The sky is (not) falling: Setting the record straight on the so-called eating disorder epidemic

Eating disorders can be a popular topic in the media, especially when they have to do with celebrities. They are usually filled with gasp-inducing statistics, a stock photo of an empty dinner plate, a bathroom scale, a tape measure, and/or a thin young woman in her underwear, possibly with scale or tape measure.

It’s not just celebrities, these stories warn us. No, no, no. Increasing numbers of young girls (AND BOYS!!!) are also starving themselves to fit into society’s ever shrinking ideal body image.

Several appeared this week:

Exclusive: Eating disorders soar among teens – and social media is to blame (The Independent- UK)

The university food fight: Eating disorders boom on college campuses (FoxNews.com)

They were both so wrong on so many levels that my first thought was “I can’t even…” Then I realized that I can even, and channeled my swear-word filled thoughts into something a little more PG-13.

It’s hard, sometimes, to see where these stories go wrong. On the surface, they look legit. Dig a little deeper, though, and you will see the flaws come out. So let’s unpack some of these stories.

Are eating disorders actually on the rise?

As much as many eating disorder non-profits might benefit from sounding the alarm that eating disorders are skyrocketing and all teens want to starve themselves to look like models, what the data says is actually quite different. Since the 1970s, diagnoses of anorexia nervosa have remained stagnant, at about 1% of the female population (data on males is much more sparse). Rates of bulimia appeared to increase in the 1990s and then leveled off, even appearing to decline slightly (Sminck, van Hoeken, & Hoek, 2012).

The diagnosis of EDNOS is increasing in the UK (Micali et al., 2013), but it’s not clear whether more people are actually developing EDNOS or physicians are more aware and more willing to give them the diagnosis. As my epidemiology professor loved to tell us, “You tend to find what you’re looking for.” If you’re not looking for EDNOS, you probably won’t find it.

I don’t know about how binge eating disorder has changed over time. Like EDNOS, awareness and diagnosis has certainly increased, but it’s not clear whether more people have BED now than they did a decade or two previously.

Look for data on eating disorders in college students and you might think that all these young people do is starve, binge drink, and hook up. Um, no. Look more closely at these statistics and you will see things like “91% of women surveyed on a college campus had attempted to control their weight through dieting. 22% dieted “often” or “always,” or “25% of college-aged women engage in bingeing and purging as a weight-management technique.” Not that these things are good, but this doesn’t mean that all of these women have an eating disorder.

The story in The Independent got their data via an “exclusive” report via ChildLine, a phone-in mental health support service for children and teens. The data from ChildLine showed a 110 percent increase in the number of children and teens seeking help for EDs in the past three years.

Here’s what The Independent says this means: the number of children and teens with eating disorders has increased 110%

Here’s what we can actually conclude from the data: 110% more young people are calling ChildLine for help about EDs. Maybe eating disorders are increasing, or maybe more people are just utilizing the service. Did inquiries on other disorders also increase? We don’t know. Sine they didn’t assess this, we can’t know. Our ability to conclude anything beyond the increase in the number of people phoning ChildLine is impossible.

The story about college campuses is even worse: they cited information from the National Institute of Mental Health saying that 25% of college students had an eating disorder. Except I couldn’t find anything on the site that said that. The other statistic, which I tracked down via a report on collegiate eating disorders by the National Eating Disorders Association, actually referred to a study on disordered eating, NOT eating disorders.

So are eating disorders actually increasing? Maybe. Maybe not.

Is social media to blame?

This is one of the problems with eating disorders: everyone thinks they’re an expert. We all have our theories as to what causes eating disorders. With an increase in the use of social media, it’s probably not surprising that people are linking it to eating disorders. The question is what do we actually know about social media and EDs?

Answer: not much.

Can social media play into an eating disorder or disordered eating? Absolutely. But there’s a huge gap between that and “social media causes EDs.” 

There was a study published in the last week or so that found regular Facebook users to have higher rates of disordered eating, but that does nothing to tell us about cause, nor about eating disorders. It could be that people with higher disordered eating are more likely to use Facebook to socialize (you can be “invisible,” no one to make you eat, etc). It could also be that the social insecurity and perfectionism that might make someone susceptible to an eating disorder also increases their search for validation about appearance, grades, etc, from peers.  Nor does disordered eating mean an eating disorder. The two terms sound the same, but they’re quite different.

In the end, we don’t know enough about what the prevalence of eating disorders were or are to make any valid comparisons, nor do we know much of anything about what causes, triggers, or precipitates an eating disorder. On the surface, they sound valid, and that’s the danger. If we said pocket lint caused an increase in EDs, we’d all be “Wha….?” Keep that attitude with all stories you read about EDs, because you’ll need it.

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12 Responses to “The sky is (not) falling: Setting the record straight on the so-called eating disorder epidemic”

  1. I think media is actually making all of this worse. They say this or that causes eating disorders but typically they are incorrect. If I have learned one thing about eating disorders it is that every single case is different. To put a cookie cutter diagnoses and/or treatment plan on an eating disorder is simply foolish.

  2. Seems to me there is a danger here: emphasising the importance of being critical/careful (as a scientific writer knows how to be) but possibly distracting readers from facing the real problems at hand.

  3. It seems to me that the articles themselves are no better or worse than most popular articles on the subject. Non-expert journalists feel the need to write a story on a subject, and for better or worse they go ahead and write one. But in so many cases like this, it seems like they bring in someone other than the original author to write the attention-grabbing headline !

    Perhaps that’s simply one of the realities of pop journalism these days, but one would hope that if these headline writers actually were getting degrees in journalism, a class in the critical assessment of statistics and research methods would be a part of their curriculum.

    • I am a journalist. I had to take a statistics and research class when I got my degree from Purdue. There was definitely a reason for that. There’s no excuse for this type of irresponsible reporting, except straight-up laziness.

  4. What really annoys me about all of this is that it risks ploughing what limited resources there are into some “fad” research or prevention approach because the media has decided that Facebook “causes” ED or something similar. There’s little enough research out there without it being distracted by an over-enthusiastic press lobby, looking for a good helpline.
    Oh, that, and it perpetuates all the myths about the origins of EDs which makes it SO much harder to talk to my GP…

  5. *headline*
    Wretched auto-correct….

  6. Excellent, balanced and reasonable article. Exactly what is missing from a lot of media reporting. I think eating disorder, addiction, depression and anxiety are buzz words at the moment (I don’t mean that in a flippant way at all) and so stories involving these get thrown about with very little regard to facts. I feel your assessment that facebook feeds the isolation associated with eating disorders as well as sufferers’ insecurities and yearning for approval is the most logical interpretation of the situation.

  7. Thanks for setting the record straight. We need a lot more science literacy in reporters and in readers.

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