Eating disorders and body image

0:00:00 - This episode may contain content that could alarm or trigger some people. Listener discretion is advised.

0:00:08 - Typically, people with binge eating disorder bulimia, you know, their family and friends may not know for eight to ten years that they actually have a disorder like this because it's so shame based and it's so highly secretive.

0:00:21 - Hello and welcome to Brainstorm. I'm Guy Rowlison. My guest today has worked in the field of eating disorders for approximately 20 years, supporting hundreds of people to achieve recovery. She's a member of the Australian Psychological Society, the Australian Association of Psychologists, and the Australian New Zealand Academy of Eating Disorders. She's a writer, advocate and voice of reason in the Health segment. And together with a team of clinical psychologists, dietitians, psychotherapists delivers industry leading counseling and treatment for eating, dieting and body image issues.

0:00:53 - Psychologist, director and co founder of Body Matters, Sarah McMahon. Welcome.

0:00:57 - Thank you for having me.

0:00:59 - How are you?

0:01:00 - I'm going well, thank you. Yourself?

0:01:02 - I'm doing okay. Look, from the outset, I have to say I was blown away by the sheer breadth of experience of the team that's been assembled at Body Matters as co founder and director. Tell me a bit more, not only about yourself, but how Body Matters came to fruition.

0:01:20 - Yeah. So I actually had a lived experience of an eating disorder as a teenager and made a decision at that point in time, I think I was about 19, that I really wanted to make a difference in this space if I ever became recovered. And I worked very hard on that. At that point in time, I was studying architecture, but it obviously compromised my experience at school and university and pulled out, got better, and the rest is history, really. I focused on subsequently just trying to make a difference in the eating disorder space. And here I am today still doing that.

0:01:56 - So to ask the very basic question, what is body image?

0:02:02 - So body image is not how we look, but it's how we think about how we look. And so there's often a massive discrepancy, actually, in relation to how people perceive themselves and how they're actually perceived by others.

0:02:15 - So can body image, or at least our perception of what body image is or should be, can that affect our mental health or our emotional thinking?

0:02:25 - Definitely, I think particularly today more than ever, because we live in a society that really values beauty, really values appearance of thinness. But social media has really taken that to another level where it's not so much about how you feel or think about things, it's how things look. So we live in a society where it is about appearances and people will do things just because they look good, not because they feel good. So I think that social media has really facilitated a complete disconnect from our bodies. And so when we're working with our clients, like, a huge part of the work that we're doing is reconnecting with our bodies, reconnecting with how things feel for us in terms of what feels good and what doesn't feel good. Because I think particularly for young people today, they've never experienced that. They've lived in a world entirely that is about how things appear.

0:03:11 - And I think at least for me and my peers and people older than me, we escaped that because social media really wasn't around when we were growing up.

0:03:23 - For many years now, we've seen the rise of niche television programming, reality shows where cosmetic surgery is almost put on a pedestal. And it wasn't that long ago that even Botox was viewed as extreme. And today, of course, just about anyone can walk into their shopping center for treatment virtually. So my question is, what's led us to this point? What are some of the things that lead to negative body image and what are some of the ways that we can cope with that negative body image?

0:03:52 - Yeah, so I certainly don't want to sound like I'm kind of focusing too much on industries, but the reality is that there are huge industries that profit here from making us feel bad about how we look and posing solutions to that. And certainly the dieting industry is a big one, the fitness industry, the beauty industry. And I think that blurring of boundaries. Now we have kind of medi clinics and cosmetic surgery Botox, even the way that we deal with our hair and our teeth, teeth whining, hair straining, it was only available to celebrities in the past, whereas now it's available to the masses. And in fact, it's actually kind of expected that you will look like a celebrity. Things that you in the past, you'd have to go to a hairdresser to facilitate that. So I think times have really changed and that's kind of just accelerated body image concerns because that ideal and the ought of how we should look, there's that expectation of adhering to that which in the past, it just sort of really wasn't available.

0:04:56 - And add to that is things like social media and the administration of apps such as that modify our appearance. So filters and things which can change how we look. Again, that was only available to celebrities in magazines, but that's so readily available. And I think that process sort of facilitates cognitive dissonance in the sense sorry, the opposite of cognitive dissonance. Cognitive dissonance is basically that our actions and our behaviors need to align. And if they don't, there's an uncomfortable feeling and one needs to adjust.

