Ep 7. Disordered Eating/Eating Disorders

Today we take a look at the prevalence of eating disorders in the queer community, and how fitness culture can be a toxic influence on our relationships with food.

Healthline article cited: https://www.healthline.com/health/disordered-eating-vs-eating-disorder#vs-eating-disorders

Transcript

Hello….

This is gay bro shit- a podcast about gay fitness culture, bodyimage and gender. And you can call me Brodacia- because I too maybe never really existed and we’ll never know. 

So Today is a bit of a heavy topic, we're going to be discussing Disordered Eating and eating disorders and so before we get into it we need to give a big content warning

If you’re dealing with, or have a history of dealing with disordered eating, this may be very triggering for you so please proceed with care. 

And I also need to state, yet again, that I am not a licensed medical provider, nor therapist, or anyone who treats people with eating disorders- I’m just a former trainer, gym bro and nerd who loves to research. 

So I will be talking about both eating disorders and disordered eating, and these are actually two different but related concepts, and I will get into the differences, but know that I may use these terms interchangeably and sometimes I use one term to refer to both for the sake of not having to say both every time. 

And I’m going to start by talking about how prevalent these issues are in the LGBTQ+ community because I want to get across how many of us struggle with these issues and in ways you may not even realize, because sometimes these behaviors take a form you don't expect them to- and because when we are truly honest very few of us have a completely healthy relationship with food. Because so often what society labels as ‘healthy’ is not that at all. 

We also need to know that the person we think of when we picture someone with an eating disorder, ususally a thin, young, white woman, is only one small portion of the people who struggle. 

Alright let's walk into the darkness because as they say- the only way out is through 

So pretty much all existing research literature on the topic has found that queer people are much more likely to experience disordered eating. I’m going to read a big chunk of text from 2020 meta review by Parker and Harriger:

“LGBT adults and adolescents experience greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts. Additionally, gay, bisexual, and transgender adults and adolescents were all at increased risk for eating disorders and disordered eating behaviors. Mixed results were found for lesbian adults and adolescents”

“Further research has indicated that approximately 54% of LGBT adolescents have been diagnosed with a full-syndrome eating disorder during their lifetime, with an additional 21% suspecting that they had an eating disorder at some point during their life 

Additionally, 60.9% of LGBT adolescents in one study reported engaging in at least one disordered eating behavior within the past year 

Transgender youth were more likely to report eating disorder behaviors compared to cisgender populations 

 Other studies indicated that LGBT youth engaged in disordered eating behaviors, such as purging, fasting, dieting with intention of weight loss, and taking diet pills at higher rates compared to heterosexual youth], putting them at greater risk for developing an eating disorder. 

Further, the results of one study indicated that over half of sexual and gender minority youth experienced weight-based victimization from family members and peers, which in turn was associated with increased rates of binge eating, dieting, and other unhealthy weight-control behaviors, in addition to stress, exercise avoidance, less physical activity, and poorer sleep

 Finally, a recent study examining participants upon admission to eating disorder treatment reported that sexual and gender minority participants had more acute eating disorder symptoms and higher rates of abuse compared to cisgender heterosexual participants”

And then they found that with regards to adults: 

“Adult sexual minorities have been found to have experienced significant disordered eating symptomology, including desire to be thin, bingeing, purging, and body dissatisfaction, which correlated with being overly concerned about body shape and size and level of femininity (regardless of sex assigned at birth). These behaviors occurred at higher rates than within the heterosexual and cisgender male population, but did not appear to be significantly different from heterosexual and cisgender females \

Adult sexual minorities also were almost twice as likely to experience food addiction (defined as the application of the criteria of substance use disorder to highly rewarding foods) compared to heterosexuals, which was aggravated by heterosexist harassment, and sexual minorities have reported higher rates of weight discrimination than heterosexual peers, even after controlling for body mass index (BMI) and race

Source: https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-020-00327-y

According to a 2019 study by Calzo, Austin and Micali in the UK, they found that, and this is a direct quote of their conclusions: 

“At age 14, gay and bisexual boys and mostly heterosexual girls reported greater body dissatisfaction than their same-gender heterosexual peers. All sexual minority boys and mostly heterosexual girls reported greater mean dysfunctional eating behaviors than their same-gender heterosexual peers. At age 16, gay and bisexual boys had 12.5 times the odds of heterosexual boys of binge eating; mostly heterosexual boys had over three times the odds of reporting binge eating. Sexual minority girls had over twice the odds of heterosexual girls of purging and binge eating.”

