seeing how great alcohol is all the time? Do we have to take some responsibility as a society for the pain caused that individual and their family? I think we do.

Society has some responsibility to try to create media that isn’t damaging. It should be free to discuss any topic it so chooses, but I think it’s entirely possible to legislate ADDITIONAL information be available about any topic that could be triggering or influencing in a negative way: for example if a TV show depicts rape, we could require that it includes a short discussion of the characters involved and why they acted in a negative way to deconstruct the negative actions they made. And as individuals, I think that we are entirely allowed to exert pressure on media to stop perpetuating shitty stereotypes and harmful messages. We are 100% obligated to be as careful as possible about the media we consume (tell TV networks when their shows are sexist, tell advertisers when they’re perpetuating rape culture).

We cannot always be critical consumers, even when we want to be. Oftentimes we’re lacking in the choices to be ethical about the way we consume media. If I want to watch a movie that is free of sexism and racism, I would be hard-pressed to find one. We need to exert some pressure on media to provide us with more options. Weinerstein suggested that when censorship is taken away, then more types of art flourish. I do agree with that, but I think that we also need to be active in promoting different types of art and different perspectives. We need to vote with our money, and I think as a society we need to discuss larger fixes to the problems of sexism and racism in media and on the internet. If an individual has only ever been exposed through the internet to individuals who say that a woman might owe you sex if you buy her dinner, are they entirely to blame if they rape someone? No. They have some responsibility, but not all of it. We are products of our society.

There is serious harm in unmitigated free speech. I don’t know what the solution is, but ignoring the fact that there are places on the internet that actively normalize hate crimes, sexism, racism, rape, cissexism, and homophobia is not helpful to anyone. We DO have an interest in trying to keep people safe from each other and safe from internalizing negative and destructive messages. I think that people who host websites and people who host other people on their websites need to be clear about what they will and will not accept: you OWN that space, and you can easily say that you will not tolerate bigotry. People do that in meatspace all the time. Why is it unacceptable online? You can get your own damn website and spew hatred. But we will minimize the damage that you can do.

I am so frustrated with the idea that individuals exist in a vacuum and that “personal responsibility” trumps all social issues. NO. Individuals should be held responsible for their actions, but their actions should be taken in context so that we know what led to the problem. If we simply keep pointing to bad behavior and saying “don’t do that” we’re just trying to take care of symptoms, not the etiology of the bad behavior. We are all a part of systems, and our whole systems are broken right now.