0:05:30 - So the process for people to identify the so called flaws or perceived flaws in their body and alter them, it actually feeds you'd think on surface level, it might make us feel better about how we look, but it actually breeds body discontent because there's a preoccupation with these perceived flaws and a manipulation of those to something that's actually physically impossible in many cases.

0:05:58 - So let me just turn say to eating disorders and how common they are. Is it still the case that these disorders are more common in women than men? And are there other groups that may be predisposed or more affected by that?

0:06:12 - Yeah, it's a great question because I think diagnostic criteria is always changing and evolving. And so in the past, things like bulimia and binge eating disorder weren't even diagnoses. It was just anorexia. So there's this kind of catch up then with research and statistics in terms of what we're seeing as a cluster of symptoms that makes a diagnosable disorder and then how that's kind of represented in society.

0:06:38 - But certainly in terms of groups, binge eating disorder tends to be equally affected by males and females. There's research to suggest that anorexia in, under 14 year old boys, that one in four cases is a male. So that's, I think very sort of unexpected and perhaps underrepresented in the media and in terms of our general knowledge about eating disorders. And one of the newer diagnosis is called Arthur Avoidant and Restrictive Food Intake Disorder, where people are restricting food not based on body image, but based on things like sensory kind of heightened sensory experiences or distress around eating that's not to do with body image, that there's far more people who are seeing diagnosed with that. And there's an overlap there between often with autism, people who or autistic people are more likely to have that. So I think we're also sort of seeing this increased awareness in terms of neurodivergence and people who are neurodivergent and people with eating disorders. And it's very much an emerging space in terms of research, but also treatment, that the treatment hasn't really caught up yet in terms of what's actually presenting, which I think is quite astronomical in the last year or two.

0:07:52 - There's so much need for services that have a really dedicated support around neurodivergence and eating issues, but the treatment protocols actually aren't there yet.

0:08:04 - So what's the difference between just overeating on occasion compared with, say, food addiction or binge eating disorders?

0:08:14 - Yeah, that's another great question. So I think binge eating, if we sort of think about that as an extreme case of disordered eating, that typically it's characterized by eating a huge amount of food in a discrete period of time, and then there's other factors. So there's a sense of loss of control, often huge amount of shame. It's often done in secret. So typically people with binge eating disorder and bulimia, their family and friends may not know for eight to ten years that they actually have a disorder like this because it's so shame based and it's so highly secretive. And so I think you think about that, that is very much disordered and it meets clinical diagnostic criteria because it impacts on somebody's life, but kind of moving from, say, what you might consider to be regular eating or normal eating. Although I think that's another issue in itself. How do we actually define that and what is that? But I think there's very much a continuum leading from that to disordered eating, like bulimia and binge eating disorder. So you've got compulsive overeating where people are kind of eating past fullness or eating in a way that's out of control, you've got overeating, but they don't kind of impact on somebody's quality of life to the same extent. And it's not used as a coping mechanism to the extent that binge eating binge eating actually is. So I think most of us can probably identify with periods where we might have eaten compulsively or eaten past fullness. And that's not necessarily a disorder. But the other kind of key factor with binge eating disorder is the frequency. So it's sort of happening at least once a week, typically to meet diagnostic criteria.

0:09:44 - So as a professional, I know as a family member or a friend, you may notice some things, but as a professional, what are the red flags that you would see on a day to day basis that may be more prevalent than others?

0:09:58 - Yeah, so I think the most obvious one is fluctuations around weight. And I think it's important to remember that fluctuations around weight could be to any number of medical or psychiatric issues or concerns. So you don't need to have an eating disorder to lose weight or gain weight rapidly. And very much eating disorders are disorders, behavioral disorders rather than weight disorders, if that makes sense. So we're looking for a cluster of symptoms, things that are occurring around the same period of time. So changes in personality, changes in relationships, often changes in relationship with food. So someone might become overly interested or completely disinterested and obviously avoidant. So it's those sorts of changes that we're noticing.

0:10:41 - And often the weight change occurs, it's sort of delayed. So these are the warning signs that we're noticing initially. By the time weight change occurs, quite often the behavior is fairly embedded.

