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Tuesday 6 March 2012

LSE Paper on Anorexia, Body Image and Peer Effects - - Costa-Font and Jofre-Bonet

Oh Sigh Sigh Sigh

This paper from the LSE has been causing quite a stir in the papers recently. Now, look, I do understand the environment has a part to play in the onset of an eating disorder but this research fails on so many levels that I can't begin to even start.  I actually started laughing (in a discombobulated way!) at parts of this.  I am hoping a U.S. friend is going to do a guest blog for me.  In the meantime, I think I should point out how far apart those of us who live in "Eating Disorder World" are from those who don't.

2. Background

Standard health production models fail to explain irregular behaviours (irregular behaviours?  what on earth is an irregular behaviour?  Hold on, do they mean the onset of a brain disorder?) such as those of anorexics. Different factors have been suggested as possible determinants of anorexia, and generally evidence does not suggest a clear consistency with the inclusion of social effects. Some of these are related to ‘nature’, i.e. gender, genes and predisposition. Other factors are more closely related to ‘nurture’ i.e. parental values (splutter!) and socio-cultural influences. In the main, these determinants seem to make individuals susceptible to having their food and exercise intake shaped by the strong socio-environmental pressures, which in this paper we define as influencing what an ideal body looks like.

Puberty and anorexia.  Girls who achieve sexual maturity ahead of their peers, with the associated development of breasts, hips, and other physical signs of womanhood, are at increased risk of becoming eating-disordered (Bordo, 2003). These girls often wrongly interpret their new curves as signs of fatness and feel uncomfortable because they no longer look like their peers, who still have childish bodies. (Er.. nothing to do with this at all, I take it.  It is NOT  a control issue, in the sense you are implying) -  A young woman in this group may ‘tackle’ her body, partly  because she wants3 to take control and ‘fix’ her insecurity and importantly because they are under the influence of a culture that equates success and happiness with thinness at times like this, I do want to scream HILDE IS DEAD and CLINICAL OBSERVATIONS ARE NOT SCIENCE alongside such comments as compulsion, misfiring, neurons. For this group of young omen, dieting, bingeing, purging, exercising, and other strange forms of behaviour are not random, but the result of a conscious decision process. ARGHHHHHH!!!!!!!!

Family and anorexia. There is some evidence indicating that eating disorders may run in families. (Yup - highly heritable) Parents influence their off-springs’ values and priorities, including those towards food (Yes, it's a parents job, is it not?). Some people with eating disorders report having felt smothered in overprotective families. (Surprisingly, as a mother, if you have a sick child, you tend to get a bit overprotective - ask any parent who has a child with a life threatening illness) Others have felt abandoned, misunderstood and alone. (Anorexia, is by nature, a disorder of isolation - for both the patient and the parents)  Parents who overvalue physical appearance can unwittingly contribute to an eating disorder, as can parents who make critical comments, even in jest, about their children's bodies. (How many parents of NON-eating disordered children have made such comments?) Furthermore, families that include a person with an eating disorder tend to be rigid and ineffective at resolving conflicts (Expletive). In some such cases mothers are emotionally cool while fathers are physically and/or emotionally absent (Bollox - this is the stereotype of parents of autistic children from some 25 years ago, conveniently transferred to parents of eating disorder children). At the same time, there are high expectations of achievement and success (It has to be said that the profile of the majority (but not all) of anorexia sufferers tends to be high achieving, perfectionist, attention to detail, black and white thinking, all of which lend themselves to academic achievement - however, are these high expectations from the parents or from the patients themselves?). Children in this type of family learn not to disclose doubts, fears, anxieties, and imperfections. Instead they try to solve their problems by manipulating weight and food (a million expletives - anorexia nervosa is not a "choice" or a manipulation), in an attempt to achieve the appearance of success, even if they do not feel successful (Bordo, 1993). Generally, anorexics reveal great fear of the criticism and rejection that would occur if their perceived flaws and shortcomings should become known (Bachar et al, 2001).

