Eating Disorders and “To the Bone”: What You Need to Know

On July 14, Netflix released a new show entitled “To the Bone”, a fictional story about eating disorders. It depicts a 20-year-old girl with an eating disorder. As her symptoms become extreme, she becomes medically unstable.  Soon after, she goes into residential treatment to get treatment and gain control over of her eating disorder.

Though the topic is controversial, producers hope that “To the Bone” can do for eating disorder awareness what the series “13 Reasons Why” did for adolescent mental health and suicide. Ideally, the show will promote a conversation about eating disorders and effective methods of treatment. However, mental health professionals caution people who are vulnerable to eating disorders to be mindful while watching. Shows like this can trigger people by watching the glorification of such a serious mental health condition. As parents, we should be prepared to have informed conversations with our children. I’ve outlined ten things you should know about eating disorders and treatment and provided links to reputable sites related to eating disorder awareness and treatment options.

10 things you should know about eating disorders:

There are several different types of eating disorders: Anorexia, Bulimia, Binge Eating Disorder and Avoidant/Restrictive Food Intake Disorder.

• Anorexia Nervosa (AN) is a restriction of caloric intake relative to requirements along with an intense fear of gaining weight or becoming fat.
• Bulimia Nervosa (BN) is episodes of binge eating (consuming large quantities of food with a lack of control) and purge behaviors (vomiting, laxatives, or extreme exercise) to compensate for binge eating episodes.
• Binge Eating Disorder (BED) is consuming large amounts of food is eaten rapidly not necessarily due to hunger and often to the point of discomfort. People with BED experience significant guilt, embarrassment and shame, but there are no compensatory behaviors.
• Avoidant/Restrictive Food Intake Disorder (ARFID) is extreme picky eating to the point that an individual has a nutritional deficiency and may rely on nutritional supplements.

Eating disorders are not just about food, weight, and body image.

There is evidence that eating disorders begin as a manifestation of perfectionism, anxiety, and the need to control things. For some kids, what, how and when they consume food is one of the only things they have control over. If eating disorders were strictly about food, the treatment would be simple: eat. However, eating disorders are usually a complex web to untangle.  There is often a secondary mental health diagnosis occurring at the same time such as anxiety or depression. 

Eating disorders can happen in any phase of life and to anyone.

“To the Bone” features the stereotypical (read: white, middle-class, high-functioning, 20-year-old female) individual with an eating disorder. Eating disorders can occur in both females and males and can develop at any age, from elementary age children to adults in middle-age and beyond. Eating disorders primarily occur in young females, but individuals of all ages may have certain risk factors.

There are risk factors to be aware of.

Some risk factors are: a personal or family history of anxiety, depression, obsessive-compulsive behavior, impulsive behavior, adolescence, addiction, food allergies, and Type-1 Diabetes, for example. Reach out to your doctor who can provide an assessment and refer you for treatment, if necessary. 

Social Media can perpetuate eating disorders.

Instagram, Pinterest, and Snapchat exist to connect individuals who have something in common but this can backfire when people with eating disorders connect via social media. Users share dangerous techniques, compete with one another, and offer validation, which can  seem to normalize destructive eating disorder behavior patterns. Social media responded by offering resources to users when a word or phase that might be considered glorifying eating disorders is searched.  A waning pops up on the screen to provide helpful resources. Terms to watch for are “pro-ana”, “pro-mia” (pro-anorexia and pro-bulimia, respectively) and thinspiration “thinspo”, among others.

Not everyone with an eating disorder is extremely thin.

It is an unhelpful stereotype that all people with an eating disorder are a certain size or body type.  People of all sizes can suffer from an eating disorder. The harm is that people who are in desperate need of treatment may not seek help because of the association that you must be extremely thin to actually have an eating disorder.

Not everyone who is extremely thin has an eating disorder.

Alternately, another unhelpful stereotype is that everyone who is very thin must have an eating disorder. Labeling and judging another person’s body objectifies them and can have dangerous implications for their mental wellbeing.  So called “thin-shaming” can be just as destructive as “fat-shaming”.

Eating disorders are very treatable with psychotherapy.

Individual, group and family therapy are the best modes of treatment for eating disorders. Common theoretical approaches are Cognitive Behavioral Therapy (connecting thoughts, actions and feelings to create change), Dialectical Behavioral Therapy (seeking a balance of  acceptance and change), and The Maudsley Method (including family members in the recovery process). People with eating disorders benefit from regularly scheduled therapy sessions. If symptoms are not severe, outpatient therapy may be appropriate. However, residential or inpatient treatment may be advised if symptoms have progressed.

Your health insurance will probably cover the cost of treatment.

Medical health insurance covers eating disorders and other mental health conditions in a similar manner as physical health concerns. Eating disorders are classified as mental health conditions, so therapy, counseling, and nutrition guidance will be covered by medical health insurance. Inpatient treatment or residential care might be a covered benefit, but be sure to  verify benefits and receive authorization from your insurance company.

By establishing and modeling a healthy body-image, parents and caregivers can provide protective factors to our children.

By now we know that mothers have a huge influence on the health and wellness of our children. Be sure to speak kindly and appreciatively about not just your body, but your child’s body as well. Don’t stop when they become adolescents. Keep encouraging wellness and health over thinness and respect for nutrition over dieting.

Check out the following links for more information:

ED Hope 

Walden Behavioral Care

NEDA

Project Heal