On this episode of 51%, we discuss eating disorders: what they look like, why they develop, and how they're treated. We also speak with advocates with the Strategic Training Initiative for the Prevention of Eating Disorders, or STRIPED, who are working to restrict the sale of over-the-counter diet pills to minors.

Guests: S. Bryn Austin, STRIPED director; Joanne Chung; and Dr. Julie Morrison, owner and director of HPA/Livewell in Albany, New York

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While 51% typically focuses on women’s stories, the subject of today’s episode is not necessarily unique to the female experience. We’re talking about eating disorders, which can affect people of all genders, ages, and races. In fact, they’re a lot more common than you might think, and as with other mental illnesses, cases have surged during the coronavirus pandemic.

S. Bryn Austin is an award-winning researcher and professor at the Harvard T.H. Chan School of Public Health, Harvard Medical School, and Boston Children’s Hospital.

"Eating disorders are common, they are deadly, and they are expensive," says Austin. "Eating disorders will affect nearly 30 million Americans in their lifetime, or close to 9 percent of the U.S. population. And eating disorders are among the deadliest of any mental condition, with over 10,000 Americans needlessly dying each year — that equates to one death every 52 minutes. Think about that: every 52 minutes, somebody’s sister or brother, parent, or child dies from this preventable and treatable condition.”

So what are these preventable and treatable conditions? Well, when we talk about eating disorders, we usually talk about the big three: anorexia nervosa, bulimia nervosa, and binge eating disorder. A person with anorexia nervosa will restrict their food intake, purge, over-exercise, and otherwise do what they can to achieve or maintain a dangerously low body weight. A person with bulimia nervosa gets there by eating large amounts of food, followed by bouts of self-induced vomiting. Binge eating, meanwhile, sometimes results in weight gain, as a person seemingly “loses control” and eats an exorbitant amount of food in short bursts of time.

The National Eating Disorder Association says binge eating is the most common eating disorder in the U.S. — but overall, it details 11 different conditions on its website, with the vague “unspecified feeding or eating disorder” among them. Austin says the range of ways in which we fall out with our bodies is wide.

"Eating disorders can be related to many kinds of factors. There’s widespread pressure to lose weight, to maintain a lower weight. And it’s not just what’s considered beautiful — there is frank discrimination that’s happening all across the country related to weight," she adds. "It’s legal, in most parts of the U.S., to not hire somebody, to fire someone — they can even be fired and told it’s happening because of their weight, and in most places people don’t have any recourse. We know it happens in schools: there’s evidence that teachers are rating students at higher weights with lower subjective scores. They’ll rate them lower on academic performance, completely unrelated to their academic performance, and instead related to these biases around weight.

These biases set people up, especially young people, to feel like they need to do anything they can to keep weight off. And that sets up a really dangerous cycle, for many people, of weight loss and weight regain.”

Austin says there are many ways that American society is not equipped to prevent or tackle eating disorders — and it’s a costly situation, as eating disorders cost the U.S. more than 10,000 lives and roughly $65 billion a year. So in 2009, she started the Strategic Training Initiative for the Prevention of Eating Disorders, or STRIPED, to build a network of trained professionals around the issue. Their latest focus has been a trio of bills in the California, Massachusetts, and New York state legisl