The Media & Eating Disorders

The media is an important aspect of life in our culture. About 95% of people own a TV set and watch for an average of 3-4 hours per day. By the end of the last century over 60% of men and 50% of women read a newspaper each day and nearly half of all girls, from age 7 read a girls’ magazine each week. In addition, people interact with a wide variety of other media such as music delivered by cd’s or videos. Online screen time via Apps on social media and use of mobile phones is accelerating. Each form of media has a different purpose and content. The media seek to inform us, persuade us, entertain us, and change us. The media also seeks to engage groups of people so that advertisers can sell them products or services by making them desirable. Institutions such as Governments and political movements also engage the public via the media to make ideas and values desirable – to influence our behaviour. We can trace our involvement with media back to the drum messages of the Indians, the shouts of the town crier and the issuing of pamphlets.  There are now many ways of information transmission, overt and covert. Media is no longer in the hands of a few industry bosses. Social media has made us all potential influencers and trend-setters via blogs, online posts, Twitter and Instagram. Some influencers have a vested financial and personal interest in promoting and fostering trends. There is constant debate about whether the media shape society or merely reflect current trends. Before the Second World War, it was thought that the media “injects” values and morals into society. However, social research in the 1960s showed that the audience is not a passive receiver of moral values. Society has many subcultures, classified by  race, social class, political outlook, values and interests such as vegetarianism or pro-anorexia. These differing social groups select and filter information and reject messages that are not consistent with the values of that group. On the other hand, irrespective of social clusters, research has shown that people with low confidence and self-esteem within each group are those who are most influenced by media communications. So, we cannot be sure about the influence of the media and social behaviour, for example sexual morality or violence. We recognise, as a result of these debates, that the interaction between message and response is complex and audience- dependent. To quote the BMA report on eating disorders, body image and the media: “In a media saturated culture, the argument that long-term exposure can help shape the world views of particular sections of the audience is one that merits consideration, however, the EXTENT to which the media contributes to personal identity remains unclear and is subject to continuing academic debate….the media do not, by their very definition, provide pure experience of the world but channel our experience of it in particular ways”. The latest “POSTMODERN” thinking on the role of media is that it provides learning that is both incidental and direct, and it is a significant part of the acculturation process. The media has always given a lot of attention to feeding, weight and shape. It has been accused of glorifying the culture of thinness, of causing an epidemic of eating distress, especially among young women. Traditional media is coy about taking responsibility for doing anything about it. Kelly Brownell, a US eating-disorder expert, argued that the media contribute to a toxic environment in which eating disorders may be more likely to occur. This is because of the “Damaging Paradox” of modern society in which the media promotes, in a compelling manner, a low weight sculptured ideal body. But at the same time the media provokes us to consume an increasing array of foods high in fat and calories, with compelling pressures from the environment which makes it easy for us to do so. Consequently, we are getting heavier, and the gap between the ideal and normal body weight gives rise to anxiety. We seek to reduce this anxiety by reducing our body weight, the preferred method being to go on a diet, since we believe that weight is under our control. Also, we believe that once weight is lost it will not be regained. But dieting causes rebound binge eating and attempts to deal with this, by going on further diets will lead many people into a disturbed relationships with food. There are other dangers arising from this cultural paradox. The models and actors who promote consumption of these calorie-laden foods are usually slim and attractive, which would not be possible in the real world if they actually ate these foods. This adds to the cultural confusion, and confusion is said to nurture the onset of eating distress. To what extent are these accusations true?

Is There An Increase In Eating Disorders?

