Stuff You Should Know - How Anorexia and Bulimia Work

Episode Date: December 12, 2019

Anorexia and bulimia - those twin eating disorders that seem so common and maybe even just a phase for a teenage girl – are actually the deadliest mental illnesses in America. Cultivating an eating disorder can create issues that can last a lifetime. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

Hey friends, when you're staying at an Airbnb, you might be like me wondering, could my place be an Airbnb? And if it could, what could it earn? So I was pretty surprised to hear about Lisa in Manitoba, who got the idea to Airbnb the Backyard Guest House over childhood home. Now the extra income helps pay her mortgage. So yeah, you might not realize it, but you might have an Airbnb too. Find out what your place could be earning at Airbnb.ca slash host. On the podcast, HeyDude the 90s called, David Lasher and Christine Taylor, stars of the cult classic show, HeyDude, bring you back to the days of slip dresses and choker necklaces. We're going to use HeyDude as our jumping off point, but we are going to unpack and

dive back into the decade of the 90s. We lived it, and now we're calling on all of our friends to come back and relive it. Listen to HeyDude the 90s called on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Welcome to Step You Should Know, a production of iHeart Radio's How Stuff Works. Hey, and welcome to the podcast. I'm Josh Clark, and there's Charles W. Chuck Bryant, and there's Jerry over there. And it's just nice and pleasant, isn't it? Chuck and Jerry. I mean, it smells in here. Is that what your referencing? Yeah, a gamey, I think. Yeah. How about this? We won't say who was in here. Okay. Just before us, but it was three men from our office, and the room smells a little

gamey, a little musky. It's hilarious. And it's warm, and Jerry's headphones are hot, and her chair's hot, and she's so creeped out. Yeah, she's getting a little sweaty. Yeah. That's the last joke I'm going to tell for this episode, by the way. You know, every time we say that, we end up like making jokes. So yeah, let's say it. Yes, this is going to be a very serious episode, and there will be no jokes whatsoever. All right, hopefully we can work in a funny or two that is clearly not at anyone's expense. Yeah, yeah. I mean, it's got to be organic. It's got to be good. Right. It's got to be worth it, I guess, is what I'm trying to say. And about each other. All right. So we're talking today, Chuck, about

anorexia and bulimia, known in the slang as Anna and Mia. Did you know that? I did not know that. Yeah. And they are actually very closely related eating disorders, so much so that if you went to the big book of eating disorders, the DSM-5, and you said, DSM-5, tell me, what is the difference between Anna and Mia? The DSM-5 would just kind of shrugged me like, I don't know, man. We're not 100% sure. There are some big differences, but they are clearly connected to some underlying degree. Yeah. I mean, they define anorexia as restrictive, restrictive as in really restrictive, severely limited intake of food. And binging and purging, which is if you don't know what that term is, that means eating and then vomiting

afterward or using laxatives to get that poop going really quickly. Sure. That is also under anorexia in the DSM-5, but that's also binging and purging obviously characteristic of bulimia, which has its own categorization. So it's a little, I guess, confusing is the best way to say it. Right, right. So I looked into it a little more, and it looks like anorexia, like you were saying is the hallmark of it is calorie restriction, but apparently some people who suffer from anorexia every once in a while will binge and purge. So it can't include that. Okay. Yes, but bulimia doesn't necessarily involve any sort of even like weight component. It doesn't include any kind of calorie restriction. It is strictly binging

and purging. That's right. So you've got these two different things, but they're both related in that your relationship with food is just not healthy in any way, shape, or form. And the other thing that really kind of ties the two things together is that they're based on a disturbed body image where you look in the mirror and what you see doesn't reflect reality at all. You might see yourself as maybe normal if it's on a good day. You probably more often than not see yourself as overweight, fat, gross, disgusting, any number of horrible things you could say about yourself where if someone else is looking at you, they would be like, wow, this person really needs to eat fast because they're emaciated, their skin

and bones, but the anorexia patient or bulimia patient does not see that at all. And so that kind of continues the cycle of either calorie restriction or binging and purging, but they're both after the same goal essentially. Right. And included, and we're going to talk a lot about the symptoms and behaviors of people that suffer from both of these, but a lot of scale work weighing yourself a lot. Sometimes, you know, multiple times during a day, obsessing over like, you know, half pounds, I saw like where digital scales are really sort of a culprit. Yeah. And, you know, obsessing over like a tenth of a pound and eighth of a pound being really upset over the gaining of any weight, even if it's just a half a pound,

let's say. And like you said, the language around food and body and self-image is really important because this can often be one of the early indicators or just an indicator for friends and family if you listen to how people talk because a lot, you know, most of the stuff is done behind closed doors and one of the big components, one of the sad components is staying in a lot and not eating out with people and keeping all that very private. So the words are really, really important here. Yeah. Because I mean, if you have anorexia and you're engaging in like severe calorie restriction, you know, that doesn't just stop when you go out with friends. Right. It is a part of you. I've seen it described akin

to a relationship, like a very intense obsessive relationship where the patient and this disorder are super tight. It's like their life. Right. So if you're out and you're hanging out with friends and trying to appear normal, there's all sorts of stuff you have to do to make it look like you've eaten, hiding food, offering other people food, trying to make a big deal about, you know, what you did eat, like really showing everybody, look, I ate this, just engaging in kind of some obvious and bizarre behavior. And that's exhausting. So it's kind of like what you said that ultimately results in the person just withdrawing from social activities because it's not worth like keeping up appearances. Yeah. And as far as bulimia

goes, you know, intentionally vomiting after a meal, one of the hallmarks is excusing yourself very quickly after a meal. And that's if you are over the social component, you are actually eating out with friends or family. And then those laxatives taking, you know, unhealthy doses of laxatives, laxatives to induce diarrhea as quickly as possible. And some other stuff, you know, trying to sweat off additional weight, you know, wearing like a plastic suit and sitting in a sauna like really extreme measures or just excessive exercise to try and get rid of the extra weight. Right. So, so what you have then is somebody who is convinced that they're overweight, first of all, even when they're not. And secondly is obsessed

