What are the causes of eating disorders?
What I tell folks is that brain chemistry and genetics load the gun – so if a family member has had an eating disorder, or there’s other mental illness in the family. But what pulls the trigger are things like bullying, traumas, how you were raised, other social or psychological factors and culture and media. There’s a Western society ideal that leads to weight stigma and fat-shaming.
Are the Kardashians contributing to these triggers?
The Kardashians are part of the culture, this Hollywood ideal that has been main-staged for a long time, and they are some of the top people followed on Instagram (Kim Kardashian has 331 million followers). People see them on their TV shows, in their photoshopped photos, with their weight-loss and diet products, and they think that this is something that they need to do, too. There’s this view if you want to be successful, if you want to be accepted, you have to look like this.
Some Kardashian images have been described as “anorexic-like.” What is anorexia nervosa, and why are eating disorders so deadly?
Anorexia nervosa is just one of a few types of eating disorders. It is categorized by a restriction of food intake or nutrition. There are subtypes of anorexia that involve purging (over-exercising, using laxatives, binging and purging).
Eating disorders in general are the second deadliest mental illness surpassed only recently by opioid overdoses. They are deadly because of medical complications driven by lack of nutrition (electrolyte imbalances, heart attacks) and suicidality: The suicide rate is very high among people with eating disorders.
Kim Kardashian said publicly that she lost 16 pounds in three weeks to fit into a Marilyn Monroe dress for an event. The comment caused some outrage. Can you talk about why?
It’s not healthy. I know she went on the record to say, ‘If I did this in an unhealthy way, I wouldn’t be talking about it.’ But I work in this field of eating disorders and disordered eating. I work on a medical campus. Losing that amount of weight in that amount of time is not a healthy way to go about that. It’s dangerous mentally and emotionally and physically. You take the risk by doing that of not only affecting your organs, including your heart, but also your brain. Because when losing weight in a way like that, your brain becomes obsessive, and you can really go down that slippery slope toward more of an eating disorder.
Are girls and younger women most at risk for developing an eating disorder?
It used to be viewed as just a middle-class, white girl’s disease, but what the last 10 years or so has shown is that eating disorders can affect everyone, regardless of gender, race, ethnicity, socioeconomic status, sexual orientation or gender identity. Males are less likely to be diagnosed, and people of color are less likely than white people to be asked about eating disorders and to be diagnosed and treated for eating disorders.
What is your reaction to the Kardashians’ weight-loss and body-shaping product promotions?
I think it’s really unhealthy. I know Jameela Jamil of the television sitcom ‘The Good Place’ has spoken publicly against the Kardashians a lot, because they are not using their influence for good. They are using it to sell waist trainers and talk about losing weight. We need to be working on acceptance of the way we look and respecting our own bodies.
Khloe Kardashian told a reporter that working out was her “new obsession.” Can the amount a person exercises be, in itself, a form of eating disorder?
It definitely can. When we move our bodies, we get that endorphin rush, and we feel great, and so there is an addictive quality to exercise. That can also become obsessive and compulsive, especially related to an eating disorder.
Yet exercise is good for us. How do we know if it’s become obsessive?
It’s all about balancing and how rigid you are around your exercise routine. How much are you doing it? Is it 90% of your life, and you’re not leaving room for other things? Is there rigidity, like when I see folks who get really upset or won’t eat or cannot move on with their day unless they get their X amount of exercise?
There is a subreddit called Instagram Reality that serves as a sort of vigilante forum, pointing out what’s real and what’s not in online photos (face and body tuning; bad photoshop; etc.). Is a forum like this helpful or harmful?
I think it’s good for us to be critical viewers and consumers of social media. It’s important to point it out because some people can really be influenced by it. But I think there’s also a trend toward shaming people and just ripping people apart for doing these things. They have a platform that they need to use responsibly. I think that we can show or point things out, but in a productive conversation, not in a shaming, mean way.
How can parents or friends help prevent someone from falling down the rabbit hole of eating disorders?
Approach them in a very nonjudgmental, compassionate way. You want to gather facts and also realize and accept that you might not get far enough to take action after one conversation. You want to listen with empathy, remain calm and not blame. Shame and isolation drive eating disorders or any addiction. You want to use ‘I’ statements like, ‘When I see you throw your lunch out, I feel concerned and sad.’ Instead of, ‘You upset me when you through your lunch out; you are worrying me.’
And eventually, you want to encourage professional help, correct?
Yes. A therapist will work with them on their self-image, self-esteem, self-confidence and self-worth. A lot of times, they are projecting feelings like sadness, anger, fear and anxiety down to their bodies, because it’s easier to focus on their bodies. So, yes, helping someone get into therapy is definitely the most important piece.
(Note: This interview was edited for brevity and clarity.)