7 myths about eating disorders

This article was written by eating disorders doctor – Dr Chuks Nwuba.

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My first few weeks working as an inpatient doctor in eating disorders largely involved me undoing inaccurate information I had accumulated over the years. Social media, TV, and film, were just some of the reasons I had formed so many misconceptions about eating disorders.

Here are 7 common eating disorder myths (that I also—once upon a time—believed):

1: “They pretty much only happen in females”

Everybody remembers their first. And I remember when I admitted my first male eating disorders inpatient. It was unusual to me because up until that point, I had only looked after women. But the thing is, it shouldn’t have felt weird.

The number of males who suffer from an eating disorder is often grossly underestimated. This is likely due to the societal narrative that eating disorders are largely a female issue. Despite limited eating disorders research studies being carried out in men (1), we know the numbers are there. Statistics suggest that 25% of those living with an eating disorder are male (2).

Four out of 10 people with binge eating disorder—the most common of all eating disorders—are male (3); and males also represent 25% of individuals with anorexia nervosa (4). Subclinical eating disorder behaviours (for example, dietary restriction, self-induced vomiting and  laxative abuse) are almost as common in males as they are females (5).

In recent years, there has been an exponential rise of muscle dysmorphia amongst men—a condition characterised by a pathological preoccupation with muscle growth (6). This often presents with heightened body image concerns, compulsive exercise and dysfunctional eating (7). In many cases, this has stemmed from greater aesthetic pressures on men to appear muscular and lean.

It is important that men with eating disorders are educated to identify when there may be an issue, are empowered to seek support despite stigma, and are taken seriously when concerns are raised.

Explore More

1. My Battle With Anorexia
   by Dave Chawner
   Comedian, Dave Chawner, gives a TEDx talk of his story about having anorexia nervosa as a man.
   Link: https://www.youtube.com/watch?v=lqbL-UhhyPk

2. Living with Bulimia
   by Freddie Flintoff
   Cricketer, Freddie Flintoff, shares his battle with bulimia nervosa. He highlights challenges in elite sport, and problems with the female-only eating disorder narrative.
   Link: https://www.bbc.co.uk/iplayer/episode/m000n1xx/freddie-flintoff-living-with-bulimia

2: “They pretty much only happen in the wealthy”

I remember one of my patients being head-to-toe with rage because someone had assumed she was wealthy. She took it personally and made sure to correct them. She highlighted that her lack of finances was in fact part of her problem. For me, this was a huge learning curve.

Eating disorders are often trivialised as being ‘illnesses of the rich’. In mainstream media, those with eating disorders are often portrayed as being wealthy. However, this could not be further from the truth. 

Statistics show that young females from low-income families are nearly 1.5 times more likely to develop bulimia nervosa than those from higher-income families (8). To mitigate hunger, research showed that some poor people, living in urban neighbourhoods, engaged in eating disorder behaviours such as skipping meals or eating smaller portions (9). The evidence suggests that with inconsistent and unpredictable access to nutritious food comes heightened eating disorder psychopathology. This can also present as excessive night-time eating, episodic binge eating, and secretive eating (10). 

Explore More

1. Not All Black Girls Know How to Eat
   by Stephanie Covington Armstrong
   Author, Stephanie Covington Armstrong, tells her story of growing up poor and hungry in New York, and her bulimia nervosa diagnosis.
   Link: https://www.amazon.co.uk/Not-All-Black-Girls-Know/dp/1556527861

3. “They pretty much only happen in White people”

A Black, male friend of mine—who I only recently found out suffered from an eating disorder—said to me that “once you don’t fit the stereotype, they don’t even ask the question”. One of my Southeast Asian male inpatients at the time said a similar thing about today’s society.

People from minority ethnic groups suffer from eating disorders too. 

Research suggests that binge eating is more common among Black women than among White women (11). Also, Black teenagers are 50% more likely than white teenagers to exhibit bulimic behaviour, such as bingeing and purging (12).

Unfortunately, Black individuals are still far less confident asking for eating disorders help (13). A combination of education, stigma and biases mean those from minority ethnic groups often do not adequately seek and receive treatment (14). And when they do present to services, often it is much later (15)—by which time the illness is likely to have further developed.

Explore More

1. The Care and Feeding of Ravenously Hungry Girls
   by Anissa Gray
   This novel depicts a story of a multigenerational, Black family where one of the main characters has a history of bulimia nervosa.
   Link: https://www.amazon.co.uk/Care-Feeding-Ravenously-Hungry-Girls/dp/1984802437

4: “You have to be underweight”

Despite most of my inpatients being diagnosed with anorexia nervosa, I eventually came to learn that the majority of outpatients do not have this diagnosis. And there I was, thinking I was looking after what a typical eating disorders patient looks like.

People living with anorexia nervosa are typically underweight. But despite being frequently talked about, anorexia nervosa makes up only 8% of eating disorders (16). The majority of people with an eating disorder are not underweight (17).

