Twenty million women and 10 million men in the United States will experience an eating disorder at some point in their lifetime, according to the National Eating Disorders Association. But in Utah, researchers don't know a lot about how prevalent eating disorders are. Experts say that's a problem.
"[My waitlist is] over a year long," said Sara Boghosian, a psychology professor at Utah State University who specializes in treating eating disorders. "And I really worry about folks waiting to get in to see someone who is trained to help them with their problem."
Boghosian is one of the authors of a new report from the Utah Women and Leadership Project, which highlights this data gap.
"My hope would be that, if we really had a better pulse on the numbers, we could maybe have some more resources to get folks trained in treating these really, really complex and deadly disorders," she said. "There's data to suggest that when doctors, dietitians and therapists who are not eating disorder experts are trying to help these folks, they actually can do a lot of harm unintentionally."
Utah can be a unique place for those dealing with an eating disorder, Boghosian said, because of the customs surrounding The Church of Jesus Christ of Latter-day Saints, which is headquartered in the state. The church has rules against consuming alcohol or using drugs, which Boghosian said are coping mechanisms used by many to deal with the stresses of life.
"Turning to an eating disorder is more culturally sanctioned," she said.
She added that church members may feel that historical discrimination against the faith may also create pressure to present to the world a positive impression of the religion.
"Any time a culture is under that kind of pressure — there is a push to show the world we're OK," Boghosian said. "You know, 'We're good, and we're not a bad faith. We're not a bad culture.' And so when you set that pressure inside of a broader national culture for us, thin equals success, thin equals happy, thin equals good. You can see how, for some folks, that pressure culminates in a lot of emphasis on image."
People can take steps to create a constructive environment for body image and eating. Boghosian suggested talking positively about dieting and bodies in front of young children and following social media influencers who have a healthy relationship with food, their bodies and exercise.
This interview has been edited for length and clarity.
Ciara Hulet: On a personal note, I had an eating disorder, and now I volunteer for the National Eating Disorders Association. And the first therapist I saw didn't have a specialty in that. And I felt like it really was not helpful or was even harmful. Is that something you see happening a lot?
Sara Boghosian: It's something that I've seen across my career, and I think it's a solvable problem.
CH: Why don't we know very much about eating disorders in Utah?
SB: It's a hard population to study in that one of the hallmark characteristics of an eating disorder is that [people] would rather not disclose that they have one. In fact, many of the women that I have treated across my career were well into their therapy process before they could admit and acknowledge that this was something that they were experiencing. But also, I think that there haven’t been resources thrown in the direction of getting good data on this in Utah.
CH: I didn't realize I had an eating disorder for a long time because I just didn't fit the stereotypical, anorexic, you can see their ribs kind of girl. And that's what I thought that sort of eating disorder looked like. And so for a long time, I actually just thought I had a food addiction. That was what I thought when I was bulimic.
SB: Yes. Thank you so much for saying that, because I think that's another thing that I really like to talk about. Eating disorders don't look some certain way. And some of the most malnourished and at-risk folks that I have treated across my career didn't fit that stereotype that you were just referred to. These disorders can wreak havoc on someone's life up to and including death without the person ever appearing visually emaciated.
CH: Another report from the Utah Women in Leadership Project says Salt Lake City has the second-highest number of plastic surgeons per capita in the United States, second only to Miami and ahead of Los Angeles. And you can see that on the freeways, there are ads everywhere.
SB: It's always striking to me when I make my drive from Logan down to the airport, how many of those ads I see. And of course, I'm in the trenches a good chunk of my week with folks who are literally dying to look good. And I see those billboards, and I sometimes kind of want to take them down, if I could.
CH: So out of all of this, what are your recommendations for dealing with eating disorders and this data gap in Utah?
SB: In terms of policy, I would just strongly advocate for early intervention [and] prevention in elementary, middle and high schools and … more funding for training so that our doctors, our therapists, our dieticians have the tools they need to recognize what they're seeing. And one of the things that's really, really frustrating for me across time is when physicians are telling my clients, who I know have an eating disorder, that they need to diet, that they're overweight, without kind of having the skill set to recognize they're talking to someone who's already doing way too much of that, and that dieting actually is the problem for that individual. I think that the ways that we, as a society, attempt to address obesity actually make eating disorders worse and don't appear to be positively impacting the obesity numbers.