0:10:53 - I know you mentioned the media, I'm sure there's peer group pressures, all those sort of things, genetics, family inspired triggers and personality types. Are there individuals that may be more prone to this sort of thing than others as well?

0:11:11 - Definitely. Certainly anorexia there's research to suggest that they're brain based disorders, eating disorders, and that there can be a genetic component to it. And I think it's really hard sometimes to aside from when we're actually looking at things like genes, it's hard to separate environmental sort of nature and nurture. So it's very common that we would see clients present with eating disorders who have family members who also have eating disorders. And so people have grown up around diet culture, for example.

0:11:41 - That's not to blame family members, because I think we're all trying to survive the world as best we can. And it's certainly not to say that the family members have caused it, but it's also we see so many families who are just the most lovely, beautiful, protective families as well. So I think kind of remembering that the key factor for families if someone develops an eating disorder is to see them as a resource rather than spend too much time thinking about how did the eating disorder develop and is the family responsible either kind of environmentally or because of genetic coding. But even like genetics is interesting because even sort of epigenetics and how those codes, genetic codes are develop.

0:12:23 - If a mother diets, for example, when she's pregnant, the body doesn't know that it's 2023 and it's cool to be thin at the moment, the body kind of thinks that they're in a famine and their child is more likely to sit at a higher body weight simply because that's to do with survival for that young person. And so our bodies are sort of fairly prehistoric, I think, in many ways, in terms of how they're actually wired. It's still very much geared around survival. And so there's this kind of real collision now when we see kind of what's happening to people when they died and then how that kind of impacts on the body and biology.

0:12:58 - This episode of Brainstorm is proudly supported by h. If what if your health insurer gave you the freedom to choose?

0:13:06 - Yeah, we're talking about 2023 and modern day thinking. So do you think health campaigns, for example, which for the most part seem to tackle obesity, potentially sends the wrong messages, particularly to those who who may be susceptible and those advertisers and marketers when they start aligning words like healthy with weight loss.

0:13:29 - Such a great point. People can lose weight in so many unhealthy ways. People can maintain low body weights through unhealthy behaviors such as smoking, purging, taking diet pills and laxatives. So it's really important that we separate the correlation between health and weight and see health more as an ongoing process that's separate from the number on the scales, which is obviously very static, but also distills a whole kind of concept down to one particular number.

0:13:57 - So that in itself is a really important thing for us to remember. But aside from that, in terms of health promotion, absolutely, I think there's so much fear mongering around obesity and so much shaming around people who are sitting in bigger bodies. And so a lot of these health campaigns really focus on fear mongering and shaming, higher body weights, and absolutely they often fall into the wrong hands. So the people who are perceptive, people who are receptive to them, are people who often are more vulnerable to developing an eating disorder. And a lot of these campaigns have no sort of evidence to suggest that they are actually effective.

0:14:40 - When we think about obesity, and I guess I'm saying this is someone who has a master's in public health, it's a real interest to me in terms of the broader kind of factors which contribute to health within our society. But there's so much evidence to suggest that obesity for using that term, and I prefer not to use that term, but there's so much evidence to suggest that if people are sitting at higher than above their natural body weight, that there's societal factors like access to exercise, access to healthy food.

0:15:15 - There's no coincidence that people are more likely to be there's a direct correlation between body weight and shape and size with living closer to the coast. The further regional someone becomes, the more likely they are to sit at a higher body weight. And you think that if you've got to jump in your car and drive everywhere, you can't sort of safely walk and access to fruit and vegetables is more limited.

0:15:39 - You can sort of see that there is absolutely a public health component. And I think the problem with these campaigns is they pitch sort of obesity or sitting at a higher body weight as an individual problem rather than something that is a systemic kind of issue. And I think it's also important that we remember and why I said I try not to use the word obesity is it sort of medicalizes bodies and kind of marginalizes fat bodies. And there is absolutely a spectrum of body weights and shapes. And so there will be some people who naturally sit at high body weights and are very healthy and engage in health given behavior all the time. And there's other people who sit at high body weights who've been on diets for their entire weight and have literally dieted themselves fat. And so it's important for us to kind of not assume that people are sitting at higher body weights because of all of those sort of stereotypes around so called obesity.

