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How Psychiatric Care Can Counteract Diet Culture as Part of Treatment

Diet culture is pervasive in every level of American life. Judgments about weight and body type are present in television, print media, social media, school and university culture, and even the medical industry.  In fact, according to Global News Wire, the weight loss industry in the United States was worth approximately $58 billion. With so much emphasis on one’s outward appearance, it makes sense so many individuals struggle with the psychological fallout from exposure to diet culture.

These psychological and psychiatric struggles often relate to a person’s body weight, body shape, negative body image, and mental health. In a society that prizes thinness above almost anything else, It can be difficult for a person to separate their self-worth from how society perceives their body or weight. These are all risk factors for a variety of eating disorders, including binge eating disorder, anorexia nervosa, bulimia nervosa, and others.

Although diet culture (and scrutiny of a person’s weight) often have negative effects on their well-being, causing or exacerbating psychiatric disorders the mental health care field is increasingly able to counteract them. A variety of therapeutic techniques (and for some psychiatric disorders, medication) can help an individual in recovery from an eating disorder achieve the most positive outcomes. Although treatment can’t remove the messaging that comes in loud and clear from diet culture, it can equip a person with the tools to understand and resist it.

Who Is Affected by Eating Disorders?

While eating disorders can affect people of all ages, sexes, genders, and cultural backgrounds, they are more prevalent in young women and girls. That’s not to say boys and men can’t be affected by eating disorders as well. In fact, binge eating disorder affects men and women almost equally. BIPOC individuals, long incorrectly considered to be at less risk of having an eating disorder, are actually at roughly the same risk (and in some cases higher) risk of eating disorders and are much more likely to be under- or undiagnosed for them. Members of the LGBT community are also at high risk for eating disorders – according to NEDA, these individuals have various sociocultural factors such as body image and bullying that raise said risk.

Another risk factor for eating disorders is an individual’s age. Although eating disorders can begin at any age, there is a statistical tendency for them to begin during adolescence and early adulthood. During this time in a person’s life, weight changes and changes in body shape are normal, of course, but they can leave a person susceptible to body consciousness and worry about their self-image. Often, diet culture will target younger people to exploit these uncertainties. Also not coincidentally, during this time, an individual; s worldview and self-image as an adult are still being formed, meaning that mediation can have a greater effect on them. Social media, especially, is most widely used by 16 – 24-year-olds – the same age group at the highest risk for the first onset of an eating disorder.

Dual Diagnosis Treatment and Diet Culture-Driven Body Image

Co-occurring mental health disorders are very common in people with eating disorders – this is usually referred to as a dual diagnosis. Conditions like depression, anxiety disorders, OCD, and especially PTSD are much more likely to be a cause of or otherwise be related to the eating disorder. They are also routinely tied to self-image ad self-esteem. The connection between these factors and the influence of diet culture is becoming clearer – in recent years the effects of social media (largely diet or weight loss accounts) have even been investigated by the U.S. Congress in 2021 (they found that companies like Facebook and Instagram bear some responsibility for negative effects on adolescents’ self-esteem).

Unfortunately, it is common for those with co-occurring mental health conditions to only be treated for one issue, hearing the effectiveness of the overall treatment program. For example, teens may enter into treatment that focuses more on the medical aspects of their condition and less on psychiatric care, leaving other co-occurring conditions such as depression untreated. Since these psychiatric and emotional disorders influence and trigger disordered eating behaviors, failure to address them can lead to relapses and continuation of the eating disorder.

Many psychiatric therapies can be used for both eating disorders and other kinds of mental health conditions. Behavioral therapy often centers on increasing mindfulness – the concept of feeling emotions and being aware of them without acting upon them. A prime example is Cognitive Behavioral Therapy (CBT), in which an individual and their client work to identify how their feelings affect their thinking, and subsequently their behavior. With time and repeated sessions, they can gradually replace harmful behaviors with more healthful ones and help counteract attitudes and thoughts that trigger eating disorders.

Although some mental health conditions such as depression or bipolar disorder can be treated with medications, psychiatric medication is not available for eating disorders. Thus psychiatric care that counteracts diet culture is of a solely therapeutic nature. Talk therapy in an eating disorder setting often has programs for education about how to manage media consumption and how to view the media critically, including social media.

What Is Eating Disorder Treatment Like?

In residential and often day treatment settings, psychiatric care is an integral part of treatment. Often the clients will meet daily with a psychiatrist who specializes in eating disorders as well as psychologists and therapists. They may also meet with a nutritionist throughout treatment to assess their nutritional intake and suggest positive changes to their diet. The entire treatment team will work together to identify critical issues that require attention and develop a treatment plan. Modern treatment should embrace a HAES (Healthy At Every Size) philosophy, in which weight and body size are not a focus; instead, the focus is on maintaining health and eating for pleasure and satiety. Renormalizing an individual’s relationship with food is often essential to full recovery.

Individualized treatment is also essential. The intake team and therapists should work to determine a client’s emotional and medical needs and plan accordingly. Once a treatment plan has been decided upon, work can begin to help teens replace their disordered eating behaviors, manage stressors, and increase mindfulness. During residential psychiatric treatment, the root causes of a disorder are addressed with cognitive retraining methodologies such as the aforementioned CBT, Dialectical Behavioral Therapy (DBT), and Cognitive Processing Therapy (CPT), the latter being a methodology specifically designed to help with trauma and PTSD. In each of these, clients may be asked to keep a food diary to become more aware of the types of situations that may lead to disordered behaviors and thoughts.

Merely making changes to one’s thoughts and behaviors is not always sufficient to cultivate a long-term recovery. This issue is one of the biggest reasons why teens and their psychiatrists need to work together to address the underlying triggers that have led to disordered eating behaviors. These range from family dynamics and genetics to social pressures like bullying, to societal pressures like food availability and sociocultural identity. Of course, a major trigger for disordered eating is the influence of the media and diet culture within it, making anti-diet education a major tenet of most eating disorder recovery plans.

Does Residential Eating Disorder Treatment Work?

Mental health treatment carries no guarantees, but in comparison to leaving an eating disorder untreated, outcomes are vastly better with some form of prefinal treatment. Research shows most eating disorder cases can be treated appropriately by a skilled team of medical, psychiatric, and mental health care professionals. There is no easy cure for eating disorders; for many individuals, long-term treatment may be necessary. And although psychiatrists, therapists, nutritionists, and dieticians can help, the individual must also learn to avoid triggers like talking about weight loss or dieting to ensure their well-being.

It is essential to remember the sooner they begin treatment, the better. When left untreated, eating disorders and similar conditions become entrenched and more difficult to overcome. Additionally, the longer one deals with disordered eating behaviors, the higher the amount of strain they put on their body and mind. Eating disorders bring with them serious health consequences, which vary depending on the disorder. However, the opportunity to enjoy long-term recovery is available for those who seek a happier, healthier life free from disordered eating.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.