How many times have you looked at yourself in the mirror? Hundreds, thousands, and maybe a million times you have seen your image when you wake up, go to the restroom, brush your teeth, and wash your face before bed.
You notice yourself growing up, getting older, and changing before your eyes. Adding to these changes is the fact that life is stressful in a different way than it was 20-30 years ago. We didn't have social media popping up with the latest trends, news, celebrity information, and personal opinions like we do today. 20 years ago if you said you didn't have a cell phone you could and would be okay; now it's a different story, not having a cell phone might lock you out of access to many things in society.
These little machines that we carry in our pockets hold so much power over how we function from morning to night, they tell us when to get up, what meeting is next, not to forget to pick up the kids, give us directions to things, access to facts and manage our self-image.
It is estimated that on average people globally spend about 4-5 hours per day on their cell phones and the typical user spends about 2.5 hours per day on social media, according to DataReportal. That's 864 hours a year of scrolling through apps, equivalent to 36 days or a little over a month. When we extend this timeframe throughout a lifetime, the numbers become even more staggering.
It’s no wonder that with us spending so much time with our heads down looking at screens emotional and mental health has taken a nosedive.
Being bombarded constantly with images of people on social media looking perfect, traveling the world, and living their best lives has built up insecurity in many people about how they look, how important they are in the world, and if they can meet the “marks” that other successful people are achieving.
Absorbing these messages that we are given in society has caused a culture of “self-induced pressure of perfection” that is unsubstainable. The fallout of this has manifested in a global mental health crisis that spans young and older generations.
One of the consequences that is often seen in many communities is a rise in eating disorders due to people trying to achieve the standards they see set by the beauty industry and social media. Global eating disorder prevalence increased from 3.4% to 7.8% between 2000 and 2018. (The American Journal of Clinical Nutrition, 2019) 70 million people internationally live with eating disorders. (National Eating Disorders Association) Due to the rise in the prevalence of the problem almost half of all Americans know someone with an eating disorder. (South Carolina Department of Mental Health)
To explore and learn more about the world of eating disorders, I had the pleasure of interviewing Dr. Kelli Rugless who is the Chief Clinical Officer at Project Heal. Dr. Rugless is a Certified Eating Disorder Specialist (CEDS) and received her doctorate in health psychology (Psy.D.) from Loma Linda University. She has had the unique experience of working with the full spectrum of eating disorders from young children in intensive feeding clinics with Avoidant Restrictive Food Intake Disorder (ARFID) to teenagers and adults struggling with Bulimia Nervosa, Anorexia Nervosa, and Binge Eating Disorder. She had the honor of developing the first Family-Based Treatment oriented medical stabilization program and outpatient eating disorder clinic at UCLA before opening her private practice, Flourish Psychology, which specializes in women’s mental health.
My Interview with Dr. Kelli Rugless
Project HEAL (Help to Eat, Accept, and Live) is a nonprofit organization in the U.S. focused on equitable treatment access for eating disorders. Project HEAL is the only major direct service nonprofit in the U.S. focused on equitable healthcare access for people with eating disorders. The organization's mission is to break down systemic, healthcare, and financial barriers to eating disorder treatment. The mission is delivered through four core Treatment Support programs: Insurance Navigation, Treatment Placement, Cash Assistance, and Clinical Assessment. Project HEAL is also active in research, education, and advocacy at the national level. The organization's vision is that everyone with an eating disorder has the resources and opportunities they need to recover.
According to Project HEAL, a typical treatment episode costs an average of $80,000, and full recovery can take years totaling around $250,000 total. Due to exorbitant costs, inadequate insurance coverage, and systemic bias within the eating disorder treatment system, only 20 percent of the 30 million Americans suffering from eating disorders receive treatment. Beneficiaries can apply for treatment support through the organization's website.
What is an eating disorder?
The term eating disorder is an umbrella term that describes any disruption in a person's relationship with food and their body. It is not specific, but it just says, this person struggles with their relationship with food in some way.