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141356/

Then there was a 2019  study by Bell, Rieger and Hirsch looking at queer adults. There’s a chart of their findings and I’m going to attempt to read through it here.

In their study 47.6% of gay men, 66,7% of lesbian women and 62.6% of TGNC- which means trans and gender noncoforming adults qualified as being ‘prone to an eating disorder’ 

23.3% of gay men, 31.9% of lesbians and 22.6% of TGNC adults reported eating in secret. 

63.1% of gay men, 81.9% of lesbians and 67.2% of TGNC adults reported that their woght affected the way they felt about themselves. 

14% of gay men, 34.7% of lesbians and 30.2% of TGNC adults were either currently dealing with an eating disorder or have had one in the past 

And 47.4% of gay men, 62,5% of lesbians, and 69.8% of Trans and gender nonconfirming individuals were currently dissatisfied with their eating habits. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331421/pdf/fpsyg-09-02692.pdf

Another study involving 289,024 college students found that more than 15% of trans people surveyed reported ED diagnoses, compared with 0.55% of cisgender, heterosexual men and 1.85% of cisgender, heterosexual women.

https://www.healthline.com/health/disordered-eating-vs-eating-disorder#risk-factors-and-demographics

So the numbers definitely vary by who you ask, but its obvious that this is a problem that dispraportionatley effects queer people 

And a lot of things I’m oulling from today are in an article on Healthline that I’ll post the URL to in the episode description, but according to this article:

People at higher body weights seem to be much more likely

 to engage in disordered eating habits, including those that could meet Eating Disporder criteria. However, because they have higher BMIs, they’re often excluded from receiving diagnoses and, therefore, treatment, 

And that just 6% of people with eating disorders are medically underweight.

Men account for about 25% of anorexia and bulimia diagnoses, and at least 1 in 7 men will experience an eating disorder by age 40. 

Disordered eating is increasing among people ages 45 and older more quickly than among younger adults.

A 2008 survey found that women in their 30s and 40s reported disordered eating at the same rate as women in their 20s.

Yikes friends. Big Yikes. 

—---------------------------

Alright, so thats just a sampling of some of the numbers I could find. Sorry for thhrowing a ton if numbers at you, but I think it was important to understand just how widespread this is. 

Now lets talk about the problem itself. 

What exactly is disordered eating?  According to the Healthline article, these are the signs and symptoms: 

• avoiding entire food groups, certain macronutrients, or foods with specific textures or colors without a medical reason
• Binge-eating
• engaging in compensatory behaviors, such as exercising to “make up for” food you’ve consumed
• exercising compulsively
• cutting food into small pieces, slowing down the pace of eating, or otherwise attempting to trick yourself into feeling fuller from less foo 
• fasting to lose weight 
• feeling guilt, disgust, or anxiety before or after eating
• following strict food rules or rituals
• intentionally skipping meals or restricting food intake — including skipping meals before or after you’ve consumed a large meal, food you consider unhealthy, or alcohol
• opting to eat only foods you consider “clean” or healthy
• participating in fad diets to lose weight
• engaging in purging behaviors, such as using laxatives or making yourself vomit to control your weight
• weighing yourself or taking body measurements often
• tracking foodTrusted Source or calories to the point of preoccupation

In one study of people with eating disorders 75% reported using myfitnesspal to track calories, anbd 73% said it contributed to their disorder

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5700836/

So didordered eating describes a range of unhleathy behavious towards food, and on the spectrum between healthy eating and eating disorders we should think of disordered eating as inbetween the two. 