There is no doubt that the ideal body size, as reflected in the style icons promoted in the media, is getting thinner in parts and bigger in others. This ideal body shape, epitomised by “celebrities” especially in the movie and music industries, is unrealistically thin (and sexy); their BMI is on the borders of what a clinician would regard as anorexic.  Trends come and go too fast for anyone to evaluate the sense of them. One day thigh gaps trend, the next trend is enhanced buttocks. How can we do both? How many normal bodies and minds can adapt to decide what is “good” or attainable?  Especially since we “the people” are getting bigger, fatter, and maturing younger as the years pass by. The gap between how we look and how we think we should look – is getting wider, and giving rise to anxiety among almost women and men, although it is the vulnerable who are most affected by an increasingly visual and accessible media. In the real world and in the media that is part of it, there is a lot of dieting, strange dietary practices such as “Clean Eating” which is a proxy for weight loss, and cosmetic enhancement going on. Most of the information thrust out is based on psuedo-science and does not stand up to scrutiny.  For a hefty investment, any untrained person with no education can become a nutrition blogger and gain a big following. Even so-called healthy blogs such as “Ella’s Clean Eating” blog has been criticised for making false claims that a specific diet can cure a serious and long-standing health problem. Although well-meant, this movement has fostered Orthorexic (faddy eating, see below) behaviour and increased concerns about normal eating among a vulnerable population who are not informed enough to make a proper judgement about what they read. Clean Eating has become a proxy for weight loss and can lead to dietary choices that harm. By following such diet or fitness blogs, social media content as well as traditional media gives the impression that everyone in the world is striving toward healthy eating or regular excessive exercise. These feeds and groups foster the illusion that everyone is thinner or prettier than you, fits into smaller clothes, has a thigh gap, or should, or eats less and better than you. Added to this, the information given by untrained people is misleading and can lead to food cravings and fatigue. Another issue common in all the visual media including social media is airbrushing or photo-shopping of images which can now be done by any ill- intentioned person with a smart phone and an App. I have known seriously unwell patients who upload pictures on Instagram that are doctored, or which don’t tell the full story. One young woman posted online pictures that made her look fit and sexy, but her hidden backstory was one of bulimia and other dangerous weight-loss strategies. She would not have the courage to explain that she had a serious eating disorder and that she was depressed and suicidal. She just wanted to build up followers and admirers. Several well-known fitness bloggers have come clean about their eating disorder and mental health issues. To pretend otherwise is an insidious form of lying. Social media involves comparing yourself to everyone else, as well as promoting unhelpful life choices. It also creates obsessive checking, loss of concentration, and sleep deprivation. Has anyone contacted me?   Why have people not sent me enough “likes?”  We think that the biggest overall effect of all this is on global self- esteem unless a person is careful. But does this vulnerable audience, many at a young age, take care?  It is worth remembering that people tend to filter out the bad things in their lives and smooth out their lumps and bumps when they post online. Some people only post when something good is happening or when they have a body-pic they like. But they don’t post when they have a bad hair day because they want to make people think that their life and their appearance is better than it is. This means that a vulnerable person could be left thinking that other people are more attractive, hence have more approval and have a more interesting fun-filled popular life. So social media gives us all sorts of ways to stage-manage the version of ourselves that we show to the world and this means we become ashamed of what we withhold. It isn’t only social media which impact on our dietary choices. Every January, the media in all directions promote dieting, dieting by undieting, clean eating, exercise, no exercise, as a means of dealing with the excess weight of festive celebrations.  Among all genders, more people diet or undergo punitive activity programmes as need to; in other words, of all people who diet, half are not overweight. However, dieting doesn’t inevitably lead to anorexia. Anorexia is not a slimming disease. But do these media and visual onslaughts CAUSE anorexia or other eating disorders?  Taking anorexia first; there are more reported cases coming to the attention of services, and we view this more as evidence of a slump in the global mental health of young people generally. Some authors put this down to broader social factors such as inequality and pressure to succeed, a socio-political argument that requires further thought. It is hard therefore to justify an accusation that exposure to supermodels or fitness Apps will cause our adolescents to develop anorexia. However, social media, Facebook and Instagram groups can justifiably be held accountable for promoting Thinspo, Fitspo and dangerous dieting and weight loss practices and glorifying anorexia as a lifestyle choice. We do not know how much damage is done, because none of the pro-eating-disorder groups are honest about the risks of dietary chaos; the effects of starvation or purging on all the body systems which keep us alive and sane. For persons trying to deal with eating distress, it is a good idea to be thoughtful about how they use social media otherwise they will be swimming in a whirlpool of unhelpful and misleading information. Anything that promotes dieting, even the most benign, such as a comment from a well-meaning friend, could lead to overeating disorders in vulnerable people because dieting behaviours are a known risk factor for compulsive eating and bulimia nervosa. Compulsive eating and Bulimia are mental health conditions directly related in part to dieting efforts and rebound over-ingestion due to food deprivation. A minority of people who experience compulsive eating learn to purge to get rid of unwanted calories and this becomes addictive partly as a way of dealing with emotional distress. So, any message which encourages dieting also fosters binge eating and bulimia. The media invests dieting behaviour of every kind with moral values, if you do it you are a good person, you will be happy, people will love you and your life will be wonderful. Dieting is no longer something that people do if they need to. Most dieters are not overweight but believe themselves to be so as a result of what the media culture tells them. This invariably leads to disordered eating because dieting is not the best way to manage one’s weight. Studies of prevalence show that bulimia nervosa and other forms of compulsive eating are on the increase. Half of all the overweight people seeking help in the community claim to binge eat in a way that affects their QOL. But how much is due to the media? People are exposed to pressures from many sides to lose weight, from their peers, from boyfriends, from parents and from the fashion shops that carry clothes in ranges and sizes that suit only the smallest among them.

