Shockingly, more than two-fifths of girls between first and third grade want to be thinner and more than eight in ten fourth graders are scared of being overweight(1). With these fears starting so young, it is not surprising that by the time they reach high school, 11% of students have a diagnosed eating disorder. However, young girls are displaying signs of disordered eating long before they enter high school, with those as young as seven following diet and exercise plans passed around the playground, often before they can even spell “diet” or the foods included in the regimens. Just one example is a fourth grade student who started to develop a more natural figure after quitting a grueling gymnastic schedule(2). What started off as cutting out high fat and sugar snack foods developed into a highly restrictive diet over the next six months, which in the end consisted only of salad and was combined with obsessive exercising, resulting in the loss of a quarter of her body weight in just a six week period and clinical signs of starvation.
So what is driving this anxiety around body image that now develops at an increasingly young age? Girls are bombarded with images in the media of ultra slim women and society expects women to be thin. Even though such a small proportion of women naturally possess this figure, teens and tweens are in pursuit of this unobtainable goal, placing their physical and mental well-being at risk in the process. At a time when some of them should still be playing with toys, they are literally starving themselves to death, but it may be the likes of their Barbie dolls that are triggering their eating disorders.
Barbie as a Dangerous Role Model
If Barbie was transformed into a real-life model she would be 5’9″, have a 36″ chest, 18″ waist, 33″ hips and her percentage body fat would be under that needed for menstruation to occur(3). Although Mattel claimed that the bulky elements of Barbie’s clothing gave her a more natural figure, stripped bare this is a very dangerous figure girls are trying to emulate. More worrying still was the Slumber Party Barbie from the 1960s that came complete with scales displaying the permanent value of 110lb and a book entitled “How to lose weight,” which only contained the phrase “Don’t eat”(4). Barbie remains the most popular doll for girls(5), so from a very young age this means they are shown an unrealistic image of a woman’s body.
Research published in the International Journal of Eating Disorders showed that to achieve Barbie’s figure, on average women would need to gain 24″ in height, 5″ to their bust and 3″ to the length of their neck, while losing 6” from their waist. While such dimensions are obviously unachievable, young girls are still trying to attain this figure and it seems that their exposure to Barbie really does drive their desire to be slim, as demonstrated by an article in Developmental Psychology(7). Researchers found that girls aged 5 to 8 who were shown a Barbie doll were more likely to have lower self-esteem and want to be thin than girls shown a more realistic size 16 doll.
Models Far from Average
The desire to be thin is the number one wish of 11 to 17 years old girls(8), but why do they want this so much? The answer may lie in the fact that they spend so much time reading glossy fashion magazines, which not only display images of highly slender models, but also numerous adverts for weight loss regimens and diet products, which are far more prevalent than in magazines targeted at men. As 83% of teen girls read these magazines for around four hours each week(9), this teaches them to wrongly question their body and whether it meets the ideal portrayed by these publications.
Eating disorders commonly categorized as anorexia, bulimia and binge eating disorder are extremely common. Most theories and treatments focus primarily on symptoms, behavior and thought modification whether through dietary or psychologically focused strategies. However at Bayside Psychotherapy in Melbourne, Australia, the clinical focus is less on food and more directed towards body image and the unique causes behind problematic relationships to such bodily experiences or representations.
While the average American women weights in at 166lb, is 5’3″ and has a BMI of 33, this is very different from the average fashion model. Even Miss Indiana from 2014’s Miss America, who was praised for looking more “normal,” still had a dress size of 4 compared to the average of size 12 or 14(10). Unfortunately, the painfully thin bodies of models are used to advertise clothing that women are told are must have and they only believe they can carry them off well if they change their body to resemble that of the models they see wearing the same clothes. This is particularly unrealistic, as even though the average BMI of American women has increased, the size of models has decreased, with many showing evidence of malnutrition and meeting the diagnostic criteria for anorexia nervosa. Indeed, a weight 15% below that expected aids diagnosis of anorexia(11) and models often have a body weight approaching 20% below that expected.
