The (forgotten) social dimension of eating disorders.

We don’t eat until your father’s at the table.

We don’t drink until the devil’s turned to dust.

 James Vincent McMorrow. We don’t eat.

Social interactions often involve drinks and food. Think about Mean Girls and the cafeteria map that Janice handles to Cady displaying where the different school tribes sit. Or the episode in The House of Cards when Frank Underwood invites the Russian President, Petrov, to a dinner in the White House in order to try to influence on a peacekeeping agreement in the Jordan Valley. Eating food can be a valuable moment to interact with our family, friends, or co-workers.

Social interactions might influence our eating behavior. In German, there is the expression “alleine Essen macht dick”, which literally, means that eating alone fattens. On the other hand, at least in Spain, you might be perceived as rude if you do not finish your meal when someone else is hosting you for dinner, so in that case, you might prefer to eat beyond satiety than to offend your host. Like, when I go visit my parents in Barcelona. My mum will always complain that I look too skinny, does not matter how many times I tell her that my weight is in the normal range. In my flight back to Germany, I will always end up weighting two more kilos.

Given the close interrelation that exists between the presence of other people and eating behavior, it is not surprising the fact that social interactions may impact in the acquisition and maintenance of pathological eating behavior. For instance, social pressures seem to have an important role in body dissatisfaction, a well-known risk factor for the development of disordered eating behavior (1).

Amongst disordered eating behavior, two patterns seem to be quite prevalent in Western populations: (a) uncontrolled eating behavior, or loss of control over food intake; as well as (b) restrained eating behavior, or continuous conscious attempts to restrict food intake in order to lose weight.

Both problematic eating patterns are interrelated (2), however, for the sake of simplicity, I will focus here exclusively on the second one. Exaggerated restrained eating can be an indicator for the presence of restrictive types of eating disorders, such as anorexia nervosa. Anorexia nervosa is a psychiatric disease characterized by excessive concern with body weight, followed by an extreme restriction of food intake, which might lead to malnutrition and to other severe health consequences, such as endocrine dysregulations. It has been estimated that, in Western societies, 0.3% of young females suffer from this pervasive health condition.

Despite the strong interrelation between eating pathology and social pressures, cognitive neuroscience has largely omitted the inclusion of the social dimension in the study of eating disorders. Admittedly, it is certainly challenging to simulate a social interaction in a dark, tight, and extremely loud 20 to 60 minutes MRI scanner. However, the incorporation of social paradigms will certainly enrich our perspective of these pervasive disorders.

Precisely, a new fMRI study has tried to address this issue by comparing patients with anorexia nervosa and healthy controls on a social evaluation task (3). Basically, participants had to rate some photographs from strangers according to how much would they like to meet this person, and later on, they were supposed to receive also the same type of feedback from these people in the scanner. One of the results that they found was related to the dorsomedial prefrontal cortex. Patients with anorexia nervosa exhibited blunted activity in the dorsomedial prefrontal area while receiving positive feedback relative to healthy participants. This fact led the authors to hypothesize the existence of possible disruptions in areas traditionally assigned to self-evaluative processes and inferences of other’s mental states (3).

Not only social pressures might be associated with vulnerability to suffer eating disorders. Many other factors, such as personality characteristics, might likely play an important role in the vulnerability and resilience of individuals. Nevertheless, I think it is important to highlight the fact that negative social experiences might exert some influence in body dissatisfaction, which in turn, might impact on the incidence of eating disorders. I think we should recognize the fact that our “civilized” Western societies tolerate toxic social messages promoting misogyny, racism, and shaming. It is important, because, in part, it is in our hands to speak out and change it. Just think about the last two months. We are witnessing extreme violence against black people in America, and absolute passivity towards the terrible fate of war refugees in Europe. In another level, but more closely related to body shaming, we have also seen the appearance of the “harpoon project” –another unfortunate manifestation of thinspiration movements or pro-anorexia trends– the commercialization of female viagras as another attempt to pathologize women’s sexuality, the use of menstruation to discredit inconvenient questions in political debates, and public shame of non-cisgender people with total immunity.

Scientific literature also plays a role in the body-shaming problem. Just go to PubMed and select a random study on obesity. Warning! Spoiler alert in the next sentence!! Typically, the opening paragraph in the introduction will contain a “catastrophic” description about how terrible obesity is for society and for an individual, how much does it cost to European or American health systems, how many months of life expectancy it reduces, and how many times does obesity increase the risk for a range of terrible diseases, such as cancer, diabetes type II, depression, and sexual dysfunction.

While it is true that obesity – specially in combination with other vascular risk factors– might prove detrimental for health, the obesity literature tends to “forget” to disclose that a number of people with overweight or obesity live a perfectly happy, healthy, and meaningful life. Moreover, body mass index, the measure more vastly utilized as surrogate for obesity (defined by kg/m2), might not be adequate to describe overweight, specially, in people with large muscular volume.

And let’s not talk about how does the media represents obesity, when referring to some scientific study. Just imagine a hypothetical scenario in which some scientist have observed that obesity is associated with something random and, in appearance, catastrophic, like 0.25% more probabilities for using the grimacing face emoji while texting on WhatsApp (is it just me? I hate this emoji!!). And let’s imagine that newspapers want to report this important bad news to the general audience. Together with the text referring to the scientific article, I am sorry to tell you that it is highly unlikely that you will see a picture of beautiful and inspiring people with obesity, like say, Tess Holliday or Adele (I mean, the Adele from “Never mind, I’ll find someone like youuuuu”; not the new slim Adele). Rather, illustrating the alarming and apocalyptic study, you will likely see a photograph portraying the centric 20% of a person’s body (well, you guess it’s a person, but since you just see 20% of the body, it could perfectly be only a pillow with a human shape), displaying a corpulent belly wearing an extremely tight, ugly, four sizes smaller, and probably fuchsia T-shirt. And you might guess, wasn’t there any other more appropriate T-shirt to wear? Was it absolutely necessary to pick the T-shirt up from the Zara kids section? Sometimes it is useful to remember that, if some jeans make muffing tops on you, it is not you the one who has a problem: simply, your jeans are too tight for you to wear them.

I eagerly await the day when we no longer tolerate social messages that shame people’s appearance, culture, or sexuality. Perhaps we can all try to transform our immediate environment in a peaceful and tolerant space, where we all feel secure enough to freely express our own personality and our own cultural traditions. We might not only reduce the incidence of disordered eating behaviors. We might also build open and inclusive societies that fight against prejudices and narrow-minded attitudes. As the transgender Leelah Alcorn famously wrote in her suicide note at the beginning of this year, ‘fix society. Please’.

REFERENCES

  1. Stice E, Maxfield J, Wells T. Adverse effects of social pressure to be thin on young women: An experimental investigation of the effects of “fat talk.” Int J Eat Disord. 2003; 34(1):108–17.
  2. Polivy J, Herman CP. Dieting and binging. A causal analysis. Am Psychol. 1985, 40(2):193–201.
  3. Via E, Soriano-Mas C, Sánchez I, Forcano L, Harrison BJ, Davey CG, et al. Abnormal Social Reward Responses in Anorexia Nervosa: An fMRI Study. PLoS One 2015; e0133539.

 

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