The vast majority of folks believe that if you have an eating disorder, you have to be extremely thin, and that is a subgroup of people with eating disorders, but it's certainly not the majority. The majority of folks who have an eating disorder will look like normal-sized individuals or will look to be heavier than what you might consider normal. It is not just about not eating, it's about how you feed yourself.
What Causes Eating Disorders?
Though we don't exactly know how they come about. We know it's a combination of genetic and environmental factors sort of coming together in a perfect storm. If your family member or a loved one has struggled with an eating disorder, a family history might be a valuable indicator.
Also, the experience of trauma. Trauma affects those ACE scores, which rate adverse childhood events. We’ve found that there's a link between how many adverse childhood events a person experiences and their likelihood of developing an eating disorder.
Then we've got to also think about cultural influences. So being in a cultural environment where unrealistic beauty standards are uplifted and an idea of universal beauty that is very narrow where only so many people can be considered beautiful, that's going to put you at risk. Being in that type of environment and, not fitting that mold is going to put you at risk for a negative body image.
I think another important risk factor for eating disorders is weight stigma. On one hand, you have unrealistic beauty standards being problematic, but also this idea that being big or being bigger than what's considered typical is terrible and that it's going to be the worst thing ever, that you're going to be shunned socially and that you won't be able to shop in certain stores anymore and face discrimination because of it. Weight stigma is also a huge risk factor for folks developing eating disorders, so we don't know exactly what causes them, but we do know that if you've got a history of trauma, a family history of eating disorders, in an environment with a lot of unrealistic beauty standards where there's a heavy amount of weight stigma, those things are going to create a breeding ground for an eating disorder.
How Do You Identify an Eating Disorder?
Some identifiers are going to be someone who is preoccupied with food. Preoccupation, meaning it influences every decision that they make. It determines whether or not they're going to happy hour by how much they've had, and if they've already eaten enough, or they're thinking about what they're going to eat on Friday when it's only Tuesday. When you say it's time to go out to a restaurant, they want to look at the menu first and check it out before they get there.
A preoccupation with food or a really big shift in someone's relationship with food is usually a sign that something is up and that they might have some challenges. Another issue is that if you notice that they are struggling with their health if they have a major health concern related to food and body, but they seem to minimize it.
Doctors might be recommending either weight loss or weight gain or something like that, but they seem to say, no, it's not a big deal. I'm fine. People with eating disorders often lose sight of the seriousness of what they might be dealing with.
I think it gets a little bit challenging to talk in generalities because each eating disorder is unique. So with anorexia nervosa, you're going to have someone who thinks they're larger than they are and seems to be preoccupied with their imperfections at times, or certain body parts being larger than others. With bulimia nervosa, you might find that your loved one often leaves after eating and maybe goes to the restroom and spends longer than you want, or it's someone who eats a muffin and says, oh, I've got to get to the gym. I've got to run this muffin off. There's this idea that whatever goes in must come out or I must earn my right to eat certain things.
When someone goes to the restaurant and there's a variety of different options on the menu but chooses to just eat bread because that's the only thing that they like, and they go hours in between meals because they can't find exactly something that suits their taste or the texture's off. Something's always wrong, and it makes it hard for them to eat. Then with binge eating disorder, you might find someone who really wants to eat alone and who doesn't like to eat in front of other people and often finds ways to eat. Everyone's sitting at the meal and everybody else is eating, and they're only eating a little bit and do not like to eat in front of other people.
Why Do Most People with Eating Disorders Not Get Treatment?
Generally, there's not a lot of training in the healthcare industry on eating disorders. The other aspect is that within the training, unfortunately, diet culture has had a really heavy influence on how we view health and how physicians are taught to look at weight and certain measures that are used like the BMI that is racist in origin and not particularly indicative of health at all. Those are still very regularly used in everyday treatment. That creates a world where providers who are not trained can cause harm.
You could go in with an eating disorder and tell them, “Hey, I have an eating disorder,” but if by their standards you look fine, they might tell you, “Oh no, you're fine. Don't worry about it.”
