Personal Inquiry Project Fed Up With Eds Kit Zachery

The purpose of this inquiry project is to determine how and if schools can
help to prevent eating disorders (EDs) among their students. Body image is an
extremely common issue that people have, and it often starts at a young age. If
we teach our students about eating disorders, the signs and symptoms, the
consequences, how to help someone with an eating disorder, what to look for,
etc., can we help prevent an eating disorder from developing? If a student
already has one, can we help them recover before it becomes too serious? Can
we help students identify unhealthy relationships with food in themselves or in
others before it develops into a full-fledged disorder? Additionally, can we help
correct any misperceptions students have about eating disorders? Can correcting
misperceptions lead to more empathy, help, and support for those who do have
an eating disorder? Do students find this information valuable and/or essential to
their education? 

Background
In societies across the world, weight and appearance have been emphasized, marketed,
and plastered everywhere our eyes can see. People of all demographics feel the pressure that
society has placed on them regarding their weight and appearance, and many people have that
pressure turn into stress, anxiety, self-hatred, and other emotions and thoughts that often
harm their mental and physical health. While the “ideal image” may vary across demographics,
one fact remains true: it is unrealistic. These unrealistic standards portrayed in the media and
expected by the general society results in numerous negative impacts, two of which include
disordered eating and poor body image.

Before I go further into the topic itself, let me discuss the “why” of this project. Firstly, I
chose this topic because of how it has impacted me, my friends, my classmates, my loved ones,
my co-workers, everyone I have ever met or will ever meet, and even the people I have never
met and never will. Weight and body image impact everyone, and no one is unaffected by the
pressure placed on them by media, peers, clothing industries, etc. While changing society itself
may prove to be a difficult challenge, I believe it starts with little steps. There are already
body-positivity movements, new companies in the fashion industry that challenge the old ways
of doing things (modelling, labeling clothing sizes, etc.), and people who are sharing their
stories to help others. Perhaps another small step can be educating students about body image
and disordered eating, which may help to build a foundation of confidence, realistic
expectations, healthy relationships with food, support for self and others, and more within each
student.
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Another reason why I chose this topic is because of the need for it. During my PSIII
experience, I have heard stories and comments that either made me angry or profoundly upset
with society. I have heard students make self-deprecating comments about their appearance,
the food they are eating, and their weight. I have heard stories from students about how others
have commented on their weight, how much they eat, how little they eat, what they eat, and
more. I have had students tell me that their goal is to lose weight or feel more beautiful. All of
these things made me realize that students of all ages, genders, cultures, backgrounds, etc.
need a break from these unrealistic expectations and have a bit of time to learn more about
positive body image, healthy relationships with food, the impact of disordered eating on the
mind and body, and more. In my experience, this sort of information is not taught until higher
grades, such as high school or even post-secondary. While the younger grades touch on the
topics, it is often skimmed. Personally, I did not learn about eating disorders until university,
and even then it was just a brief introduction to the topic. Given the importance of the topic
and how many people it impacts, I am hoping sharing my research and knowledge with the
younger students will help prevent disordered eating and improve positive body image among
them.

What Are Eating Disorders?

Before going into the results of my project, let me first share my research with you. By
giving you some foundational information on what disordered eating is, how it impacts our
health, and strategies for reducing or preventing disordered eating in people, I am able to
extend my teaching and also help to ensure that we are all on the same page in regards to
terminology, previous research and studies, strategies, etc.

For the purpose of this project, an eating disorder is defined as an umbrella term for
psychological disorders that pertain to an unhealthy relationship between a person and food.
These unhealthy relationships are characterized by abnormal or disturbed eating behaviours,
which include restricting, starving, binging, and more.

There are many types of eating disorders, but the most common and/or well-known
ones are anorexia nervosa, bulimia nervosa, and binge/compulsive eating. There are also eating
disorders that have been coined as “eating disorder not otherwise specified”, commonly
referred to by its acronym of EDNOS. These eating disorders are ones that do not quite fit into
the categories of anorexia, bulimia, or binge/compulsive eating but still involve a pattern of
abnormal or disturbed eating behaviours and/or relationships with food.
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Anorexia Nervosa
One of the primary identifiers of anorexia is a person’s intense, and often irrational, fear
of gaining weight or becoming fat. This is often accompanied with a distorted self-image, an
obsession with weight, and a fear of food and/or eating. There are many behaviours that a
person with anorexia may have, some of which include restricting food intake, obsessively
counting calories, exercising intensely, self-induced vomiting, and misusing laxatives. It is
common for anorexia to lead to another eating disorder, such as bulimia. A person with
anorexia is typically below-average weight; if a person is average or above-average weight, they
will likely be diagnosed with atypical anorexia nervosa or anorexia nervosa type (explained
further below).

An ED similar to anorexia is “avoidant and restrictive food intake disorder”, otherwise

known as ARFID. While both disorders involve the person restricting food intake and/or
avoiding food, ARFID is ​not characterized by a fear of gaining weight or becoming fat. Unlike
anorexia, a person with ARFID is not distressed about their body shape or weight. However, if
left untreated, ARFID may very well develop into anorexia or bulimia.

Bulimia Nervosa
Bulimia is characterized by a person’s pattern of restricting food, binging, and then
purging. As such, bulimia is often associated with anorexia and a person with bulimia typically
has a history of anorexia.

A person will often restrict food (similar to anorexia or ARFID), but they end up binge
eating. Binge eating, or binging, is the act of a person losing control of how much food they are
consuming and ultimately consume such a large amount of food in a short period of time that
they are physically uncomfortable. While a “loss of control” is subjective and the amount of
food/calories consumed will vary from person to person, it is not uncommon for these binges
to be anywhere from 1,000 to 3,000+ calories in a single sitting.

After binging, the person will then attempt to purge the calories they consumed.
Purging is an attempt to compensate for food intake or prevent weight gain associated with the
binge eating, and purging can be done in a variety of different ways. While some of the most
common methods are self-induced vomiting or misuse of laxatives, other methods involve
excessive exercise, fasting, severe food restriction, etc.
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Binge Eating Disorder

Binge eating is a relatively newer disorder that is being diagnosed, but it has been
around for much longer. Previously, it was either associated with bulimia or not taken seriously,
but it is now classified as its own eating disorder. Unlike bulimia, binge eating disorder is not
associated with any form of purging.

Binging is the act of a person losing control of what they eat or how much they are
eating, and they eat such a large amount of food that they are physically uncomfortable. In
other words, they go beyond their body’s needs and end up putting themselves in pain or
extreme discomfort. While most people overeat from time to time (such as during family
dinners, special occasions, etc.), people with binge eating disorder do it on a regular basis and
to a much greater extent.