There is no doubt that the media including online Apps provides significant CONTENT on body-related issues to young women, over 50% of whom, (between the ages of 11 –15 years) read fashion and beauty related magazines and 95% are exposed to social media influences by the age of 19. The exposure to ideal images and toxic information about eating, coincides with a period in their lives where self-regard and feelings of control and effectiveness is in decline; where body image is at its most fragile due to the physical changes of puberty and where the tendency for social comparison is at its peak. Girls thus find themselves in a subculture of dieting, reflecting messages not only from the media but also from parents, peers, members of the opposite sex as well as the media. Boys are not immune to these pressures and the prevalence of weight control practices among young men, including steroid abuse, is rising. Analysis of media content wherever we find it, provide a stream of articles on weight control, either through fitness or food control, and physical beauty, together with female models whose curvaceousness has declined steadily over the period between 1959 & 1978 (Guillen and Barr). This can be mapped across to males who are exposed to widespread and doctored images of six-packs and muscles. In all cases, the emphasis on diet or fitness was designed to help someone become more physically attractive and thus acquire status. In the late 1990s, there was a fair degree of comment from the media about Sindy dolls sold to girls under the age of puberty, with an impossible bust-to-waist ratio and impossibly long, lean legs. The accusation was that Sindy dolls would “encourage anorexia” by providing young girls with an adult body shape that they would aspire to but never achieve. Various experts appeared on radio and TV accusing the manufacturer of social irresponsibility. It must be pointed out however, that, while it is true that growing and adult persons are exposed to slim – fit images and many articles on diet and fitness, this tells us little about how these messages are received by the audience or by parts of it. In early 2019, the death of a young woman Molly Brown aged 14 was blamed directly on her exposure to images of self harm on Instagram. The algorithm following her interest provided her with disturbing images of self harm and pro-anorexic content such as Don’t be afraid of hunger pangs – this is your stomach congratulating you for keeping it empty. Few people are in doubt of the power to social media to lead vulnerable persons into dangerous and often fatal actions.

There are several studies that attempt to combine analysis of the content of messages with studies of attitudes or behaviour to assess the impact of images and messages. However, we are warned to guard against the short-term view of media influence on body image or eating behaviours, rather than assess the long-term outcome of exposure to certain images and values.  It is hard to know what social values are changed by media or by other aspects of social and technological change. We are living in an era of tghe shifting -sands of public opinion. Some of these studies point to a measurable, short-term association between reduced self-esteem, heightened anxiety or anger and depression, and exposure to culturally ideal body shapes, less among men and more among women. However, there is no way to know how, or if this anxiety persists over time or translates into future dieting or aberrant eating behaviours. One other study showed that there was no relationship between body dissatisfaction and the number of hours of TV watched per week, although there was a relationship between body anxiety and number of hours spent watching soap operas. Drive for thinness, a different construct, is related significantly to watching pop or music videos and Instagram feeds among adolescent girls. Women in a variety of studies consistently report that magazines, music videos and online activity influence their idea of what a good body shape is, and lead to determination to lose weight with subsequent dieting behaviours. These findings must be interpreted against the fact that women tend to overestimate their body size, a feature that extends back to early days of puberty. Waller and Hamilton have an interesting view of the effects of the media in this respect. They claim that the media may act as a “negative re-inforcer of body size overestimation, which may lead to eating disorder”. In other words, the media doesn’t make women need to be thinner, but the media may assist them in feeling bigger than they already feel themselves to be. The starting position for many females is thus a built-in vulnerability, which is reinforced by the culture of the media. This view must be considered alongside other, parallel studies on body image. These show that the development of body image over time, a more useful predictor of protection from eating distress, is dynamic and affected by many variables, including exposure to traumatic events, body issues in childhood and general self-esteem derived from core personality traits.