But this list - if you were keeping track you probably were able to identify at least a handful of things that you’ve done personally. I counted 10 out of the 14 that symptoms listed that I’ve personally done in the past. And Im currently weighing myself every day and tracking all of my food using an app- so, does this mean I have a problem with food. 

Maybe? But by this metric almost everyone does. And the reason we need to be aware of this because its a proverbial slippery slope from disordered eating to an actual disorder

We might ask then, when does it rise to the level of actually being a full blown disorder? 

In the simpest term Disordered behavior becomes a disorder when the behaviors overtake your life and becomes your primary focus. 

But people can also be very good at denying and hiding their situation or mimimalising it because they thing their behaviors are common. 

Unlike disordered eating, Eating Disorders are specific diagnosable deseases with a set of criteria that must be met in order for the diagnosis to be made. 

Theres a few esoteric disorders we wont cover today, but  The I’m going to go over the main eating disorders are and attempt to explain in the simplest way

Anorexia- attempting to lose weight by starving yourself. Avoiding food as much as possible

*for simplicity I’m going to define starving as eating 30% fewer calories per day than what you need- in general thats anything less than 1200 calories a day for the average women and 1800 calories a day for the average man.  

Binge Eating Disorder- repeated episodes of rapidly consuming an excessive quantity of food

Bullemia- bing eating behavior is followed by purging via vomiting, laxatives, exercise or fasting 

Purging disorder- peple who eat normally but still purge. 

ARFID- Avoidant and restrictive feeding disorder- Where people avoid specific foods due to sensory characteristics such as texture, smell, appearance, taste. These people arent trying to lose weight they just mistrustful of food or uninterested in it. They might also have traumatic experiences with food such as choking or diogestive issues.  In extreme cases people eat as few as only 5 different food items. This is more common in children and with people on the Autism spectrum. But can also be a symptom of a mental health issue. 

*I know when I’m really struggling with my mental health I have zero interest in food, sometimes for weeks at a time- so I definitely have experienced this. 

Pica- eating or craving things that are not food- I’ll let your imaginations run wild with that. 

Atypical Anorexia- We’re going to talk about this more but  this describes people who qualify as anorexic, but whos bodyweight is not underweight according to their BMI. the cut-off for this is usually a BMI of over 18.5

Orthorexia- Not offiicaly a disorder in the current DSM- but its a porposed disorder where an obsession with clean eating goes to a pathological place

So let’s start with Orthorexia becuase I think more than the other disorders mentioned it feels like the logical extreme conclusion of wellness and fitness culture. 

Here’s what that might look like: 

• Compulsive checking of ingredient lists and nutritional labels
• An increase in concern about the health of ingredients
• Cutting out an increasing number of food groups (all sugar, all carbs, all dairy, all meat, all animal products)
• An inability to eat anything but a narrow group of foods that are deemed ‘healthy’ or ‘pure’
• Unusual interest in the health of what others are eating
• A feeling of superiority around their nutrition and intolerance of other people’s food behaviors and beliefs
• High levels of perfectionism
• Spending hours per day thinking about what food might be served at upcoming events
• Showing high levels of distress when ‘safe’ or ‘healthy’ foods aren’t available
• Obsessive following of food and ‘healthy lifestyle’ blogs on social media
• Body image concerns may or may not be present

source:https://www.nationaleatingdisorders.org/orthorexia/

Accordsing to the Proposed criteria developed by researchers Dunn and Bratman: 

The compulsive behavior and mental preoccupation becomes clinically impairing by any of the following:

• Malnutrition, severe weight loss or other medical complications from restricted diet
• Intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviors about healthy diet
• Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined "healthy" eating behavior.

Source: https://pubmed.ncbi.nlm.nih.gov/26724459/

Alright so heres the thing about this particular disorder that I find fascinating and terrifying. The behaviors outlined as a disorder are extremely common in the fitness community and in the wellness community and industry. 

