THE SKINNY TRUTH: A CRY FOR MORE RESEARCH1
The Skinny Truth
Why Government Intervention is Necessary
001286542
UNI 110
Professor Newton
According to information collected by the United States Census Bureau, the current population of the United States is approximately 324,920,000 and rising.[1] Of that population, over two million people (the majority being women and girls) are currently suffering from an eating disorder.[2] “Approximately one in one-hundred and fifty teenage girls fall prey to anorexia nervosa” and an unknown number suffer from bulimia nervosa.[3]The failure of medical practitioners and the general public to identify the warning signs of eating disordered behavior (due to a lack of distributed information) is the driving force behind the need for increased government action in order to diminish the total number of cases. The United States Government has allowed healthcare providers and the media to freely determine what treatment is covered by insurance; what types (and the cost) of care available; and the types of body images the media can advertise. In order to make a significant impact in slowing the spread of eating disorders in the United States, the government needs to take me productive actions regarding the issue and increase their influence over these groups and how they respond to eating disorders.
The true number of people afflicted with eating disorders is impossible to calculate since doctor’s offices are not required to survey or report information regarding disordered eating patterns. As an adolescent growing up, I attended an annual check-up examination at my local clinic where my height, weight, heartrate and other medical information would be carefully recorded and charted along with a survey. When completing the survey, I would always be careful to check all of the boxes correctly and honestly. However, these surveysnever once asked if I had ever fasted, engaged in excessive exercise, or binged after eating large meals which would have clearly signified that I was struggling with Bulimia. Although, my answers suggested that I had the need to remain in constant control of my weight the only pamphlets I was handed at the end of my examinations were those concerning living with anxiety and local therapists I could see regarding this issue, but there were no pamphlets regarding struggling with body image or eating disorders. After admitting to my closest friends and family that I had been struggling with Bulimia for the past six years in the fall of 2015, they too seemed skeptical. Although I appeared sickly and had lost a significant amount of weight overtime, I did not resemble the typical picturesque figure expected from eating disorders. I was able to overcome my disorder and improve my health because I acknowledged that I was not healthy and wanted to get better; however, others are not as lucky. Which is why eating disorders have the highest mortality rate of any mental illness.[4]
In order to understand why more awareness, research, and aid is necessary, it is important to acknowledge common factors attributed to the development of eating disorders within women stemming mainly from social, psychological, and biological factors. The three primary social factors are; intra-sexual competitionor perfectionism (two issues with Austin’s research include; the failure to provide a representative sample within her case study by only observing the motivations of heterosexual women which prevents her from concluding if her hypothesis was correct or not; and her research only proves that intra-sexual competition is a strong manipulating factor for bulimia but there is not a solid link between intra-sexual competition and any other eating disorder);[5]the exposure to thin images in mass media(Levine and Murnen’s article seeks to hold the media responsible and seek the passage of eventual legislature which will reduce the presence of overly thin models being displayed within the media; therefore, their article displays some bias especially in that their language choices seek to accuse the media of eating disorders even if their research does not fully support this);[6] and “thin fantasies”(a phrase coined by Polivy and Herman to describe an extreme desire to become thin. The duo’s research is largely inconclusive since their research does not include any data which can firmly back their claims asserted.)[7]The most cited psychological factors which are attributed for causing eating disorders include non-specific personality traits such as negative emotionality(referring to the propensity a person has towards becoming anxious or depressed, and is often characterized by reacting to stressful situations with negative emotions) or neuroticism[8] and a home environment where children feel excessive parental pressure, low parental contact, or parental abuse.[9] Finally, the biological factors attributed to causing this behavior to arise includes; genetic influence which are rooted in a person’s genes and neural circuitry which can greatly impact the way in which they eat and a lower amount of serotonin genes (however this is heavily speculated as a cause since there is not enough current research to prove it), but it is assumed to work in tandem with personality traits as causing the behavior to arise.[10] While these are the current answers research teams have provided as a cause for eating disorders, more may become apparent as research continues. In addition, eating disorders are not typically caused by one factor, it is a combined result from the social, psychological, and biological factors; therefore, no one reason can be singularly attributed as the leading cause.
