There is no known cause for an eating disorder, and people from any demographic may develop at ED at some point in their life. Despite this, there are risk factors that are commonly associated with those diagnosed with eating disorders.
Cena et al. (2017) hypothesized that people who experienced being overweight or obese during adolescence were more likely to develop an eating disorder in the future, primarily based off of the influence of social media and how that may result in bullying, weight stigma, etc. However, their study also looked at other factors, such as athletics, having family members who experienced difficulties with obesity, maternal past history of eating disorders (MPHEDs), dieting behaviours, and gender. As various causes and risk factors are detailed more below, the findings of the study by Cena et al. will be further discussed in their respective categories.
- Low self-esteem
- Body dissatisfaction
- Distorted body image
- Experience of weight stigma
- Genetics
- Dieting
- Trauma
- Peer pressure, bullying, etc.
- Other mental/neurological/emotional disorders, illnesses, etc.
Cena et al. (2017) hypothesized that people who experienced being overweight or obese during adolescence were more likely to develop an eating disorder in the future, primarily based off of the influence of social media and how that may result in bullying, weight stigma, etc. However, their study also looked at other factors, such as athletics, having family members who experienced difficulties with obesity, maternal past history of eating disorders (MPHEDs), dieting behaviours, and gender. As various causes and risk factors are detailed more below, the findings of the study by Cena et al. will be further discussed in their respective categories.
Confidence, Self-Esteem, and Body Image
Low self-esteem, body dissatisfaction, distorted body image (e.g. body dysmorphia), and having a poor body image can be a result of many different factors and sources. For example, it could come from experiencing weight stigma, spending too much time on social media or being exposed to media that promotes certain body images as “ideal”, experiencing peer pressure, bullying, trauma, etc.
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Weight stigma, otherwise known as weight bias, is when someone is treated differently or experiences others being treated differently due to their weight and body shape, size, etc. For example, a student being bullied for either being overweight or underweight. As mentioned by Cena et al. in their 2017 article in Eating Disorders, “children with obesity are often teased about their weight by peers or family members which decreases their self-esteem” (p.217).
Body dysmorphia is a medical condition for when a person becomes obsessed or otherwise overly concerned about their appearance, and their mind distorts how they actually look to emphasize that concern. In terms of disordered eating, it is common for people with an eating disorder to believe they look larger than they truly are. For example, they may feel as though their hips are too wide, arms are too large, etc. It is important that body dysmorphia is not a true representation of how they look and people with this condition have difficulty understanding how they truly look to others.
Body dysmorphia is a medical condition for when a person becomes obsessed or otherwise overly concerned about their appearance, and their mind distorts how they actually look to emphasize that concern. In terms of disordered eating, it is common for people with an eating disorder to believe they look larger than they truly are. For example, they may feel as though their hips are too wide, arms are too large, etc. It is important that body dysmorphia is not a true representation of how they look and people with this condition have difficulty understanding how they truly look to others.
Social Media
In terms of social media, it is possible that it is a primary cause of promoting disordered eating in people of all demographics. Teenagers, on average, spend about eight hours a day on some form of media (NEDA). By spending so much time on social media, these teenagers are being exposed to advertisements and posts about weight, dieting, clothing sizes, make up, workouts, and more. With such an emphasis on appearance, it is common for people to compare themselves to others and fall victim to advertisements.
Furthermore, Cena et al. mentioned that “media emphasizes thinness and often portrays those with obesity as having a lack of self-control and willpower” and that “modern society… perceives obesity as unattractive” (2017, p.217).
Unfortunately, these posts and advertisements are often based on false and/or unsubstantiated claims (NEDA). Additionally, posts are often only what people want others to see - it is not the true reality of their lives. The use of filters and other edits are also creating an unrealistic expectation of how people should look. Thus, people are only seeing lies, partial truths, altered realities, and fake information.
NEDA also mentioned that the Dove Global Beauty and Confidence Report found that approximately 70% of women and girls report a decline in body confidence and an increase in beauty and appearance anxiety, which is driven by the pressure for perfection and an unrealistic standard of beauty from the media. It also found that 79%-85% of girls and women would rather opt out of a social event rather than attend when they do not feel that they are looking “their best”, and that 90% of women say they will not eat and put their health at risk when they feel bad about their body image.