0:16:38 - I think think about the seven deadly sins glutton and slothfulness. Like, how many of those sorts of things are correlated in our minds often, unfortunately, with higher body weights. And so all things that we need to be mindful of and careful about.

0:16:54 - We have to be careful though, too. I know we have to draw a plimsal line across the way we diagnose things and we look at ourselves. But there are those very generic charts where if you're a certain height and you need to fall into a range and that can be dangerous, can't it?

0:17:13 - Yes, that's right, because they don't take into account things like genetics, for example, or kind of ethnicity. So there's a lot of evidence to suggest that people, for example, with Asian backgrounds are more likely to sit at a lower body weight. And so according to BMI charts, they might be in a so called healthy weight range, but for them, it may not actually be the healthiest weight for them. And again, I kind of want to steer away from pathologizing weights specifically, but I think we really which I've just done in that example, but I think we need to remember that there's a whole heap of factors which contribute to the weight that somebody's sitting at.

0:17:55 - So from a professional perspective, why are eating disorders so hard to recover from?

0:18:04 - I think one of the hardest things with eating disorders is firstly, people are terrified often that if they make changes, they're going to put weight on. And so living in a society that glorifies thinness and kind of demonizes fatness, that's for many people their worst nightmare. And one of the maintaining factors for the eating disorder for most people is the belief that it's keeping them at a lower body weight, whether or not that's actually true.

0:18:29 - And so giving up something that they've often invested years, sometimes decades, huge amounts of money into huge amounts of time, it's come at the cost perhaps, of their education, friendships, relationships, to turn around and kind of take the risk of doing something where there's a perception that it's going to result in weight gain. That in itself is absolutely terrifying. But I think, again, when we think about societal ideas, so much ideals, so much of these ideals that society upholds are kind of exhibited by eating disorders. So we talk in our language about being self controlled around food and you didn't eat much today, you're great, good on you, you haven't eaten bread today.

0:19:16 - And it's kind of the moral association with thinness, but it's also the moral association with behavior. And so for many people to recover from an eating disorder feels like they're acquiescing, that they're giving in, that they're failing. And so even if the eating disorders come at huge cost to them, and there's a part of them that can recognize that, and their friends are saying, get better at family, we want you not to have an eating disorder anymore, it's very hard for someone to actually see that for themselves.

0:19:45 - And the process of recovery is difficult. I think for most people it's the hardest thing they'll ever do in their entire life. Because when you're recovering, and I can say this from lived experience, your brain has played a big trick on you for many years. And it's a really hard thing to kind of acknowledge that and kind of start to take steps towards recovery.

0:20:07 - So in that situation, what are some of the treatments, say, today compared to 510, 15 years ago, or approaches that need to be employed? And has there been any recent developments in research? When it comes to treatments?

0:20:22 - Yeah, research is always developing and improving, and I think particularly the ARFID space, there's more restrictive food intake disorder that I mentioned earlier, that there's developments now, there's protocols around that, and there's protocols around more protocols around kind of even working with people at higher body weights who have eating disorders. So I think there's definitely emerging research. And in Australia, there's been huge strides in the last 510 years, in particular in terms of even disseminating this. So we've got some, I think, in terms of like mental health conditions the eating disorder space? Have they been really successful in advocating for Medicare funding, in advocating for or in setting up training and kind of consistent body or bodies, which kind of are really just making sure that Eden just sort of stay on the agenda for health professionals and in the government and in terms of advocacy.

0:21:22 - But in terms of protocols, I think there's still a massive gap in terms of the severe and enduring anorexia that there's a lot of people who have had a long term anorexia, and I feel like it's one area in Australia where we still don't have good treatment for, and it's a difficult thing. I think from the government's perspective, they're kind of thinking like we can kind of increase Medicare, like we have x amount of funds to spend on eating disorders. Are we going to focus on early intervention through and treatment for the people who are more of the sort of so called worried, well, who can get better with 20 or 40 sessions via Medicare or are we going to put funding into this chronic and enduring space? And unfortunately, I think that time and time again that group of people has really missed out in terms of accessing treatment.

0:22:11 - So how can we talk about body image with our loved ones in a way that is supportive and helpful and what are some of the questions that we can ask to determine whether he or she has an eating disorder?

