Are Eating Disorders Back with a Vengeance?

For better or worse, the ‘90s and early 2000s are experiencing a resurgence in popularity. 

Paris Hilton is shilling for multiple brands, Sex and the City tried (and failed) to make a spinoff that satisfied its fans, and low-rise jeans are reportedly making a comeback. 

Something else synonymous with this bygone area? Concerningly thin frames on celebrities spilling over into everyday life. With the rise of social media and its algorithmic desire to engage at any cost, trends like “SkinnyTok,” where influencers detail exactly how they maintain a size 0 waist, are reinvigorating the conversation around nefarious diet culture. Partnered with North America’s fascination with semaglutides, which have been hailed as the death knell for obesity, and you have a pressure cooker of a situation about to blow at any moment. 

So, what’s with the shift?

Hidden in Plain Sight

At the turn of the century, a paper published in The New England Journal of Medicine estimated that around five million Americans had an eating disorder, defined as a “serious disturbance in eating” that can include food restriction, bingeing, and purging, paired with “excessive concern” about the shape of their body. Decades later, a 2020 report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders estimated that 29 million Americans—around nine percent of the population—will have an eating disorder at some point in their life. And despite what pop culture may reflect, a study published in Frontiers of Psychiatry notes that ethnicities and gender expressions other than cis Caucasian women, including Asian-American men, transgender people, and Black women, have been found to have higher prevalence rates of EDs.

“Eating disorders … do not discriminate and occur in individuals of all ages, genders, races and body types,” says Doreen Marshall, a psychologist and the chief executive officer of the National Eating Disorders Association (NEDA). “Because there is a misperception that those impacted by eating disorders tend to be young, white, thin, and female, those who belong to other demographic groups can be overlooked, and subsequently not receive treatment or support.” This could mean that the number is, unfortunately, much higher than suspected.

The Cost of “Perfection”

Eating disorders have the highest mortality rate of any psychiatric disorder, and the ways in which they accomplish this are as numerous as they are sneaky: dehydration, cardiac arrest, and drug and laxative abuse are just some of the ways that those with eating disorders may find themselves hospitalized, or worse, dead. Put simply, it’s far more than just an aesthetic gone wrong. 

And as noted, it’s not just women who can fall prey. Muscle dysmorphia, sometimes called “bigorexia,” is on the rise in men, especially young men, which often manifests as an obsession with gaining muscle through overexercising, counting macros, supplementation, and even anabolic steroid use. Of those 29 million U.S. citizens who will have an ED, around 10 million are men (nearly one-third of those diagnosed), and while the age range experiencing the largest rise is those 12 to 14, a quick scan of social media will tell you that some of the older gym bros out there may not be alright, either. According to a study issued by SickKids, a children’s hospital in Toronto, Ontario, over the first 20 years of the century ED hospitalizations in young men rose by an astounding 416 percent. 

As Marshall explains, “Young men are also impacted by societal body ideals, though what is reinforced for men may differ. As with other mental health issues, men may be less likely to access traditional support, and their eating disorders may be overlooked
in traditional medical settings.” Sharing their stories publicly can help lessen the stigma and promote greater understanding, she adds.

“Eating disorders … do not discriminate and occur in individuals of all ages, genders, races and body types.”

Social Media’s Impact

Though TikTok has made it much more difficult to promote pro-ED content on its platform, as with most “trends,” devotees have found loopholes, couching extreme diet content under the umbrella of “clean eating” and associated hashtags. 

“SkinnyTok is essentially pro-ana (pro-anorexia) culture with new branding,” insists Angela Karras, a licensed psychologist in New York and Massachusetts who works with patients trying to overcome disordered eating. “The algorithms make it more dangerous because you watch one video and suddenly your feed is flooded with restrictive tips, and people who are susceptible find themselves going down a rabbit hole.” Some of her own patients have even begun quoting these types of videos in their sessions, she adds, which shows how insidious the problem has become.

“The body positivity movement did a lot of good by broadening representation, but it also made some people feel like failures if they didn’t ‘love’ their bodies,” notes Karras. “Now we’ve swung back to glorifying thinness, and that’s equally damaging.” Instead, she says people should focus on what she calls “body neutrality.” “I often tell people, you don’t have to love your body to love your life. You just need to respect it and take care of it.”

Warning Signs

On its website, NEDA offers tools and resources that can help determine whether you or someone you care about is experiencing an ED. But overall, some things to look for in yourself and those around you include a preoccupation with food; an obsession with “wellness,” “clean eating,” and “what I eat in a day” content; avoiding others, especially around mealtimes; and physical signs such as fluctuating weight, frequent dizziness or low energy, and changes in hair, skin, or dental health.

“SkinnyTok is essentially pro-ana culture with new branding.”

The reality is, you can’t fully escape society’s continued fixation on weight. What you can do is remind yourself that your body is more than a series of measurements, express joy in your ability to move and savor all life has to offer, especially when around younger, more impressionable people, and be on high alert for potentially problematic habits—as with many diseases, the faster you notice the signs, the better.

“Getting help sooner can lead to better outcomes for treatment and recovery,” says Marshall. “As a parent or friend, I’d recommend learning the signs and encouraging help by starting with a caring conversation that is not focused on appearance but on the behaviors you are noticing and connecting the person to [professional] help.” Knowing that someone has recognized their struggles can help give them the courage they need to fight—and win.