with the idea of getting rid of that additional weight. And they do it by engaging in unhealthy behaviors with food and depending on how they do it, you've got anorexia or you have bulimia. And there's some symptoms, some of which we kind of just went over, but some are kind of obvious. Some are red flags, you know, like if somebody starts to become very thin to where you can see their bones, that's a big sign that they have anorexia. But they, you know, you can have anorexia and not ever necessarily become emaciated. I think the diagnosis as far as the American Psychological Association is concerned is if you, if a patient comes to you and they weigh 15% less than their normal weight for their height and age,

you would be able to diagnose them with anorexia. At the very least, you should start asking them questions about whether or not they have anorexia. Yeah. And bulimia is very complex too, because there's not one pattern. It's not always just binge and purge every day, although it can mean that. Sometimes if you suffer from bulimia, you will eat, you won't binge, you'll just eat normal meals and then purge those. Sometimes you will restrict eating just sort of as a rule, but then occasionally you will binge and then purge, like eat, you know, a huge, enormous meal, which, you know, binge eating is a whole different eating disorder that, you know, all of these are sort of related

and have some overlap. But I think for this, this show, we're just going to kind of concentrate on anorexia and bulimia, right? Right. Yeah. Yeah. Yeah, binge eating disorder, I think it deserves its own thing, because it's so prevalent and so many people have it and don't even realize it, which I suspect has to do with the food supply. I think we've been inadvertently addicted to food. Have you, I told you about that book, The Dorito Effect, right? Yeah, yeah.

Well, like in the premise of it is that like to feed this many people, we've had to basically create franken foods and to make them taste good, we've had to use these different additives and artificial flavors and colors and all this stuff. And the kind of idea behind it is that in doing this, we've accidentally created these things that are super addictive and people have become addicted to food. It's just a very common thing, whether it was intentional or unintentional. At this point, it doesn't really matter. People are just addicted to terrible food that's really bad for them. Yeah. So as far as the symptoms go, you know, we talked about some of them, you know, the

obvious ones that you could as a friend or family member maybe notice as far as the exercise, not eating in public and stuff like that, the preoccupation with weight. But physically, you know, you can lead to things like brittle hair, difficulty thinking, fainting and passing out. And that's, you know, stuff that people might notice in public. Something that they may not see on the inside is anemia, chronic fatigue, constipation, slowed pulse. And then I hadn't heard of this, the growth of fine hair on the body, that lanugo that in newborn babies is one of the most adorable little things, this little furry fuzz on a baby. Yeah. Supposedly there's some waxy substance that covers the baby in the womb and prevents

them from getting chapped and chafed by the amniotic fluid. And that lanugo hair kind of grows in like this, this kind of downy fine fur that lets that waxy substance stick to the skin. And again, if you become malnourished, it triggers lanugo to grow like later on in life. That's a big sign. Another one is amenorrhea, which is the absence of menstruation in menstrual periods, right? And that used to be like, even I knew that as like a sixth grade boy or something back in the 80s, like that was like a huge thing. If a girl didn't have a period of menstruation, she had anorexia. And apparently the DSM-5, the latest version said, no, we're going to take that up because it's not the case with everybody. Like, yes,

it definitely can lead to that. And if you have amenorrhea, there's a possibility it's from anorexia, but if you have anorexia, it doesn't mean you're going to stop having your period. Yeah, absolutely. And you know, I wonder how many like 14 year old girls listening to this, we just lost because I said period twice. Hopefully hang in there. Hang in there, everybody. Exactly who should be listening to the show. Yes. And if we're talking about girls and women more, and we'll get to the stats, they suffer from anorexia and bulimia more than men do. But that is not to say that men don't suffer from it and they absolutely do. I mean, I might as well go over a few of these, have some other statistics

I found. Okay. At least 30 million people of all ages and gender suffer from eating disorder in the United States. And that's all eating disorders. Every 62 minutes, at least one person dies as a direct result from an eating disorder. Wow. The few of these are just so sad. Eating disorders have the highest mortality rate of any mental illness period. I saw that too. 13% of women over the age of 50, 13% engage in eating disorder behaviors. I saw that 3.5% can have a diagnosable eating disorder. 3.5 over the age of 50 or 40? Over 40, yeah. And that midlife eating disorder thing is like a big and growing problem right now. Yeah. I mean, we'll, you know, we talk about adolescents a lot in here, but it's not something

restricted to young people. This one is super sad as well. 16% of transgender college students have reported an eating disorder. Boy, these are so sad to read out loud. 50 to 80% of the risk for either one is genetic. And we'll talk about the genetics of it a little later too. And then more than half of bulimia patients have comorbid anxiety disorders. Yeah, I saw that too. It was like, I saw something like 50% of people with anorexia have, I think anxiety and like 95% or something of people with bulimia have anxiety disorder. Yeah. Anxiety disorders, mood disorders, substance abuse disorders. It says usually alcohol. It's one in 10 bulimia patients. So it's just, you know, these are the worst kind of statistics

to read off, but it's important to know that it's across the gender spectrum, across the age spectrum. If you think that it's just something teenage girls go through, that's just not the case. Yeah. And not just teenage girls for a long time. It was a teenage white girl problem. And they're starting to realize like, no, this is, it was like you were saying, like it spans ethnicities, genders, nationalities, ages. It's a much bigger problem than we used to think. And I don't know if it's become a bigger problem or if just under awareness and understanding of it has grown or something like that. But did you mention suicide? I don't think I did. So you were saying that this is, and this is one of the reasons we're

talking about this. Anorexia and bulimia are one of the, maybe the deadliest mental disorder there is as far as statistics go, like you were saying. And one of the big reasons is because so many people with anorexia or bulimia die by suicide, something like 200 times at a 200 times greater rate than the general population. Yeah. It says here one in five of anorexia deaths is by suicide. And then if it's not by suicide, there's a host of other ways that you can die from anorexia. You can simply starve to death where your, your heart can stop, your organs can shut down. And it's from this lack of energy that you're putting into your body, your, your body's organs start to kind of slow down,

