• What is anorexia?
• The long-term effects of anorexia
• Who is most at risk of anorexia?
• Factors that increase the risk of anorexia
• Reducing the risk of developing anorexia
• Conclusions

 

What is anorexia nervosa?

The term anorexia is originally from the Greek: an = - ‘without’ + orexis = ‘appetite’.

 

Anorexia nervosa is a complex eating disorder and serious mental health condition in which people severely reduce their food consumption, or refuse to eat, in order to achieve extreme weight loss.

Research suggests that this kind of eating disorder is a way of trying to cope with mental distress associated with a negative, distorted self-image of the body and a fear of weight gain.

 

Individuals suffering from anorexia, rather than seeing food as a temptation to be avoided, are more likely to be disgusted by food and often continue to see themselves as overweight however much weight they lose.

 

The long-term effects of anorexia

Anorexia can have profound effects on long-term health. In its most extreme form, anorexia weakens the heart, which then loses muscle mass along with the rest of the patient’s underweight body. This is one reason anorexia is known to have the highest death rate of any mental illness.

 

Up to 18% of people with anorexia eventually die from the condition. The National Center for Biotechnology Information (An official website of the United States government)

 

There is also a concern that death rates are underreported, which has resulted in MPs in the UK calling for better research and improved data collection on eating disorders such as anorexia.

 

Who is most at risk of anorexia?

There are five main groups of people who seem to be at greater risk of being affected by anorexia:

• Teenagers
• Fashion models (as role models)
• ‘Body checkers’
• Obese men
• Sexual minority groups.

 

Teenagers 

Anorexia tends to emerge during teenage years and is four-times more likely to affect women than men. One possible reason for this gender difference is the societal value where women attach greater importance to outward appearance and physical attractiveness than men. This is especially true when there are also differences in the criteria associated with feminine and masculine attractiveness, for example a greater association with slenderness in women and muscularity in men.

Fashion models (as role models)

More disturbingly, there has been a trend over several decades of using ever-thinner models in women’s magazines, especially in fashion, where the ideal of beauty is increasingly associated with slimness. From size zero models to airbrushed images in magazines, the messages about the value of thinness are largely directed at girls.

‘Body checkers’

One report suggests some other consequences of this: ‘women have been shown to be more likely than men to report body-checking behaviours, such as ritualistic weighing or trying on special clothing to check for fit, or to engage in body avoidance behaviours, such as not wearing form-fitting clothes that would make the wearer more aware of her body shape’.

Obese men

While research shows that women are typically more likely to experience anorexia than men, analysis of NHS data shows a huge rise in the number of men experiencing problems. There is evidence to suggest that men are also facing increasing body image pressure and are affected by anti-obesity messages.

Although anorexia is heavily gendered and often associated with ‘femininity’, it is estimated that up to 25% of men experience an eating disorder of some kind.

Sexual minority groups

An area where further evidence is required is the increased risk of eating disorders within sexual minority groups. Of the limited research available, there is a growing field of evidence suggesting that LGBTQ+ groups are at a greater risk of emotional and behavioural eating disorders and body image disorders compared to heterosexual individuals.

At a lower risk?

It has been suggested that anorexia is less common in cultures where a fuller, curvier female figure is considered to be attractive, such as in parts of Africa and Latin America, and among African Americans and Latinos.

However, this finding may simply reflect a lack of research into anorexia among non-White populations, although it is an area probably worth researching further.

 

Factors that increase the risk of anorexia

Anorexia, with its associated mental health conditions, is such a complex eating disorder that a wide range of factors can influence it. These are some of the better known factors:

• Traumatic early life experiences
• Parental relationships
• The ‘glorification’ of thinness in society and culture
• Social media and social networking
• Exposure to online images of weight loss and anorexia
• Personality traits
• Impact of the Covid-19 pandemic

 

Traumatic early life experiences

Studies have shown that eating disorders in general – not just anorexia – tend to occur more frequently among those who have experienced maltreatment as children.

Women with eating disorders, including anorexia, have reported higher rates of sexual abuse. This incidence of sexual abuse in eating disorder patients appears significant. Fifty percent of both anorexic and bulimic patients reported a history of sexual abuse. This compares with only 28% of the non-anorexic, non-bulimic control population.

Parental relationships

One review has suggested that ‘difficulties in parent–child relationships predispose women to eating disorders’.

 

The ‘glorification’ of thinness in society and culture 

Studies have shown that a person’s attitude towards their own body and weight can be shaped by the media, peer groups and by family. When this influence results in a negative self-perception, it can increase the risk of anorexia.

There can be significant consequences to the ‘glorification of slenderness and thin people, leading to, and supported by, the internalization of a slender… beauty ideal’. For example, if someone defines themselves in terms of their weight or their appearance, or they grow up in an environment in which there is a preoccupation with weight, or learn to associate ‘irrational anxiety about body fat with gaining weight’, or have ‘prejudicial, stigmatizing beliefs about fat people’, they can be at a greater risk of developing anorexia.

 

Social media and social networking

This glorification of thinness in our social media age is probably greater than ever before. It has been shown to heighten feelings of bodily dissatisfaction among teenagers through the representations and images conveyed. Most concerning is the existence of pro-anorexia websites, which promote unhealthy, underweight ideals and images.

A number of studies over the years have also pointed to a significant association of the condition with social class, particularly linked with girls from middle-class and upper-middle-class backgrounds. However, this association has been questioned, and a Swedish study of 2 million males and females found a stronger association with levels of parental education than with social class.

Recently, there has been a growing concern that the use of social networking sites by those suffering from, or at risk of, eating disorders may lead to an increase in symptoms and adverse effects on their mental health.

