*Please note, the article originally appeared in the Summer 2011 Behavioral Health Nutrition Dietetics Practice Group newsletter.
We live in a world where thin is glorified and unrealistic images of feminine beauty are plastered online, in print, and on TV. These images are hard to avoid and they present serious challenges for clients struggling with eating disorders and body image concerns. In the Spring 2011 issue of the BHN newsletter, Katie R. Gilder, RD wrote an article outlining the very real threat of “thinspiration” media that is widely available and easily accessible. “Thinspiration” websites, forums, and YouTube videos provide pro-eating disorder advice and support to those looking for it. Recent research from the University of Haifa showed that “the more teenage girls are involved in Facebook, the higher their risk of having a negative body image and developing eating disorders such as anorexia and bulimia”(1). Additional research shows that idealistic images of female beauty effect mood, body dissatisfaction, and eating disorder recovery (2,3,4,5).
While social media presents challenges for those struggling with eating and body issues, a whole new world of eating disorder support and positive body image advocates exists online. Social media is defined as “the use of web-based and mobile technologies to turn communication into interactive dialogue” (6). This article will highlight one client’s experience of integrating social media into her recovery as well as provide a list of tools and resources that clinicians may share with their clients.
One Client’s Journey
Kay has suffered from an eating disorder for eight years and has actively been pursuing treatment for her eating disorder for the past eight months. Three months ago Kay was “stuck”. She believed that she could not possibly accept her body the way it was and also thought she couldn’t continue along the same self-destructive path that brought her to my office. Additionally, she truly believed that every woman hated her body and lived on a diet. She once said, “Marci, you are the only woman I know that seems to have a happy relationship with food and believes it’s possible to reject society’s expectations of a perfect body.” Aside from me, she felt she had no positive food or body role model around her. I advised that feeling better about herself was going to take consistent work. And that if she wanted a shift in her recovery, she’d need to fill up on positive messaging, even if she didn’t yet believe it for herself. Kay decided to accept my challenge and we created a plan for the coming week. This is what we agreed on:
• Take a break from reading any websites, TV shows, or magazines that left her feeling worse about herself.
• Write one thing each day that she likes about herself, physical or not.
• Read a positive body image blog for 5 minutes each day.
• Do her best to follow her meal plan.
She came back to my office one week later and to my surprise and relief she was ecstatic. In addition to what we agreed on, she spent an hour each day reading positive body image blogs and bought a book on self-acceptance (Radical Acceptance by Rosie Molinary). This week became a turning point in Kay’s recovery. She was amazed that even though her body hadn’t changed, the way she spoke to and thought about herself did! Three months later, she and I continue to work on this project. Kay still has her struggles; she still has ups and downs. But rather than feeling stuck, she feels the grip of the eating disorder and self-hatred beginning to loosen. Hope and courage has replaced hopelessness and fear.
In Kay’s words:
“When I began the process of recovery, one of my biggest struggles was comparing me to others. I wanted to be “normal” in regards to my eating and body. But I didn’t realize that normal is different for everyone! It’s not the ideal body type that we see in mainstream media. I felt like I was surrounded by messages that counteracted my recovery. I felt like I couldn’t escape the negative messaging about never being good enough in my own skin. When I reached a particularly low point I decided to actively seek out the messaging that I was looking for. I perused the web for blogs, websites, and twitter feeds for anything I could find that would help cultivate complete body and self acceptance. I couldn’t believe the amount of information I found! Suddenly I was surrounded by people just like me, virtually, who were promoting and passing on the messages that I needed to keep me going on the path to recovery and self love. Now it’s a daily ritual of mine to go through my newsfeed of positive messaging and journal about how I feel after reading them. It makes me feel like I have a community that is supporting me on a positive path, whereas I used to feel so alone in my struggles.”
Virtual Resources Offer Hope and Healing
I share this story, because as an eating disorder clinician I’ve experienced clients who feel trapped, not realizing that there are options to living a life of self-hatred. They are astounded and relieved to know that there is a huge community of people fighting their same struggle, raising a voice of hope and healing. While the social media scene may seem like a land mine for our clients, some of the best treasures are there for the taking, if only they knew where to look. Here are some favorite social media resources:
Pro-Recovery Virtual Communities
Something Fishy: www.something-fishy
Positive Body Image Blogs
Adios Barbie: www.adiosbarbie.com
Body & Brood: www.bodyandbrood.com
Medicinal Marzipan: www.medicinalmarzipan.com
Nourishing the Soul: www.nourishing-the-soul.com
Rosie Molinary: www.rosiemolinary.com/blog
The Body Image Project: bodyimageproject.com
Operation Beautiful: operationbeautiful.com
Weightless on Psych Central: blogs.psychcentral.com/weightless
Twitter Chat Parties: they are a very fun and interactive way to chat about a specific topic. There are a couple of twitter chats specific to eating disorder recovery. This is a useful primer for anyone new to using Twitter chats (7).