to metabolize more slowly to kind of conserve what little energy they do have. And eventually it just doesn't work any longer. Your body stops basically and you can die just from not eating, not because there wasn't any food. There was plenty of food and everyone who was around you wanted you to eat. You just wouldn't do it because you felt fat. Yeah. And I don't even think it's a lot of times a matter of if, I mean, if you don't get treated and you don't get help and it gets bad enough, then you will die from organ failure at some point. Yes. But we have to say we don't want to get all like horribly grim because there are studies

that are coming out now that are saying actually we've been studying these people for like 25 years and we're finding that over the long haul you can cure anorexia for good. It just takes a while. And it also from what I've seen takes a patient who wants to be cured. Right. Absolutely. And then one more thing here if we do need to talk about puberty and adolescence because it can have really long lasting effects if that's the time of your life where this is happening. Long term effects on your development, on your growth. If you, I think it says if you have anorexia, beginning at age 10, all the way through your 20s,

you can have permanent stunted growth. You can have reduced secondary sexual characteristics like your pubic hair won't grow in, your breasts won't develop, and maybe a lack of administration from the beginning, not like the cessation administration, like you may never get your period. Right. And you may be infertile as a matter of fact as an adult. That's right. It's just because of the age that it sets on, I guess. It's such an important time for the development of your body. It's like the last time you should be like, I'm just not

going to eat for a couple of days. Yeah. It has some real sweeping effects for sure. Yeah. And bulimia too for its part is really rough on the teeth. Yellowing, decaying teeth, sensitive teeth, swollen sore throat, acid reflux, like all the time, and then electrolyte imbalances being in the bathroom a lot because you're tricking your body essentially into thinking it's getting some nutrition and then getting rid of that food really quickly and that nutrition really quickly.

Right. And that can lead to fainting, fatigue, and eventually heart attacks and strokes. Yeah. Serious stuff. Yeah, it is extraordinarily serious stuff. And a lot of people are like, well, this is how my daughter or my sister or my friend likes to look. She likes to be skinny. And this is a really persistent problem with dealing with anorexia is that I've seen it multiple places. It's not a lifestyle. It's a mental health disorder.

Yes. And it has to be treated because again, it is statistically speaking the deadliest mental health disorder there is. Should we take a break? Yes. We're going to take a break and we're going to come back with a whole list of jokes. That's right. Hey, friends. When you're staying at an Airbnb, you might be like me wondering, could my place be an Airbnb? And if it could, what could it earn? So I was pretty surprised to hear

about Lisa in Manitoba, who got the idea to Airbnb the Backyard Guest House over childhood home. Now the extra income helps pay her mortgage. So yeah, you might not realize it, but you might have an Airbnb too. Find out what your place could be earning at Airbnb.ca slash host. On the podcast, Hey Dude, the 90s called David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're going to use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it and now we're calling on all of our friends to come back and relive it.

It's a podcast packed with interviews, co-stars, friends, and non-stop references to the best decade ever. Do you remember going to Blockbuster? Do you remember Nintendo 64? Do you remember getting frosted tips? Was that a cereal? No, it was hair. Do you remember AOL Instant Messenger and the dial-up sound like poltergeist?

You'll leave a code on your best friend's beeper because you'll want to be there when the nostalgia starts flowing. Each episode will rival the feeling of taking out the cartridge from your Game Boy, blowing on it and popping it back in as we take you back to the 90s. Listen to Hey Dude, the 90s called on the iHeart Radio app, Apple Podcasts, or wherever you get your podcasts. Okay Chuck, lay the first joke on us. All right, I have no jokes.

Although I will say, I think it's time for a great sidebar. We got one of those home, I'm not going to buzzmark anyone, but one of those home units that you speak to, and it tells you the weather and stuff. Like one of those robots? Yeah, like a little robot you put on your desk. Robot Butler? I've been testing it out with my daughter lately, and those robots that talk to you can tell jokes.

Did you know that? Yes, I did. And some of them are kind of funny, and they're all kind of great for four-year-olds. Well, what you got? Oh, I mean, some Thanksgiving jokes around this time, and I think they try to be topical jokes. Sure. So there's like Christmas and Thanksgiving jokes going on right now.

But you're not going to tell us one of the jokes. No, I'm trying to remember some of them. I mean, trust me, they're not great jokes for adults, but four-year-olds eat it up. They're probably like deeply copyrighted too. Maybe. I don't know if you can copyright these kind of dumb jokes. A Thanksgiving joke, you kidding me? It's like what our country has founded on.

All right. We're writing Thanksgiving jokes. That's been going on at our house is a lot of joke-telling, and they can make burp noises and toot noises, and I'm trying to test the limits of how blue they can go. Remember that little handheld box we had that would make different like fart sounds and honking sounds? Sure. So basically, this is what this is, is a high-tech robot butler that makes fart sounds.

Yeah, it's great. Is it on wheels? No, it's not on wheels. It's on your nightstand or wherever you want it. I got you. All right, enough fun and games. Yeah, we should talk a little bit about the causes of anorexia because this is one of the more confounding, well, I mean, a lot of mental health disorders are confounding

in this way actually, but we don't know the cause of it. It is probably a lot of causes. Some of them may conflict with one another, but it is probably a very complex bag and mix of societal pressures, which we're going to talk about, your environment, and then genetics look like they do play a part. Yeah, they think that it's a... This is what they call a grab bag catch-all, that there is a biopsychosocial mechanism underlying anorexia and bulimia.

That's biological, psychological, and social. And they're probably right. I mean, there's probably components of all of them put together, which would explain why it's so hard to understand at this point. And so hard to treat. It's very tough because it's not like you can point to one thing and say, correct this part of your life and... Do it.

Yeah, and it'll be better. There's so many prongs, it's really, really tough. Yeah, absolutely. Because let me think about it. If you have a person who has anorexia and they want to get better, but the reason that they developed anorexia in the first place is because they have a parent who's on them about their weight all the time, you have to correct the parent's behavior in addition to possibly treating the patient in the hospital for malnourishment.