Eating Disorder Not Otherwise Specified (EDNOS)

EDNOS occurs and/or is diagnosed when a person has disturbed eating habits that may
be similar to the above disorders but do not quite meet all of the criteria. There are a variety of
different types of EDNOSs, some of which are:

Atypical Anorexia Nervosa or Anorexia Nervosa Type: Despite meeting all of the same
criteria as anorexia, the different for this ED is that the person is considered normal or
above-average weight, whereas people with anorexia are below-average weight. This often
occurs when the person started at a higher than average weight and has lost a significant
enough amount of weight.

Binge Eating Disorder Type: ​This disorder still involves periods of binge eating, but they
are less frequent. Whereas someone with binge eating disorder may binge on a frequent basis
(more than once a week), a person with this type of EDNOS will often binge less than once a
week.
Night Eating Syndrome: ​This syndrome involves a person eating an excessive amount of
food after waking up at night and/or after their evening meal (such as dinner). While “midnight
snacks” are not uncommon, night eating syndrome involves eating such a large amount of food
that it could be classified as an additional meal.

Purging Disorder: This disorder involves frequent purging (excessive exercising,

self-induced vomiting, etc.) despite the lack of binging. While bulimia involves restricting,
binging, and then purging, this disorder involves either restricting or eating normally followed
by purging.
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Causes/Risk Factors
There is no known cause for an eating disorder, and people from any demographic may
develop at ED at some point in their life. Despite this, there are risk factors that are commonly
associated with those diagnosed with eating disorders.
- Low self-esteem
- Body dissatisfaction
- Distorted body image
- Experience of weight stigma
- Genetics
- Dieting
- Trauma
- Peer pressure, bullying, etc.
- Other mental/neurological/emotional disorders, illnesses, etc.

Cena et al. (2017) hypothesized that people who experienced being overweight or
obese during adolescence were more likely to develop an eating disorder in the future,
primarily based off of the influence of social media and how that may result in bullying, weight
stigma, etc. However, their study also looked at other factors, such as athletics, having family
members who experienced difficulties with obesity, maternal past history of eating disorders
(MPHEDs), dieting behaviours, and gender. As various causes and risk factors are detailed more
below, the findings of the study by Cena et al. will be further discussed in their respective
categories.

Confidence, Self-Esteem, and Body Image

Low self-esteem, body dissatisfaction, distorted body image (e.g. body dysmorphia), and
having a poor body image can be a result of many different factors and sources. For example, it
could come from experiencing weight stigma, spending too much time on social media or being
exposed to media that promotes certain body images as “ideal”, experiencing peer pressure,
bullying, trauma, etc.

Weight stigma, otherwise known as weight bias, is when someone is treated differently
or experiences others being treated differently due to their weight and body shape, size, etc.
For example, a student being bullied for either being overweight or underweight. As mentioned
by Cena et al. in their 2017 article in ​Eating Disorders,​ “children with obesity are often teased
about their weight by peers or family members which decreases their self-esteem” (p.217).
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Body dysmorphia is a medical condition for when a person becomes obsessed or

otherwise overly concerned about their appearance, and their mind distorts how they actually
look to emphasize that concern. In terms of disordered eating, it is common for people with an
eating disorder to believe they look larger than they truly are. For example, they may feel as
though their hips are too wide, arms are too large, etc. It is important that body dysmorphia is
not a true representation of how they look and people with this condition have difficulty
understanding how they truly look to others.

Social Media
In terms of social media, it is possible that it is a primary cause of promoting disordered
eating in people of all demographics. Teenagers, on average, spend about eight hours a day on
some form of media (National Eating Disorder Association, n.d.). By spending so much time on
social media, these teenagers are being exposed to advertisements and posts about weight,
dieting, clothing sizes, make up, workouts, and more. With such an emphasis on appearance, it
is common for people to compare themselves to others and fall victim to advertisements.

Furthermore, Cena et al. mentioned that “media emphasizes thinness and often
portrays those with obesity as having a lack of self-control and willpower” and that “modern
society… perceives obesity as unattractive” (2017, p.217).

Unfortunately, these posts and advertisements are often based on false and/or
unsubstantiated claims (National Eating Disorder Association, n.d.). Additionally, posts are often
only what people want others to see - it is not the true reality of their lives. The use of filters
and other edits are also creating an unrealistic expectation of how people should look. Thus,
people are only seeing lies, partial truths, altered realities, and fake information.

NEDA (National Eating Disorder Association) also mentioned that the Dove Global
Beauty and Confidence Report found that approximately 70% of women and girls report a
decline in body confidence and an increase in beauty and appearance anxiety, which is driven
by the pressure for perfection and an unrealistic standard of beauty from the media. It also
found that 79%-85% of girls and women would rather opt out of a social event rather than
attend when they do not feel that they are looking “their best”, and that 90% of women say
they will not eat and put their health at risk when they feel bad about their body image.

One study on social media found that teenage girls who use social media are
significantly more than non-social media users to have poor body image, strive for thinness,
and engage in body surveillance. Another study found that social media use is linked to
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self-objectification (seeing one’s self as an object, primarily focused on the body); using social
media for just 30 minutes a day can change the way a person views their own body (National
Eating Disorder Association, n.d.).

Dieting
As NEDA mentions in their Statistics & Research article, there was a large study done in
2016 that focused on primarily 14 and 16 year-olds and their eating habits. The study was
mainly looking at two factors: did the teenager have an eating disorder, and did the teenager
ever go on a diet. What it found was that teenagers who diet, or engage in “clean eating”, are
significantly more likely to develop an eating disorder. In fact, it found that those who engaged
in moderate dieting were five times more likely to develop an eating disorder as compared to a
person who did not engage in dieting, and a person who engaged in extreme dieting was
eighteen times more likely to develop an eating disorder (National Eating Disorder Association,
n.d.).

Unfortunately, another study found that approximately 59% of girls and 28% of boys
were actively dieting at the time of the study, and about 68% of girls and 51% of boys exercise
with the goal of losing weight (as opposed to improving their health, meeting health goals, etc.)
(National Eating Disorder Association, n.d.).