It seems that these unhealthy images of models have a direct impact on the development of eating disorders, as women receiving outpatient treatment for anorexia reported comparing their body to those shown in fashion publications, knew which characteristic they wanted to emulate and cut out pictures of models to motivate their weight loss(12). Many women don’t appreciate how it is virtually impossible to achieve the figures they are shown in magazines, which are often edited and this photo retouching puts them further out of reach. Common tricks include digitally pinching a waistline and thinning down thighs so that models appear just like Barbie. At the same time it is not uncommon to touch up ribs so they seem less prominent, making women oblivious to the fact that to achieve this look the models are actually emaciated. Thankfully, some celebrities speak out about the unrealistic editing of their shots; notably, the slimming of Jessica Simpson’s hips so that one disappeared altogether and the narrowing of Kelly Clarkson’s arms and shoulder. Seeing such images even women without a history of disordered eating start to feel less confident about their bodies and it is no wonder that women with eating disorders constantly try to be thinner.
Negative Effects of TV on Body Image
Before the introduction of TV to Nadroga in Fiji in 1995, there was just a single case of an eating disorder in the province, as a fuller body shape and hearty appetite was still valued as part of their traditional culture. However, in as little as three years, almost seven in ten teen girls in the province started dieting and almost three-quarters felt dissatisfied with their weight, with more girls showing characteristics of disordered eating by 1998(13). More than 80% of the girls admitted that seeing TV changed their opinion of their bodies and they wanted to appear more like the figures they saw on TV shows, particularly as they felt this would make them more successful.
It is certainly true that 95% of female characters in sitcoms are of recommended or below recommended weight(14), even though just one in three American females in reality achieve this(15). What is more worrying is that larger characters are more likely insulted, which gives the impression that women are not valued unless they have an attractive figure.
Normalizing Disordered Eating
Many women with an eating disorder don’t see themselves as suffering and that in the pursuit of a desirable figure nothing can be considered too extreme. This is so much so that women who promote bulimia or anorexia as a lifestyle choice motivate each other and share tips that can only be considered as starvation to an outside observer. While many pro-anorexia websites and forums have been taken down, members now use social media to interact, as this is much harder to regulate.
The way in which these groups make disordered eating habits seem so normal means that even women who visit the sites just once are at risk of changing their eating habits. For instance, research reported by the National Association of Anorexia Nervosa and Associated Disorders highlighted that just one visit to such a site led to significantly reduced calorie intake, which continued for a three week period(16). This was among girls with no history of eating problems, so these sites are an even more dangerous influence for young women already struggling with disordered eating.
As unrealistic body shapes are typically portrayed by the media as the norm and women are led to believe this is desirable at no matter what cost, it is easy to see why many young women risk their health and even their life in pursuit of this, with just some of the complications of eating disorders including hormonal changes, osteoporosis and organ damage(17). Although the road to recovery with an eating disorder is often long, with specialist treatment it is possible to resume a healthy relationship with food and return to a healthy weight. However, it is preferable to prevent their onset, so increasing awareness of the distorted images of women’s bodies that are all around us is vital to reduce the poor self-esteem that ultimately leads to disordered eating.
The Link with Substance Abuse
Even more dangerous than an eating disorder alone is when it occurs in combination with an addiction to alcohol or drugs. There is indeed evidence of an increased prevalence of substance misuse among eating disorder sufferers, particularly those with binge eating disorder and bulimia. For example, once diagnosed with binge eating disorder the lifetime risk of alcohol or drug abuse is 25%(18), while as many as 40% of people with bulimia also suffer from substance abuse(19). Rates of heavy drinking and drug taking are highest among bulimics who binge and purge, leading to addictive behavior, and while rates of substance misuse are overall lower among people with anorexia, those who restrict their food intake most severely are at greatest risk.