0:22:26 - I think in terms of language and in terms of general communication around food and bodies, one framework that I love is Health at Every Size. And the reason why I love it is because I think in the past what's happened is the things which are being kind of praised and celebrated in someone in a higher body weight, such as counting calories, restricting food, doing lots of counting footsteps, these sorts of things are then diagnosed. You see exactly the same behavior with someone in a lower bait and you think weight and you're thinking gosh, this person's got an eating disorder. So it's really confusing for someone to kind of go through that process like 1 minute they're being rewarded for behavior that six months later is what actually lends them to being diagnosed with an eating disorder. So the Health at every size kind of framework I think is nice messaging in general that regardless of someone's weight, it doesn't matter, we don't have the number on the scales as a destination. We're thinking about an ongoing process irrespective of weight, that involves all aspects of our personhood. And it's not focused on weight loss. It's focused on a continual pursuit of health as a general concept. So I think that's really a protective way in our community for us to be embracing how we talk about health and how we talk about bodies.

0:23:40 - And if we're concerned about someone who might have an eating disorder, it's important to actually speak to them the Butterfly Foundation. And there's also states here in Australia have some states around Australia have state based charities as well. But the Butterfly Foundation, as a starting place has a great call line, and it's worth kind of seeking out specific support if you're concerned about a loved one.

0:24:06 - Talking about your concerns, talking about whether you think that there might be a problem kind of validating or confirming whether that's possible, and having someone who can coach you through that process of engaging with them, because it's likely that it's going to be a number of conversations over a long period of time before they start to acknowledge that something's not right. And just because someone responds in a way that's angry or that they're upset about what you've said, doesn't necessarily mean that you've gone about it in the wrong way or that you shouldn't have actually said it. So I think it can be really confusing because I think we sort of expect that we'll have a conversation with someone and say, I think you might have an eating disorder. And they say, yes, I think I do, I'm going to go and get help. And it just doesn't work like that, I think because there's that reluctance to firstly, the lack of insight typically and lack of motivation to make change, that it's a process of someone firstly acknowledging that something's not right.

0:24:57  - Secondly acknowledging that it's an eating disorder. And then, thirdly, making a commitment or making even a decision as a starting place that they're interested in, even beginning to think about making change. And then that takes time for that process to occur.

0:25:13 - It seems all very common sense, but it's not necessarily, is it?

0:25:18 - No. I think in reality it's easy for me to talk here and talk about the do's and the don'ts don'ts. But the reality is that living with someone and loving someone who has an eating disorder is hard work. And it's very much that the family has an eating disorder in many senses because the impact is so widespread on siblings, children, parents, partners, so much resources is really directed towards parents. But the reality is that so many people with eating disorders are adults. They're married, they've got children. And I think we kind of really sort of stereotype eating disorders as a problem that teenagers experience. And of course, typical ages of onset are teenage years and it's very common in those years. But there's a lot of people who never had the opportunity to get better or haven't recovered, or who have onset as well as adults. So it's important that we remember that.

0:26:14  - So just wrapping things up, if there's one message, a single message that people can take away from our conversation today, what would that be in your mind?

0:26:23 - A single message, I would say, in terms of prevention, is have a look at health at every size. It's not a perfect philosophy, but it provides a framework. If you're not familiar with it, to think about how we talk about bodies and weight and shape and exercise and all of those sorts of things. And then the other thing is, if you're concerned that someone or you might have a problem with food is reach out and spend some time just trying to understand what's going on and start starting with someone like the Butterfly Foundation is a great start. They can help support the process of contemplating what might be going on, and they can make recommendations and referrals for treatment.

0:27:05 - And if anyone wants to get in touch with the team at BodyMatters, how do they go about that?

0:27:09 - They're more than welcome to get in touch. Our website is quite comprehensive, www.bodymatters.com au. And from that there's links to email or phone us, and we'd love to have a chat with anyone that we can help.

0:27:20 - It's a confronting conversation sometimes, and one that we have to have on so many fronts by so many people in so many parts of the world that we live in today. Senator McMahon, thank you for your voice, the work you're doing, and your time today.

0:27:35 - My pleasure. Thank you for having me.

0:27:38 - The views and opinions expressed in this podcast are for informational purposes and not intended as a substitute for professional advice, diagnosis or treatment. For questions about your own emotional health and well being, please consult a medical professional.