However, dieting is not nearly as effective or healthy as people seem to believe it is. In
fact, people who diet are 12 times more likely to binge as compared to those who do not diet
(National Eating Disorder Association, n.d.). This is often associated with the restriction of food
that comes with dieting. As a person refrains from eating, their body becomes increasingly
hungry, and the primitive instinct to satisfy that hunger eventually leads to the person
consuming a large amount of food in a short period of time. This also helps to explain why
many people with atypical anorexia nervosa and people with bulimia nervosa are either an
average weight or even overweight. Furthermore, 95% of all people who diet will regain their
lost weight within five years (National Eating Disorder Association, n.d.). This is because diets
are temporary and not meant to be lifestyle changes. As the person dieting goes back to their
normal eating habits, their body will also return to how it was prior to the diet. In fact, dieting
has been found to be a predictor of both weight gain and increased binging in both boys and
girls (National Eating Disorder Association, n.d.).

With all of these studies explaining the negative effects of dieting and proving that
dieting is more likely to cause negative outcomes than positive ones, why do people diet? Aside
from people simply wanting a “quick and effective” way to lose weight, they are also being
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tricked by the media. A content analysis in 2001 found that more than 50% of weight loss
advertisements made use of false, misleading, and/or unsubstantiated claims (National Eating
Disorder Association, n.d.). It is important for people to do their research and know what they
are purchasing before they engage in any of the typical dieting and weight loss programs,
products, etc.

For example, many people will purchase weight loss pills and powders without their
being any studies to prove that these products are effective or safe. There are often diet trends
that become popular in the media, with some examples being garcinia cambogia, acai berry,
and raspberry ketone. These things can be in the form of pills or powders, or sometimes they
are added to smoothies, meals, etc. All will claim they have some ability to help a person
control and/or lose weight, however these claims are often unsubstantiated or misleading. For
example, they may say something along the lines of “may help a person lose weight” or “in
addition to exercise and a healthy diet”. Yet, the weight-loss industry is a 60-billion dollar
industry each year in North America.

Obesity, Genetics, and Illnesses

In the study done by Cena et al. in 2017, it was found that people who were overweight
or obese during puberty were reportedly twice as likely to develop an eating disorder as
compared to those who were of a normal or lower-than-normal weight during puberty (p.222).
They particularly noted that these people were more likely to develop either bulimia nervosa or
binge-eating disorder, as opposed to other types of disordered eating (p.223).

The study also found that people with MPHEDs were ten times more likely to develop an
eating disorder, as compared to people who did not have MPHEDs (p.223). Unfortunately, the
study did not indicate whether this correlation was based on genetics or other factors, such as
relationships, communication, etc. For example, a child whose mother has an eating disorder
grows up seeing their mother struggle with it, look a certain way, etc. Their mother may also
make comments that affect the child, or the mother might even have certain expectations of
their child.

It has been discussed that developing an eating disorder may be a symptom or a result
of another illness. For example, women with ADHD are prone to developing an eating disorder
for a variety of reasons. One reason is because ADHD often goes undiagnosed in women, and
they may become conflicted and/or confused as to why they are different from their peers.
Because they struggle to fit in, make friends, etc., they may believe factors, such as their
appearance, are to blame. In a study conducted by Biederman et al. (2007), they “found that
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adolescent females with ADHD were at an elevated risk of developing an eating disorder”
(p.305). This was determined after they studied 112 adolescent females with ADHD and
discovered that 16% had a history of disordered eating. They also stated that “ADHD females
were 3.6 times more likely to meet criteria for an eating disorder (either bulimia nervosa or
anorexia) compared to control females” (p.304). However, other articles have noted that
people with ADHD are also more likely to develop binge-eating disorder or bulimia nervosa, and
this due to the poor impulse control that often comes with ADHD (Olivardia, 2020). This same
article goes on to explain that “​both binge-eaters and people with ADHD have trouble heeding
their internal cues of satiety and hunger”.

Another example would be people with anxiety and obsessive-compulsive disorder

(OCD). People who are “perfectionists” may feel the need to be in control, and it is not
uncommon for these people to try to control their appearance. If they begin to gain weight or
otherwise appear in a way they do not want to, they may feel as though they have lost control.
NEDA (n.d.) mentions that approximately 66% of people diagnosed with an eating disorder
showed signs of anxiety prior to the development of their disordered eating.

It is also common for depression to go co-exist with an eating disorder. Sometimes the
eating disorder is a cause of the depression, due to hormone imbalances in the brain from a
lack of nutrition; however, there are times that both will co-exist and not be directly connected
to one another.

As mentioned in NEDA’s article, there was a study done in 2014 with over 2,400
participants with eating disorders that looked at the connection between disordered eating and
trauma, PTSD, and psychosocial resources. It found that 94% of the people had a coexisting
mood disorder, most commonly being depression. 56% had an anxiety disorder, 20% had OCD,
22% had PTSD, and 22% had an alcohol or substance abuse disorder. NEDA goes on to mention
a variety of studies, concluding that “there is a markedly elevated risk for obsessive-compulsive
disorder among those with eating disorders.”

Gender and Sexuality

In the study done by Cena et al. (2017), it was found that women were five times as
likely to develop an eating disorder as compared to men (p.223). However, other studies have
found that the actual ratio is closer to 3-to-1; in other words, 66% of all cases are women and
33% are men (National Eating Disorder Association, n.d.). Despite all of this, it is still possible for
these numbers to differ in reality. As many men do not seek help, it is difficult to know exactly
how many are struggling with an eating disorder. Still, it should be noted that “from 1999 to
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2009, the number of men hospitalized for an eating disorder-related cause increased by 53%”
(​National Eating Disorder Association, n.d.​). This may be a result of more men developing eating
disorders, however it is more likely that men are more actively seeking help than they used to.
Based on studies researched by NEDA, they have stated that homosexual men are three
times as likely as hetereosexual men to develop an eating disorder. Meanwhile, homosexual
women are about just as likely as hetereosexual women to develop an eating disorder,
although NEDA mentions that more research is required in this area. They also mention that
more studies are required in terms of transgender people and eating disorders, though they do
state that “transgender individuals experience eating disorders at rates significantly higher than
cisgender individuals” (​National Eating Disorder Association, n.d.​).

Race and Ethnicity

In a study done by Gordon, Perez, and Joiner, (2001), it was discovered that visible
minorities are less likely to be identified as having an eating disorder as compared to
causcasians. The study involved a hypothetical woman named Mary, and participants read
about Mary’s eating habits. When Mary was described as being caucasian, 93% of participants
identified her as having disordered eating. When Mary was described as being Hispanic or
African American, only 79% of the participants identified her as having disordered eating
(p.222). The study did note, however, that the participants’ own ethnicity appeared to have no
impact on their decision regarding Mary’s eating habits (p.222).