I've had plenty of clients tell me that they went to a provider and said, I've got this issue and they were told they don't. So that's also another reason why folks aren't getting treated. Providers don't have the ability or the training to diagnose it, or even when clients go in and say, I have this problem, they're not getting recommended, they're not getting the proper treatment recommended at all.
How Does Society Encourage Eating Disorders?
I think social media is a huge contributing factor to the development of eating disorders. Social media is a world where you can present yourself the way you want to, and that image might not be accurate. That image might not be reflective of how you actually look, but for the person looking at the screen, it's hard to remember that most everyone is posting their highlight reels and that most everyone is posting images that are touched up or images that have really good and natural lighting that hides marks and imperfections.
Everyone is looking thin, and it makes us feel bad. Almost every research study that's been done on social media has found that the more time you spend on it, the more anxious and the more depressed you feel.
When it comes to body image, an important part of developing a healthy body image is seeing a wide variety of bodies, seeing them in all of their natural glory, and becoming desensitized to the fact that stretch marks are normal and cellulite is normal, and acne is normal, and acne scars are normal.
How Does the Body Positivity Movement Help or Hurt Eating Disorders?
The body positivity movement has been extremely helpful for people who are dealing with eating disorders and hopefully preventing folks from ever developing one. The ultimate goal of the body positivity movement has been to give folks permission to enjoy themselves and enjoy life regardless of what type of body they have.
For such a long time, our society gave the message to people in larger bodies that they shouldn't wear certain things and they shouldn't go out in public, and they shouldn't be seen doing certain things and almost basically shunned them and said, well, until you get the right body, you need to stay over here in obscurity.
The body positivity movement has shown that is not true. That it is possible to live full, happy, healthy, and exciting lives in every type of body, and that every type of body should be allowed to live their life to the fullest.
Do Eating Disorders Affect Everyone?
One of my passions within working in the eating disorder field is working with marginalized communities. There's the stereotype that everybody with an eating disorder is thin, but there's also the stereotype that everybody with an eating disorder is cisgender white or a girl, and that's not true.
In terms of Black people and people of color, we don't have a lot of data out there. On one hand, we know that eating disorders affect everybody from all ethnic groups and all socioeconomic statuses equally, yet the vast majority of the eating disorder research is focused on people who are in treatment centers, and the vast majority of treatment centers are filled with that stereotype. So, it's sort of like a never-ending cycle where the data only looks at the group that's in treatment, and the only group that's in treatment looks a certain way.
What we know from the few studies that have been done is that Latino and Black teenagers are 50% more likely to experience the symptoms of bulimia than their white teenage counterparts. We know that regarding binge eating disorder, the rates of binge eating disorder in Black people are equal if not more than what they are in white people. Black people are struggling with their relationship with food and struggling with their relationship with their bodies. If you think about the historical harm that's been done to communities of color, it makes sense that these groups would struggle with body image and struggle with how to feed themselves. When you think about the history of Jim Crow, it didn't just affect Black people. Sometimes we think Jim Crow is only about African Americans, but colored covered anyone who was not white.
It impacted everyone. While Black people were harmed probably more than everybody else, a lot of folks were considered colored and did not have access to a lot of different things during that time. So, my work has been to educate people, raise awareness, and treat folks who you wouldn't imagine have eating disorders, because eating disorders can look a little bit differently in each marginalized community, depending on what the beauty standards are, depending on what the cultural rules are around food.
Another group often overlooked is men and boys and though they don’t make up the majority of the general population in the eating disorder community, they are a marginalized group. For a long time to be diagnosed with anorexia, for example, that diagnosis used to require a missed period. That left a lot of men out of the conversation and unable to even get that diagnosis.
There's a lot of work that we still have to do to make sure that our systems that are in place can accurately diagnose these conditions across different groups where it might look and present slightly differently than how it presents in the groups that have mostly been studied.
How Can Families Help Children and Teens with an Eating Disorder?