It is a big, complex ball of stuff, but there are studies that have turned up little bits here and there like, oh, here's a little, I don't know, like a matchbox car or something and a pile of rocks. I'm not sure what that means. What's something you want? Like a diamond in the rough, basically. Okay. Haven't you ever found a matchbox car and a pile of rocks?

I was really glad that I found this. I thought it was just some dumb, boring pile of rocks. I had no idea where you were going there. Well... But I'm glad we got a laugh out of this. I was being serious. Oh, sorry. Are you talking about the study, the twin study?

I'm talking about all the studies. Okay. They did do a twin study and they found, as in studying human twins, not two different studies that look alike, but they found that if, and this is sort of helps back up evidence of a genetic component, but if one twin has anorexia, then their identical twin, not fraternal, was 29 to 50% more likely to also have that same disorder. Right. And not, like you said, among fraternal twins because I mean, you'd think like, you know,

you see identical twins and think like, what did your mother do to you to how could this be allowed to go on? But if that's not the case with fraternal twins, then that removes that environmental component and strongly suggests that it's a genetic component. Yeah. And maybe to some degree, a social component, I mean, not all the time, but I would imagine fraternal twins are generally subjected to this or it's similar social components. Yes.

The only thing that would confound that is fraternal twins can also be like boy and girl. Oh, sure. So, I mean, if they tossed out the boy and girl and just had like fraternal twin girls or fraternal twin boys in the study, I would say that would strongly suggest it's a genetic component. But I mean, in any home, a boy and a girl are going to be treated or a son and a daughter is going to be treated differently.

It's just the way it is. True. Unless you live in a skinner box. Oh, gosh. That should lighten the mood. Right. Unless your dad shocks you for studies at home. They did not have not found a gene they can pinpoint.

They have found 30, I'm sorry, 43 genes that could potentially be of use when it comes to linking genetics to these disorders, but they haven't, it's nothing is very clear cut at this point. Right. That's about as far as they've gotten on the biological component. As far as the psychological component, like you were saying, they found there's a lot of co-morbidity with other behavior disorders and personality disorders like depression, anxiety disorder, obsessive compulsive disorder.

They bear a lot of resemblance to one another in that like with anorexia or bulimia, something called ritualized food behaviors develop where you cut food into small pieces first to make it seem like there's more or make it seem like you are eating more than you actually are. Right. But what makes it ritualized is you couldn't eat food any other way. Right. Or you have to arrange food a certain way on the plate before you eat it.

Or even like religiously counting and tracking calories is considered a ritualized food behavior. It really kind of traipses into the realm of something like obsessive compulsive disorder or experiencing anxiety if you're forced to eat food on a plate that's not arranged in the way that you're used to. So the idea is that you eat one English P at a time, you are taking a lot of bites and therefore, hey, look, I'm eating a lot. Yeah. So it's kind of more deceptive behavior and that would probably be like a twofer or something.

I mean, self-deceptive even, you know? Sure, sure. But also deceptive to like your parents who might be watching you like a hawk or something, you're like, no, no. I see that fork moving a lot. Yeah. Exactly. It's really interesting.

But if you couldn't eat peas any other way but that, then that would be a ritualized food behavior. Right. This statistic, as far as meeting criteria for at least one other mental health disorder, it's 56% of anorexia patients and 95% for bulimia. Yeah. That is really high. Yeah.

And that's what makes it weird that the two are so overlapped because so you've got anorexia nervosa and bulimia nervosa. And again, they each have their own separate entries in the DSM. But then there's kind of a binge-impurged bulimia component to anorexia. But the personality disorders that, or even the types of personalities that engage in each one are really, really different. Like with anorexia nervosa, the patients are usually low novelty seeking. So they're not like trying out new things.

They have a low emotional responsiveness, decreased pleasure, and reduced social spontaneity. That's typical of someone with anorexia nervosa. With bulimia nervosa, it's like kind of the opposite. They tend to be impulsive. They look for new experiences, and they can have characteristics of a borderline personality disorder from what I've read. So they're like two totally different types of people, but engaged in the same behavior. And it's one of those things where it's like, okay, if you have two different types of people

who are trying to do the same thing or trying to achieve the same end, what commonalities do they have? In exploring those commonalities, maybe we'll find the answers to what causes eating disorders like this. Yeah. It's interesting. I've had a bit of sense when you look at the, you know, like someone suffering from anorexia would avoid going out to eat spontaneously with friends, let's say, at all costs.

Someone with bulimia might jump right in there because in their mind, they may think that they have a solve for that behavior, which is, I'll excuse myself to the bathroom right afterward, and I can still go out with my friends and eat a regular sized meal. I think it's a really good point. So either way that regardless of how that person is personality wise, they're going to engage in trying to maintain their weight. But depending on their type of personality, they're going to choose this route or that route.

Yeah. Yeah. I think you're on to something, Dr. Schuck. Well, the other thing too is with these personality traits, they found correlation with things like perfectionism, irritability, and like you were talking about this sometimes being impulsive or sometimes the opposite, but what they found too is, you know, if you're studying adolescence and puberty, a lot of these are normal traits of adolescence. So it's really hard to distinguish sometimes.

And a lot of times these things, it's a chicken or the egg. These are caused by the eating disorder and not the other way around. Yeah. That also applies to differences in brain structure too. Yeah. Like they found things like reduction in the gray matter and the white matter in the brain of people with one of their nervoses, or they have more cerebral spinal fluid, and then other regions of the brain are smaller compared to people who don't have these disorders.

But they clear up when the anorexia is successfully treated. So it's kind of, it really makes you wonder like where, you know, did it cause it or like it doesn't prove or disprove it either way. It's just the two are related and we're not sure which causes which. Yeah, I thought this FMRI stuff was interesting because, you know, our motto, when in doubt, go into the wonder machine and see what's lighting up. Be very instructive. And they did.