Goeree, Ham, and Iorio (2011) found that “African Americans are more likely to exhibit
bulimic behavior” (p.21) after analyzing 2,379 young women over the course of 10 years. The
study looked at factors contributing to disordered eating, specifically ethnicity, age, family
income, education of parents, body dissatisfaction, distrust, ineffectiveness, and perfectionism.
They found that being white significantly reduces the odds of a person having disordered eating
(p.13). Other factors that reduce the odds of a person having an eating disorder include coming
from a higher-income family and having parents with a higher level of post-secondary
education.

Based on these studies, it is important for race and ethnicity to be taken into account
when diagnosing and treating an eating disorder. If doctors, therapists, etc. are like the
participants in the study by Gordan et al., they may not diagnose a non-Caucasian person with
an eating disorder when they do actually have one. People must be educated on this
discrepancy between races and ethnicities, in order to help all of those who need the help. As it
currently stands, non-Caucasian individuals are less likely to receive the help they need, even if
they do reach out. The importance of this is enhanced by Goeree et al.s’ study, as they found
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that African Americans are more likely to develop an eating disorder than Caucasians are. While
they study does not look at other ethnicities, such as Hispanics, Asians, etc., it can be assumed
that they are either just as likely or more likely than Caucasians to experience disordered
eating.

Other
In regard to athletics, numerous studies have found that people who engage in sports,
particularly competitive and/or aesthetic ones, are more likely to develop an eating disorder as
compared to those who either did not engage in sports or instead engaged in sports that were
less competitive and/or not considered aesthetic. For example, Cena et al. (2017) found that
participants who engaged in competitive sports during their childhood were four times more
likely to develop an eating disorder as compared to the participants who did not engage in
competitive sports (p.223).

Furthermore, NEDA (n.d.) refers to studies that have found that 90-95% of
post-secondary students belong to a fitness facility of some kind, and that an estimated 3% of
gym-goers have a destructive relationship with exercise; however, other studies believe that
this number is actually upwards of 42% of all gym-goers. While NEDA did not write an
explanation for it, it could be argued that those who attend the gym are attending for the
purpose of losing weight. If their goal is to lose weight, rather than to be healthy, build muscle,
be more active, etc., then it is not unlikely to assume that the persons’ relationship with
exercise is unhealthy and, thus, destructive. In fact, NEDA does state that there is a strong
correlation between compulsive exercise and disordered eating. As mentioned above,
compulsive and/or excessive exercise is often associated with anorexia and bulimia, and it can
also be used as a form of purging.

Prevention
The first and most important step in prevention is to educate yourself. Be aware of the
risk factors associated with disordered eating, and know what disordered eating looks like.
Many risk factors have been identified throughout this project, however it is important to
continue research and identify other risk factors that may contribute to the development of an
eating disorder.

Aside from educating yourself and others on these risk factors, there are other ways to
help prevent eating disorders. Whether you are a doctor, parent, teacher, friend, etc., here are
some ways to help prevent disordered eating in yourself and others:
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1. Avoid labeling food​ as “good”, “bad”, “safe”, or “unsafe”.

2. Discourage the idea that dieting is effective or necessary​.
3. Focus on what you do like​ about your body.
4. Focus on what your body can do​ for you.
5. Do not comment on the weight or size of someone else’s body​, even if you mean it as a
compliment.
6. Do not comment on the weight or size of your own body​. For example, do not say
things such as “I really need to lose weight”, “I let myself go”, “I wish I was skinnier”,
“I’m so fat”, etc.
7. If you catch yourself judging either yourself or others based on appearance, correct
yourself. Recognize that these thoughts are not healthy or relevant, and remember that
a person’s appearance does not tell you anything about their personality, character,
feelings, etc.
8. Analyze all forms of media​, especially when they relate to body image and food. Ask
yourself what message the media is sending, how it impacts you or others, etc.
9. Get rid of anything that makes you feel bad about yourself​. If you follow someone on
social media that makes you feel unworthy, unfollow them. If you see an advertisement
that makes you feel sad or upset, report the ad or unfollow the page that posted the ad.
If you see a page in a magazine that makes you feel bad, rip the page out and throw it
away.
10. Talk to yourself the way you would talk to your loved ones​. We often encourage and
support our loved ones, yet we talk down on ourselves. If we learn to love ourselves and
say positive things, we can help to improve our confidence, self-image, body image, etc.
11. Make all of your health-related goals unrelated to your weight​. Your weight is not an
indicator of your health.
12. Surround yourself with positive people​. If your social circle is full of people who are
promoting a certain body image, discussing weight, judging others, etc., you may want
to consider expanding or changing your social circle to include people who are
encouraging, uplifting, supportive, non-judgmental, etc.
13. Wear clothing that makes you feel comfortable​. Do not worry about sizes - just buy and
wear what makes you feel good.
14. If you think a loved one may have an eating disorder, ​gently ask them about it and try
to have a discussion. Encourage them to reach out for help if they need it.
15. If you think you may have an eating disorder, ​talk about it with someone you trust and
feel comfortable with.
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Treatment and Help

Treatment varies greatly from person to person, as many factors will impact the type of
treatment a person needs. Gender, race, income, sexuality, coexisting and co-occurring
disorders, illnesses, etc., family history, etc. will all help to determine the type of treatment a
person needs, thus no one will experience treatment the same way.

For example, someone who is experiencing both ADHD and an eating disorder will have
a variety of different treatment options as compared to a person with an ED but no other
disorders. The same goes for men with eating disorders, as they may not necessarily receive the
same treatment that a woman would.

Options and Steps

- Talk to a healthcare professional about your concerns. It might be scary, but this is the
first step to receiving a diagnosis. While there are some forms of help that do not
require this step, it is required to receive medical treatment. This person could be your
family doctor, therapist, psychologist, psychiatrist, etc.
- Call a help phone. ​There are a variety of helplines listed online, and NEDA’s is just one
of many. You can call these phone numbers and talk to someone trained in disordered
eating, similar to Kids Help Phone being available to help children who are struggling
with self-harm and suicidal thoughts.
- Message an online help chat. If you prefer to talk via text message or e-mail, there are
many options available online. Again, NEDA’s is just one of many. You can chat with a
person anonymously and discuss your concerns, ask for help, etc.
- Join an online forum. There are many forums online that can help connect people and
families struggling with disordered eating. They can discuss problems, answer questions,
address concerns, share helpful information and strategies, etc.