 

Exposure to online images of weight loss and anorexia

Research suggests that their exposure to very thin and toned body images, so called ‘fitspiration’ (an combination of the words ‘fitness’ and ‘inspiration’), and harmful advice with images of restricted and extreme weight loss (‘thinspiration’), could lead to the development or aggravation of eating disorders.

It has also been suggested that eating disorders are being glamourised, romanticised and promoted on these social media platforms.

Personality traits

One study suggested that people living with anorexia tend to exhibit “perfectionism, high harm avoidance, high persistence’, while another pointed to other personality traits including ‘high levels of social anxiety, guilt, shame, and irritability… impossible standards, [which are] experienced as internalized musts and should… [and which lead to] extreme attempts to compensate for failure’.

 

Impact of the Covid-19 pandemic

A 2021 report describes how the Covid-19 pandemic had an impact on how people view their bodies and how it may have led to an increase in the number of people with anorexia. Data also show that the incidence of eating disorders rose due to people feeling out of control, and that pandemic lockdowns and isolation allowed eating disorders to thrive.

 

Reducing the risk of developing anorexia

There is ample literature on the treatment of anorexia – i.e. after it has been diagnosed. However, here we are focusing instead on the prevention of anorexia. A number of approaches have been investigated:

 

Media literacy

Researchers have found that media literacy programmes are one of the most promising interventions to help prevent anorexia. These programmes combat the ‘glorification of thinness’ by helping people learn, understand and think critically about the ways in which they are affected by media and by the images portrayed in it.

• The Media Smart curriculum, developed in Australia, involves a series of lessons where students examine various ads, magazines, social media posts, etc., and then work together to ‘rehearse ways to resist negative appearance comments, weight/shape-related teasing’ and other ‘distorted attitudes’.
  A UK-based version of this programme provides materials and teaching resources for young people, parents and educators.
• The Body Project, developed by the National Eating Disorders Association (NEDA) in America, has been shown to be effective in reducing body dissatisfaction and unhealthy eating and dieting tendencies among women and girls. It is a ‘group-based intervention that provides a forum for women and girls to confront unrealistic beauty ideals and engages them in the development of healthy body image through verbal, written, and behavioural exercises’.

Building coping skills and a sense of self-esteem

A comprehensive guide to the prevention of eating disorders describes a concept called ‘ego-oriented individual therapy’ as being effective in preventing anorexia in young people. This therapy ‘focuses on building coping skills, developing one’s identity (i.e. beyond the pursuit of thinness) and on addressing interpersonal issues regarding physical, social, and emotional maturation’.

Cognitive behavioural therapy (CBT)

CBT can be used as a therapy encouraging people to engage in ‘counter-attitudinal exercises that target potential risk factors for eating pathology’ (e.g. body dissatisfaction and internalisation of the “thin-ideal”)’ This is considered a promising intervention for the prevention of anorexia, although the long-term preventative effects of such therapies have not yet been assessed.

Apps targeting anorexia in young people could also help to provide support by overlapping with CBT techniques. There has been a surge in the development of mobile health apps in recent years, although their content and effectiveness are still largely unexplored.

The role of families

The role of families in preventing anorexia has not yet been studied in depth. One review of prevention programmes noted, ‘interestingly… [it had] failed to identify any controlled trials investigating prevention strategies involving families’, but that there could be strong potential for educating and creating awareness in parents to identify the early signs of anorexia and prevent its onset.

Schools-based programmes

If teachers make opportunities to disseminate appropriate messages and to address issues that are impairing the quality of life of many students, eating disorders could potentially be reduced through school-based initiatives.

Policy changes

Researchers have proposed that ‘sanctions of unrealistic body types and legislation of healthy role models [be] put into place’, most especially to limit the negative impact of pro-anorexia websites on adolescents.

Improved data collection

In recent years, there have been calls for eating disorder deaths to be recorded on a national register. A better understanding of the numbers affected by anorexia could help us understand the true scale of the issue and therefore identify where support can be best targeted.

 

Support from charities

There are a number of charities that provide support and information to those experiencing an eating disorder. Beat is the UK’s leading eating disorder charity.

 

https://www.beateatingdisorders.org.uk/   England:                0808 801 0677 Northern Ireland:   0808 801 0434 Scotland:               0808 801 0432 Wales:                    0808 801 0433   24/7 SMS: Text SHOUT to 85258

 

As well as campaigning for better services for those affected by eating disorders, the charity provides self-help support through its online services (information, message boards and online chat) for people with an eating disorder, as well as for their families and friends.

 

Conclusions

• Anorexia is a serious mental illness which can lead to people starving themselves to death. The true numbers of deaths caused by anorexia is thought to be underreported, and there have been calls for better data collection on the number of deaths caused by eating disorders, including anorexia.
• Anorexia is believed to be most common among white teenage girls. However, more research is needed into groups also affected, including ethnic minorities and LGBTQ+ groups. There is data to suggest that eating disorders in men is also on the rise.
• Anorexia had been particularly linked with girls from middle- and upper-middle-class backgrounds, although this link is now being questioned.
• Anorexia appears more common in societies where there is a glorification of thin females in the media and culture.
• Risk factors include childhood trauma (such as sexual abuse); difficulties in parent–child relationships, and anxious and controlling personality traits.
• Research also suggests that Covid-19 has increased the number of people with anorexia.
• Actions to reduce the risk of anorexia are needed by families, schools, health professionals and the government. These actions include unlocking the potential of media literacy programmes and cognitive behavioural therapy.

 

Lindsey Stack July 2023. Next review June 2027.

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These articles on the Age Watch website may also interest you:

• Mind: Cognitive behavioural therapy
  
  
• Mind: Health apps – a help or a hindrance?
  
  
• Mind: Building our resilience