There are certainly characteristics shared by eating and substance misuse disorders, which helps to explain why the two conditions often co-exist. For instance, they both involve urges to abuse the body, the same way that drugs like oxycontin have devastating effects on our bodies.these behaviors give sufferers a mental kick and both habits can take over causing victims to neglect other aspects of their life. It is also likely that they share similarities in the way that the reward pathways in the brain reinforce the destructive habits of disordered eating and substance misuse. Often the sufferers of either disorder share similar traits as well. Examples include feeling anxious in social situations and being more prone to depression, with people often seeing dietary restrictions and rules, and addictive substances like cocaine, as a way to temporarily improve the way they feel. It has also been suggested that both groups suffer from an addictive personality, which makes it logical that an addiction to habits related to eating could lead to alcohol or drug addiction, or vice versa. There is even evidence that food addiction is more common in eating disorders(20), especially in bulimia, making the link to other addictive substances even more plausible.
To promote lasting recovery it is essential that both disorders are diagnosed and effectively treated, as managing just one without the other increases the risk of relapse. Seeking specialist addiction help with a dual diagnosis is therefore vital.
Resources:
1 “Eating disorder statistics,” North Dakota State University, accessed November 10 2014
2 Margaret Renkl, “The scary trend of tweens with anorexia,” CNN, accessed November 10 2014
3 Yona McDonough, “Barbie doll,” The New York Times, accessed November 10 2014
4 Ryan Grenoble, “Slumber party Barbie diet book from 1965 offers troubling advice,” Huffington Post, accessed November 10 2014
5 “Barbie,” Barbie Media, accessed November 10 2014
6 Kelly Brownell & Melissa Napolitano, “Distorting realities for children:body size proportions for Barbie and Ken dolls,” International Journal of Eating Disorders, 18(1995):295, accessed November 10 2014
7 Helga Dittmar, Emma Halliwell & Suzanne Ive, “Does Barbie make girls want to be thin?” Developmental Psychology, 42(2006):283, accessed November 10 2014
8 “Eating disorders: body image and advertising,” Healthy Place, accessed November 10 2014
9 Wendy Spettigue & Katherine Henderson, “Eating disorders and the role of the media,” 13(2004):16, accessed November 10 2014
10 Amy Hubbard, “Miss Indiana’s body is not normal or average,” LA Times, accessed November 10 2014
11 “Eating disorder criteria,” University of Nevada, accessed November 10 2014
12 Steven Thomsen, Kelly McCoy & Marleen Williams, “Anorexic outpatients’ experiences with women’s beauty and fashion magazines,” Eating Disorders – The Journal of Treatment and Prevention, 9(2001):49, accessed November 14 2014
13 Anne Becker et al, “Eating behaviors and attitudes following prolonged exposure to television among ethnic Fijian girls,” The British Journal of Psychiatry, 180(2002): 509, accessed November 10 2014
14 Alexandra Hendriks,”Examining the effects of hegemonic depictions of female bodies on television,” Critical Studies in Media Communication, 19(2002):106, accessed November 10 2014
15 “Obesity and overweight data,” CDC, accessed November 10 2014
16 “Eating disorders and the internet,” ANAD, accessed November 10 2014
17 “Eating disorders,” University of Maryland Medical Center, accessed November 10 2014
18 L Schreiber, B Odlaug & Grant J,”The overlap between binge eating disorder and substance use disorders,” Journal of Behavioral Addictions, 2(2013):191, accessed November 10 2014
19 A Conason, A Brunstein Klomek & L Sher, “Recognizing alcohol and drug abuse in patients with eating disorders,” QJM, accessed 99(2006):335, accessed November 9 2014
20 Ashley Gearhardt, Rebecca Boswell & Marney White, “The association of food addiction with disordered eating and body mass index,” Eating Behaviors, 15(2014):427, accessed November 10
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