May 10, 2023
Digital Diets and Dove
By Dr Kathy Weston
A video currently doing the rounds on social media is causing ripples of reflection, concern, vigilance (and hope) among parents and educators. It is a campaign, created by the beauty company, Dove, that tells a story of a young girl, Mary, and her journey from happy young child to teenager battling an eating disorder.
Believe it or not, Dove has been making videos about body positivity for a decade and their work is actually evidence-based. It’s not just dreamt up by a marketing team, but derived from research from centres like the Centre for Appearance Research in the UK. The video itself comes with the caveat that it contains some ‘distressing images’ and so does this edition of Wednesday Wisdom, which is devoted to the theme of understanding eating disorders and the possibility of recovery, co-written with specialist Clinical Psychologist, Dr Sophie Nesbitt. Sophie works with young people and their families in clinical practice and we regularly engage in dialogue about disordered eating and eating disorders. We exchanged some thoughts about the new Dove video and I discovered that not only does Sophie use Dove video resources in her practice, but that ‘this video surpasses anything they have done before”.
So, let me talk you through the video and its component frames. It plays to the backdrop of the song, “You are so beautiful to me” by Joe Cocker, a tune which immediately draws you in as a loving parent. Snippets of old family video clips pepper the film and you witness the normalcy of Mary’s early childhood with its familiar and happy components; her love of learning, favourite books, fun times with her ‘bestie’, living room singing performances with hairbrushes for microphones, kisses from her mamma, blowing out candles on birthday cakes, until we reach the milestone age of 12. At this point, she unwraps her presents surrounded by family and takes out something large and pink: a smartphone.
When I watched this bit, I started to tear up, as I imagined what was coming. Her interest seems to shift gradually from childhood play to a focus on exercise and fitness videos. She starts keeping a diary noting her daily moves. Then the ‘selfies’ start and my heart starts to hurt. Her self-worth, which has been nicely evolving and developing, suddenly changes course. It becomes dependent on digital feedback, ‘likes’ perhaps, and seems wholly based on physical beauty. You witness her drawing away from her own environment and moving towards a digital world and reality. She starts to ‘act out’ what she sees online; posing in mirrors, changing the angle of her poses, photographing herself in clothing that suddenly takes on more shape and tuck at the waistline. This is the juncture where I say, it is normal for tweens to suddenly take an interest in appearance, the views of others and become more self-conscious about presentation. However, little red flags in the narrative of the video help us differentiate between normal and concerning. The relationship between Mum and Mary, once close, becomes conflictual, and the removal of the phone causes angst and upset. Her private diary begins to detail a heavy interest in food intake and exercise. She starts to set a ‘goal weight’ and films herself on the bathroom scales. Dark shadows appear around her eyes and she seems paler. Her digital appetite is for appearance-focused social media and she develops a particular interest in very small waist sizes. She views those images more than most. She becomes highly self-critical, judging herself for ‘over-eating’ and the selfies she takes reference her desire for protruding cheekbones. She seems to be following people who like to take a tape measure to their thighs and discuss ‘thigh gaps’. A deeply loved child begins to see herself as ‘ugly and gross’.
As a viewer, you know she is in deep water at this point and it is really frightening to witness. Suddenly, the film jumps to a clinical ward; ‘patient notes’ visible, a plastic identifying bracelet on her wrist. She is turned away from the camera, slumped in a chair, her plaited pigtails a reminder of her young age and, at this point, we’re asked to contemplate ‘the cost of toxic beauty’ (the campaign’s title).
Just when you thought you couldn’t tear up anymore, the real ‘Mary’ appears on screen, her mother repeating the words, ‘you are so beautiful to me’ and we understand that recovery was successful. Recovery is defined within the film as meaning a return to relationship with oneself, the rediscovery of the bond between parent and child, between child and body, made possible through therapeutic intervention, love, hope, time and commitment. In witnessing the recovery, you feel parental rage against a whole host of contemporary features of modern society: toxic perfectionism online and in print media, algorithms and the big tech firms that ignore their own data on the harm they cause, products that promote body altering and face filtering software, legislators who don’t take strong enough steps to protect children’s mental health and the influencers and celebrities who sell a version of reality that simply doesn’t exist. Although this particular video addresses eating disorders in young women, we know that body dissatisfaction and eating disorders are on the rise for boys and young men who also face a barrage of images, apps and products that suggest they aren’t ‘good enough’, and medical services have seen a significant rise in men being treated for eating disorders in recent years.
I asked Dr Nesbitt how realistic the chronology from early onset to hospitalisation depicted in the Dove film is. She told me that, in many ways, the film depicted a typical scenario that she might see in her clinic and how in a first assessment with parents, they tend to detail the change; from ‘bubbly and effervescent’ child to sensitive, thoughtful ‘middle aged’ child.
Apparently, in those first conversations with a clinician, parents commonly explain how they just assumed this change could be easily explained by hormones and the onset of puberty. Who would blame them? However, normal ‘body consciousness’ morphs into something else, something darker, called ‘body obsession’ when an eating disorder takes hold. Dr Nesbitt describes this stage as ‘food monitoring and healthy eating’ with the ‘first signs’ being eating slightly less snacks, before moving to the consumption of smaller portions and eventual meal-skipping. At this point, the child may significantly reduce their calorie intake, which can precipitate significant weight loss.
