Josie L. Tenore, M.D. has found that “Eating disorders …During the past three decades…[have] increased dramatically [and] currently, the overall incidence is approximately 5 percent.” According to the National Eating Disorder Awareness Society, “In the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life.” This may be anorexia nervosa, bulimia nervosa, binge eating disorder, or EDNOS (eating disorder not otherwise specified). While initially eating disorders were believed to affect only socioeconomically advantaged white women, the trend has evolved during the past decade and now includes a wider range of age groups, including a significant amount of elderly people. While this problem does occur among men, it continues to be much more prevalent among women. Psychologists, medical professionals, and others who study these disorders agree that “the media, the fashion industry and changing societal norms” are partly “responsible” for the historic increase in these trends. Eating Disorders are now more recognized and dealt with, as well.
While women were definitely body-conscious before, the significant rise in eating disorders is mainly thought to have occurred during the second-half of the twentieth century. The image of “Twiggy” in 1967 at 92 pounds became an iconic and idealized body that other women and girls would strive to replicate. It was not until the 1970s and 1980s that eating disorders received media attention, much of it brought on by the disturbing death of Karen Carpenter, a singer in her thirties who died of cardiac complications of anorexia nervosa. “This was the first time the media focused on the fact that eating disorders can have life-threatening consequences and are not simply a group of ‘benign’ psychiatric illnesses.” Carpenter’s death opened up space for the media to recognize the growing problem not only among celebrities and athletes, but among American women.
The reporting of Karen Carpenter’s death and subsequent “investigations” and admissions of eating disorders show how new and seemingly “hidden” this illness had been. In trying to understand and perhaps cope with her death, America and the media went in-depth into examining her eating disorder. Documentaries (1989) were made to help people understand the pressures she felt to “be perfect” and how pressure to have a perfect body ended up being fatal. This and this shows some of the initial news reports about Carpenter’s death and this, this and this show attempts to understand and bring awareness to her death later. As the reporter says, “Karen Carpenter’s life was a symbol of the American dream and her death was the symbol of the disease anorexia nervosa.” Celebrities and public figures were beginning to talk about this issue and bring recognition to the detrimental influence of societal trends on women’s heath. Princess Diana was thought to have been bulimic. Here she does not address her own experience, but talks about the issue to a group who are gathered to also discuss the problem and potential treatment.
During the 1990s, increasing attempts were made to bring eating disorders out into the open. Books like Marya Hornbacher’s “Wasted” talked about her own experience with anorexia and bulimia and the contextual factors of family and societal influence that she attributed to her developing the illness. At the same time, society questioned whether sharing such experiences was “healthy,” as many feared that doing so would “romanticize” the illness and encourage other women to follow such examples.
Popular culture has portrayed eating disorders in a variety of ways. Some portrayal have been positive in helping to rid the illness of the stigma that one must be “skinny” to have an eating disorder, and show it as an illness that affects all people. Some point to family stresses as causes of disorders such as in The Best Little Girl in the World (1981) and Hunger Point (2003). Others focused on pressures faced by female athletes such as Perfect Body (1997) and Dying to Dance (2011). Katie’s Secret (1986) was groundbreaking in making people more aware of bulimia, which was previously less understood than anorexia. Some of these films, which may or may not show the reality of eating disorders, are shown to young women, especially in health classes. I remember watching A Secret Between Friends: When Friendship Kills (1996) when I was in about eighth grade. This was the first time I learned about eating disorders in a formal way and I do not think it offers a very complete perspective of the dangers of eating disorders. Even though this film was sad and disturbing, it seemed to glamorize some aspects of eating disorders.
These illnesses have gained more recognition in the recent past, but it is still considered an “epidemic” among American women. One of the greatest contemporary challenges is diagnosing and properly-treating those with an eating disorder. It seems that eating disorders are still not taken totally seriously as a life-threatening illness, as most health care facilities and insurance companies only offer limited care for patients with eating disorders. “By stressing the medical complications of eating disorders, the focus may shift from the psychiatric to the medical, possibly altering how these illnesses are viewed by the insurance industry and, ultimately, how treatment services are offered.”
What about prevention? While America’s multibillion-dollar “diet food industry” has produced numerous nutritionally empty low-fat foods, these are obviously not the solution and, in fact, growing evidence suggests that “dieting itself may be the initiating factor in the development of eating disorders.” The media and the fashion industry play a significant role in establishing society’s body image norms. As discussed in earlier posts, advertising has presented and continues to present some of the strongest messages about women’s bodies.
Josie L. Tenore, “Challenges in Eating Disorders: Past and Present,” American Family Physician, 367-369.