Editors Note

Welcome to the thirty-eighth edition of the NEDC e-Bulletin. New ‘fad’ diets are constantly being introduced, making dieting a frequent topic of discussion in modern society. Disordered eating behaviours, particularly dieting, are the most common indicators of the development of an eating disorder. This month we look at what disordered eating is, explore the history of dieting and seek expert advice from an experienced dietitian.

If you are interested in collaborating with the NEDC, we encourage you to become an NEDC member.

Contents

1. Feature Article: Dieting and Disordered Eating in the Home Environment
2. Interview: Recognising and Treating Disordered Eating Behaviours
3. PhD Spotlight: History of Dieting
4. Dieting and Disordered Eating Factsheet – Download

A preoccupation with weight, shape and size is increasingly being recognised as an emerging public health issue. Given such, there is an increased importance on understanding some of the influences that potentially impact on the development of dieting and disordered eating behaviours (Yager & O’Dea, 2010). The act of starting any diet increases the risk of eating disorders. Research conducted in Australia has shown that adolescent females who diet at a severe level are 18 times more likely to develop an eating disorder within six months, than someone who does not diet (Daee et al., 2002; Yeo & Hughes, 2011). Some of the latest research focuses on the impact of various parental attitudes towards dieting, suggesting that certain attitudes held may encourage the development of an eating disorder. This highlights the importance of family involvement during eating disorder treatment (Lantzouni, Cox, Salvator, & Crosby, 2015).

Eating Disorders are complex psychiatric illnesses involving psychological and biological factors (Frank & Kaye, 2012). Research recognises that multiple factors, including social, environmental and genetic, contribute to the development of an eating disorder. More recently, studies have focused on the potential influence of parent behaviour, attitudes and parent-child interactions around dieting, body shape, weight and size. Evidence is growing to support the idea that ways in which weight, shape and size are discussed in the home have a strong impact on the development of self-esteem and an individual's self perception. Neumark-sztainer et al., (2010) and Loth et al., (2014), found that parent comment, dieting behaviours and family weight-based teasing may contribute to the development of an adolescent's disordered eating and dieting behaviours.

Not everyone who diets will develop an eating disorder. However, individuals with an eating disorder commonly have a history of dieting and disordered eating. Unhealthy weight loss dieting is also associated with other health concerns including depression, anxiety, nutritional and metabolic problems, and, contrary to expectation, an increase in weight (Paxton, Wertheim, Pilawski, Durkin, & Holt, 2002). Among girls who diet, the risk of obesity is greater than for non-dieters (Daee et al., 2002; O’Dea, 2005). In addition, young people who engage in unhealthy dieting practices are almost three times as likely as their peers to score high on measures assessing suicide risk (Daee et al., 2002).

This emerging research exposes some of the key protective factors in helping to minimise the development of an eating disorder. It is often the case that health messages, inside and outside of the home, intending to positively influence an individual’s health, may in fact cause unintended harm. This shines light on the importance of education, awareness and family based approaches in supporting healthy relationships with ‘the self’. A focus on the development of knowledge and more understanding of ‘the self’ can help to minimise the potential risks around the development of an eating disorder.

References

Daee, A., Robinson, P., Lawson, M., Turpin, J. a, Gregory, B., & Tobias, J. D. (2002). Psychologic and physiologic effects of dieting in adolescents. The Southern Medical Journal, 95(9), 1032–1041.

Frank, G. K. W., & Kaye, W. H. (2012). Current status of functional imaging in eating disorders. The International Journal of Eating Disorders, 45(6), 723–36.

Lantzouni, E., Cox, M. H., Salvator, A., & Crosby, R. D. (2015). Mother-daughter coping and disordered eating. European Eating Disorders Review, 23(2), 119–125.

Loth, K. A., Ph, D., D, R., Maclehose, R., Ph, D., Bucchianeri, M., … D, R. (2014). Predictors of Dieting and Disordered Eating Behaviors From Adolescence to Young Adulthood. Journal of Adolescent Health, 55(5), 705–712.

Neumark-sztainer, D., Ph, D., D, R., Bauer, K. W., S, M., Friend, S., … T, L. M. F. (2010). Family Weight Talk and Dieting : How Much Do They Matter for Body Dissatisfaction and Disordered Eating Behaviors in Adolescent Girls ? Journal of Adolescent Health, 47(3), 270–276.

O’Dea, J. a., & O’Dea, J. a. (2005). School-based health education strategies for the improvement of body image and prevention of eating problems: An overview of safe and successful interventions. Health Education, 105(1), 11–33.

Paxton, S. J., Wertheim, E. H., Pilawski, A., Durkin, S., & Holt, T. (2002). Evaluations of dieting prevention messages by adolescent girls. Preventive Medicine, 35(5), 474–491.

Yager, Z., & O’Dea, J. (2010). A controlled intervention to promote a healthy body image, reduce eating disorder risk and prevent excessive exercise among trainee health education and physical education teachers. Health Education Research, 25(5), 841–852.

Yeo, M., & Hughes, E. (2011). Eating disorders: Early identification in general practice. Australian Family Physician, 40(3), 108–111.

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We spoke with Kate Unicomb to seek expert advice on dieting and disordered eating behaviours. Kate is an Accredited Practicing Dietitian who consults to The Butterfly Foundation’s intensive outpatient program. Kate has extensive experience in clinical and outpatient settings, and has a passion in assisting individuals to overcome eating disorders.

Research indicates that approximately 1 in 20 Australians has an eating disorder, and this rate in the Australian population is increasing. Based on your experience as a dietitian, what do you think has contributed to the increase in disordered eating and dieting behaviours?