Medical Treatment
If you receive medical treatment, there are many different paths you could go down.
Some of these paths could involve:

- Intensive outpatient allows the patient to come and go from the clinic, hospital, etc., as
they do not require 24/7 monitoring.
- Inpatient treatment typically involves the patient being checked-in to a program for a
set period of time, during which they are monitored for their safety.
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- Psychotherapy is a general term for talking about your feelings, emotions, thoughts,
etc. with a mental health care provider. There are many forms of psychotherapy, so it is
important for you and your health care provider(s) to determine which one is best for
you. Here are some of the most common or effective psychotherapy options:
- Acceptance and Commitment Therapy (ACT) focuses on changing your actions
rather than your thoughts, feelings, or beliefs. ACT will teach the person core
values and help them develop goals and action plans that relate to these values.
Instead of doing things that “feel good”, the person should instead do things that
connect with their core values. In doing so, they will find that they will start to
feel good.
- Cognitive Behavioural Therapy (CBT) is a short-term therapy treatment that
helps a person overcome a generalized and distorted belief. For example, CBT
would aim to help a person recognize that their belief that their weight
determines their worth is distorted and maladaptive, and that they are worthy
regardless of their weight.
- Cognitive Remediation Therapy (CRT) attempts to overcome rigid thinking
processes and develop a person’s ability to focus on and believe more than one
thing at a time.
- Dialectical Behavioural Therapy (DBT) focuses on changing the disordered and
maladaptive eating behaviours and replacing them with healthy, effective eating
behaviours. It focuses on mindfulness, interpersonal relationships, emotion
regulation, and distress tolerance.
- Family-Based Treatment (FBT) chooses to focus on refeeding and weight
recovery for treating the ED rather than trying to find the root cause. It is a
home-based treatment that aims to establish healthy eating patterns, regain
control, and stop self-destructive behaviours.
- Interpersonal Psychotherapy (IPT) looks at four problem areas, which include
grief, interpersonal role disputes, role transitions, and interpersonal deficits. By
addressing these areas, IPT helps improve the person’s communication and
relationships, while also resolving interpersonal issues.
- Psychodynamic Psychotherapy aims to find the root cause of the eating
disorder. It will consider things such as internal conflicts, underlying motives,
unconscious forces, etc. By identifying and addressing the root cause(s), it hopes
to treat the disordered eating and prevent a relapse.
Personal Inquiry Project Fed Up With Eds Kit Zachery

Helping Others
If you know someone who has an eating disorder, here are some ways that you can
help:

- Educate yourself. Learn as much as you can about disordered eating, including the
signs, symptoms, risk factors, etc.
- Know what you want to say. If you need to, write a script or write down your key
points.
- Discuss it in private. Wait until you are alone with the person you want to talk to, just as
you would with any sensitive and/or personal topic. Do not talk about it in a public
place.
- Use “I” statements and not “you” statements. It is important that you say how you are
feeling, what you have noticed, what you are thinking, etc. Say things such as “I have
noticed that”, “I am concerned about”, etc. Avoid putting any focus or blame on the
other person, as they may become defensive. Avoid saying things such as “you haven’t
been eating”, “you’ve lost/gained a lot of weight”, “you are exercising a lot”, etc.
- Be honest and stick to the truth. State the facts and give specific examples, rather than
general statements (e.g. “I noticed you skipped breakfast and lunch for the past week,
and I am worried that you’re not eating enough” instead of “you seem to skip breakfast
a lot”).
- Avoid making rules or threats. ​Try to have it as an open-ended conversation, rather
than an ultimatum or punishment. For example, do not say “you have to eat breakfast
and lunch for the rest of the week” or “if you don’t start eating more, I’ll tell mom about
you”.
- Avoid making promises. While it may be tempting to say “I promise not to tell anyone”,
that is not necessarily a promise you can or should keep.
- Avoid making simplistic solutions. It is not as simple as saying “just eat” or “just stop
it”. An eating disorder requires empathy, understanding, compassion, communication,
and more. If you simplify it too much, the person will likely feel misunderstood and that
their problem is unimportant/not serious.
- Be prepared for a negative reaction. While some people are grateful when others
notice that they are struggling, others are in denial and/or do not want help. It is
common for people with eating disorders to not want help, as it will likely flip their life
around. For example, if the person’s goal is to lose weight and be skinny, receiving help
would likely involve changing their way of thinking and gaining weight. If the person
reacts negatively, reassure them that you are there for them whenever they need you
and that you care about them. You are just concerned for their wellbeing and you just
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want to be there for them. If they still do not want to talk, you may want to either reach
out to someone else for help, or drop the subject and bring it up again another time.
- Be prepared for the person to be in denial. A person may not be aware that they have
an eating disorder, or they may just not accept that they have one. If that is the case,
they may try to avoid or drop the subject, laugh it off, become frustrated or annoyed,
etc.
- Encourage them to talk to someone. ​Know where they can go for help and let them
know their options. As mentioned above, there are helplines, chat lines, forums, and
more. They can also reach out to a medical professional, such as their family doctor.
- Be there to support them. You might want to offer to help them call to make an
appointment or drive them to their first appointment. You can also offer to lend your
ear if they need to talk to someone.
- Remind them why they want to get better. ​After they have started to get help,
encourage them to create a list of reasons why they want to get better. If they ever start
to question their recovery or if they begin to lose hope, remind them of all the reasons
why they want to get better. Some common reasons include improving their social life,
enjoying food again, feeling more in control of their life, feeling more confident, having
more free time, etc.
- Do not discuss their weight or appearance. Whether it is a compliment, joke, etc., it is
best to stay far away from making any comments on someone’s weight or appearance.
You never know why someone may have lost or gained weight, so it is better to just
leave the topic alone. If you think someone looks good, just tell them they look good!
- Do not comment on their eating habits. While these types of comments are often out
of concern or meant to be a joke, it is a topic best left alone. People often become quite
self-conscious about their eating habits, and it is best to not contribute to these
thoughts and feelings. For example, if your friend has a big appetite and eats a lot, you
do not need to joke about how they are always eating or how they always have room
for more.

The Passion Project

This project was about body image and disordered eating in middle and high
school-aged students, with the intention of finding out what students already knew and felt
about disordered eating and then seeing what they could be taught over the course of two or
three lessons. Ideally, the project would educate students on these sensitive topics, increase
their empathy, and reduce or prevent the development of disordered eating among the
students. It involved all students taking a survey, engaging in two or three lessons and
discussions, and then re-taking the survey.
Personal Inquiry Project Fed Up With Eds Kit Zachery

While the project initially involved grade six, seven, and nine students, it was later
changed to just involve grade seven and nine students. This was because a week of lessons
were lost when I had to quarantine for two weeks, and it was not possible to make up that lost
time with the grade six students. However, two grade seven classes and two grade nine classes
were still able to participate in the project.

The Process
There were five parts to this project, all of which were scaffolded to help guide the
learning process for the students and have them realize their own growth throughout the
project.

