Understanding the Complex World of Eating Disorders 

By Jamie Bussin and Dr. Linda Booij PhD

In Episode #320 of The Tonic Talk Show/Podcast, I interviewed Dr. Linda Booij PhD about eating disorders and their causes. This is a digest of that conversation.

There are many different kinds of eating disorders, which are serious conditions. The most well-known ones are anorexia nervosa, bulimia nervosa and binge eating disorders. They’re slightly different from each other, but they also have something in common, which is some sort of preoccupation with weight, control of weight and body image. 

The most well-known eating disorder, anorexia nervosa, means that someone restricts food intake, and sometimes (but not always) is doing a lot of exercise, which leads to a weight that is lower than what would be healthy for this person. And in spite of this low weight, the person is also afraid of gaining weight. 

A person with bulimia nervosa has binge eating episodes. So that means the person eats large quantities of food in a short period of time, does not have control over  it, and this is then followed by some sort of effort to compensate for that lack of control. And this can be, for example, a misuse of laxatives or vomiting. Someone with bulimia nervosa often feels a lot of shame around the binges and food purchases, so it can also take a long time before the person would actually seek help. 

Unlike anorexia nervosa, someone with binge eating disorder, generally has a normal weight or a bit higher weight, which makes the condition harder to detect. With binge eating disorder the person feels no control over the binges, but doesn’t engage in types of compensatory behaviours. 

Anorexia nervosa and bulimia nervosa tend to occur more often in females than in males, although males could also get these types of eating disorders. But for binge eating disorder the prevalence is roughly the same for males and females. 

Although Canadians are aware of eating disorders, there are many myths and stereotypes that people have. For example, eating disorders would only happen in young women. In fact eating disorders can affect anyone from any walk of life. Another common misunderstanding is that you have to be thin to have an eating disorder. But people with any body type or weight could get an eating disorder. Some people think that family dysfunction is to blame for these conditions. i.e. a mother that’s too much involved or not much involved at all. However family often can be very supportive for someone who has an eating disorder. 

Eating disorders are caused by a multitude of biological, social and psychological factors that work together and contribute to the conditions. 

Biological and epigenetic factors: Eating disorders do have a genetic component and are heritable. However, even if you have, for lack of a better term, the wrong genes, it doesn’t mean that you are destined to develop an eating disorder. It constitutes a predisposition and epigenetics. Epigenetic factors which could occur before birth or in the first years of life or later on which trigger genetic modulation. 

Recent research has identified certain genes that might play a role in the development of eating disorders. Most of the work has been done in research of people with anorexia nervosa. What these studies have found is that people who are more at risk for anorexia nervosa, involve genes tied to mental health, metabolism, and immune function. These genes are not fixed. They actually need to be turned on or turned off by environmental factors (the aforementioned epigenetics). 

Research has shown that the act of dieting can, gradually over time, lead to eating disorders. For some who try to lose weight they can, over time, become obsessed. If the person becomes gradually malnourished it also could further increase obsessions around shape and weight. During malnourishment certain brain chemicals may not be produced, exacerbating the problem.

Social factors work together with biological and environmental factors to determine whether a person might develop an eating disorder. Examples include: trauma, being bullied at school, or even cultural factors such as body ideals leading to the pressure to be thin.

Dr. Booij cites the pandemic as a factor in eating disorders. COVID had a big impact on eating disorders. It led to changes in routine, loss of structure, influence of social media and social isolation and so on. Research showed that the number of people who developed an eating disorder for the first time really increased during the first phase of the pandemic, and especially teenagers, particularly girls who developed anorexia nervosa. 

There was also, especially among children and teenagers, an increase in emergency visits and in hospitalization rates. Some studies have shown that for those people who already had an eating disorder when the pandemic started, their eating disorder got worse. 

Although the data regarding changes, and increases in eating disorders, come from the early phase of the pandemic, Dr. Booij believes that it’s important to continue monitoring to see what happens over the years, and to think about ways  we can improve access to care for anyone who needs to recover from an eating disorder.