The deadliest of mental illnesses, eating disorders are thought to affect at least nine percent of the global population, up to a fifth of whom will die without treatment—mortality rates comparable to, and often exceeding, road deaths and some cancers. According to the USA’s National Association of Anorexia Nervosa and Associated Disorders (ANAD), more than a quarter of people with the condition will attempt to take their own life.
“Eating disorders can be such a hidden illness that it can be affecting your colleague or the person sat next to you on the bus, and you wouldn’t know,” says Kristie Amadio, who had an eating disorder for 14 years, and founded Recovered Living NZ, a not-for-profit eating disorder recovery organisation based in Christchurch. “When it comes to the medical profession, our systems are completely overloaded. My waiting list is 12 months long.”
A Growing Problem
In the UK, admission numbers for treatment for eating disorders more than doubled between 2010 and 2018, a continuing trend that has been compounded during the covid crisis. As the pandemic took root in 2020, mental health organisation the Priory Group reported a 61 percent rise in inquiries at its private clinics for treatment of anorexia nervosa, and a 26 percent increase for binge eating disorder treatments inquiries. Dr Agnes Ayton, chair of the Royal College of Psychiatrists’ Eating Disorder Faculty, describes a “tsunami” of patients at her Oxford workplace, with admissions of urgent referrals up to 80 percent, from the usual 20 percent, as of February this year.
Eating Disorders Association of New Zealand (EDANZ) says that emails and calls to the charity’s helpline also doubled last year, with no signs of letting up in 2021. EDANZ president Nicki Wilson laments that health professionals are so overworked “they just can’t cope with the demand”, with wait times so long “people are becoming much more unwell than they should…and the suffering is terrible”.
Kristie says that eating disorders don’t discriminate, with little regard for “age, gender, ethnicity or socioeconomic status”.
“It’s said that one in 10 men have an eating disorder but based on the split in my practice right now, I’d estimate it to be higher,” she continues. “What we’re seeing with a lot with men is muscle dysmorphia, which is leading to multiple hours at the gym without rest days, and steroid use, as well as eating disorders.”
From 2019 to 2020, admissions of 10- to 15-year-olds, and under 20-year-olds, doubled at Starship Hospital, with similar jumps at Waikato Hospital, and increases of nearly a third in Wellington during the same period.
“The deadliest of mental illnesses, eating disorders are thought to affect at least nine percent of the global population.”
Elaine was 14 when she developed an eating disorder, which, she says, was down to a “passionate interest in latest fashions—and especially those who modelled them”.
“I wanted to be those people, and look equally amazing,” she tells Verve. “And with each kilo I lost I felt closer to that goal.”
But Kristie does emphasise that “it’s a misconception that only adolescents or those in their twenties are affected”, or that it’s always about body image. Her oldest client is 72 years, and her youngest, shockingly, just seven years old. I ask her what drives such a young person to such a condition.
“If I knew that, I’d be a well-published author. We still don’t know exactly what causes eating disorders. We do know that there is a genetic component, but it’s often said that while it’s the genes that load the gun, it’s the environment that pulls the trigger. There could be two siblings with that gene, but only one develops the eating disorder because of the experiences they’ve had. Like with the breast cancer gene, multiple people have it without ever developing the disease.”
Social Matters
Social media has intensified the issue, with some ‘influencers’ going so far as to glorifying the like of self-starvation.
“Social media exploited covid on a whole new level,” says Kristie. “Places like Instagram—which many call ‘pro eating disorder’ sites—has people promoting eating disorders as a cool thing to do.”
I ask Kristie if the emphasis on body positivity and promotion of plus-size models as cover stars has helped alleviate the issue in any way.
“It’s another complicated issue because although it’s fantastic that there are more diverse models out there, there is still that part of it that’s all about a focus on the body.”
Kristie says that though there is a broad framework of treatments, “every disorder is different and there needs to be an individual approach for each client’s disorder’s characteristics”.
Every disorder is different and there needs to be an individual approach for each client’s disorder’s characteristics.
For Elaine, it meant regularly consuming high calorie foods, specially formulated drinks, refraining from strenuous exercise, and regular weight checks.
“I learnt to treat what I read and saw in the media with a grain of salt,” she says. “And that one can turn things around if one wants it badly enough. But I knew that I could never ever let myself go down that tunnel again. Basically, I did a lot of growing up – and fast.”
I ask Kristie if eating disorders are a kind of ‘inverted addiction’, and she says that it’s a “hotly contested debate” with different philosophies.
“If you’re addicted to alcohol for example, then abstinence is part of the recovery process. But if you have an eating disorder, you can’t abstain from food because you need it to live. You need to form a different relationship with that ‘substance’ that you are using to numb your emotions or deal with anxiety or whatever it may be.”
There was a time when many believed that people with depression should just ‘snap out of it’, are there now similar misunderstandings about eating disorders?
“Definitely. So often you hear people say they just need to eat or to stop throwing up, but the truth is that it is a mental illness, and if they could stop, they would. Just because it’s a mental illness doesn’t mean you can’t recover from it. No one was born with an eating disorder, and no one should have to live with one.”
But what makes eating disorders so difficult to confront is that they are so easy to hide, with many people being otherwise highly functioning professionals, and often parents.
“Many with eating disorders remain in denial because they’re living relatively normal, busy lives,” says Kristie. “The majority of my clients are what most would call a healthy body weight.”
When Elaine’s parents encouraged her to seek help, she told them they were overreacting.
“I was too young to really understand what I was doing to my health, and I became critically ill,” she recalls. “I continued to lose weight, getting weaker, and at one stage weighed only 28kg. It was only when I woke up to the fact that I was dying, and also causing those I loved tremendous distress, that I decided to claw my way back to normality. I had never meant to get sick in the first place, it just happened. In the end I just desperately wanted to be a normal teenager, go to parties, have boyfriends, that sort of thing.”
Signs to look out for in for those worried that a loved one may have an eating disorder include fad diets “that appear more an obligation than a choice”, loss of spontaneity or flexibility with food, or withdrawing.
“I’m really an advocate for people speaking up rather than walking on eggshells,” says Kristie. “So many don’t want to say anything for fear of making things worse, but I believe that the biggest encourager for an eating disorder is silence.”