One study on social media found that teenage girls who use social media are significantly more than non-social media users to have poor body image, strive for thinness, and engage in body surveillance. Another study found that social media use is linked to self-objectification (seeing one’s self as an object, primarily focused on the body); using social media for just 30 minutes a day can change the way a person views their own body (NEDA).
Furthermore, Cena et al. mentioned that “media emphasizes thinness and often portrays those with obesity as having a lack of self-control and willpower” and that “modern society… perceives obesity as unattractive” (2017, p.217).
Unfortunately, these posts and advertisements are often based on false and/or unsubstantiated claims (NEDA). Additionally, posts are often only what people want others to see - it is not the true reality of their lives. The use of filters and other edits are also creating an unrealistic expectation of how people should look. Thus, people are only seeing lies, partial truths, altered realities, and fake information.
NEDA also mentioned that the Dove Global Beauty and Confidence Report found that approximately 70% of women and girls report a decline in body confidence and an increase in beauty and appearance anxiety, which is driven by the pressure for perfection and an unrealistic standard of beauty from the media. It also found that 79%-85% of girls and women would rather opt out of a social event rather than attend when they do not feel that they are looking “their best”, and that 90% of women say they will not eat and put their health at risk when they feel bad about their body image.
One study on social media found that teenage girls who use social media are significantly more than non-social media users to have poor body image, strive for thinness, and engage in body surveillance. Another study found that social media use is linked to self-objectification (seeing one’s self as an object, primarily focused on the body); using social media for just 30 minutes a day can change the way a person views their own body (NEDA).
Dieting
As NEDA mentions in their Statistics & Research article, there was a large study done in 2016 that focused on primarily 14 and 16 year-olds and their eating habits. The study was mainly looking at two factors: did the teenager have an eating disorder, and did the teenager ever go on a diet. What it found was that teenagers who diet, or engage in “clean eating”, are significantly more likely to develop an eating disorder. In fact, it found that those who engaged in moderate dieting were five times more likely to develop an eating disorder as compared to a person who did not engage in dieting, and a person who engaged in extreme dieting was eighteen times more likely to develop an eating disorder (NEDA).
Unfortunately, another study found that approximately 59% of girls and 28% of boys were actively dieting at the time of the study, and about 68% of girls and 51% of boys exercise with the goal of losing weight (as opposed to improving their health, meeting health goals, etc.) (NEDA, n.d.). |
However, dieting is not nearly as effective or healthy as people seem to believe it is. In fact, people who diet are 12 times more likely to binge as compared to those who do not diet (NEDA, n.d.). This is often associated with the restriction of food that comes with dieting. As a person refrains from eating, their body becomes increasingly hungry, and the primitive instinct to satisfy that hunger eventually leads to the person consuming a large amount of food in a short period of time. This also helps to explain why many people with atypical anorexia nervosa and people with bulimia nervosa are either an average weight or even overweight. Furthermore, 95% of all people who diet will refrain their lost weight within five years (NEDA, n.d.). This is because diets are temporary and not meant to be lifestyle changes. As the person dieting goes back to their normal eating habits, their body will also return to how it was prior to the diet. In fact, dieting has been found to be a predictor of both weight gain and increased binging in both boys and girls (NEDA, n.d.).
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With all of these studies explaining the negative effects of dieting and proving that dieting is more likely to cause negative outcomes than positive ones, why do people diet? Aside from people simply wanting a “quick and effective” way to lose weight, they are also being tricked by the media. A content analysis in 2001 found that more than 50% of weight loss advertisements made use of false, misleading, and/or unsubstantiated claims (NEDA, n.d.). It is important for people to do their research and know what they are purchasing before they engage in any of the typical dieting and weight loss programs, products, etc.
For example, many people will purchase weight loss pills and powders without their being any studies to prove that these products are effective or safe. There are often diet trends that become popular in the media, with some examples being garcinia cambogia, acai berry, and raspberry ketone. These things can be in the form of pills or powders, or sometimes they are added to smoothies, meals, etc. All will claim they have some ability to help a person control and/or lose weight, however these claims are often unsubstantiated or misleading. For example, they may say something along the lines of “may help a person lose weight” or “in addition to exercise and a healthy diet”. Yet, the weight-loss industry is a 60-billion dollar industry each year in North America.