Many cultures confer status on a slim body size, for example in China – and some have had a preference for large builds for both sexes, such as in Polynesia. Anne Becker, an anthropologist of Harvard Medical School, who has worked extensively with the Fiji population, has shown that exposure to western ideals of beauty have led to a high percentage of adolescents dieting within the last decade. It is hard to prove that it is exposure to TV images which have caused this change, although it is reasonable to assume it. It is hard to evaluate the relationship between the media and eating disorder without considering the multifaceted impact of media messages on body size, on food consumption, on the desirability of certain foods and their consequent consumption, and other matters relating to personal identity and status.

The media can have many influences in relation to food and eating including:

• It confers hidden meanings on food – nostalgia, sexiness, being a good housewife and mother, rewarding oneself, having uninhibited fun etc, and creates unnatural drives for food.
• The media can persuade us that wrong eating habits are right and natural. A Macdonald’s ad. widely slated, featured a young boy who persuades both his parents to take him for a burger and chips rather than a healthy outing at the zoo.
• The media can create anxieties about being deprived if we don’t have what “everyone else is having.”
• The media presents us with an idealised shape which is invested with attributes of being attractive, desirable, successful and loveable but which is unattainable without resorting to sinister or dangerous eating habits.
• The media perpetuates the feeling in people who do not have the ideal shape that their life would be fine if they were slim.
• There is a proliferation of cooking programmes, like Nigella and Master Chef fetishising food, usually rich in calories, but we do not know the effects of this on eating or dieting behaviours.

Body image is an important part of self-identity and self-esteem. We all have a body image which is defined as the physical and cognitive representation of the body which includes values about how we should look across many dimensions (age, size, height, colour, attractiveness etc) and emotional feelings connected to acceptance or rejection. Body image is closely connected to self-esteem. It is possible to have poor body image and good self-worth if personality is robust. Conversely, if self-esteem is poor it tends to map to bad evaluations of appearance. Most women and men have some notion of how they would like to look – we call this an internalised ideal body.  They compare their perceived-actual shape against the socially represented ideal (Myers and Biocca). This presents a body image which is elastic, i.e. it will feel different at different times and in different contexts. For example, if you are on a beach in a swimsuit you may feel uglier than if you are sitting by the fire with friends. We have already explained that the ideal body has become smaller, thinner and differently shaped over the past 20 years. The ideal female body is now sculptured, pared of fat (with a BMI that would place most models firmly in the anorexic category), with narrow hips, a small waist and rounded breasts/ buttocks, a look that can only be achieved with the help of surgery since under conditions of weight loss, breast tissue tends to shrink. This helps explain:

• Why women consistently overestimate their weight, and
• Why dieting behaviours are so prevalent and toxic. Dieters, especially young ones, tend not to be responsible in their eating habits. And what is worrying is that, responding to this harsh level of body dissatisfaction; women may be harming themselves with their responses. In a study of 869 Australian diets in 1998, one third were using extreme methods such as fasting, crash dieting, smoking or drugs, in the belief that these methods would be harmless.