Part one was all of the “behind the scenes” work that I had to do to make the lessons
and this project possible. It involved doing research, putting all of my knowledge and learning
together, creating a survey, designing my unit and lesson plans, and finding videos, articles, and
more for the lessons.

Part two was the survey. At the start of the unit, each student was asked to complete a
survey on their knowledge of disordered eating. It asked questions ranging from their
demographics to what they think anorexia is, and also asked about their feelings towards
disordered eating and those that experience disordered eating. By completing the survey
before me teaching them anything, I was able to gauge what students already knew and
thought about the topic and could compare it later on. Thus, I would be able to see how
students’ thought processes have changed throughout the unit.

Part three was the unit itself. It involved either a live or recorded Zoom session with a
guest speaker and one to three lessons on body image and disordered eating. The guest
speaker was Dr. Stephanie Cassin, a psychiatrist and also a professor at both the University of
Toronto and Ryerson University. She is a specialist in disordered eating and held a live Zoom
session with one of the high school classes on body image. The remaining classes were able to
watch the recorded session, which was also a beneficial experience. After that, the lessons
involved videos, discussions, and lectures on what disordered eating is, the impact it has on our
mental and physical health, ways to support yourself and others, and strategies for improving
body image and recovering from disordered eating.

Part four was for students to re-take the initial survey, so that they could reflect on what
they have learned and gained from the unit. It also allowed me to compare and contrast their
Personal Inquiry Project Fed Up With Eds Kit Zachery

thoughts and feelings surrounding disordered eating, which gave me an insight into how
teaching about these topics impact students, whether or not it is necessary, and more.

Part five was to compile all of my results and finish this project. Having the surveys
completed, I had to compare the “before and after” answers, analyze the answers and how
they changed (or did not change) throughout the unit, and what all of it meant.

Classroom Teachings
Please refer to ​www.fedupwitheds.weebly.com for all unit and lesson plans, as they
detail what each lesson was about and what was included. However, summaries of the five
lessons are as follows:

Lesson One
The first lesson was an introduction to the project and unit, and had students complete
the survey. No information was given prior to the completion of the survey, as to not skew the
results.

After students finished the survey, we watched a video on body image and then had a
class discussion about it. Students discussed how men and women are different in terms of
body image, how body image expectations differ by gender in the media, how the media
impacts our body image, etc.

Lesson Two
The second lesson involved a guest speaker who attended via ZOOM. Her name is
Stephanie Cassin, and she is a registered clinical and health nurse who is also an associate
professor of psychology at Ryerson University. She runs the Healthy Eating and Lifestyle (HEAL)
Lab at the university, and is very experienced in the topics of body image and disordered eating.

Dr. Cassin spent the class discussing body image and also mentioned how it can relate to
the development of disordered eating. She discussed what body image is, what impacts it, how
we can improve our own body image, ways we can help support body image positivity for
others, and more.

Lesson Three
The third lesson was about some statistics regarding EDs, as well as the primary risk
factors. The lesson started by presenting students with common beliefs and perceptions of
eating disorders, and then asking the students whether they believe that statement to be true
Personal Inquiry Project Fed Up With Eds Kit Zachery

or false. As such, the class worked through important facts and fallacies regarding disordered
eating, thus having students recognize any potential misinformation, misperceptions, or
misbeliefs.

Risk factors were discussed in more depth, as we discussed why they are a risk factor
and what implications that may have (doctors misdiagnosing or not diagnosing at all due to
biases, watching what we say to and around other people, checking in on those who are most
at-risk, recognizing those risk factors in ourselves, etc.).

Lesson Four
The primary focus of the fourth lesson was on anorexia, bulimia, and binge-eating,
although EDNOS was also discussed. We briefly mentioned PICA and RFID, and how they are
different from these other eating disorders.

The rest of the lesson was lecture-style as the students learned about the different
disorders, as well as the signs and symptoms. We talked about how anorexia is primarily
diagnosed by a person’s intense fear of gaining weight, and that there are two main subtypes:
typical and atypical. We moved on to also discuss bulimia and binge-eating, and how all of
these EDs are similar to and different from one another.

The signs and symptoms were skimmed relatively briefly, but emphasis was put on the
more serious and/or less-known symptoms (such as death, hair loss, brittle nails, always feeling
cold, exercising compulsively, etc.).

Lesson Five
The fourth and final lesson was about prevention, treatment, and recovery. Students
learned strategies for preventing disordered eating from developing in ourselves and others
(e.g. positive self-talk, stepping back from social media, critically analyzing the media,
surrounding yourself with positive people, etc.), what treatment looks like and how it can differ
from person to person, how to reach out for help and/or get treatment, what recovery means
and looks like, and why recovery is so important.

While the lessons were “over” as of lesson five, students took the first 15mins of the
next class to retake the survey. This time, they had nearly five full lessons worth of knowledge
about body image, disordered eating, and support. Thus, having them complete the survey for
a second time would allow them to apply what they learned and also allow me to see what they
learned and how their thoughts and feelings may (or may not) have changed throughout the
unit.
Personal Inquiry Project Fed Up With Eds Kit Zachery

Other Lessons
One of my grade seven classes had more opportunities for learning more about body
image and disordered eating, and thus they had some additional lessons. These students had a
Google Suite class three times a week, plus our Wellness class once a week. While the Wellness
classes were reserved for any discussion of disordered eating, the Google Suite classes had
students analyzing social media and discussing the impact that the media has on our body
image. Students learned that pre-teen and teen rates of self-harm and suicide have increased
drastically since social media has been a centerpiece in our lives (The Social Dilemma, 2020),
and they also discussed social media addiction, how and why social media impacts our lives,
and what forms of media we should be critical of (social media, advertisements, movies, etc.).
As a class, we watched a variety of movie trailers and discussed the messages that they send to
us, and we also discussed ways in which the media can actually help to improve our body
image. For example, we talked about body-positive posts, representation in the media, sharing
information, etc.

Survey Findings
The survey involved between 59 and 29 students, between the first and second rounds
of the survey being administered. The variance in numbers is primarily due to COVID-19, as it
drastically impacted the school and how classes were taught. My PIP lessons were cut a day
short, and this resulted in none of my grade 7 students being able to complete the second
survey. Thus, the decision was made to not compare the “before” and “after” results, and to
instead just discuss the findings of the “before” and note on how students appeared to change
throughout the unit. While this is less valid and reliable, it was simply not possible to compare
the “before” and “after” findings.

Before discussing the findings, it should first be noted that this is not professional
research of any kind and all findings should be taken with a grain of salt. While I would like to
do professional research in the future, this is merely some personal research for my
Professional Inquiry Project. There are many sources contributing negatively to the reliability
and validity of this research, although it does serve as a good starting point for future research.