One research study showed that nearly 90% of those with binge eating disorder, and 33% of those with bulimia nervosa, were clinically obese at some point (18).

It is impossible to tell if someone has an eating disorder based on their weight alone. And so it is vitally important that assumptions are not made based on one’s weight. A person who is not underweight may be much more unwell than one who is.

There are many biopsychosocial markers that form the basis for an eating disorder diagnosis, and so it is important for weight not to be considered in isolation but examined alongside trends, mental state and the complete context of the individual.

Explore More

1. Hunger 
   by Roxanne Gay
   This memoir covers the intersection of binge eating, body sizes and interpersonal interactions.
   Link: https://www.waterstones.com/book/hunger/roxane-gay/9781472153791

2. Russell Brand and Megan Jayne Crabbe
   by Under The Skin podcast
   This podcast episode includes discussions on body weight, misconceptions and eating disorder recovery.
   Link: https://youtu.be/d0Y-YkOdIRM

5: “The media’s to blame”

One of my patients knew that she had an issue with comparing herself on social media so offered for staff to look after her phone in the evenings. But I was remarkably surprised by how only a few spoke of being on social media, and even less had an issue with it.

The media—and social media—can be valuable for the creation of health promotion strategies. But unfortunately, it may also be partly responsible for the increase in the prevalence of eating disorders (19). This being said, there are many other contributing factors—genetic and environmental—as to why an eating disorder may develop and persist.

Scientific studies show a relationship between eating disorders and neurodevelopmental conditions such as autistic spectrum disorder (20), and anxiety disorders such as obsessive compulsive disorder (21). 

Experiencing personal trauma (22) or having significant issues with family dynamics (23) can increase the likelihood of developing an eating disorder. Also, those competing in sports where leannes, or a specific body weight, is considered essential, are statistically more likely to develop an eating disorder (24).

Explore More

1. Eating disorders through developmental, not mental, lens
   by Richard Kreipe
   In this TEDx talk, paediatrician and adolescent medicine specialist, Dr Kriepe, challenges stereotypes about eating disorder development.
   Link: https://www.youtube.com/watch?v=OAlyBWRmkxs

6: “Purging means vomiting”

I distinctly remember having to go back through my notes, for the first eating disorders inpatient I ever clerked in, and change the term ‘purging’ for ‘self-induced vomiting’. I’d been told that I needed to be more specific because purging could be a host of different things.

Purging is a compensatory mechanism to counteract food that has been eaten. This is typically done in an effort to influence a person’s weight or shape. The most common type of purging is self-induced vomiting (25). However, this is not the only one. 

Individuals can also use diet pills, laxatives, enemas, caffeine and diuretics to accelerate food and liquids through the body (26). Other forms of purging include excessive exercise.

There are many physical risks of purging, many of which are potentially life-threatening. Purging can also have profoundly negative psychological effects, including irritability, mood swings and increased anxiety (27).

Explore More

1. Good Enough
   by Jen Petro-Roy
   This is a personal account of an eating disorders inpatient stay which includes challenges of tackling purging behaviours.
   Link: https://www.amazon.co.uk/Good-Enough-Novel-Jen-Petro-Roy/dp/1250123518

7: “It only happens in young people”

The first time I had come across the term SEED (severe and enduring eating disorder*) was when we admitted a 64-year-old female to the inpatient unit. All my preconceived notions—of how old a patient with an eating disorder should be—were shattered in an instant.

Anyone, of any age, can develop an eating disorder. Some develop an eating disorder for the first time when young. Of these, some recover; but many remain chronically unwell for years (28). Some develop an eating disorder for the first time when middle-aged or much older.

Twenty percent of patients with anorexia nervosa end up chronically unwell. Up to 20% of those with binge eating disorder (29), and up to 40% of those with bulimia nervosa (30), fail to ever recover. 

But having one for many years does not mean that recovery is no longer possible. There is always hope of recovery.

*The term, SEED, is given to those who have had an eating disorder for a long time and have  had many unsuccessful treatment attempts (Kotilahti, 2020).

Explore More

1. The Longest Match
   by Betsy Brenner
   This memoir highlights the challenges that a life with a chronic eating disorder poses.
   Link: https://www.amazon.co.uk/Longest-Match-Rallying-Disorder-Midlife/dp/195512308X/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=&sr=

Other Resources

1. Beat
   (www.beateatingdisorders.org.uk/)

2. SEED charity 
   (www.seed.charity/)

3. The Eating Disorder Recovery Journal by Cara Lisette
   (www.amazon.co.uk/Eating-Disorder-Recovery-Journal/dp/1839970855)

4. Jameela Jamil x Tommy Hilfiger Body Neutrality course
   (www.futurelearn.com/courses/exploring-body-neutrality-jameela-jamil)

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