Last month, Instagram joined Tumblr and Pinterest in taking a stand against pro-eating disorder content. Similar to the other major social networking platforms, they published new guidelines prohibiting users from sharing images that were found to be “encouraging or urging users to embrace anorexia, bulimia, or other eating disorders; or to cut, harm themselves, or commit suicide…”

This was a bold move by the photo-sharing service, which boasts over 100 million active users. Creating limitations on users is never popular, particularly with youth who use such applications as a means of unrestrained expression.

Perhaps not surprisingly, soon after Instagram announced the change, users created new hashtags to reference the pro-anorexia and pro-bulimia content (such as spelling “thinspo” as “thynspo”). While Instagram quickly caught up to the change, therein lies the rub. Censorship can often have deleterious effects. People don’t like to be told what not to do. Perhaps especially people who are already feeling depressed and outcasts of society.

So these disenchanted folks go further underground and get more creative. They feel more isolated, a well-known risk factor for nearly all mental health problems. And what we know about pro-eating disorder sites is that they are built and used out of a need for connection.

Not only that, but what are the implications of beginning to censor the internet? Where does freedom of speech fit in, even for those on the fringes?

On the other hand, not making a statement against this kind of content could feel like turning a blind eye to the kid cutting himself in the corner. These sites are like huge unregulated playgrounds with youth bullying each other and themselves. If they can step in and provide some safeguards, perhaps the rampant spread of self-harm can be slowed. And if even one life can be saved, might it not be worth implementing a few rules?

So what do you think? 

{image credit : afgfitness via pinterest}

A few months back, I read a post over on Psychology Today by the woman who fearlessly reminds us to have our cake and eat it too (damnit!), Kate Fridkis. She wrote about observing that skinny woman at the gym, the one who you just know has an eating disorder, and not being able to say anything. She ends the piece,

But to the extent that we still tiptoe nervously around eating disorders and pretend we don’t see them when they are right in front of us, something needs to change. Otherwise, how can we keep going back to the gym, and watching women fade around us? And won’t it be that much easier to quietly start skipping meals ourselves? Knowing that first people will say, “Oh, you’ve lost some weight! Good for you!” And then a few of our mothers and best friends will say, “I’m worried about you.” And after that, no one will say anything at all.

We’ve all seen here there, pounding the treadmill like our grandmothers beat down the dough that was to become our bread. It doesn’t look like she’s had any of that bread in a while. In fact, it doesn’t look like she’s subsisting on anything more than water and the occasional carrot.

So what do you do when you see a stranger with an eating disorder?

Well, the first thing you do is recognize that you actually have no idea if that person has an eating disorder.

Eating disorders don’t just look like the emaciated woman on the treadmill. They can also look like your neighbor, Sarah, who’s eight months pregnant. Or like your teacher, Paula, who most people remark could stand to lose a few pounds. Or like your cousin, Rich, who can no longer sit on regular furniture due to fear of injuring himself. Or like your friend, Amy, who looks just the same as she always has.

We cannot simply look at an individual at know if they struggle with an eating disorder. That would certainly make it easier for those of us whose job it is to tell! But the truth is that we don’t know what’s up unless we understand a number of other factors, like the person’s eating patterns, their perception of their own body, their desire and attempts to control their weight, and much more.

We all know someone who has lost weight following surgery, due to an illness, or related to stress or depression. We all also know someone who has gained weight following surgery, due to an illness, or related to stress or depression. This doesn’t mean that the person wouldn’t potentially benefit from psychological help, but they wouldn’t necessarily be diagnosed with an eating disorder.

The other side of this sticky coin is that many of those who have struggled with disordered eating are very attuned to the signs of a potential eating disorder. Some of the red flags include frequently hiding or eating food secretively, having bloodshot eyes and puffy cheeks, growing fine hair all over the body, doing strange things with food (like mixing items together that seem odd or tearing food apart into little pieces), and isolating from the people that they love. Hypothetically, all of these signs could mean a number of things. But for those with experience having an eating disorder or working with those that do, they send off flares in the brain.

Still, however, we usually don’t have the opportunity to observe whether the girl at the gym is hiding food under her bed or has disconnected from her friends. All we know is that she looks very thin and not so healthy. We don’t want her to die, perhaps especially if our own lives have been touched by the pain of an eating disorder. So what do we do?

Do we leave her a note telling her that we know what she’s going through and a place she can get help? Do we talk to the management of the gym about her compulsive exercise and tell them that they need to address this? Do we wait at her car and stage an intervention? Do we leave her alone and hope for the best? Do we tell ourselves we have no idea what’s going on and try to focus on our own lives?

This is a sticky situation, and I suspect that there are lots of different feelings about what to do. I’m going to go ahead and say that there is no one right answer. There’s only what you think you would do, which is what I want to know.

Thanks for taking the poll if you did, but be sure to also comment below and get the conversation going.

What do you do when you think a stranger has an eating disorder?

Would you pay $1.44 more for a six-pack of Pepsi? What about 50 cents more for your favorite french fries?

Mark Bittman, journalist and food activist, is banking on the answer being no – and yes. In a recent New York Times opinion piece, Bittman outlined a push for creating an excise tax on certain foods deemed to be unhealthy, with the subsidies used to promote healthier options.

Despite my initial cringe at the reference to “bad food” (I work tirelessly to eliminate the categorical and moral language of “good” and “bad” when it comes to food among my patients), I read on to learn more about Bittman’s theory.

And what he suggests makes sense – at least initially. He starts his argument by reminding us all of the dangers of obesity (another cringe, but still reading…) and the increasing health-care costs piling up due to our heavily non-nutritive U.S. diet of potato chips and doughnuts.