#endED: a monthly chat on ending eating disorders. Typically the last Wednesday of every month at 8:30 EST. Visit www.facebook.com/marciRD, then click on past events to learn more.
#MHSM: a weekly Mental Health and Social Media Chat on Tuesdays at 9:00 EST.
#VIRChat: a weekly pro-recovery chat on Mondays at 9:00 EST. Visit www.voiceinrecovery.com to learn more.
Media Literacy Websites
When looking for research on the benefits of social media and its potential positive effects on eating disorder recovery and promotion of positive body image, two university studies published in the ‘90s looked at the effect of media on attitudes and behaviors regarding body image (8, 9). In 1998 JAMA published a consensus statement on interactive health communication (IHC) (10). Their conclusion was that the use of IHC had potential benefit to improve health, but they cautioned the IHC may also cause harm. Few applications have been evaluated. (10). It appears that no research has been published regarding IHC and social pressure on body image in the past 10 years, hence this is an area that deserves attention for future research.
The ADA Standards of Practice (SOP) and Standards for Professional Performance (SOPP) on disordered eating and eating disorders (DE & ED) are scheduled to be published in JADA August 2011 along with the updated position paper on eating disorders. These publications will be a welcome addition to support registered dietitians in effectively treating eating disorders. The field of dietetics, especially working in counseling clients with DE & ED is both an art and a science. As clinicians, we can benefit from having multiple tools in our tool box as we continue to do our part in offering our clients support, guidance, and hope for recovery from DE, ED and body image issues.
1. Link found between Facebook use and eating disorders. Available at http://www.jpost.com/Health/Article.aspx?ID=206145&R=R1. Accessed April 17, 2011.
2. Pinhas L, Toner BB, Ali A, Garfinkel PE, Stuckless N. The effects of the ideal of female beauty on mood and body satisfaction. Int J Eat Disord. 1999 Mar;25(2):223-6.
3. Field AE, Cheung L, Wolf AM, Herzog DB, Gortmaker SL, Colditz GA. Exposure to the mass media and weight concerns among girls. Pediatrics. 1999 Mar;103(3):E36.
4. Thomsen SR, McCoy JK, Williams M. Internalizing the impossible: anorexic outpatients’ experiences with women’s beauty and fashion magazines. Eat Disord. 2001 Spring;9(1):49-64.
5. Turner SL, Hamilton H, Jacobs M, Angood LM, Dwyer DH. The influence of fashion magazines on the body image satisfaction of college women: an exploratory analysis. Adolescence. 1997 Fall;32(127):603-14.
6. Social media as defined by Wikipedia. Available at http://en.wikipedia.org/wiki/Social_media. Accessed April 17, 2011.
7. Tweeting With Your Twitter Community: How To Participate In A Twitter Chat. Available at
http://www.twitip.com/tweeting-with-your-twitter-community-how-to-participate-in-a-twitter-chat/. Accessed on May 1, 20118. Gleason NA. A New Approach to Disordered Eating—Using an Electronic Bulletin Board to Confront Social Pressure on Body Image. J Am Coll Health. 1995:44(2):78-80.
9. Rabak-Wagener J, Eickhoff-Shemek, J, Kelly-Vance, L. The Effect of Media Analysis on Attitudes and Behaviors Regarding Body Image Among College Students. J Am Coll Health. 1998:47(1):29-35.
10. Robinson, T, et. al. An Evidence-based Approach to Interactive Health Communication: A Challenge to Medicine in the Information Age. JAMA. 1998:280(14):1264-1269.
About the Author: Marci E. Anderson is a dietitian in private practice in Cambridge, MA. She specializes in treating eating disorders and body image concerns. She blogs at www.marciRD.com and can be followed on Twitter @MarciRD. She created and hosts the monthly Twitter chat #endED which is dedicated to ending eating disorders through education, discussion, and support.