Genetic Factors. Some studies suggest that there may be a genetic component in anorexia. According to recent research (Fairburn et al 2005) genetic factors account for more than half (56%) of the risk of developing anorexia nervosa and work on the genetics of bulimia and binge-eating is under way. There are suggestions that women who develop anorexia nervosa have excess activity in the brain's dopamine receptors, which regulate pleasure. This may explain why they feel driven to lose weight but receive no pleasure from shedding pounds (Sigh, sigh sigh)(Frank, et al 2005).4

Network effects: the media. Many people believe media stereotyping helps explain why about 90% of people with eating disorders are  women and only 10% are men (Thompson and Heinberg, 2002). In westernised countries, characterized by competitive striving for success, women often experience unrealistic cultural demands for thinness. According to  Health magazine (April 2002), in the United States (US) 32% of female TV-network characters are underweight, while only 5% of the female audience is underweight. Similarly, only 3% of female TV-network characters are obese, while 25% of US women fall into that category (There is a massive difference between obese and overweight.  The actual figure is 7.6 are clinically obese, rather than overweight). The differences between media images of happy, successful men and women are interesting. While women appear young, beautiful and thin, men are young or old, but strong and powerful in all the areas that matter  – physically, in business, and socially. Thin is not desirable in men; power, strength and firmness are. (Sigh sigh sigh.  Is this an attempt at making a Feminist point that is not particularly relevant in discussing eating disorders?)

But the biggest splutter of all is reserved for this sentence

"Our results were consistent with the assumption that individuals trade off health against selfimage."

This is wrong on SO many levels but just a few:

Anorexia Nervosa is a brain circuitry disorder.
Anorexia Nervosa is not a choice.
Anorexia Nervosa patients often suffer from anosognosia, so are unaware how ill they are
Not all Anorexia Nervosa patients exhibit Body Dysmorphia symptoms
Body Dysmorphia can be a co-morbid condition and entirely separate from Anorexia Nervosa
Body dissatisfaction is an end stage symptom of Anorexia Nervosa, not the disorder itself.
The assumption that an Anxorexia Nervosa patient CHOOSES to starve themselves and to ruin their health is just plain ridiculous.


  1. Charlotte, I agree with you that this is SO overwhelmingly bad that addressing concerns about it require writing a huge paper yourself! The wrongheadness of this does seem to stem from their mistaken notion that anorexia is a choice and that people can be influenced fairly easily by the culture and those around them to manifest this disorder. Nothing can be further from the truth. How to deal with this . . .

  2. Yes. x1000

    Everyone feels the right, and often the arrogant responsibility, to have an opinion on eating disorders. It's appalling.

    I base my opinions about eating disorders on the best science, the best clinicians and researchers, the ones who publish in the highest-quality journals - not the ones I like or want to believe in.

    I also take full and considered responsibility for anyone I may influence when I give my opinion. Do these people have the same ethic? I don't think so. And yet THEY are being heard this week in the marketplace of ideas.

    Appalling. Thank you for blogging on this and your wise and delicious commentary.

  3. The LSE paper is so ignorant I really don't know where to start. There are some people who just shouldn't even attempt to write about EDs...

    I may dissect it in the way that you have done, Charlotte, on my blog when I have cooled down and cease to have smoke puffing out of my ears...

  4. *Sigh sigh sigh*.
    If it were a choice, I don't think I'd have CHOSEN to spend the last 20 ears battling and struggling to stay alive.
    Nor would I have CHOSEN to cause such heartache and distress to my family and loved ones.
    I wouldn't have CHOSEN to try and try again only to be defeated time and time again and wind up in a hospital bed, head bent in shame, humiliation, embarrassment and frustration.
    I wouldn't have chosen to spend more time as an inpatient than an outpatient so far this year (and true of many years prior to this one).
    I wouldn't choose now to see my parents aging before my eyes, and to feel such helplessness - in that I should be looking after THEM. I wouldn't choose for them to have their daughter be such a burden and a worry.
    I didn't choose failing kidneys, a struggling heart, wonky ecgs, electrolyte imbalances that could stop my heart in a beat. I didn't choose to have my bowels fall out of my arse, or the humiliating round of investigative procedures and eventually removal of growths that followed (a buggered-up bowel is an inviting place for such lovelies). Nor did I choose to have crumbling and rotting teeth, thinning hair and skin so thin and dry that a mere touch and it flakes off; a slight knock and bruising appears.
    I'd never choose the stigma, the looks, the sneers. I wish I could choose NOT to see the looks of pity and frustration from staff, as I leave inpatient treatment, again. And the same looks when I return weeks/months later because I have apparently CHOSEN not to look after myself and not to keep myself safe. What do I expect other than to wind up in hospital? Again.
    This is not a "poor me" whine (well, maybe just a little..will pull myself together in a moment;)), but it is the truth.
    Choice doesn't come into it. Either the gun's loaded, or it's not.

  5. I wouldn't have chosen to spend the last 20 Years battling and struggling to stay alive, either :P..Nothing like a typo to add a little levity..doh!

  6. Ignorance is not bliss and the LSE paper is ignorant on a mammoth level. How embarrassing that they are so publicly dim. Sigh.