It's the longest motto ever. It is. Trademark. You can fit on the front and back of a t-shirt, but not a hat or a coffee mug. It just kind of peters out down the bottom. That's right. And then the script to just, you know, like a pen, like you fall asleep while writing something.

Right. Yeah. And then my wonder machine has found that it lights up those reward centers in the brain show increased activity. If you have anorexia and you're shown photos of someone who is drastically underweight. So that's a pretty obvious, you know, sign right there. Another one is noticing fine details. When you are shown a picture of your own face that reward response is just lighting up the

reward center. So that means that they are hyper aware of their appearance at all times. Yep. For sure. And like they notice things that might not even be there. Right. And then finally you get to the social part of the biopsychosocial components. That's the environmental factors.

And one of the big ones that has kind of emerged is the idea of sexual abuse in creating anorexia and nervosa kick starting it in people. I saw that, I think Johns Hopkins said sexual abuse has been reported in 20 to 50% of individuals with anorexia nervosa and bulimia nervosa, right? And it doesn't necessarily have to just be sexual abuse, but there is a consistent reporting of some sort of trigger like the people who have bulimia and anorexia typically can point to the moment that it started or the thing that created this idea in their mind. It could be a parent being overly critical of their weight.

It oftentimes is a parent, I think. Yeah. It could be a coach who is overly critical of their weight. It can be a bully teasing them about their weight. It could be a friend making a joke about their weight. It just depends on the moment. You know how like how something can bother you, but it doesn't seem to bother anybody else and vice versa, you know, something that bothers someone else, you're like, that's

not that big of a deal. But it's all just based on the person and the context and the setting and maybe even just that perfect combination of neurotransmitters that happen to be active in their brain right then and just something got them just right. That has been found to kickstart anorexia and bulimia under a lot of circumstances. Yeah. It's just for parents, it's so important how they talk about and not just to their kids, but anytime your kid can hear you speaking words, how you talk about weight and how you

talk about your own body and how you talk about health and you know, having a kid now it's just, it's made me realize how unkind I can be to my own self being overweight and you can't say those things in front of a four year old. You have to talk about health and you know, daddy's exercising because daddy wants to be healthier and stuff like that because you'd be surprised that, you know, these little ears, they hear it all and the last thing that you want is for anything that you say to be, to have an impact on your child in an unhealthy way about their body image. You know, it's just super, super important.

I think it's gotten much, much better than the old days when, you know, I know a lot of women who talk about, you know, whether or not they suffered from anorexia or not, it's struggling with their body image because most of the time mom talking about it growing up. Yeah. I'm sure dads play a part too, but I've heard a lot of anecdotal examples of women talking about in this, you know, in the 70s, mom talking about, you know, you can't eat this, you can't eat that because you won't get a boyfriend or this won't happen or that won't

happen. Right. And that's, yeah, I've seen that a lot of places too for researching this, but one of the other things I saw is like what you were saying where you were talking about yourself, you have to watch what you say around your daughter. When you say disparaging things about yourself, that's called fat talk. And it is like a pastime in the West, like getting together with friends or just having a conversation around the water cooler or something about how fat you are or how much

you ate and how much you need to lose weight. And that they found it can actually be a real driver for leading to eating disorders as well. Yeah. I mean, I make jokes all the time about that with you and everyone I know, but I don't use that word in my house. I have to stop myself from making jokes about myself. It's just, it's no good for anyone.

One question I have though is like, I was a pretty husky boy. You were robust? I was, very. Like I had the Pillsbury Doe Boy nickname and like, I mean, like I was the fat kid in class for sure. And it bothered me. It like really set the tone of my childhood in a lot of ways. Like I had a really great childhood and I loved it, but I also had like a real bummer

childhood in that sense too. But like what do you do when your kid is demonstrably overweight and needs to lose weight or else they're going to spend the rest of their life struggling with their weight, which is not fun at all? Well, like what do you do? How do you approach the little fragile ego of a kid and say, we need to get some weight off of you, you know, without leading them down this path to an eating disorder? That's got to be one of the trickiest things you would ever have to talk about with your

kid in that situation. Yeah. And also, especially now in a day where there is such a movement to be accepting of who you are no matter how, what size you are, it's just such a fine line to walk between good health and accepting who you are. Like I don't necessarily have a super poor self-image, but I want to be alive in 30 years for my daughter, you know? Right.

Sure. Like the vanity's kind of gone at this point. I'm 48 years old. But I want to be healthy, and those, you know, a healthy weight goes hand in hand with not having the stroke and the heart attack later on. Exactly. But I think a lot of people would say like, okay, yes, there is health to be gained from eating better or from exercising or doing both ideally.

But one of the problems that we have is this ideal where it's like, well, keep going until you have washboard abs and until you have like these amazing biceps and... Yeah, that's not me. So you just want to do nothing but walk around in a speedo or something like that. And the fact that like those are the models that we see on the billboards, that drives even that idea of health, healthiness to this kind of perverted, weird place that can kind of develop eating disorders as well. Yeah, that's not me.

I have no illusions about ever having a washboard stomach. I've given up on this. I don't want a washboard stomach. I want one just to see. Oh yeah? Just to see what it's like. And then I'd be like, all right, give me a donut. I like a little softness to a body.

It's nicer to hug on and lay around with. I don't want to... I do too. Emily doesn't want to put her head down on a washboard stomach. Right? She doesn't want to bounce a nickel off of those? No. So I want to see what it would look like on me and then that'd be fine.

That's it. I don't really have like any... It's not my ideal look or anything like that. I just want to see if I could ever do it. Yeah, I just need to get healthier and drop some weight and feel a little bit better day to day like moving around the world because it has an impact on that stuff too. That's the key is feeling better day to day, feeling good in your clothes, feeling to the point where you're not thinking about what you're eating or how much you're exercising

because you're getting enough. That's the key right there. That's the goal. Yeah. So let's talk about social pressure because that's kind of, we're right in the middle of it. Okay. Well, actually let's take a break.