It seems that the media doesn’t simply make the ideal body desirable, it promotes the message that anything else is undesirable. People who diet accept the message that they are unattractive and that this will affect their ability to get a good job or attract members of the opposite sex. This is true to a certain extent. Research shows clearly that overweight women suffer in some important respects. They are less likely to be accepted into higher education, they have lower salaries; they are less likely to date in adolescence and are less likely to be married in adult life. Conversely, graduate career women are more likely to feel guilty about eating than any other target group. This finding reflects the conflicting pressures on women of today which are reflected in the media. Women are supposed to be thin, attractive and successful in the workplace and in academia, while maintaining feminine characteristics of nurturing, maternal, warm, socially engaging and givers. It is thought that women who cannot reconcile these roles and who feel out of control of their lives may turn to the control of weight to regain a sense of coping. However, this is just a hypothesis.

It is hard to separate the influence of the media in the development of eating disorders. Various studies point to the correlation between low self-esteem in young girls and high scores on eating distress measures as they grow. Does the media affect self-esteem? Probably yes. Self-esteem is a dynamic construct, like body image, which is influenced by a whole variety of factors such as parenting, childhood experiences, core personality and body image, especially in girls. It follows thus by logical reduction that influences on body image will affect self-esteem and promote the risk of developing an eating disorder as a person turns to the control of their body in order to feel acceptable. In this respect, the media may contribute to low self-esteem by promoting slenderness as the pathway to gaining love, acceptance and respect while at the same time reflecting a trend in society to demonise fat. When women and men are asked what they fear most in life, most will describe their fears of gaining weight. When women are asked what they least like about themselves, most describe a part of their body (usually stomach, thighs, legs) rather than no physical attributes like laziness or low confidence. Men conversely are more likely to mention non-physical attributes. When women are asked what men find attractive in them, most mention physical appearance. Women thus feel judged by their looks rather than their other resources. Esteem isn’t the only risk factor for an eating disorder. Traumatic childhood experiences, timing of puberty, family functioning, emotional resilience, exposure to unhealthy eating patterns in other people, family concerns about weight, fear of growing up, sexuality problems, bullying, loss, history of dieting; all may have an influence on a person’s relationship with food. So we can conclude that the media may both steer and reflect our cultural obsession with how we look and what we put into our mouths.

Advertising Policies And The Counter Argument

Some institutions in Government, Psychology and the media industry itself are becoming concerned about the use of thin models to promote goods and service. There was a Government “Thin Summit” in 2000 to which moguls of the magazine industry were invited. In some countries such as Israel it is unlawful to employ models with a low BMI. In a similar vein, the Independent Television Commission has issued guidelines stating that it is desirable to ensure that advertising does not stimulate unhealthy attitudes to eating and that is must not imply that being underweight is desirable. There is an All-Party Parliamentary Committee on Body Image trying to put a finger in the dyke. Good in theory, but none of this has had significant impact on the size of models in magazines, nor of the shape of girls in music. Celebrities continue to attract attention for their weight loss rather than their accomplishments, and the greater the furore about their size, the more attention they receive. “Celebrity Anorexia” may be creating more ripples in society than any former use of models in fashion shoots. A few years ago, and as a direct repose to “do-gooders” in some sections of the media, a wristwatch manufacturer used an excessively thin model to advertise his watch. Many publishers, while paying lip-service to a policy of self-acceptance at any weight, continue to print pictures of slim models, run articles about dieting and fitness, and promote all sorts of weird eating plans. The new wave of articles on healthy eating is just dieting in another guise, the objective being to manage health through control of weight thereby undermining such defences as may exist against dieting. These new wave articles are so compelling, that, viewed against a background of increasing confusion about what is good or bad to eat, they are creating a new eating disorder known as “Orthorexia”. This is a condition where the sufferer becomes obsessed about so-called healthy or virtuous eating plans (such as veganism, no carbohydrates or anti-allergy plans) which imply weight loss and which mask an unhealthy relationship with food. Some style-setters in the media frankly refuse to adjust their policies, they say, not unreasonably, that women like to look at perfect bodies, they won’t buy magazines with pictures of ordinary people, and that they are not quite as silly to believe that these fantasy figures, photographically enhanced in many cases, are bodies that they can aspire to. This is somewhat confirmed by my own discussions with teenage girls in schools, who are fully aware that diet and exercise is not enough to get them looking like a model in a magazine.