For example, many people will purchase weight loss pills and powders without their being any studies to prove that these products are effective or safe. There are often diet trends that become popular in the media, with some examples being garcinia cambogia, acai berry, and raspberry ketone. These things can be in the form of pills or powders, or sometimes they are added to smoothies, meals, etc. All will claim they have some ability to help a person control and/or lose weight, however these claims are often unsubstantiated or misleading. For example, they may say something along the lines of “may help a person lose weight” or “in addition to exercise and a healthy diet”. Yet, the weight-loss industry is a 60-billion dollar industry each year in North America.
Obesity, Genetics, and Illnesses
In the study done by Cena et al. in 2017, it was found that people who were overweight or obese during puberty were reportedly twice as likely to develop an eating disorder as compared to those who were of a normal or lower-than-normal weight during puberty (p.222). They particularly noted that these people were more likely to develop either bulimia nervosa or binge-eating disorder, as opposed to other types of disordered eating (p.223).
The study also found that people with MPHEDs were ten times more likely to develop an eating disorder, as compared to people who did not have MPHEDs (p.223). Unfortunately, the study did not indicate whether this correlation was based on genetics or other factors, such as relationships, communication, etc. For example, a child whose mother has an eating disorder grows up seeing their mother struggle with it, look a certain way, etc. Their mother may also make comments that affect the child, or the mother might even have certain expectations of their child.
It has been discussed that developing an eating disorder may be a symptom or a result of another illness. For example, women with ADHD are prone to developing an eating disorder for a variety of reasons. One reason is because ADHD often goes undiagnosed in women, and they may become conflicted and/or confused as to why they are different from their peers. Because they struggle to fit in, make friends, etc., they may believe factors, such as their appearance, are to blame. In a study conducted by Biederman et al. (2007), they “found that adolescent females with ADHD were at an elevated risk of developing an eating disorder” (p.305). This was determined after they studied 112 adolescent females with ADHD and discovered that 16% had a history of disordered eating. They also stated that “ADHD females were 3.6 times more likely to meet criteria for an eating disorder (either bulimia nervosa or anorexia) compared to control females” (p.304). However, other articles have noted that people with ADHD are also more likely to develop binge-eating disorder or bulimia nervosa, and this due to the poor impulse control that often comes with ADHD (Olivardia, 2020). This same article goes on to explain that “both binge-eaters and people with ADHD have trouble heeding their internal cues of satiety and hunger”.
Another example would be people with anxiety and obsessive-compulsive disorder (OCD). People who are “perfectionists” may feel the need to be in control, and it is not uncommon for these people to try to control their appearance. If they begin to gain weight or otherwise appear in a way they do not want to, they may feel as though they have lost control. NEDA (n.d.) mentions that approximately 66% of people diagnosed with an eating disorder showed signs of anxiety prior to the development of their disordered eating.
It is also common for depression to go co-exist with an eating disorder. Sometimes the eating disorder is a cause of the depression, due to hormone imbalances in the brain from a lack of nutrition; however, there are times that both will co-exist and not be directly connected to one another.
As mentioned in NEDA’s article, there was a study done in 2014 with over 2,400 participants with eating disorders that looked at the connection between disordered eating and trauma, PTSD, and psychosocial resources. It found that 94% of the people had a coexisting mood disorder, most commonly being depression. 56% had an anxiety disorder, 20% had OCD, 22% had PTSD, and 22% had an alcohol or substance abuse disorder. NEDA goes on to mention a variety of studies, concluding that “there is a markedly elevated risk for obsessive-compulsive disorder among those with eating disorders.”
The study also found that people with MPHEDs were ten times more likely to develop an eating disorder, as compared to people who did not have MPHEDs (p.223). Unfortunately, the study did not indicate whether this correlation was based on genetics or other factors, such as relationships, communication, etc. For example, a child whose mother has an eating disorder grows up seeing their mother struggle with it, look a certain way, etc. Their mother may also make comments that affect the child, or the mother might even have certain expectations of their child.
