Body of Evidence

Dispatches from the forefront of eating disorder science

What's Photoshop got to do with it?

Disordered eating and eating disorders aren't the same thing.

Last week, the American Medical Association released a policy statement about Photoshopping models and eating disorder prevention.

The statement:

Advertisers commonly alter photographs to enhance the appearance of models' bodies, and such alterations can contribute to unrealistic expectations of appropriate body image - especially among impressionable children and adolescents. A large body of literature links exposure to media-propagated images of unrealistic body image to eating disorders and other child and adolescent health problems.

The AMA adopted new policy to encourage advertising associations to work with public and private sector organizations concerned with child and adolescent health to develop guidelines for advertisements, especially those appearing in teen-oriented publications, that would discourage the altering of photographs in a manner that could promote unrealistic expectations of appropriate body image.

"The appearance of advertisements with extremely altered models can create unrealistic expectations of appropriate body image. In one image, a model's waist was slimmed so severely, her head appeared to be wider than her waist," said Dr. McAneny. "We must stop exposing impressionable children and teenagers to advertisements portraying models with body types only attainable with the help of photo editing software."

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A digitally altered Ralph Lauren ad from 2009.
And if the AMA had left out the mention of "eating disorders" at the end of the first paragraph, I wouldn't have had anything to say except to nod my head in agreement. Because the alteration of images is appalling and imappropriate and, indeed, harmful. The problem is the link to eating disorders. The AMA said there was a "large body of research" linking media exposure to eating disorders.

So I went looking to see if I could find this large body of research. I went to PubMed and searched for "eating disorders media" and indeed, I pulled up 264 studies on the subject. But if you read the studies more closely, you'll see that there's lots of links between "disordered eating" and "eating pathology" and "body image dissatisfaction" and media exposure, but there's very little mention of linkage to outright, diagnosable eating disorders as spelled out by the DSM-IV. One study did actually say that "media contributes to the development of eating disorders," but when I looked at the studies cited, all I saw were examples that linked media exposure to disordered eating.

A lot of the media coverage of the story has said that Photoshopped images "promote anorexia." I'm not entirely sure I understand what that means. I think I know what they're getting at--that looking at these images make you more likely to develop anorexia--but there's no actual evidence that this is true (at least, none that I could find). We don't think ads for disinfectant somehow promote OCD. We also don't think that those Bluetooth headsets promote schizophrenia because it looks like you're talking to yourself.

I think the big difference is that people don't think they know what it's like to have schizophrenia because they've been paranoid at one time or another, or that they've had a rather animated conversation with themselves. But people do think they know what it's like to have an eating disorder because they've dieted and asked their husbands if these jeans make their butts look big.

It's a common mistake, confusing disordered eating and eating disorders. We often think that eating disorders are just extreme diets, when they're not. Many men and women are unhappy with their bodies and are on a diet. People with eating disorders also often express extreme body dysmorphia and restrict their food intake. They do look alike on the outside, but the internal experience is very different. Dr. Sarah Ravin summarizes the difference between disordered eating and eating disorders as follows:

Disordered eating is very widespread in our country, especially among women. I define disordered eating as a persistent pattern of unhealthy or overly rigid eating behavior - chronic dieting, yo-yo dieting, binge-restrict cycles, eliminating essential nutrients such as fat or carbohydrates, obsession with organic or "healthy" eating - coupled with a preoccupation with food, weight, or body shape.

By this definition, I think well over half of the women in America (and many men as well) are disordered eaters.

The way I see it, disordered eating "comes from the outside" whereas eating disorders "come from the inside." What I mean is this: environment plays a huge role in the onset of disordered eating, such that the majority of people who live in our disordered culture (where thinness is overvalued, dieting is the norm, portion sizes are huge, etc) will develop some degree of disordered eating, regardless of their underlying biology or psychopathology.

In contrast, the development of an eating disorder is influenced very heavily by genetics, neurobiology, individual personality traits, and co-morbid disorders. Environment clearly plays a role in the development of eating disorders, but environment alone is not sufficient to cause them. The majority of American women will develop disordered eating at some point, but less than 1% will fall into anorexia nervosa and 3% into bulimia nervosa.

I think it's great that the AMA is trying to protect children and adolescents from companies that would turn actual women into bobblehead models (the woman in the Ralph Lauren ad looks a bit like a bobblehead since her head is so disproportionately large compared to her body). Our ideas of what "normal" and "healthy" look like are disorted and it is harmful. On that subject, the research is clear.

Carrie Arnold is in recovery from a decade-plus battle with anorexia and is working on her third book, Decoding Anorexia: How Science Offers Hope for Eating Disorders.

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