Okay. Okay. I'm going to go do some crunches. All right. I'm going to hold your feet down. We're going to talk about social pressure right after this. Hey, everybody. When you're staying at an Airbnb, you might be like me wondering, could my place be an

Airbnb? And if it could, what could it earn? So I was pretty surprised to hear about Lauren and Nova Scotia who realized she could Airbnb her cozy backyard treehouse and the extra income helps cover her bills and pays for her travel. So yeah, you might not realize it, but you might have an Airbnb too. Find out what your place could be earning at Airbnb.ca.host. On the podcast, HeyDude, the 90s called David Lasher and Christine Taylor, stars of the cold classic show, HeyDude, bring you back to the days of slip dresses and choker necklaces.

We're going to use HeyDude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it, and now we're calling on all of our friends to come back and relive it. It's a podcast packed with interviews, co-stars, friends, and non-stop references to the best decade ever. Do you remember going to Blockbuster? Do you remember Nintendo 64? Do you remember getting Frosted Tips?

Was that a cereal? No, it was hair. Do you remember AOL Instant Messenger and the dial-up sound like poltergeist? You'll leave a code on your best friend's beeper, because you'll want to be there when the nostalgia starts flowing. Each episode will rival the feeling of taking out the cartridge from your Game Boy, blowing on it and popping it back in as we take you back to the 90s. Listen to HeyDude, the 90s called on the iHeart Radio app, Apple Podcasts, or wherever you

get your podcasts. So Chuck, those were pretty good crunches. Not bad. Not bad at all. I'm going to go with a B+. You know, I started seeing a trainer. Did you really? Yeah.

Well, that's pretty cool, man. I didn't know that. About a month then. It's like kind of cool and supportive or like drill instructor type, like Bernie Army. Well, she is former Army, funny enough, but she is cool and supportive and more than anything, it's just like I got to show up at her house three days a week and do it. And I can't, you know, I can't not do it. And that's, I am one person who will not do it if given any opportunity to not do it.

Yeah. It's so easy to just shirk on that kind of stuff and just, you know, there's always reasons to not go or not do it or whatever. If you have somebody there that like, you know, is motivating you, that definitely helps. Yeah. Nice. Good for you, man. Thanks, dude.

She's killing me. She's kicking my butt. Right. But it's what I need right now. So. Yeah. I could use one of those two admittedly. Throwing it out there.

I'll give you your number. Michelle, she's great. Thanks, man. So, social pressures, we're talking about, you know, this is from a Western point of view here in the United States, Canada, some places in Europe, although that can vary pretty greatly on how they look at their bodies there. Right. But definitely in the United States, our culture has demonstrably said loud and clear, thin

is in, you got to be skinny, whether it's TV or advertising or Instagram now or YouTube. It's starting to change a little bit more because there's another whole wave that I was talking about, about accepting yourself and being happy with whatever size you are. But that still can't counter the onslaught that has happened for decades and decades in this country. No, but it is gratifying to see it changing over time. Like you see like plus size models everywhere. For sure.

Like they don't, there's not like some big write up in people about how this daring company, clothing company used to plus size modeling where it's just become a normal thing. Yes. It's becoming normalized. So, I think that's a big, big component because a lot of people point to the mass media in the West as the main driver for eating disorders because they say, this is the ideal weight body mass index, body fat percentage. Go attain to this.

Do whatever you need to do to get here. And if you don't, you're an ugly face. Right. What I think is super interesting about this, because everyone knows that, it's like, yeah, sure, ads and models and Instagram, like that's stuff you should know, chump change. But what's really interesting is, I mean, we're not enlightening anyone as to, that's not breaking news. Oh, I got what you meant.

But what's really interesting to me is to look at, all right, if it is media, what about pre-television, like has this stuff increased or what about non-Western cultures, what about if someone were to move over here from another country where anorexia isn't very prevalent, how would they change? And it appears that that does have an impact. It does, but not like a night and day kind of thing like you'd expect. Like the studies aren't just backing one another up left and right to where, yes, it's the mass media.

And that doesn't necessarily mean it's not the mass media. It just means that they haven't figured out how to control for all these confounding factors that also come along with something like moving to the US as an immigrant and all the things that come along with it, in addition to being exposed to Western mass media, or what else changed over time? Well, we got richer, food got cheaper, junk food became more abundant. Maybe that has something to do with it and not just this growing of mass media and the middle to late 20th century.

So there's a lot of studies that do say, yes, there does seem to be a correlation. There's never been a smoking gun. It's like the same thing with violence in media or sex in media. The idea that the media just has no effect on us whatsoever is ridiculous to me, but I also suspect it doesn't have quite the pronounced effect on us that we like to think or just assume. Yeah. Like you said, there are just so many factors.

You can't control all of them, but there are a couple of interesting findings. This one study, they found a rate of eating disorders in places like Iran, Singapore and Japan increased among women who were exposed to Western culture either by being there for a little while or living there for a little while, even if it was just a vacation or through media. And another one found that women who were at least one generation removed from immigration into Canada thought about dieting more than women who were immigrants themselves. Yeah.

And dieting behavior is a very Western thing. And it's starting to spread elsewhere. There's countries like Egypt and Iran and Japan and China where they're starting to notice eating disorders that are considered non-Western cultures. But they're again, they're like, well, has the Western media kind of infiltrated those spaces more? Or is it people who've spent time in the West who are now coming back home and they've developed an eating disorder, what is it exactly?

But there's a really big point to this that I think is easily overlooked is if it is the Western media and it is something like saying, here's this ideal body image, get to it however you have to, a lot of people in the West engage in diets. And basically everybody in the West is exposed to that media and yet less than 5% of people in the United States will ever develop an eating disorder in their lifetime. Why isn't it more prevalent if it's just the media or just trying to diet? What is it that makes that extra step? And that I think is where that bio-psycho component comes in to the whole bio-psycho

social thing. I think it's just kind of like a triple whammy that gets some people just right who may be genetically predisposed, who may be psychologically predisposed and then the right combination of social factors all converge to make somebody develop anorexia or bulimia. Yeah. If you're an athlete, this is interesting because you can have medical complications as an athlete who has to drop weight, either some sports you have to have a lower weight like if you're a dancer or a jockey or a gymnast or something like that.

