Eating disorders and advertising

¶ … wafer-thin model smiles wanly at the reader. The blonde model is eating a large, greasy slice of pizza. The headline proclaims: "Looking Beyond the Runway for Answers on Underweight Models." Although the New York Times is a respectable media publication, in many ways this sensationalist and simplistic attitude perfectly sums up the popular media attitude towards eating disorders. The media focuses on the glamorous, the strange, and the visible side of eating disorders. A slice of pizza and some more vigilance from designers can 'cure' a psychological illness. The popular media focuses on the physical image of dangerous or beautiful thinness. or, sometimes the media focuses on a personal story which is supposed to highlight all of the facets of a complex disorder. In contrast, although less story-oriented, scholarly publications tend to examine issues of treatment from a clinician's, rather than a sufferer's perspective. The popular media is driven by the visual, by personal narrative, and explaining the causes of eating disorders and treating the disorders as social phenomenon. Scholarly publications focus on the specific treatment needs, psychology, and physiology of the psychological profession, and do not focus on individuals or even on causation at all.

Another, local media publication called the Greeley Tribute tells of: "The struggle against anorexia: Former UNC swimmer battles the disease." In this article, anorexia is portrayed as mysterious, unstoppable force. The anorexic young woman was a talented swimmer, apparently happy (according to her parents and the article) but after some encouragement of her swim coach to drop some of her baby fat, she engaged in a deadly diet that eventually required her to be hospitalized. Now, Brittany Bethel has been hospitalized multiple times to be 're-fed' but has failed to maintain her discharge weight and has since been expelled from school. According to the article, no one understands, not even Brittany herself, why she cannot maintain her weight and seeks to cope with her problems through starvation. Anorexia has cost her school, friends, and even the swimming talent that apparently drove her to starve in the first place.

Scholarly publications focus not on the face of the disease, or certain subsections of the disease such as models, or social policy such as limiting model's BMI (Body Mass Index) from sinking below a certain number. Practical, clinical questions are proposed. The Nutrition Research newsletter directed to clinicians describes one of the challenges of anorexia treatment in terms of returning the malnourished body to its state of homeostasis, specifically the difficulty in determining the correct caloric intake for institutionalized patients. There are often great discrepancies between predicted and measured values of resting energy expenditure (REE) between normal and anorexic patients in terms of expected weight gain. A study set out to identify the factors associated with the increase in REE during refeeding, comparing eighty-seven malnourished anorexics and 48 healthy, non-anorexic patients. The anorexic's rates of caloric burn were measured, along with their energy or caloric intake (EI), physical activity, body composition, smoking behavior, complaints of abdominal pain, anxiety, depressive mood, serum thyrotropin and thyroid hormone, and urinary catecholamines. Caloric expenditure had increased significantly more in the anorexics, from 3.84 to 4.36 MJ/day, versus the control group, and the 13.4% increase was greater than that expected on the basis of the increase in lean muscle tissue. This related to four factors: energy intake, anxiety, abdominal pain and depressive mood. Another article, "The Application Criteria of Enteral Nutrition in Patients With Anorexia Nervosa: Correlation Between Clinical and Psychological Data in a Lifesaving Treatment" similarly focused on optimal treatment in terms of nutrition and counseling, although in a more diffuse manner.

Scholarly article review

The Application Criteria of Enteral Nutrition in Patients With Anorexia Nervosa: Correlation Between Clinical and Psychological Data in a Lifesaving Treatment" concedes that the data and research increasingly point to multiple factors in the genesis of eating-behavior disorders, and studied 24 female patients with anorexia, some of whom purged, others of whom merely restricted their calories. It stated that eating disorders have personal, psychological, familial, and societal factors, although psychological and physical factors were primarily scrutinized by the study. In the New York Times article, the physical complaints of anorexia, other than death, were given little attention at all. Rather, the focus was on the media's ability to influence girl's self-esteem and the responsibility of the fashion establishment to change its image as promoting eating disorders by requiring thinner and thinner models, even as the average American grows heavier and heavier. This scholarly article only examined the patients in the hospital, not how they functioned in larger society.

While the popular articles attributed tremendous power to the media change the mind and the bodies of the next generation, this article from JPEN: Journal of Parenteral and Enteral Nutrition article focused on the power of nutritional replentishment and institutionalization. It detailed the different criteria for various levels of intensive hospital admission, the types of psychological tests deemed useful in assessing the patient's willingness to gain weight during treatment, and the tests performed to assess the patient's state of health at different times during treatment. Certain treatments for unspecified reasons were discounted as part of the study, such as family therapy, which was feared to be too traumatizing to the young women, given their fragile psychological and physical states. However, there was no extensive literature review of why certain treatment approaches were selected over other approaches, despite the diversity of different theories about the etiology and treatment of the ailment.

All subjects who took part in the study manifested some medical risk that justified hospital admission and each patient agreed before hospitalization that treatment would include food taken by mouth and by intravenous methods. Their willingness to ingest food was subjectively evaluated and actual food intake was objectively estimated during the stay. The patients were given numerous personal psychological inventories. The focus was always on the patient's psychological and physical profile, and on quantifiable assessment of health, rather than subjective detailing of different patients' reactions and experinces. Blood chemistry, nutritional consumption, and self-perception were recorded, and the differentiation between the personal profiles of the patients was to note that the younger patients tended to be more compliant, and that all patients were anxious about gaining weight, although they passively, in the words of the study acknowledged the need to gain weight. The article did not make an argument per se, but stressed the need for immediate intervention, the sooner the better, in anorexia treatment and chronicled intervention's metabolic and physical effects, and the results of the numerous psychological tests taken by the 24 women. Recovery was assessed both in terms of weight gain and self-perceptions of body image.