As suggested above, a completely unrealistic expectation of body beauty, perpetuated by social media and toxic perfectionism can fuel and motivate the desire to lose weight. Once a pastime, body obsession can take over a child’s life and as Dr Nesbitt notes, “the child may now be unable to engage in any spontaneous behaviour around food or within life”. Parents can really struggle at this stage to control or influence what is occurring and can feel helpless. Family activities like shopping for food, meal preparation or visits to other people’s homes can be incredibly challenging and anxiety-inducing, for both parents and child. Social activities around food, popping to the coffee shop, getting an ice cream in the park or a bite to eat out can become a difficult ordeal. As a result, families have to learn to adapt and manage. Social activities around food tend to become non-existent and family life has to adjust as the eating disorder takes hold. Families may eat in separate rooms at different times to ease the pressure on the child and on siblings. Dr Nesbitt tells us that ‘kind and caring parents’ (as seen in the video) can witness their child losing weight, becoming ‘physically exhausted, withdrawn and isolated.’ Can you imagine the pain, worry and isolation parents may go through? This is often the point where they may decide on the need for clinical intervention. Two things sprung to mind when she said this. What can we do in terms of early intervention as a society, in schools and in our parenting? And how can we ensure ease of access to support and help, as and when young people and their families need it? Let’s start with the latter question.
If you are reading this, recognise some of the signs described in this piece and feel motivated to seek help, please know, support exists and you are not alone. Even if you have early concerns, always seek advice. Pathways to specialist support can be accessed via a family doctor (and onto CAMHS) or via specialist dieticians who can do assessments and refer to specialist clinical psychologists like Dr Nesbitt or a Child and Adolescent Psychiatrist. You can even call Beat’s helpline if you are worried and don’t know what to do or whether to act. Check out their tips poster if you want to learn more about early signs. For those supporting a young person with a diagnosed illness, there is a variety of literature that comes highly recommended by clinicians. Try Eating Disorders: A Parents’ Guide, or Skills-Based Caring for a Loved One with an Eating Disorder by Janet Treasure. Dr Nesbitt has authored a workbook that can help young sufferers of anorexia nervosa and her new book on the recovery process is a welcome source of information for practitioners and parents. I think what I have learned in my line of work and from what I know about eating disorders is that early intervention really does matter, so don’t ignore what your gut feeling tells you or your own intuition as a parent. I have also learned that asking curious questions in caring ways can be a really good starting point for parents and for school staff. All we can do is our best and sometimes that looks like seeking support and advice from those around us as to how best to proceed.
What gets any of us through anything difficult or traumatic? People, support, help, good listeners, clinical intervention, time, love, patience. Yes, the Dove advert is painful to watch, but its message is one of hope and all parents may find solace in that.
Research reflects the fact that, with support and treatment, young people can and do recover. Recent figures suggest that 46% of patients suffering from anorexia nervosa recover fully, with a further 33% improving. Roughly 20% remain chronically ill. Similar research into bulimia nervosa suggests that almost 45% make a full recovery, 27% improve considerably, and 23% suffer chronically. Further studies suggest that almost 50% of people who access treatment for ‘binge eating disorder’ have positive outcomes in terms of recovery (Beat 2023).
What does recovery look like? What do we know about it as a process? What are the component parts of the support that you might seek as a family? Dr Nesbitt describes an eating disorder as ‘creating a paralysis within a family’. Every member can feel the impact. For recovery to be possible, both the young person and the family need to understand their role in that therapeutic process as the young person can seldom do this on their own.
Dr Nesbitt details the various stages of recovery under the care of a clinician that might reassure many of you unfamiliar with the process. The first is re-establishing eating, this often takes the form of a meal plan outlining the number of calories needed for the young person to gain the weight needed to take them to a healthy place. The paradox here is that whilst this can be life saving at times, it can also create a rigidness within eating that becomes the very issue that needs to be treated further down the line in stage two and stage three recovery.
Once a young person has physically restored weight, their emotional world becomes more accessible. This can happen at any point during the physical weight restoration as each individual has a different threshold in terms of accessing their emotional worlds. In terms of therapeutic work, Dr Nesbitt describes how, “this can take time and effort from the young person and is often not desirable, but it is essential”. A specialist therapist will be able to engage a young person even when they are treatment resistant and help them to explore any original issues that may have ignited the illness.
At a surface level, many young people think their eating disorder was a way of changing their weight and body shape. Dr Nesbitt explains that, ‘whilst that might have been a driver in the beginning, underneath there is often a degree of emotional dysregulation and the young person has been using food restriction to make themselves feel better about other difficult emotional challenges”. This work needs to be explored in the context of a warm and caring therapeutic relationship. It takes time and (clinical) patience to truly understand the function of an eating disorder for children and young people and every child is different.
