National Eating Disorders Awareness Week ended a few days ago. I am always a little surprised that this is such a huge event for so many of my colleagues but so few people know about it at church, and I feel like I have a lot of work to change that even within my own micro-community.

This year NEDA (The National Eating Disorders Association) did a campaign titled "Let's Get Real." This campaign's purpose was to broaden the conversation about eating disorders and talk about the stories we don't hear much about. The marginalized people with eating disorders.

Even though it is four days past NEDA Awareness Week, I still think this is an important conversation to have, especially within the church. Because, you see, you are so often the front lines in this disorder. You may be the person watching a friend struggle and if we don't combat myths and stereotypes you may not even know that they are having a hard time. Since early treatment for eating disorders has the best success, we have no time to waste.

I am asking you to get real with me. For just a few minutes. Let's talk about some ways that eating disorders can hide among us:

Eating Disorders Can Hide in Larger Bodies: Eating disorders can exist at any body size. A person in a larger body can even have anorexia, which is a clinically significant and serious eating disorder no matter what someone weighs. People in smaller bodies can also struggle with binge eating disorder, because eating disorders are about behaviors and not necessarily about body size. People can have serious health complications even if there weight is "normal." Even if a person has perfect health and is engaging in eating disorder behaviors, this can be common and the eating disorder still needs treatment.

Eating Disorders Can Hide in Men: Men are significantly impacted by eating disorders. In fact, subclinical disordered eating behaviors are almost as common in males as they are in females. Several studies indicate that the mortality rate (eating disorders are the most deadly mental health disorder) for males with eating disorders is higher. This is often because treatment is not sought due to shame, stigma, and lack of understanding.

Eating Disorders Can Hide in People of Color: Many people wrongfully assume that people with eating disorders are white, wealthy, female, and thin. This is just the population that, sadly, gets the most media attention. In fact, studies have reported that a person from a non-Caucasian population that struggles from an eating disorder, is actually more likely to be dismissed even if they are involved in the same eating disorder behaviors these behaviors are seen as "not problematic." Sadly, this same study revealed that clinicians are less likely to recommend treatment for African Americans than they are for Caucasians.

Eating Disorders Can Hide in People of Lower Socioeconomic Status: Resources and treatment for people who struggle with eating disorders at a lower socio-economic status are often non-existent. This is alarming, especially considering that teenage girls from lower income families are 153% more likely to struggle with bulimia. 

Eating Disorders Can Hide in Diet Culture: Your friend who is "just dieting" might very well be engaged in serious eating disorder behavior. It's hard to know because our culture that supports dieting basically supports eating disorders. You can't prescribe a symptom for one set of people that you would pathologize or diagnose in another. This makes my job incredibly hard and my clients' recovery seem impossible some days. Dieting is the greatest predictor of eating disorder development. People who diet moderately are 5 times more likely to develop an eating disorder, and extreme dieters are 18 times more likely to develop an eating disorder. This is alarming considering that Weight Watchers just launched a "free" teen summer program for adolescents. 

Eating Disorders Can Hide in our Health-Obsessed Culture: Contrary to popular belief, not all people who develop an eating disorder want to avoid becoming fat. I have a few clients who entered the eating disorder world by trying to become "healthier." These are actually some of the most difficult cases to treat, especially considering how strongly our culture reinforces their fears and behaviors. This is commonly called orthorexia, and it is becoming more and more of a problem, especially now that diet companies have gotten smart and have started to sell their products as "whole/clean/healthy" eating.

Eating Disorders Can Hide in Sneaky Ways: Most of my parents who bring their adolescents to me will think that they have "caught the disease early." Usually they are surprised to know how long eating disorder behavior has gone on unnoticed. Sometimes years. They often ask, "How could we not know?" The truth is, the beginning of an eating disorder often starts subtly. We are all familiar with the giant red flags, but by that point the disorder has often progressed. I had a doctor once tell me that, in 30 years of practice, they had only seen two people with an eating disorder. That's statistically impossible. They just weren't asking the right questions. Sara Upson and I have created a resource for screening that includes some subtler cues to watch for.

Eating Disorders Can Hide in Your Pews: This is one of the reasons I am so passionate about speaking about this issue to the church. Trust me, someone sitting next to you on Sunday is struggling with an eating disorder, and they may not look the way you think. It is too serious to ignore! This is an issue that you cannot "pray" or "count your blessings" away. It just doesn't work like that. In fact, many of my clients have been seriously harmed by this mentality. Now they still struggle with an eating disorder along with guilt about not being "Christian enough." Speak out in your churches, reject diet culture and fat phobia, and be a safe space for someone to come to by not offering platitudes and advice. Stop praising people for being thin while shaming people for being fat--that reinforces eating disorders within our churches.

I hope you have learned a little more about eating disorders today. My goal is to help bring understanding into our places of worship. It is far more likely that someone who is struggling with an eating disorder will come to you before they come to me! If you know someone who is struggling, know that 100% recovery is possible and help them get the help they need with a trained eating disorder therapist and dietitian.