Before The Lessons

The first time the students were asked to complete the survey, many voiced their
concerns of not knowing anything about disordered eating. While some joked about it, others
were quite distressed over not being able to correctly answer the questions. They were assured
that this was simply a survey to determine their understanding and knowledge of disordered
eating, and that it was not going to be used to summatively assess them in any way. However,
Personal Inquiry Project Fed Up With Eds Kit Zachery

there were still students who knew a lot about the topic and were eager to answer the
questions and help educate others.

Of all the students, the gender between the four classes was nearly a perfect split. 47%
identified as female, 51% identified as male, and 1% preferred to not answer the question. Of
these students, nearly 49% of them were between the ages of 10-12; meanwhile, 49% were
between the ages of 13-14, 1% were between the ages of 15-16, and 1% preferred to not
answer.

When asked about their history with eating disorders, 75% stated that they did not have
nor have they ever had an eating disorder. 12% said they either currently had or think they
currently had an eating disorder (most of which were in grade 7), or that they had used to have
an eating disorder but have recovered from it. Additionally, 22% stated that they either knew or
thought they knew someone who currently had an eating disorder. In fact, more than one
student approached me either during or after the survey to inform me of a family member or
friend who had an eating disorder.

The next section asked students about their level of knowledge regarding various eating
disorders. In regard to anorexia nervosa, 47% said they knew absolutely nothing about it, and
31% said they knew a little about it; only 5% said they either knew a fair bit or a lot about it. For
bulimia nervosa, 78% said they knew nothing about it, and the remaining 22% said they knew
just a little about it. Binge-eating disorder appeared to be the ones students were the most
familiar with, as 46% said they either knew a fair bit or a lot about it. Meanwhile, 29% said they
knew a bit about it, and 25% said they knew nothing about it.

When asked about helping others or themselves in dealing with an eating disorder, only
12% and 15% of students felt confident in being able to help others or themselves, respectively.
Meanwhile, 29% and 46% said they had no confidence at all in being able to help either others
or themselves in dealing with an eating disorder.

The next section asked students to describe, in their own words, what various terms
meant. The terms were disordered eating, anorexia nervosa, bulimia nervosa, binge-eating
disorder, purging, and binging, The majority of answers were some variance of “I do not know”,
with a few guesses here and there as to what they meant mean. For each one, there were only
one to three answers that were either correct or close to being correct (with the correct
answers having been defined in the “What Are Eating Disorders?” section).
Personal Inquiry Project Fed Up With Eds Kit Zachery

The true and false section for the grade sevens was skewed, as they had not been given
the option of answering “I do not know” or skipping the question. This resulted in students
guessing randomly and throwing off any real indication of what students did or did not know.
This error was corrected for all subsequent surveys, and for the second survey for the grade
sevens; however, it unfortunately meant that no valid and/or reliable analysis could be done for
the first survey for the grade seven students.

The final section asked about students' feelings toward eating disorders. They were
asked about their comfort levels with discussing disordered eating with their families and
friends, being friends with someone who was experiencing disordered eating, and the topic of
disordered eating being taught in school.

19% indicated that they would be very comfortable discussing eating disorders or their
relationship with food with their families, whereas 5% said they would be extremely
uncomfortable with it. 42% said they are neutral on the matter. On the other hand, 20% said
they would be very comfortable discussing disordered eating with their friends, and 14% said
they would be extremely uncomfortable with it.

In terms of being friends with someone with an eating disorder, 49% of students said
they are very comfortable with it and only 3% said they would be extremely uncomfortable
with it. When asked if they would treat someone the same after discovering that they had an
eating disorder, 66% said they would treat them exactly the same and only 3% said they would
treat them very differently.

Finally, 41% strongly believe that disordered eating should be discussed more in school
and 29% want to learn more about preventing and recovering from an eating disorder. 27% and
27% want it to be discussed more in school and to learn more about preventing and recovering
from an ED, respectively, and only 11% and 17% strongly believe that it should not be taught in
school and do not want to learn more about it.

Discussion
After the first survey, it became clear that the majority of students knew little to nothing
about disordered eating. While some students knew a bit and the majority attempted to
answer the questions, very few students were confident in their knowledge of definitions, facts,
misperceptions, helping others, or helping themselves. Even though there was no comparison
of the before and after for the grade 7 students, it can be assumed that the results would have
been similar. Even during discussions and lessons with the students, it was clear that their
Personal Inquiry Project Fed Up With Eds Kit Zachery

understanding of EDs were increasing and they developed more confidence in asking and
answering questions, contributing to the conversation, and considering all of the risk factors,
signs, and symptoms.

By comparing the second survey to the first, it was obvious that the grade 9 students’
confidence grew dramatically and their knowledge of the topics also increased significantly.
Between the two, students’ confidence in knowledge regarding anorexia, bulimia, and
binge-eating disorder grew substantially. See the comparisons below.

2 3
Scale 1 4 5
A little Somewhat
ED Not confident Fairy confident Very confident
confident confident

Before: 33.3% Before: 41.7% Before: 20.8% Before: 4.2% Before: 0%

Anorexia After: 0% After: 6.9% After: 27.6% After: 58.6% After: 6.9%
-33.3% -34.8% +6.8% +56.4% +6.9%

Before: 70.8% Before: 29.2% Before: 0% Before: 0% Before: 0%

Bulimia After: 3.4% After: 10.3% After: 27.6% After: 48.3% After: 10.3%
-67.4% -18.9% +27.6% +48.3% +10.3%

Before: 20.8% Before: 37.5% Before: 37.5% Before: 4.2% Before: 0%

Binge-Eating After: 0% After: 0% After: 27.6% After: 62.1% After: 10.3%
-20.8% -37.5% -9.9% +57.9% +10.3%

When it came to the true/false questions, there was also an impressive improvement
between the surveys. After the first survey, an average of 13.26% of the grade 9 students
answered “I do not know” for the questions. For the second survey, an average of 3.37% of the
students answered “I do not know”, which was a decline of 9.89%. Thus, students
demonstrated that they were more confident in their knowledge of eating disorders and their
signs and symptoms. For detailed results on each specific section, please refer to the table
below.

Answer
True False I Don’t Know
Question

People with TYPICAL

anorexia nervosa can Before: 16.7% Before: 20.8% Before: 62.5%
have an average or After: 34.5% After: 58.6% After: 6.9%
above-average BMI.