Recommendations that I have for parents of young children is to delay regular social media use and exposure as long as possible. I understand that it is a big part of young people's social experience, but there's just no denying the harm that it does. So I would honestly recommend that if you have young children who are not yet on social media and are asking for it, delay it. Young kids and teenagers are in a stage of development where they're trying to learn about themselves and understand who they are, and social media just provides too much outside feedback into a process that should be singular and should be done with close friends, family, and people that know them.
Then I also encourage parents to be mindful about the way that they talk about food and the way that they talk about the body, and that goes for how they talk about their bodies, how they talk about their own food goals. Children are going to listen to what you say about yourself, and they're going to internalize it as a way they view themselves.
As a parent, if you're always talking about losing weight or the next diet or how terrible you look, you might think that's harmless because you're talking about yourself, but your children are learning by example how hard or gentle they should be on their body, how critical or accepting they should be about their body. Use the same goals for how you talk about food. If you've got strong black-and-white rules about this food is healthy and this food is bad, and this is junk food your children are going to internalize those rules, and they might not be able to apply them in a nuanced way and having such rigid ideas about food and health could also put them at risk and contribute to the development of an eating disorder.
Talk about what your body does. Remember to always focus on all the things that your body does regularly. Try to compliment your children on their strength and their speed and on other things that their body is doing besides their appearance. It's not to say that you can't tell your children that they're beautiful or that they're attractive, but it is to remember that the world is going to do that for them. The world is going to focus on the superficial way more than it focuses on anything else.
If you in your home can make sure that you're focusing on the function of their body and their other personality characteristics that you think are valuable, that that's going to go a long way towards building out their sense of self and making sure that body image doesn't play a huge role in how they view themselves and in their overall self-esteem.
What Does a Healthy Relationship with Food Look Like?
A healthy relationship with food is one in which we can see food as the multi-dimensional thing that it is. Food is fuel, it's nutrition, and it's a necessity for living, but it's also a way to connect with others. It's a source of joy. It's also a source of comfort.
I think having a healthy relationship with food is knowing the basics, understanding nutrition so that you know what you're eating and why you're eating it, and how your body uses it and needs it, and then allowing that to be the foundation of how you make your choices. In addition, you're able to listen to your body. You're able to honor cravings, able to honor the fact that it's a social engagement, and “I'm going to eat birthday cake” because it's a birthday and all foods fit.
There is no right or wrong or good or bad. All foods have value, all foods have nutrition, and it's just a matter of us having a basic understanding of what balance looks like and what our body needs, and being able to honor our hunger and fullness cues and what our body is saying to us.
A healthy relationship with food is a healthy relationship between the mind and the body.
About Project Heal
In the United States alone, 30 million Americans are suffering from an eating disorder, and that only includes those who receive a formal diagnosis. Despite this prevalence, less than 20% of people with eating disorders ever receive treatment. The other 24 million cannot access the care they need due to insurmountable financial and insurance barriers, in addition to pervasive systemic oppression and bias. These barriers have serious consequences: eating disorders are the second most fatal mental illness (after Opioid Use Disorder), with one person dying as a direct result of an eating disorder every 52 minutes.
Project Heal’s mission is to break down systemic, healthcare, and financial barriers to eating disorder healing.
Project HEAL was founded in 2008 by Liana Rosenman and Kristina Saffran, who had met while undergoing treatment for anorexia nervosa. In honor of their work, Rosenman and Saffran were named to the 2017 Forbes 30 Under 30 Social Entrepreneurs list. Also in 2017, the organization partnered with the producers of To The Bone, a film about anorexia that was released worldwide on Netflix in July 2017.
Since its inception, Project HEAL has helped hundreds of people access treatment and is spearheading a movement to reform and transform the American mental health care system to work for everyone, not just the privileged few.
About The Author
Annmarie Hylton, Head Marketing Strategist and Content Developer at Project Good Work, a boutique marketing group focused on helping individuals who want to launch social impact projects, charities, and change-making initiatives. The marketing group works to develop branding, marketing strategy, and content to connect clients with the people who believe what they believe so that their project and business can thrive.
If you have a passion for an unserved community, a social justice problem, or want to change minds, contact Project Good Work at ProjectGood.Work to start your project of change today.