Gathering around the dinner table is meant to be a source of joy and a place to bond with loved ones. But for many, mealtimes can be filled with anxiety and dread because of a complicated relationship with food. Dr. Kelsey Delph, child and adolescent psychiatrist at our Virginia Treatment Center for Children and Dr. Kelsey Hagan, a clinical psychologist with VCU Health, answer these 6 questions about eating disorders and just how many people, across all segments of the population, are impacted by them.

How prevalent is disordered eating and what groups are impacted?

Almost 1 in 10 people will have an eating disorder at some point in their lives. While some groups may be at higher risk than others, food-related mental health conditions do not discriminate and have the potential to impact all people.

What are the biggest misconceptions surrounding eating disorders and those who suffer from them?

The biggest misconceptions are encompassed by the (false) skinny, white, affluent, girl stereotype of eating disorders. Another example: if someone is at a so-called “normal” body weight, they must not have an issue with food. Eating disorders come in all shapes and sizes, and less than 10% of people dealing with disordered eating are medically underweight. While disorders like anorexia nervosa and bulimia nervosa have also been thought to be diseases of affluence, this is simply untrue, as research shows that factors like food insecurity and neighborhood violence increase a person’s risk. Finally, eating disorders affect people of all races, ethnicities and genders.

How prevalent is disordered eating in males and how (if at all) does treatment for male patients differ from female patients?

Eating disorders are about half as prevalent in males than females, though much of the data for screening, identification and treatment has been in predominantly cis-female populations. Many of our current screening tools were developed in girls and women, and research suggests that boys and men experience symptoms differently. For instance, males tend to emphasize muscularity in body image and present later for care in a more severe state of illness. The field would benefit from more gender-expansive representation in research to better understand differences in presentation so we can identify at-risk individuals sooner.

There seems to be a bigger emphasis on body positivity and societal acceptance of all body types – has that had any impact on the percentage of people who suffer from eating disorders?

While the emphasis on body acceptance and neutrality is certainly helpful, the reality is that the focus of criticism instead shifts to something else, especially with social media. For example, instead of criticism of weight, shape or size, it shifts to emphasis on “clean eating” or food trends (e.g., “what I eat in a day”), which can also be harmful.

When people are fighting alcoholism or drug addiction, the best course of action is to eliminate those substances altogether. But when people suffer from disordered eating like food addiction or binge eating, that’s not possible. Can you explain the challenges of overcoming those types of disordered eating when people need food to survive?

We all need a variety of nutrition to survive, and in eating disorder treatment, food is seen as medicine. Instead of eliminating food, or certain types of food, treatment is centered on navigating and repairing the complex relationship with food and eating.

What eating disorder seems to be the most prevalent and when is treatment most effective?

The most common condition is referred to as other specified feeding or eating disorder (OSFED), which is a catch-all category that includes people who don’t neatly meet criteria for eating disorders like bulimia nervosa or anorexia nervosa. Evidence suggests that the sooner someone gets treatment, the better for preventing a long-term illness course. That said, people with a longstanding eating disorder can and do recover. We have evidence-based treatments that work for about half of adults with bulimia nervosa and binge-eating disorder, and half of adolescent patients with anorexia nervosa, bulimia nervosa, and binge-eating disorder. At present, there are the fewest evidence-based options for adults with anorexia nervosa.

Eating disorders are complex psychiatric conditions that affect the whole body and have the second highest mortality rate of all mental illnesses. Seeking treatment with a therapist who has experience treating eating disorders, even when just suspected, as soon as possible is advised. We also know that involving parents and caregivers is generally the best approach when treating children and adolescents.

Learn about the outpatient services offered at our Virginia Treatment Center for Children or Jackson Center at VCU Health.