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SALT LAKE CITY — When employees at a local eating disorder clinic asked a teenage resident why she was refusing to eat, the teen lifted up her shirt and pointed at her stomach.
"I would rather die than have tummy rolls," she said.
Christine Parks, a care technician who witnessed the interaction at Utah's Center for Change, has gone through recovery for eating disorders and felt flooded with emotion — and protectiveness.
She knew that the girl's statement was not an exaggeration. Eating disorders have the highest mortality rate of any mental illness, and they are impacting teenage girls now more than ever.
Experts say that since the COVID-19 pandemic began, there have been documented increases in eating disorders in the United States, Canada, Australia, Europe and the Middle East.
According to a study from the Centers for Disease Control and Prevention released last week, emergency room visits for eating disorders doubled among 12- to 17-year-old girls nationwide since the pandemic began. And those are just the cases that are life-threatening enough to warrant emergency admission during a pandemic.
The National Eating Disorders Association has reported a 107% increase in calls to their help line since March 2020.
Researchers have found a number of potential reasons for the growing number of eating disorder cases, including having to eat meals in front of others, having less-structured meal times, exercising at home using videos on social media and apps, video conferencing and increases in stress levels.
Multiple studies have shown that the heightened attention to weight gain on social media during lockdown led people to increase their physical activity to an excessive level out of fear. One 2021 study from the University of Connecticut Rudd Center for Food Policy and Obesity found that over 50% of teenagers saw social media content that stigmatized weight gain during that time period.
Although no organizations are quantifying exactly how many eating disorder cases there are in Utah, the demand for treatment has skyrocketed since 2020.
"Every person I know is full or has a waitlist and has closed their waitlists, including dietitians and people working at hospitals. I have colleagues who prefer not to treat eating disorders, and it's not an option anymore," said Dr. Corinne Hannan, a psychologist specializing in eating disorders and assistant clinical professor at Brigham Young University.
"From my chair, it's not showing any decline. Quite the opposite," she added.
A culture of perfection
When a former college track athlete, who asked to remain anonymous for privacy reasons, arrived at the Utah university a couple of years ago, she noticed a pattern in the people around her that she said she didn't see nearly as often in her home state.
She said it was completely normal for her friends and teammates to eat foods they deemed unhealthy or fattening and then compensate by "running it off" for miles and miles or exercising excessively. In fact, she said this behavior was rewarded and encouraged. She said her coach at the time even told her to lose 3 to 5 pounds, even though she was regularly exercising and lifting weights.
Excessive or compulsive exercise as a form of purging is also known as anorexia athletica or exercise bulimia, but it is not a recognized clinical eating disorder in the Diagnostic and Statistical Manual of Mental Disorders. However, the National Eating Disorder Association website states that compulsive exercise can be a symptom of disordered eating or a recognized eating disorder, and the symptom itself can lead to bone density loss, loss of menstrual cycle in women, and other severe medical conditions, some of which can be life-threatening.
Hannan explained that it was impossible to find data on how many Utahns are dealing with eating disorders because the data does not exist. There's not enough research being done and not enough funding for researchers to pursue it.
The former athlete's mother, Michelle, who runs an international Facebook group for family members of people with eating disorders, expressed that another problem gathering this data is that everyone has different definitions of what recovery means. So local treatment centers, which go largely unregulated, might not report accurate recovery rates.
Every person interviewed for this story mentioned a culture of toxic perfectionism that applies to appearance.
Hannan speculated that the high rates of perfectionism she sees in clients and students in Utah occur because of an association with physical perfection and religious worthiness or an unconscious need to stand out as the most perfect in a homogenous crowd of other white, slim people who make up the majority demographic of the state.
No matter the reason, it is impossible to drive down a freeway without coming across billboards telling you to change your appearance through plastic surgery, cool sculpting or dieting, Park said.
"It's definitely a beauty-saturated place," she continued. "Hair extensions, fake eyelashes, spray tans: It's almost like the expectation is that everyone should have that. … How did we get here? How did Utah's beauty ideals become like this? It's so preventable."
No specific look or size
Although the reported number of hospitalizations is growing specifically among adolescent girls, eating disorders do not pertain only to people of a certain look or size.
During Parks' work at Center for Change, she has come across grandmothers who have had an eating disorder for 40 years, military personnel, athletes, mothers, and people of all ages and backgrounds.
"You can never tell based off looking at someone," she said. "It gives me so much more compassion for anyone who struggles with food and body issues because it's truly an invisible disease. Everybody is worthy of getting help."
Multiple studies show that marginalized populations like people of color and members of the LGBT community have higher rates of developing eating disorders. And children are far from immune, as some Americans are putting children on diets at younger and younger ages.
"I wish the average person understood that eating disorders are not something you can diagnose with your eyes. They are underdiagnosed and underrepresented due to misinformation and normalization and promotion of disordered eating of society," Hannan said.
Anyone of any ethnicity, gender, size, age or ability could possibly have an eating disorder, she added, but the biggest predictor of youth developing an eating disorder is dieting.