Whilst the young person is engaging in their recovery journey, so too are the rest of the family. They may be trying to understand more, and develop new ways of managing and coping, whilst remaining compassionate and caring even when they are feeling worn down and broken. Eating disorder recovery runs alongside normal family life, where parents may be working, caring for elderly parents and parenting other children too. By working together in a therapeutic alliance, parents, clinicians and schools can come together to support the child and their recovery. Perhaps you know a family going through this process? What more can you do to support them? How might you be sensitive to what they are feeling and experiencing? Just supporting a friend with invitations for a walk and a chat, or offering to help them in other aspects of their lives can prove life-saving. Siblings of those suffering from an eating disorder mustn’t be forgotten either. They can feel sad, worried, anxious and even fearful of getting an eating disorder. Support, listening spaces and resources exist for them too so, where appropriate you might signpost schools or friends to them.
As for those who find the Dove video a bit scary and are seeking immediate, actionable, evidence-based ideas to ward off disordered eating and eating disorders (as much as we can), here are some tips gleaned from a dive into the research evidence in this area. These are tips that I try to apply in my own parenting and they are relevant to all of us who might be concerned about protecting our children’s mental health and wellbeing in general.
First of all, have a think about how you talk about weight, dieting and/or being fat in family life. Dr Dasha Nicholls, a leading psychiatrist working in the area, told me directly that we should have ‘fat-free’ talk as far as possible in our homes, workplaces and schools. Secondly, when we look in the mirror, what are we modelling? Self-compassion or criticism? What are we valuing in family life? Courage or perfection? Are we commenting on how beautiful our children’s bodies are or we instead emphasising what they are capable of and expressing gratitude for that?
Taking considered and careful steps towards giving young children access to digital media and in particular social media is important. Recently, I spoke to the Head of a Pre-Prep where the majority of her young pupils owned their own smartphone. By the time children are ten years of age in the UK, half will own smartphones and we know from Ofcom data that around 21% of children aged 8-11 year olds have a social media account!
Next, we need to teach our children about algorithms and how they work. An interest in appearance-focused apps or exercise-focused influencers can drive children down a rabbit hole of self-criticism and may prompt restrictive eating practices. Professor Tracey Wade’s work reminds us that the more social media apps a teen girl has, for example, the higher the likelihood of disordered eating. As parents, we can teach our children to be digitally literate and to critically consume what they are seeing and reading. Teach them to ask themselves, is this fake or real? Is this helping or hindering me? Emphasise and reiterate their digital power; they can unsubscribe, mute, unfollow material or people that undermine their sense of self and self-worth.
Self-worth isn’t entirely derived from social media of course. As Dr Nesbitt explains, ‘it develops when we feel really seen for our intrinsic value”. We can all ask ourselves and perhaps our children if they feel valued, heard, appreciated and, if not, take steps to address that.
Remaining emotionally attentive as parents is important. Take a general interest in perceptions they hold about their life, their friendships, their feelings. Help give them words that match feelings and talk through what works for them when it comes to their own personal happiness and wellbeing. Try to help them problem-solve through everyday difficulty, rather than aiming to fix things for them. Be a coach rather than a soother and ‘lean in’ to ask how they are doing. Take care of yourself too. We can only look after our children optimally if we put our own masks on first. Self-care is something we can model at the same time as showing and expressing our unconditional love for our children.
Are you a Tooled Up member?
Parents and staff in Tooled Up Schools can learn more about eating disorders from a wide range of resources on the Tooled Up site. If you are interested in hearing more from Dr Sophie Nesbitt, she has answered all of your frequently asked questions and also provided us with advice specifically for school staff. We’d urge any family looking for a message of hope to listen to our interview with Eva Musby, author of Anorexia and Other Eating Disorders: How to Help Your Child Eat Well and Be Well, as she talks about her experiences and the role that parents need to play in the treatment and recovery of young people with eating disorders.
We have a range of other interviews with experts on eating disorders in the library. Sophie Medlin, consultant dietitian and Chair of the British Dietetic Association for London, joined us to discuss risk and protective factors around the development of eating disorders, how to talk about food and nutrition without causing harm and supporting young people to have positive body image. PhD candidate, Nora Trompeter, explored the links between bullying and eating disorders and the impact of appearance-focused bullying, examined the current research evidence, and considered what schools and parents can do to help. Dr Dasha Nicholls spoke to us about all the things that parents should understand when it comes to eating disorders. She gives us advice on how to keep a watchful, balanced and empathetic perspective on our children’s eating behaviours and tells us all we need to know about the main types of eating disorders and their triggers. We also learned about the potential negative impact of social media on young people’s body confidence and eating habits from Professor Tracey Wade, who shared advice on how parents can help to educate children about body image and healthy eating habits.
It can be hard for young people to know how to help a friend or sibling with an eating disorder, so we spoke to experts in these fields, Dr Amy Harrison and Dr Sophie Nesbitt, who gave us a whole raft of evidence-based advice. We also have a list of other useful resources that might help.
We know that seeking help for disordered eating as soon as possible is hugely beneficial. If you are worried about your child but aren’t quite sure what to say to your GP, using this observation diary template in the run up to an appointment might help you have some key information to hand.