Other times like if you're a wrestler, you have to make a certain weight or a boxer, a weight class. And this is not the same thing. I mean, it can be unhealthy weight loss. It's not the same thing necessarily as anorexia, but it looks like that could be a trigger for anorexia after you stop your athletic career. Yeah. It's like that part in...

What was that Channing Tatum Steve Carell movie set in the 80s where he was the wrestler? Oh, yeah. The Fox, whatever. Yeah. Fox Hawk or Fox... Fox Sound, Fox Blood. Something like that. Uh-huh.

It's that part where he loses a match and he goes and just binges. And I think his brother comes up and makes him throw up because he's got to keep wrestling and he needs to make that weight class. So the idea that some people who engage in these sports internalize that idea and that behavior and can become anorexic or bulimic, that just makes utter and complete sense. Same with the army too, or not just the army, but the military where they have weigh-ins and fitness benchmarks. If you miss those, you're in big trouble.

So people will engage in this kind of eating disorder like behavior, but they don't necessarily develop an eating disorder, although some people go on to do just that. Yeah. It says there is one study that found enrolling in the military led to an increase in eating disorders. Yeah. It's interesting. And true stuff you should know fashion, we'll talk about history here at the end because

I think all the other stuff was probably more important than the history and who first named it. Yeah. But we like to cover our bases. And Anorexia Nervosa was named by Sir William Gull. He was Queen Victoria's doctor. And he published a paper and this was- Whoa, you're just walking right past like one of the most interesting facts of the podcast.

You like that fact? All right, go ahead. Yes. You're being so generous. Oh, thank you, sir. Yeah. Sir William Gull is one of the dudes who, all right, you think this is interesting? Fine.

He may or may not have been Jack the Ripper. Yes. This guy who coined the term Anorexia Nervosa was one of the first to describe it in a scientific paper is also one of the people that is liked for Jack the Ripper. Yeah. But again, so why did I even bother? Because you didn't enjoy it enough. You didn't relish it enough.

Okay, I got you. So Jack the Ripper published a paper in 1873 and this is after treating young women who, by all appearances, had Anorexia. What we now know is Anorexia. Right. And you could tell he was Jack the Ripper because the paper started Dear Boss. That's the first line. How long have you been sitting on that one?

That just came up right now. Really? Yeah. Why does it say Dear Boss on your paper? So he had drawings in there, eventually he had photos in there of before and after treatments and just like us today, he was uncertain about the nature of the disorder to begin with. What we do know historically is the 1970s here in America is where it really kind of became a big thing and thanks to a couple of things, in 1978 there was a very popular

book published by Hilda Bruch, The Golden Cage, colon, the enigma of Anorexia nervosa and obviously, and super sad, Karen Carpenter was the face of Anorexia in America and America got to see her struggle off and on with this for years until she died from complications from Anorexia in 1983. Yeah. She died basically from organ failure, from drinking too much Ipacac over the course of her life. It was a big deal in the United States.

I mean, that really put it on the map in a big, big way. Yeah. So there is like, if there's a silver lining to the death of Karen Carpenter and there are very few of those. And if you're too young to know who Karen Carpenter is, do yourself a favor and go look up the Carpenter's right now. Sure. And have fun listening to that.

Yeah. But Ipacac is in a medic, which means you drink it and it makes you throw up. And for the 20th century, maybe even the 19th century too, doctors recommended parents keep that stuff around their house. So if they're dumb little kid, rat poison under the sink, you give them some Ipacac, they throw it up and their life would be saved. Well, they started to realize, especially after Karen Carpenter, that this Ipacac serve was being abused by anorexia patients and bulimia patients all over the US.

And they apparently called for a ban on over-the-counter sales of Ipacac and that directly came from Karen Carpenter's death. But I didn't see that it actually ever went through. Oh, really? Yeah. As recently as 2003, they were calling for a ban on non-prescription Ipacac sales. And unless over-the-counter and non-prescription are not the same thing, then no, they didn't get it pushed through.

Can you buy it today? Do you know at all? Yeah. I mean, I believe at the very least you could get it from a pharmacist, but I think you might be able to still buy it in a drugstore. I'm not sure. Haven't tried. And this was 2003, but I didn't see anything about it actually being banned.

Well, just really quickly, as you can see here, 2008, there's an article called Ipacac, the most dangerous over-the-counter drug, so. Right. Interesting. Yeah. So they basically just... Look into that. Tarnished Karen Carpenter's memory.

Yeah. So treatment is tough because, like we said, there are so many prongs and we don't want to be down on it because you can't overcome this. But obviously the end goal is multi-pronged as well. What obviously you want just physically is to eat healthily again, but another big part of that is to feel better about yourself and to have a better self-image and to overcome this mental illness that's the underlying cause of these physical symptoms. Yeah.

If you have a friend or a loved one or somebody you care about that has anorexia or bulimia, one of the things you can do is just be supportive and non-judgmental in the hopes of, like you were saying, kind of help build their self-esteem because it is definitely a crisis of self-esteem as a big component of it. But what you don't want to do is make them feel bad or shameful for not eating. You don't want to focus on the food because it's really not the food. The food is almost like a convenient... Basically the food is the one thing that say a teenage girl can control in her life in some cases.

How much she eats or doesn't eat and this becomes manifested in anorexia nervosa. So the idea that, no, just eat the food, but your problem with food, it really doesn't have much to do with the food. The food is just this kind of red herring in the whole thing. Yeah, the food is almost like the drug except the idea is to not take the drug if that makes any sense. It does not. I thought that was making sense, but as it was coming out of my mouth, I started to realize

it didn't. Yeah, right up to the end. Treating it can be done on an outpatient basis. They have high calorie supplements, dietary recommendations, obviously. If you have serious medical complications, you might have to have a hospital stay, but they have shown that just putting someone in the hospital has no improvement on the outcome of their mental health. You really have to attack it from all angles.