Effects of social media
Parks was 15 years old when she first started developing orthorexia, an eating disorder characterized by an obsession with healthy eating. She didn't see it as a problem. After all, she told herself, she was just trying to be healthy.
This was also when Instagram was fairly new, and it became the breeding ground for her issues with food.
"I 100% used it as a resource to figure out how to lose weight. I remember looking up strategies of what to do when I'm hungry instead of eating," she said.
Now, after recovering from her years of being trapped in a cycle of heavily restrictive eating — becoming nutritionally and calorically deprived, binging secretly and resetting weight loss goals in shame — she runs an account specifically dedicated to eating disorder recovery on the same platform that encouraged her illness: Instagram.
When she was an undergraduate at Brigham Young University, all-consuming thoughts of food terrorized her during 90% of her waking hours. She began to isolate herself from everyone, even planning her walks across campus to avoid crowds so she wouldn't be seen because she "didn't feel worthy or valuable as a person until (she) was thin enough."
In 2019, she attended a meeting on campus that addressed disordered eating and eating disorders and promoted intuitive eating, or making peace with food and relying on your body's cues to decide what and when to eat.
As Parks began to work with a dietitian and a therapist to get her life back, she came across a quote from Dr. Thema Bryant, a psychologist and minister, that inspired her to write about the eating disorder she had kept hidden for so many years.
"When you shatter the shame and begin sharing your story, a thousand chains will fall off people you never met," Bryant wrote.
Parks wrote out her story in a blog post titled, "The eating disorder that no one talks about." She took a deep breath and clicked "publish." The response from her community was immediate.
"Messages upon messages came pouring in from people I know and people I didn't know," she said.
Later that year, she decided to start an Instagram account called @ed_stories. She shared 120 recovery stories within the first year from people across the country and abroad.
"Advocating lights my soul on fire," Parks said, and her experience running the account has shown her social media's "incredible capacity for good."
"Now I follow a million therapists and dietitians in the eating disorder space. You can curate your feed for recovery," she said. "But it does need to be heavily regulated and monitored."
The National Eating Disorder Association website states that 7 out of 10 women and girls report a decline in body confidence attributed to pressure to attain society's unrealistic beauty standards.
In October, Frances Haugen, a Facebook data scientist turned whistleblower, leaked internal Facebook studies that showed that Instagram harmed teenagers. One study, in particular, showed that 17% of teenage girls reported that the app made eating disorders worse. Haugen testified before Congress on Oct. 5, 2021, stating, "Facebook knows that they are leading young users to anorexia content."
When Hannan heard this news, she was disappointed and angry but unsurprised.
"There is a substantial body of research showing how social media can contribute to disordered eating and body negativity. The issue with Facebook is a continuation and magnification of an already existing problem," she said.
It is almost impossible to use social media without coming across millions of money-making accounts that invent a flaw, make you feel insecure, and then sell you a solution, Hannan explained. And youth are using social media for hours as a part of their daily routine.
"Companies with all this power and influence are preying on the most vulnerable of us: teens and children. There's no accountability and no ethics. It continually breaks my heart," she said.
However, she also believes social media can reach and connect people worldwide in an unprecedented way and share accurate information. But doing so in a way that competes with the multibillion-dollar diet industry takes a lot.
Although she hasn't done publishable research on curating a social media feed, Hannan has found that if she only followed and interacted with very specific accounts, she could limit the amount of damaging material she was exposed to.
"I wouldn't be surprised if curating a media feed that supports your recovery is as powerful as being exposed relentlessly to hours and hours of images," Hannan said, and she's optimistic that people with the time and team will create content to make a better world.
Parks also said she doesn't recommend blocking teens from accessing social media. Instead, she suggests taking breaks, paying attention to the research being done on social media consumption, educating teenagers about the risks, unfollowing any accounts that promote unhealthy behaviors or comparison, and following specialists and doctors involved in eating disorder recovery and intuitive eating.
Recovery is possible
The biggest point every interviewee emphasized was that recovery from eating disorders is absolutely possible.
Hannan's clients sometimes refer to the journey to recovery with pop culture references, like Frodo destroying the ring in "Lord of the Rings" or Ron Weasley having to face all his worst fears before destroying a horcrux in the Harry Potter movies.
Michelle recommends that parents and supporters help their loved ones with eating disorders find evidence-based treatment that will lead to long-term recovery.
Rewiring the brain doesn't happen overnight, but for Parks, recovery looks like getting her life back: dating, creating and deepening relationships with friends, being present with family, pursuing a career, and living a fulfilling and happy life.
She still struggles occasionally, but she really does feel as though a thousand chains have fallen off her since she began recovery. She is miraculously, gloriously free.
Resources for people dealing with eating disorders
- The National Eating Disorder Association has a 24/7 confidential, toll-free helpline at 1-800-931-237, and an online chat option.
- The National Association of Anorexia Nervosa and Associated Disorders has a helpline at 1-888-375-7767, open from 8 a.m. to 8 p.m. MST.
- FEAST is a nonprofit global support and education community of and for parents of those with eating disorders.
- Wondering if you have an eating disorder? Mental Health America has an online evaluation, though an official diagnosis should come from a health care professional.