Disordered Eating Behaviors manifest in many ways and are categorized into three primary groups. These groups are; Anorexia Nervosa which is displayed by an extreme phobia of gaining weight which is characterized by a “relentless pursuit of thinness;”[11] Bulimia Nervosa which is characterized by episodes of consuming large amounts of food followed by periods of purging, fasting, and/or extreme exercise;[12] and eating disorder not otherwise specified (EDNOS) which includes several variations of eating disorders, most of which are very similar to Anorexia or Bulimia.[13]It is also important to note that not all eating disorders cause the sufferer to become extremely thin. Those with Binge Eating Disorder are often overweight and most afflicted with Bulimia appear to be an average or healthy weight. Eating disorders arise out of the extremes. This means that a person may feel the urge to have smaller or larger amounts of food than normal then overtime this can spiral out of control and the person begins to reduce or increase their intake extremely; therefore, becoming extremely distressed and consumed with the outward appearance of their body and how they are perceived. With each of these conditions there are multiple side effects on the individual’s health which include; brittle hair and nails; dry and yellowish skin; mild anemia; low blood pressure, the thinning of bones; lethargy; the overall drop in body temperature; kidney problems from diuretic; gallbladder failure; etc.[14]
The serious health effects sustained from engaging in disordered eating behavior means that individuals must spend several months at recovery facilities or attend multiple therapy sessions in order to learn healthier eating habits. However, most private insurance providers do not cover these costs since eating disorders are not deemed a serious mental illness by most healthcare providers. The United States Government should universally recognize eating disorders as a form of serious mental illness (or Biologically Based Mental Illness) in order to ensure the coverage by insurance plans for eating disorder treatment. This needs to occur since “the failure to acknowledge the seriousness of eating disorders has resulted in a health care crisis for sufferers and their families.”[15] The average cost of securing treatment at a facility costs an average of thirty thousand dollars a month, and most patients need an additional three or more months of treatments resulting in ninety thousanddollars’ worth of care which is not covered by most insurance providers due to eating disorders not being labelled a Biologically Based Mental Illness.[16] The high costs of treatment (which equals a college payment at most state universities) means that the majority of individuals afflicted with eating disorders are left to their own devices and must rely on sub-par therapy (which still may cost anywhere from seventy-five to one-hundred and fifty dollars[17]) or by simply working through it themselves.If a family is willing to pay the thirty thousand dollars for treatment, it is likely that they will have to drive or fly in order to reach it since only a few states are privileged enough to have a top-rated clinic within their locality.[18]Simply because most states refuse to label eating disorders as a serious mental disorder until they gain status as a Biologically Based Mental Illness. Until researchers can prove that an eating disorder is in fact a serious mental illness, which results from the neurobiological disorder of the brain and “significantly impairs cognitive function, judgment, and emotional stability, and limits the life activities of the person with the illness,”[19] health care providers and the states are not required to cover eating disorders within their insurance plans; therefore, resulting in an uneven distribution of treatment within sufferers of eating disorders. In order to combat this, the United States Government should declare eating disorders a Biologically Based Mental Illness or provide alternative rehabilitation facilities which are less costly than the current options.
Extending healthcare coverage to those with eating disorders would eliminate the disparity in treatments; however, this causes a debate among Americans who are afraid that their healthcare costs will rise due to the high costs of care for people recovering from eating disorders. “Spending for health care services in the United States is [already] highly concentrated among a small proportion of people with very high use.”[20] Based on data collected in 2009 for the NIHCM Foundation’s 2012 data set for healthcare spending, twenty percent of healthcare spending is spent by the one percent of insured persons, and nearly fifty percent is spent by five percent of insured persons. This depicts that the top one percent of spenders are allotted more than 90,000 dollars in care while the bottom half only have about 236 dollars for spending.[21] However, the major issue with this counterargument is two-fold. The first part of this is that only thirteen-point-five percent of zero to thirty-four-year old’s make up the one percent of top spenders, and since the elderly make up thirty-nine-point-nine percent of the top one percent of spending, it is apparent that if anyone drives up health care rates it will be the elderly rather than young people who wish to use insurance to cover eating disorder treatment.[22] The second error in this argument is that the information provided within the data brief does not suggest that mental health spending drives up health care costs overall.[23] Although the people who argue against eating disorders being covered by insurance are not against people with eating disorders recovering, they are just afraid that it will raise their healthcare costs; however, these fears were disproved by the data provided by NIHCM. In addition, the data collected by NIHCM is outdated meaning that most arguments based upon it are inaccurate and potentially no longer applicable.