For a long time, there has been a seeming acceptance of the ‘thin ideal’ reinforced by the media and the false belief that being ‘thin’ or looking a certain way, leads to beauty, success and happiness. The idea that self-worth is based on appearance is ever present. The rise in use of technology, and the subsequent increase in popularity of social media has meant a constant stream of information can and is, shared to push this ideal. Images for weight loss and articles on fad diets through these mediums are all but inescapable. Round the clock access to information of varying degrees of accuracy, and the constant glorification of self-proclaimed ‘experts’ who often receive more notoriety than health professionals, has clouded the minds of many Australians who are seeking direction, and often negatively influencing their dietary habits.

Dieting is the number one cause of the onset of an eating disorder. From your experience, what are some early signs of disordered eating?

Early signs of disordered eating can include:

• Skipping meals regularly
• Frequent fluctuations in weight
• Rigid exercise regime and/ or diet - using a limited selection of foods, counting calories, fasting, replacing food with fluids
• Rules about eating specific food at specific times
• Feelings of guilt and shame when unable to maintain food and exercise habits
• Use of compensatory behaviours - exercise, food restriction, fasting, purging, laxative use or diet pills to “make up” for food consumed.
• Change in behaviour around food - avoiding social situations around food, eating in secret, hiding food, lying about food consumed.

Can disordered eating and dieting behaviours be changed?

Absolutely! However, it is important that someone with an eating disorder seeks the help of health professionals that specialise in this area. A professional will work to help resolve both the medical and psychological issues that contribute to, or result from, disordered eating. The most effective treatment involves the support of a psychologist/ counsellor/ psychotherapist, GP and Dietitian.

Parents and families play a pivotal role in the development of young people. How can parents and families help prevent disordered eating and dieting?

We can all make a positive difference to those in our lives by:

• Promoting positive body image conversations, which avoids emphasising topics like weight, ‘diet talk’ and physical appearance. Teaching young people that self-worth is not related to how they look.
• Encouraging more frequent and enjoyable family meals – turn off the television!
• Encourage healthy eating not dieting, and avoid categorizing foods as “good or “bad”.
• Never use food as a reward or a punishment. By using food in this way this sends the message that food leads to love and acceptance. This can encourage loved ones to seek out food for comfort or self-punishment.

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We spoke with Jess Parr about the history of dieting. Jess is a member of the NEDC and a current PhD candidate at the University of New South Wales, investigating popular responses to obesity overtime and the history of dieting. As this is such a relevant and intriguing topic to the NEDC, we asked Jess to provide insight into her research focus and an overall snapshot of her study.

Can you tell us a bit about your academic studies and why you chose obesity and dieting as a PhD focus?

I came into the Humanities PhD program at the University of New South Wales after completing a Bachelor of Arts (Hons) majoring in History and Philosophy of Science. I am fascinated by how different communities understand wellbeing and the relationship of these collective ideas in the development of healthcare practices and social medicine. This is evident in my research interests that include the histories of chronic disease, psychiatry, diet culture and pharmaceuticals in the twentieth century. My PhD research focuses on the popular responses to obesity from the late 1940s to 1970. This includes examining the changes in the way obesity was understood, popular public responses to the perceived obesity crisis and the implications that can be drawn to today’s climate around obesity and dieting.

Obesity and dieting is a fairly broad topic. How are you conducting your research and have you had any significant learnings along the way?

I chose to apply a historical lens to obesity, overeating and overweight stigma, because obesity and dieting narratives are so pervasive in current western medical and diet discourse. The hysteria surrounding the ‘obesity epidemic’ and the formidable diet industry has shaped a collective consciousness that often blurs the lines between aesthetic and medical concerns in relation to body shape and further fuels the social stigma around the overweight body. We can be forgiven for assuming that widespread concern for weight management is a relatively recent phenomenon with public health bodies presenting obesity as a health conundrum from the late twentieth century. Anxiety around the health hazards of excess body fat surged after the Second World War with the American Public Health Service announcing in 1950 that obesity was the nation’s leading preventative healthcare problem (sound familiar). Thus, in understanding the politics of obesity management, diet culture and overweight stigma it is important to include the historical narratives of medical experts as well as lay perspectives, which I argue have played a significant role in the construction of our collective ideas around the healthy body and dieting practices.

Can you explain the scope of your research and its current status?

A PhD project has boundaries in terms of funding and time so I have limited my research to the United States of America between 1945 and 1970 but I would be interested in future projects to extend my research to include other western nations including Australia. I am currently in the ‘write-up phase’ of my thesis and I am hoping to submit by the end of this year.

One of the important research findings that I have included in my thesis is the examination of the convergence of mutual aid, group therapy and Alcoholic Anonymous practices by ordinary Americans to help make sense of their health, combat growing overweight stigma and to manage their weight. From 1948, grass-roots weight loss groups proliferated across North America. These early weight loss groups played a central role in diversifying how mainstream America sought help for compulsive overeating, that now no longer needed to include the medical profession. These postwar groups also expanded the language and practices for weight loss, many of which form the framework for diet culture today including the “biggest loser” phenomenon, personal shaming and the commercialisation of weight management programs.

To put simply, the last 60 years have seen an escalation in medical and popular concern around body weight and so obesity discourse since the 1940s has played a significant role in the history of dieting.

Jess Parr’s research raises an important issue around the potential risks of obesity discourse and weight management commercialisation. Health promotion strategies should consider eating disorders and obesity as a coupled illness that seeks to communicate joint messages. The NEDC provide more information on safe messaging here

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Dieting is the number one cause of the onset of an eating disorder. Download this fact sheet on Dieting and Disordered Eating to further your understanding and share the right information.

Workplace Suggestions

• Print and pin the factsheet on your work noticeboard
• Have printed copies available in the staffroom
• Distribute the factsheet at a staff meeting

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