It has been discussed that developing an eating disorder may be a symptom or a result of another illness. For example, women with ADHD are prone to developing an eating disorder for a variety of reasons. One reason is because ADHD often goes undiagnosed in women, and they may become conflicted and/or confused as to why they are different from their peers. Because they struggle to fit in, make friends, etc., they may believe factors, such as their appearance, are to blame. In a study conducted by Biederman et al. (2007), they “found that adolescent females with ADHD were at an elevated risk of developing an eating disorder” (p.305). This was determined after they studied 112 adolescent females with ADHD and discovered that 16% had a history of disordered eating. They also stated that “ADHD females were 3.6 times more likely to meet criteria for an eating disorder (either bulimia nervosa or anorexia) compared to control females” (p.304). However, other articles have noted that people with ADHD are also more likely to develop binge-eating disorder or bulimia nervosa, and this due to the poor impulse control that often comes with ADHD (Olivardia, 2020). This same article goes on to explain that “both binge-eaters and people with ADHD have trouble heeding their internal cues of satiety and hunger”.
Another example would be people with anxiety and obsessive-compulsive disorder (OCD). People who are “perfectionists” may feel the need to be in control, and it is not uncommon for these people to try to control their appearance. If they begin to gain weight or otherwise appear in a way they do not want to, they may feel as though they have lost control. NEDA (n.d.) mentions that approximately 66% of people diagnosed with an eating disorder showed signs of anxiety prior to the development of their disordered eating.
It is also common for depression to go co-exist with an eating disorder. Sometimes the eating disorder is a cause of the depression, due to hormone imbalances in the brain from a lack of nutrition; however, there are times that both will co-exist and not be directly connected to one another.
As mentioned in NEDA’s article, there was a study done in 2014 with over 2,400 participants with eating disorders that looked at the connection between disordered eating and trauma, PTSD, and psychosocial resources. It found that 94% of the people had a coexisting mood disorder, most commonly being depression. 56% had an anxiety disorder, 20% had OCD, 22% had PTSD, and 22% had an alcohol or substance abuse disorder. NEDA goes on to mention a variety of studies, concluding that “there is a markedly elevated risk for obsessive-compulsive disorder among those with eating disorders.”
Gender and Sexuality
In the study done by Cena et al. (2017), it was found that women were five times as likely to develop an eating disorder as compared to men (p.223). However, other studies have found that the actual ratio is closer to 3-to-1; in other words, 66% of all cases are women and 33% are men (NEDA, n.d.). Despite all of this, it is still possible for these numbers to differ in reality. As many men do not seek help, it is difficult to know exactly how many are struggling with an eating disorder. Still, it should be noted that “from 1999 to 2009, the number of men hospitalized for an eating disorder-related cause increased by 53%” (NEDA, n.d.). This may be a result of more men developing eating disorders, however it is more likely that men are more actively seeking help than they used to.
Based on studies researched by NEDA, they have stated that homosexual men are three times as likely as hetereosexual men to develop an eating disorder. Meanwhile, homosexual women are about just as likely as hetereosexual women to develop an eating disorder, although NEDA mentions that more research is required in this area. They also mention that more studies are required in terms of transgender people and eating disorders, though they do state that “transgender individuals experience eating disorders at rates significantly higher than cisgender individuals” (NEDA, n.d.).
Based on studies researched by NEDA, they have stated that homosexual men are three times as likely as hetereosexual men to develop an eating disorder. Meanwhile, homosexual women are about just as likely as hetereosexual women to develop an eating disorder, although NEDA mentions that more research is required in this area. They also mention that more studies are required in terms of transgender people and eating disorders, though they do state that “transgender individuals experience eating disorders at rates significantly higher than cisgender individuals” (NEDA, n.d.).
Race and Ethnicity
In a study done by Gordon, Perez, and Joiner, (2001), it was discovered that visible minorities are less likely to be identified as having an eating disorder as compared to causcasians. The study involved a hypothetical woman named Mary, and participants read about Mary’s eating habits. When Mary was described as being caucasian, 93% of participants identified her as having disordered eating. When Mary was described as being Hispanic or African American, only 79% of the participants identified her as having disordered eating (p.222). The study did note, however, that the participants’ own ethnicity appeared to have no impact on their decision regarding Mary’s eating habits (p.222).