There is one aspect of media policy which Government likes to ignore. This is the use of media to promote unhealthy eating attitudes which may be contributing to a national epidemic of obesity. This remotely provokes damaging eating strategies as our ever-expanding nation seeks to control its waistline. An individual who watches TV for two hours per day sees over 20,000 food advertisements in one year, most promoting foods high in sugar and fat, urging us to consume for reasons that have little to do with survival. The problem is worse for our children. During child-friendly broadcasting hours, they are exposed to a continual stream of advertisements for sweets, chocolate, and sugar -laden cereals. This aspect of media functioning supports the food industry in contributing to a significant effect on future problems with eating and weight.

The media does not influence eating patterns or self-esteem in an exclusively negative fashion. Broadcast and written media can be a source of valuable information on health and well-being. In addition, awareness of eating disorders, through magazines, articles, online activity and television programmes may educate people about the danger of abusing food and may help to make sufferers aware that they have a problem and they are not alone. In this respect, the media may be useful: firstly, arguably in health promotion for the public at large; secondly, in the arena of primary prevention. Health promotion seeks to nudge the public into healthful behaviours or attitudes. But the use of algorithms shows that targeted advertising to vulnerable groups works better than broad exposure. Primary prevention is defined as an activity designed to eliminate or render ineffective, factors involved in the causation of a disorder and an activity designed to strengthen the host against noxious influences. There have been eating disorder awareness campaigns, but these seem ineffective in reducing the incidence of eating distress and eating disorder stigma. From this definition, it appears that the media both opposes and contributes to health promotion and primary prevention.

It is suggested that the media might respond to its critics in the following ways;

• Present a greater variety of body shapes and sizes in photos, in the music industry, as television presenters etc.
• Should discourage dieting
• Should assist people with an influence on young people (such as parents, teachers) from making weight an issue
• Provide positive overweight role models
• Should not glamorise celebrities who lose weight or be critical of those who gain weight
• Changes like these would take a while to filter down through society before any significant shift in attitudes could be achieved.

Would all this work anyway? There is no guarantee. There is a larger dynamic behind cultural trends, which drive behaviours, values and attitudes. There is some media sensitivity toward helpful trends such as a body positive movement trending online in the second decade of the millennium.  The media does create useful trends as well as mirroring values which already exist. The media is increasingly part of a global culture and the bad news about this is that the trends across the developed world are consistent in their glamorisation of slenderness, fitness and youth as a feminine, and now a masculine ideal. Despite recent movements such as Fat Acceptance and the Health at Every Size movement, it is hard to find an individual who would aspire to a high BMI.

Conclusion

Young people with poor body image and poor self-confidence need guidance and mentoring regarding their use of social media.  Here are some of the things we recommend (acknowledgement Maudsley) and there is an expanded version of our Guide to Use of Social Media on this website

• Do you use an App to monitor your eating habits or activity levels? Do you feel like a bad person is you don’t do 10,000 steps a day? What effect do you believe this has on how you feel each day? How much stress do you think this gives you? How do you imagine people even functioned when social media wasn’t around?
• If you want to use less of these checking Apps, you might like to try some of these things
• Limit how long you will access your apps during the day. First see how much time you are spending online, then set a time limit – like once every 3 hours.
• Set a limit on how much time you spend on your App. Say, 5 minutes each time.
• Find a way to distract yourself when you have an urge to access your App.  See if you can postpone the time between the urge and the behaviour.
• Increase the time between checks. Try to get it down to once per day or once per morning and once in the evening.
• Reward yourself if you manage to reach your App reducing goals and targets.
• Try leaving your phone at home when you go out and have fun in other ways. The sky won’t fall down.
• Agree not to open an App or look at an eating or fitness blog after 9 pm.
• Remove temptation, why not delete any apps from your device that you really know are causing you stress or making you feel bad about yourself.
• Notice the effect on your mood and anxiety of using a food or fitness app. Notice how you feel when you take a break from it.
• Expect to feel some anxiety at first, but you can expect to feel much better in a short time.