If you get on the internet, or watch tv, listen to podcasts, etc. you are bombarded with information about which foods are supposedly good and which ones are supposedly bad. And so much of the reasoning sounds plausible or compelling but also completely contradictory

Lets just give an example here: 

First we hear someone talking about how gluten causes inflammation, so we cut out gluten even if we arent gluten intolerant. We start buying gluten free products at the grocery store

But then we hear that packaged gluten free foods arent good because they contain alot of extreme chemicals to make them more palpable so we stop eating these too. 

Then we hear all grain is bad because it spikes your insulin too much and insulin is really the thing thats mking you fat. So you cut our rice and oats and corn and quinoa. And now were only getting our carbs from fruits, vegetables, nuts and legumes

But then one of these paleo people says that actually beans are bad because we only started eating them in the last few thousand years and our bodies dont know how to digest them fully and they contain lectins which can cause inflammation in your gut. 

Then we hear we cant eat fruit, because our body cant tell the difference between the sugar in fruit and the sugar in processed foods and we know sugar is bad because everyone knows that. 

Now we can eat still eat vegetables and meat and fish

But oh wait- fish contains mercury, which is highly toxic so if were eating more fish because we cant eat these other things now were getting more mercury. So maybe we wont eat any large fish and stick to shellfish and freshwater fish

But shellfish are bottomfeeders that ingest any number of potential bad things and filter it out so how can we trust that were not eating bad things when we eat shellfish.

Cant eat Red meat because it increases your risk of certain cancers 

Cant eat eggs because they have too much cholesterol

Cant eat dairy because thats food for the animals babies and not meant to be eaten by humans

Cant eat nuts because it takes 3 gallons of water just to grow one almond

…

And you can keep applying different moral or health metrics until eventually all you can have is water…

Somewhere along the line you have to decide to stop- 

That whatever you’re eating is good enough, healthy enough, clean enough becuase if you dont draw a line you’re left with nothing. 

And I'm struck by how easy it is to just believe something that someone says because you trust and respect them and never question where they got it from. And suddenly that information becomes the truth and you carry it with you forever. 

And this is what makes parasocial relationships so dangerous and why it's so easy to fall for charlatans. 

Sometimes dr oz. Had legitimate medical information and sometimes he's just trying to sell you supplements he makes money off of. 

sometimes Joe Rogan has smart people on and sometimes he asks really good questions, but then he gives an outlet to wild conspiracy theories. 

But I also have this internal tension as someone who likes to eat a very specific, intentional way and who has fitness goals and has asthetic goals.

I’m lucky that I have the constitution of a goat and I can pretty much digest anything without problems so I can basically eat most anything but then I start applying some kind of judgement to it- either moral or based on its perceived benefit that it sometimes is hard to enjoy eating. I kind of eat the same things over and over again because its just much easier to buy for and prepare and track the macros. 

And i’m not super obsessive, I have room for play in there, usually at least one meal a day is more spontaneous but I’m still probably going to be thinking about does this meal have enough grams of protein, does this meal have enough carbs? Is there fiber? Is there some healthy fat? Is there a cup or more of vegetables? 

I’ve been doing this long enough that it doenst feel particularly difficult- I dont really stress out about food- but when I’m travleing or working a lot it can be really stressful to figure out what and how to eat. 

And while I generally feel better when I’m eating with a purpose, eating with the view of fueling myself- I do envy anyone who can just eat purely intuitively with no emotional feelings about what they eat other than pleasure. That sounds so freeing. Like when I see a group of bears just eating whatever…

But food has become so political, so loaded with judgement. We use the way we eat to send a signal about our values, our our status or our image. 

Because we have built a society where being healthy and thin is morally good, and being unhealthy and fat is morally bad. 

And much of this fear of fatness is rooted in racism- specifically the othering of black and brown bodies which are often bigger than white bodies. And our continued promotion of thiness is a way of reinforcing white supremacy. 

On that note- lets talk about Atypical Anorexia.

As I said before this is when somebody  starves themselves, but because their BMI is over 18.5 they look either normal weight or fat and they dont look like they have an easting disorder. 

Fat is a term that is based entirely on comparison to others. Someone is only fat becuase other people in proximity to them are thin. 