People with ATYPICAL

Before: 8.3% Before: 8.3% Before: 83.3%
anorexia nervosa can
After: 62.1% After: 20.7% After: 17.2%
have an average or
Personal Inquiry Project Fed Up With Eds Kit Zachery

above-average BMI.

People with bulimia

nervosa can have an Before: 12.5% Before: 0% Before: 87.5%
average or After: 62.1% After: 13.8% After: 24.1%
above-average BMI.

People with
binge-eating disorder Before: 25% Before: 4.2% Before: 70.8%
can have an average or After: 58.6% After: 10.3% After: 31%
above-average BMI.

People with bulimia

nervosa often have an Before: 8.3% Before: 4.2% Before: 87.5%
average or After: 44.8% After: 24.1% After: 31%
above-average BMI.

People with binge-eating Before: 12.5% Before: 16.7% Before: 70.8%

disorder often purge. After: 72.4% After: 17.2% After: 10.3%

People with bulimia Before: 25% Before: 0% Before: 75%

nervosa often purge. After: 62.1% After: 17.2% After: 20.7%

People with anorexia

Before: 58.3% Before: 4.2% Before: 37.5%
nervosa have an intense
After: 93.1% After: 3.4% After: 3.4%
fear of gaining weight.

People with an eating

Before: 12.5% Before: 58.3% Before: 29.2%
disorder think all people
After: 13.8% After: 82.8% After: 3.4%
should be skinny.

People with an eating

Before: 0% Before: 83.3% Before: 16.7%
disorder choose to have
After: 89.7% After: 6.9% After: 3.4%
an eating disorder.

People with an eating

disorder can be any Before: 87.5% Before: 0% Before: 12.5%
gender, race, age, size, After: 93.1% After: 3.4% After: 3.4%
weight, etc.

Going on a diet increases

Before: 16.7% Before: 25% Before: 58.3%
your risk of developing
After: 86.2% After: 6.9% After: 6.9%
an eating disorder.
Personal Inquiry Project Fed Up With Eds Kit Zachery

People between the ages

of 12 and 19 are most Before: 62.5% Before: 4.2% Before: 33.3%
at-risk of developing an After: 69% After: 20.7% After: 10.3%
eating disorder.

Women are more likely

Before: 33.3% Before: 16.7% Before: 50%
to develop an eating
After: 62.1% After: 31% After: 6.9%
disorder than men.

Many people who

Before: 16.7% Before: 12.5% Before: 70.8%
recover from an eating
After: 72.4% After: 10.3% After: 17.2%
disorder will relapse.

Anorexia nervosa is one

Before: 12.5% Before: 8.3% Before: 79.2%
of the most deadly
After: 82.8% After: 10.3% After: 6.9%
mental illnesses.

Eating disorders can Before: 29.2% Before: 8.3% Before: 62.5%

result in hair loss. After: 93.1% After: 3.4% After: 3.4%

Eating disorders can Before: 54.2% Before: 12.5% Before: 33.3%

result in weight gain. After: 86.2% After: 6.9% After: 6.9%

Eating disorders can Before: 70.8% Before: 0% Before: 29.2%

result in death. After: 93.1% After: 0% After: 6.9%

As for thoughts and feelings toward disordered eating and those with disordered eating,
there was not as much of a change. As the majority of students already felt comfortable being
friends with those with an ED, said they would not treat someone with an ED differently,
believed information about EDs should be taught in school, and wanted to learn more about
preventing and recovering from disordered eating, it enforced the idea that students find this
information valuable and want to learn more. If there had been a big change, that would have
meant that the five lessons had a negative impact on their thoughts and feelings regarding
disordered eating, and that they did not find the information valuable and did not want to learn
more. For detailed results on each specific section, please refer to the table below.

Summary
Despite this being a very brief unit, students communicated that they found the
information valuable and still wanted to learn more. Many showed improvement in their
knowledge about disordered eating, and this improvement is definitely capable of preventing
disordered eating, reducing the impact of disordered eating, helping people recover, and
educating people on how to help others seek treatment and recover.
Personal Inquiry Project Fed Up With Eds Kit Zachery

While this project itself is not capable of determining if it is actually doing all of these
things, my hypothesis is that it will, at the very least, have an impact. If students know what to
look for, how to help, and how to identify maladaptive beliefs and behaviours, they can change
their life and the lives of others. Furthermore, by knowing about the serious consequences of
disordered eating, students will better understand the impact of eating disorders. Hopefully,
this will result in students making healthier choices and finding ways to improve their body
image and eating habits.

Over all, students in both grade 7 and 9 showed a significant improvement in their
knowledge of disordered eating and body image, and also how to help others and themselves.
The majority of students communicated that this information is valuable and engaging, and
they believe it should be taught in our education system.
Personal Inquiry Project Fed Up With Eds Kit Zachery

References
Bell, M., Rodgers, R.F., & Paxton, S.J. (2017). Toward successful evidence-based universal eating
disorders prevention: The importance of zooming out. ​Eating Behaviors, 25(​ 1), 89-92).
https://doi.org/10.1016/j.eatbeh.2016.10.012

Biederman, J., Ball, S.W., Monuteaux, M.C., Surman, C.B., Johnson, J.L., & Zeitlin, S. (2007). Are
girls with ADHD at risk of eating disorders? Results from a controlled, five-year prospective
study. ​Journal of Developmental and Behavioral Pediatrics, 28(​ 4), 302-307.

Cena, H., Stanford, F.C., Ochner, L., Fonte, M.D., Biino, G., De Giuseppe, R., Taveras, E. & Misra,
M. (2017) Association of a history of childhood-onset obesity and dieting with eating disorders.
Eating Disorders, 25(​ 3), 216-229. ​https://doi.org/10.1080/10640266.2017.1279905

Goeree, M.S., Ham, J.C., & Iorio, D. (2011). Race, social class, and bulimia nervosa. ​The Institute
for the Study of Labor​, 1-33.

Gordon, K.H., Perez, M., & Joiner, T.E., Jr. (2001). The impact of racial stereotypes on eating
disorder recognition. ​Wiley Periodicals, Inc​, 219-224. DOI: 10.1002/eat.10070

National Eating Disorders Association (n.d.). ​Identity & eating disorders.

https://www.nationaleatingdisorders.org/identity-eating-disorders

National Eating Disorders Association (n.d.). ​Statistics & research on eating disorders.
https://www.nationaleatingdisorders.org/statistics-research-eating-disorders

National Eating Disorders Association (n.d.). ​Warning signs and symptoms.​

https://www.nationaleatingdisorders.org/warning-signs-and-symptoms

Rhodes, L., & Orlowski, J. 2020. ​The Social Dilemma [​ Motion picture]. The United States of
America: Netflix.