Q&A with Dr. Tara Arnold on Adolescents and Eating Disorders
An Interview With Dr. Arnold, Asking the Important Questions About Eating Disorders in Adolescents, With Over a Decade of Experience
1. Why Do You Think Adolescence is Such a Vulnerable Period for the Development of Disordered Eating?
Tara Arnold: Adolescence is a vulnerable time for the development of eating disorders because developmentally, we are in a very open and impressionable space. We are eager to understand the world and ourselves, and so we look to media and social media, our families, our culture (national, regional, ethnic, socioeconomic, and more). Once we hit puberty, there is a phenomenon known as the “desirability” shift. (Mary Phieper wrote about this in an old seminal piece called ‘Reviving Ophelia- Saving the Souls of Adolescent Girls’- I would add, and boys now too). This desirability shift makes us go from being more comfortable with our individual uniqueness to being more attuned to the way the gender that we are attracted to sees us, and what they find attractive. Then we try to move ourselves, our behavior, our appearance, our ways of being towards what we think is the more “attractive or alluring” way to be. This is not an all- or- nothing time, but a time that we begin to tune into a different part of the world and how we fit into it.
Of course, we are all different, and this timeframe of our awareness of attractiveness and acceptability can vary depending on the age of our siblings, our peer group, and many other factors. Humans want to fit in and be part of the group from an evolutionary standpoint, so we are attuned to those factors from an innate survival instinct that was more helpful in the cave times than now, but it is still part of our reptilian brain that is highly active (likes on socials impact on us, etc.).
2. How Do Societal Expectations Around Body Image and Control Affect Adolescents Differently From Adults?
Tara Arnold: For body image- Our culture in America, in Atlanta, in our socio-economic demographic and culture within those cultures, dictates our concept of beauty and can make unattainable standards of beauty seem very important, and can make us feel unacceptable if we do not exactly fit the mold. And this was all happening even before social media. Add to this pressure the global pressures of access to tons of different ideas of beauty, filters, and unrealistic images of perfection, and we have a recipe for people to do very unhealthy and self-destructive things to try to be attractive, accepted, loved, desired, popular, or what they find important. Now there is also so much access to ways people attain these beauty standards that can suggest very unhealthy and extreme behaviors to achieve these goals.
3. Are There Certain Messages That You Think Are Especially Harmful to Adolescents?
Tara Arnold: In the eating disorder world, we were so thrilled a few years ago when more diverse body types were being represented in the world through mannequins of varying body types and even pictures of people in clothing of different body types and more models with diverse body types. We have a model of health called HAES- Health at Every Size- that promotes the idea that our medical labs and our bodies’ functions (ability to do what we want to do- run, move furniture, hike with friends) are determinants of health versus our thinness or the perfect shape of our bodies. We all know genetics plays a huge role in our body types, so thinking that we should all look the same or that there is one “beautiful” is vastly untrue. HAES helps people nourish their bodies, move their bodies, and love their bodies in a way that is less objectifying and more sustainable.
Once diverse body acceptance had seemed to take hold, then along came the GLP1s. The advent of GLP1 has set the body image world back as the “thin ideal” has become a huge force again, and the virtue signalling of thinness being a choice to those with financial means can make it seem a value signal to use the drugs (with no long term data about the true health impact of GLP1s, just like every weight loss fad that has come along every decade and proven to have long term adverse health impacts- like FenFen damaging people’s hearts). One study that is available, that is, of course, not being touted, shows a shortened life span for those on GLP1s due to it weakening muscles- and guess what a muscle- our heart is.
4. Are There Common Things Parents or Educators Unintentionally Do That Can Worsen Disordered Eating?
Tara Arnold: Body image is impacted by everyone that we look up to, parents, family members, siblings, teachers, doctors, coaches, principals, etc. Now add to the global influence of influencers, movie stars, and models. These people we look up to are human, so they have their own imperfections, and they live in diet culture like the rest of us. They can have their own body image struggles, body shame, and self-esteem struggles. Therefore, they can see us lose weight and compliment us, or we can overhear them complimenting someone else’s body for getting smaller. Or the reverse, we can hear them criticize or judge their bodies or the bodies of others, and that sticks. Now we know what they prefer, we take that in consciously and unconsciously, and we may internalize that message knowingly or unknowingly. Again, culturally we hear a lot of messages about beauty- the size of butts, breasts, hips, stomach, etc. Bigorexia is also a concern where people who want to be seen as strong and muscular can never feel like they are “big” enough or muscular enough. The preferences of our specific culture will influence us the most. Our MD may comment on our bodies on the growth chart, and or when we go through puberty and gain weight before we get taller ( we need to gain weight at this time to give our bodies the energy that they need for huge growth spurts), we may start to feel self-conscious and not understand that our body changing is a natural part of growing up. Also in puberty, our appetites may largely increase as we are burning tons of calories to get ready for growing. Our large appetites may scare our families or us, and we may start to feel judged about our food intake or our bodies, which can make us disconnect from our natural hunger and start some disordered eating- restricting, dieting, hiding food, undereating, then getting really hungry and overeating, binging, etc.
Diet culture is a multi-billion-dollar industry, and they do not make money if diets work, so they craft these images and diet plans that are not realistic for the long term or sustainable to keep themselves employed. Most diets are very restrictive, and they then create an overindulgent response when the diet is over. Then we do the notorious yo-yo dieting, which is what changes our metabolism and creates long-term weight gain and less health for our bodies as the genetic blueprint is overridden.
5. Have You Seen Changes in the Prevalence or Presentation of Disordered Eating in Teens Over the Past Decade?
Tara Arnold: Over the last few decades, the ages of people developing eating disorders have gotten lower and lower, and inpatient eating disorder treatment centers have been created for younger and younger ages as our culture becomes more and more superficially motivated and the need for acceptance and connection increases. There is an epidemic of loneliness Post-pandemic, and the disconnection created by the internet and social media, etc., and the many ways that people do not truly connect, make us vulnerable to eating disorders. We cannot control others, and relationships can be confusing, so we can fall into the trap that we falsely believe we should be able to control” our bodies when everything else feels out of our control. There is also a feminist concept of the patriarchy creating the thin ideal to keep women (and men, of course) obsessed with obtaining an unattainable goal- aiming for something (like the thin ideal) that they cannot really control, so that they cannot use their time and energy to fight more important battles like social justice, women’s rights, anti-child trafficking, etc. The system has been created to keep the status quo. I digress… sorry to be political, but it is a REAL problem.
6. What Does Recovery Realistically Look Like for a Teenager, Emotionally and Behaviorally?
Tara Arnold: Eating disorder treatment for teens and adolescents is powerful and helpful. Treatment for eating disorders takes time, but awareness and prevention are powerful tools to fight eating disorders. The sooner they are treated, the better and the faster the outcome is typically. It is never too late to start recovery, of course. Individual therapy, medication, nutritionists who are informed about eating disorders, and primary care doctors/ pediatricians are all part of a team for recovery, depending on the length and severity of the disorder. Starting with an eating disorder therapist is the first step to assess the severity and create a plan for recovery for adolescents and teens, as well as adults. Eating disorders are dangerous and deadly, so having an expert is highly important- more so than most other mental health concerns, as eating disorders are in the top two most deadly mental health disorders. Treatment involves learning to face our feelings and our emotional needs in nurturing ways and connecting with others, rather than turning to food to cope. Oftentimes, we turn to food for things only relationships with others can solve, like loneliness, sadness, disconnection, and anxiety, so learning to feel our feelings and reconnect to others who are healthy is the key to healing.