Yeah, and that's a big problem too is when you have medical issues like a low pulse and you are, say, emaciated, they're going to take you to the hospital and the doctors are not necessarily psychologists or psychiatrists, they're doctors who are going to try to treat your emaciation or treat your low pulse. That's good. You need that kind of treatment, but it doesn't actually heal the anorexia at all. There has to be a multi-pronged approach, and in particular, if you do need to be nourished like you're at death's door because you haven't eaten in too long and your body's become malnourished

and your organs are starting to fail, you have to go to a specialist in this because I think we talked about in the Angus Barbieri short stuff, the idea of refeeding syndrome where if you introduce nutrients too quickly to somebody who hasn't eaten in too long, they can die basically from overdosing on nutrients. You have to go to a specialist in refeeding. It's not just something that anybody can do. Ideally you will catch this long before you could die from refeeding syndrome or anything like that, but it is a concern and an issue that you would want to go to a specialist

physician for refeeding. Yeah, and we were talking about parents earlier too. It's also interesting that early on, Gull, and this continued for a while, felt that the parents could be a big part of the problem in this negative influence, especially if it's all of a sudden it is being treated and parents like you need to eat each, you need to eat this, you need to eat that, and so they would move kids out of the home in order to treat them more successfully because a lot of times the parents were contributing to the whole cause and to begin with.

Yeah, they would call that a parentectomy. Oh, really? Yeah, that's what Gull called it, and so that's like one theory of treatment that the parents are the problem and you need to get the kid away from the parents, not like get him in a foster care or anything like that, but more that the kids are being oppressed in some way by the parents, and Hilda Brooke, B-R-U-C-H, I'm going with Brooke. In the book. Yeah, the one who wrote the Golden Cage.

She concluded that the reason for anorexia was that the teenagers were afraid of becoming teenagers, that they just pleased the adults and their parents their whole life, and they were afraid to kind of venture out on their own, and so this was some means of control maybe, I'm not sure, but it definitely goes in with that parentectomy thing where if you take the kid out and teach them to take on this disorder on their own, it can really boost their self-esteem quite a bit and potentially cure anorexia as it is. That's one theory. Yeah.

There's another that basically is the opposite. It says, hey, family, let's get together and help this. That's right. It's like a family therapy. It's the Maudsley method, and this was based on the work of a psychiatrist named Salvador, not Maudsley, Salvador Mnuchin. Yes. It's not the Mnuchin method though.

No one knows who Maudsley is. Maybe that was his hotel pseudonym. Maybe, but this is, like you said, and this makes a lot of sense too, like getting the whole family in there because if you go to therapy as a family or as Metallica, it's going to bear fruit, most likely, because especially with something like anorexia and bulimia, there may be a lot of tendrils throughout your family that is potentially causing some of this to begin with. Get mom and dad in there, get brothers and sisters in there, and I'll talk it out.

It'll probably help everyone involved. Get weird uncle Al in there? Oh, no. Whoever. Just keep him at Thanksgiving and keep him quiet. One of the things I saw about that family method is one of the techniques they use is called externalizing, where they basically say, you have an interloper in your family known as this eating disorder, and you need to come together as a family to get this eating

disorder out of your family. You guys gang up as a family against the eating disorder, not against the person with the eating disorder or against one another, gang up on the eating disorder and support the person with it to help them, which is great. Like we said, you can recover from an eating disorder. Yes. Johns Hopkins says that 50 to 75% of patients with anorexia or bulimia will eventually recover. How many?

That's a lot. 50 to 75%. That's great. That is a really great recovery rate for what is ultimately a chronic mental disorder. Yeah. Can we shout out a website here? Yeah. It is a website called Alsana.com, and it is an eating disorder helpline of all stripes,

so anorexia, bulimia, I would imagine binge eating, any kind of eating disorders, you can call 888-822-8938 at any time, and someone is going to be there and try and help you out. Nice. Sure. We talk about it all the time, just that first step. Super crucial. Yep.

Good job. Thanks. You too. Well, if you want to know more about eating disorders like anorexia or bulimia, you can go to where Chuck just sent you, or you can pick up the phone and call, and you can also just hold tight and wait for a listener mail, which is coming right now. That's right. And yeah, we should mention there are many, many, many helplines in many organizations.

But again, everything I've seen is if you suspect that your friend or loved one or sister or son or daughter has an eating disorder, you need to confront it. They don't just clear up on their own, and it's not just a lifestyle choice. Yeah. That's right. The National Eating Disorder Helpline is another one, 800-931-2237. Nice. We need to put that in our slogan, our motto, on the t-shirt.

Well, how about this? I don't have a great listener mail today, so let's just encourage everyone to look out for their friends and family, and if you have someone in your family that you think may be suffering from one of these disorders, then reach out to them with compassion. And if you have one of these disorders, call one of those numbers and just take that first step toward getting some help. Yeah. Very nice, Chuck.

Thanks. I think that was even better than any listener mail. Of course. For a lot of listener mail. Anything's better than listener mail. Come on. That was tops. We're just kidding.

We love listener mail. And if you want to get in touch with us, you can go on to stuffyoushouldknow.com, and we've got all our social links hanging out around there, and you can also send us a good old-fashioned email. Wrap it up, spank it on the bottom, and send it off to stuffpodcastatihartradio.com. Stuff You Should Know is a production of I Heart Radio's How Stuff Works. For more podcasts from I Heart Radio, visit the I Heart Radio app. Apple podcasts are wherever you listen to your favorite shows.

From the podcast, Hey Dude, the 90s called, David Lasher and Christine Taylor, stars of the cult classic show Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're going to use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it, and now we're calling on all of our friends to come back and relive it. Listen to Hey Dude, the 90s called on the I Heart Radio app, Apple podcasts, or wherever you get your podcasts.

Listen to Frosted Tips with a Lance Bass on the I Heart Radio app, Apple podcasts, or wherever you listen to podcasts.