Goeree, Ham, and Iorio (2011) found that “African Americans are more likely to exhibit bulimic behavior” (p.21) after analyzing 2,379 young women over the course of 10 years. The study looked at factors contributing to disordered eating, specifically ethnicity, age, family income, education of parents, body dissatisfaction, distrust, ineffectiveness, and perfectionism. They found that being white significantly reduces the odds of a person having disordered eating (p.13). Other factors that reduce the odds of a person having an eating disorder include coming from a higher-income family and having parents with a higher level of post-secondary education.
Based on these studies, it is important for race and ethnicity to be taken into account when diagnosing and treating an eating disorder. If doctors, therapists, etc. are like the participants in the study by Gordan et al., they may not diagnose a non-Caucasian person with an eating disorder when they do actually have one. People must be educated on this discrepancy between races and ethnicities, in order to help all of those who need the help. As it currently stands, non-Caucasian individuals are less likely to receive the help they need, even if they do reach out. The importance of this is enhanced by Goeree et al.s’ study, as they found that African Americans are more likely to develop an eating disorder than Caucasians are. While they study does not look at other ethnicities, such as Hispanics, Asians, etc., it can be assumed that they are either just as likely or more likely than Caucasians to experience disordered eating.
Goeree, Ham, and Iorio (2011) found that “African Americans are more likely to exhibit bulimic behavior” (p.21) after analyzing 2,379 young women over the course of 10 years. The study looked at factors contributing to disordered eating, specifically ethnicity, age, family income, education of parents, body dissatisfaction, distrust, ineffectiveness, and perfectionism. They found that being white significantly reduces the odds of a person having disordered eating (p.13). Other factors that reduce the odds of a person having an eating disorder include coming from a higher-income family and having parents with a higher level of post-secondary education.
Based on these studies, it is important for race and ethnicity to be taken into account when diagnosing and treating an eating disorder. If doctors, therapists, etc. are like the participants in the study by Gordan et al., they may not diagnose a non-Caucasian person with an eating disorder when they do actually have one. People must be educated on this discrepancy between races and ethnicities, in order to help all of those who need the help. As it currently stands, non-Caucasian individuals are less likely to receive the help they need, even if they do reach out. The importance of this is enhanced by Goeree et al.s’ study, as they found that African Americans are more likely to develop an eating disorder than Caucasians are. While they study does not look at other ethnicities, such as Hispanics, Asians, etc., it can be assumed that they are either just as likely or more likely than Caucasians to experience disordered eating.
Other
In regard to athletics, numerous studies have found that people who engage in sports, particularly competitive and/or aesthetic ones, are more likely to develop an eating disorder as compared to those who either did not engage in sports or instead engaged in sports that were less competitive and/or not considered aesthetic. For example, Cena et al. (2017) found that participants who engaged in competitive sports during their childhood were four times more likely to develop an eating disorder as compared to the participants who did not engage in competitive sports (p.223).
Furthermore, NEDA (n.d.) refers to studies that have found that 90-95% of post-secondary students belong to a fitness facility of some kind, and that an estimated 3% of gym-goers have a destructive relationship with exercise; however, other studies believe that this number is actually upwards of 42% of all gym-goers. While NEDA did not write an explanation for it, it could be argued that those who attend the gym are attending for the purpose of losing weight. If their goal is to lose weight, rather than to be healthy, build muscle, be more active, etc., then it is not unlikely to assume that the persons’ relationship with exercise is unhealthy and, thus, destructive. In fact, NEDA does state that there is a strong correlation between compulsive exercise and disordered eating. As mentioned above, compulsive and/or excessive exercise is often associated with anorexia and bulimia, and it can also be used as a form of purging.
Furthermore, NEDA (n.d.) refers to studies that have found that 90-95% of post-secondary students belong to a fitness facility of some kind, and that an estimated 3% of gym-goers have a destructive relationship with exercise; however, other studies believe that this number is actually upwards of 42% of all gym-goers. While NEDA did not write an explanation for it, it could be argued that those who attend the gym are attending for the purpose of losing weight. If their goal is to lose weight, rather than to be healthy, build muscle, be more active, etc., then it is not unlikely to assume that the persons’ relationship with exercise is unhealthy and, thus, destructive. In fact, NEDA does state that there is a strong correlation between compulsive exercise and disordered eating. As mentioned above, compulsive and/or excessive exercise is often associated with anorexia and bulimia, and it can also be used as a form of purging.