While disparities do exist and more research and treatment options do need to become more evenly distributed, some countries have begun to attack what they have attributed as the leading causes of body dissatisfaction and disordered eating patterns, namely the mass media.These laws created explicitly target the modeling industry since it is the easiest sociocultural cause of eating disordered behavior to monitor and restrict. The first of which laws passed was on March 19, 2012 in Israel. This was titled the “Law for Restricting Weight in the Modeling Industry” and was the response to a recorded growing number of eating disorders within the country and several deaths within the modeling industry resulting from eating disorder complications.[24] However, this law was eventually overturned due to challenges by models who claimed that the law was discriminatory and restricted their freedom of occupation, even if it claimed to protect them by relieving them so that they could improve their health.[25] The overturning of the “Law for Restricting Weight in the Modeling Industry” demonstrates one of the primary hurdles ‘preventative eating disorder legislature’ faces. The legislature must find a way to restrict the exposure of impressionable audiences to dangerously thin imagery while not discriminating against thin models (even if they have their health in mind). While Israel’s law was overturned, private organizations such as the hosts of Fashion Week Madrid and Milan are within their legal means when they require a body mass index of at least eighteen to walk the runway since unlike the government they are not restricting the model’s freedom of occupation and are rather limiting the outlets in which dangerously thin models can participate.[26]Israel’s Weight Restriction Law further demonstrates the common dilemma which states face when looking towards enacting laws which would protect their audiences from dangerously thin images, and it further explains why the framework adopted for addressing such issues revolving eating disorders and media exposure to thinness to the private sector. Even so, in 2015 French Lawmakers seemed to find their way around the issue of discriminating against dangerously thin models. They did this by instead of banning the hiring of any model with a body mass index under eighteen, they would punish any modeling agency who hires a model with a body mass index under eighteen with up to an 82,460-dollar fine or up to six months in prison.[27] This bill is permissible while the Israeli bill was not because the French bill allows models to continue looking for work it will simply make agencies much more hesitant in hiring them out of fear of prosecution. In addition to limiting the number of thin models seen by the public, the law will also encourage models who are currently dangerously thin to gain weight so that they may be hired by agencies.
The United States has remained largely silent regardingeating disorders and what the officials feel is a feasible way to reduce the number of people effected. It has been two years since the French Government passed its law against overly thin models and the United States still has made no advancement towards creating any similar statutes.[28] While numerous case studies have received, mixed results regarding if the media is to blame for the outbreak of eating disorders, cracking down on excessive use of photoshop and dangerously thin models seems like a step in the correct direction. However, it can be argued that the United States Government has taken action through inaction by allowing the private sector to create more feasible body images for people to wish to emulate. Such as through the Aerie ad campaign which stresses that women above a size zero are still beautiful and the abandonment of photoshop (which has caused a surge in sales suggesting that women are becoming less enchanted by the “supermodel standard”),[29] yet there is still an emphasis on thin, tall, and slender models as seen through national events such as the Victoria’s Secret Fashion Show which did not include a single model who was above a size zero.[30]The average size for a Victoria’s Secret Model is five feet ten inches tall and 115 pounds;[31] however, the average size for a woman aged twenty years or older is five feet three inches tall and 166 pounds[32] showing a significant disparity between the models advertised as the ideal beauty standard and the actual sizes of American women. This further advocates the depiction of attainable beauty standards within the media.
The United States Government has attempted to respect the private sector (and the first amendment rights of modeling agencies to employ whoever fits the message they wish to communicate), by not infringing on insurance coverage, treatment costs, or how the media handles thin models, they have remained silent long enough. As a result, they have deeply hurt the two million people currently afflicted with eating disorders through their inaction. It is time for them to start defending their people who are struggling to stay alive, and they can do this by; recognizing eating disorders as a ‘Biologically Based Mental Illness’which would force insurance agencies to include eating disorder treatment options under their coverage plans; allot other (less costly) treatment options for those seeking to recover from their disorder to ensure equal access to treatment; and conducting research studies which will provide the general factors and warning signs for the behavior which would allow people to take preventative measures.[33]