He suggests that the food industry is incapable of marketing healthier foods (and based on my analysis of the baby carrot gaffe, I would have to agree) and are not incentivized to do so. Thus, he says, it’s up to the federal government to intervene on behalf of the health of its citizens.

What makes a tax such as this more palatable is that the funds generated – which are expected to be in the billions – would help to subsidize healthy food options for the poor, something that is direly needed regardless of the means. Indeed, a substantial proportion of our nation lives in what has been termed food deserts, areas that lack access to affordable fruits, vegetables, whole grains, low-fat milk due to lack of transportation, proximities of grocery stores, or other reasons. (To determine if your area is a food desert, check out this locator.)

According to Bittman, as well as researchers at the Rudd Center for Food Policy at Yale, an excise tax would work to decrease the consumption of sugary foods, decrease disease and health-care costs, and raise funds for health-focused programs. Millions of Americans would benefit from having nutrient-rich foods more available and making feeding their children healthy options one less thing to worry about. The potential impact of this cannot be overstated.

But we’re still left with the difficult questions about the role of government in helping us make our food choices. Bittman suggests that public health has always been the role of government. But does public health call for making Red Bull less affordable?

Also, what is the long-term impact of beginning to categorize foods as good or bad, as would be required to decide on what items to tax? If one food is taxed and another is not, should that really inform our food choices? What about making those decisions based on our own body’s particular needs and desires?

I also worry about the implications of the data that has and will most certainly been used to popularize these types of initiatives. When we talk about posting calories at restaurants and other such (formerly radical) ideas, proponents frequently point to the “obesity epidemic” and the “war on obesity,” a term and movement fraught with bias and discrimination. Is there a way to propose a food tax without implying fat people make bad food choices unless made to pay more? Perhaps, but it’ll require more creativity than we often see in politics and the media today.

Those are some of my initial thoughts, but I want to hear yours! What do you think?

Make sure to share your reactions, thoughts, and ideas in the comment section below! We need to learn from one another.

When Diana Spechler, author of the soon-to-be-released novel about a weight-loss camp, contacted me to tell me about a new website she had created, I was decidedly curious. In her email, Diana described the site as a “place where people can anonymously post their feelings about their bodies.”

As I thought about the potential for this body-focused PostSecret-esque venture, I wanted to know what had prompted Diana to create the site, so I asked her to share with me its evolution. “When I was writing Skinny… I was terrified to write about my characters’ body image issues and relationships to food because I worried that the book would get published and everyone would know that I had body image issues… I had to get over that before I could write the book,” she said.

So Diana began pouring out her “secrets” – the dark thoughts about herself and her body that she found so shameful – in the novel.  She recalled, “I had to remind myself a million times along the way to be honest, to stop hiding. It wasn’t easy. But five years later, I feel better. I can talk about my own body image issues and eating issues much more freely. And that’s because I spent so much time telling my secrets in my novel.

Like many others, Diana found healing in sharing what she had perceived as unspeakable. She gave voice to the negative thoughts that plagued her and found that as she shared these thoughts, they became less powerful. They loosened their grip.

“It seemed miraculous to me, and I wanted to find a way to give that gift to others,” Diana told me. “I wanted to tell the world, “Just talk about it! You’ll feel better!”

And so Body Confessions was born. It developed as a place for women to feel connected. Diana feels that “pretending that the problem is something different from what it is harms all of us and compounds the shame we already feel. [It’s] so we can say the things we aren’t supposed to say, and so that other people can read the truth and feel less alone.”

But does connecting over a shared hatred for our bodies really do us any good? Could it be more harmful than helpful? Where is the line between releasing shame and spiraling into negativity drawn?

These the question that began to stir in my mind as I perused the site. What I found saddened me for the women who had written the “confessions.”

Take this one, from an anonymous visitor: There are two possible reasons God did not create me as pretty and beautiful as other women. Either He thought I’d be able to handle it. Or I am just not worthy. I’m leaning towards the latter because I just can’t handle this.

Other confessions are equally heartbreaking (and potentially triggering), ranging from complaints about the size of one’s tummy to struggles with binging and purging to certainty that one’s partner will cheat because of one’s size. There are also the occasional uplifting posts, such as this one: I love myself the way I am. Affirmative posts like this are certainly more the exception than the rule on the site, however.

Personally, I didn’t leave the site feeling any better about my body. I actually didn’t feel much of anything about my own body, but rather a sense of helplessness in wanting to take away the pain of those posting these messages.

However, Diana has found that the site makes people feel less alone. And Glamour recently shared it on own of their blogs.

Interestingly, and perhaps contradictorily, Glamour’s recent piece in its March issue on body image included research suggesting that negative body thoughts actually shape our brains in an unhealthy way, promoting even more negative thoughts.

Ann Kearney-Cooke, Ph.D., a Cincinnati psychologist who was quoted for the article, said, “Neuroscience has shown that whatever you focus on shapes your brain. If you’re constantly thinking negative thoughts about your body, that neural pathway becomes stronger—and those thoughts become habitual,” she explains. “Imagine a concert pianist. Her brain would have stronger neural pathways that support musicality and dexterity than someone who hadn’t spent her life practicing.”

So, what do you think?

___________________________________________________________________________________

___________________________________________________________________________________

Respond to the poll and then share your thoughts in the comments below. We want to know! Do you feel it’s healing to get those thoughts out of your mind and onto the computer screen, knowing that others have “been there?” Or does it fuel more self-deprecation? Have you found writing your negative thoughts down to be helpful in other ways? What has helped you in overcoming negative body image? Would you ever use this site?