Similarly the BMI was originally based on comparison to others rather than judging an individual against set standards. The original definition of obesity was just the top 5% of fattest individuals in a given population, so the cutoff could be totally different depending on the population of people you’re looking at. 

There’s a reasearched named Erin Harrop whose work specializes in looking at atypical anorexia, so alot of this information is coming from then. 

Were unsure how many people have atypical anorexia but its porbably the most common eating disorder, and our best estimate is that 2-2.8% of people have the disorder - but in one small study of 2500 people it was as much as 13%

More people with higher BMI suffer from EDs then those in the underweight category. But most studies done on eating disorders have a BMI cuttoff of 17.5-18.5 so most of these people are missed. 

Erin also says that 11.6 years is the average time people live with symptoms before seaking treatment. 

And this sounds like a crazy amount of time but its because bodies differ in their adapation to foo restirction.  Some people get sick and emaciated very quickly, and others can survive for long periods on little food. Especially for fat people who may be rewarded by others for their weight loss even if these people are actually starving. 

And when people do seek treatment Clinicians often dont understand fat people seaking treatment for ED’s and question if they really need treatment, or treat for them different disorders based on assumptions (assuming people have binge eating disorder).

 Erin gives their own personal experiences of being an atypical anorexic and seeking treatment only to be put on a calorie restricted diet for weight loss when they needed a refeeding diet. 

Because people have got int into their head that number one health issue effecting fat people is the fact they’re fat- and our health care system and providers are constantly looking to get fat people smaller before threating them for any other condition. Ignoring the fact fatness may be the result of any number of other issues that need to be addressed first. 

And while being fat may or may not you make you unhealthy and may or may not lead you to dying a bit younger than you would have- starving yourself is going to make someone die much much faster. Potentially in a matter of weeks if you eat nothing at all. 

Eating disorders are much more immediately dangerous than fatness. If you stop eating you will die very quickly. If you become fat you will not. 

And in study after study when people are surveyed on their attitudes about fat people, participants believed that people with obesity were less evolved and less human than people without obesity

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563065/

So clearly this is a big problem- and yet, beyond a few health class vidoes were forced to watch in school and the occasional character in media- we dont hear much about these issues- and when we do its always in the form of a dangerously thin person. 

Why is nobody doing anything?

Because in 2023, just the US weight loss is 159 billion dollar industry. That is more than the entire Annual encoconmic output of 153 countries. 

Novo Nordisk, the maker of the latest supposed miracle obesity durg Ozempic has seen its value QUADRUPLE to over 400 Billion dollars. 

There is so much money to be made by telling people that theyre fat and selling them a solution to make them less fat. 

From seemingly innocous things like diet books, diet foods, supplements, mobile apps, workouts plans, to extreme measures like surgery, medication, supervised fasting, residential clinics, fat camps. There are a lot of people making a lot of money on our fear of fatness. 

So this is the landscape we’re dealing with

Queer people, especially young queer people and trans people are the most at risk of eating disorders

More fat people have eating disorders than thin ones

And our economy and culture built around reinforcing disordered eating. 

And of course I dont have the solutions because this a problem well beyond anything that anyone person could solve. 

But I do think that we can start by working on ourselves because thats one thing we can control. 

We can recognize when we’re eating in a disordered manner and work to mindfully reverse those behaviors

We can think cirticially about what is informing our desire for thinness. 

We can stop judging others peoples health based on their size

We can stop rewarding people like celebrities, influencers who reinforce thin supremacy with our attention and money. 

We can set and enforce boundries with how we allow other people to talk about our or other peoples bodies. 

We can stop applying values to neutral things like food- All food is just food, it is neither good nor bad, healthy nor unhealthy, nutritious nor trash. It is a necessity for survival and nothing more or less. 

So I’m going to leave you with that- Be kind to your selves and be kind to others Bros. 

Outcomes and Treatment

Treatment struggles in non white and lower income populations because the environment is so different then the ones they came from so they struggle to adapt when they leave the treatment center and return to their environments. 

High risk of relapse

Practical 

https://www.opalfoodandbody.com/eating-disorder-resources/