Episode 086: Welcome back to Real Health Radio. It’s another guest interview episode of Real Health Radio and this week I’m speaking with Andrea LaMarre.
Andrea LaMarre is a PhD candidate and Vanier Doctoral Scholar at the University of Guelph in Canada. Her dissertation research is focused on the experiences of people in recovery and their supporters. She is a blogger and activist engaged in the eating disorders community on and offline, and is a member of a number of organizations for eating disorder professionals, including the Academy for Eating Disorders and the Eating Disorders Association of Canada, and volunteers for the National Initiative for Eating Disorders in Canada.
More information can be found about her at www.andrealamarre.com
00:00:00
00:03:20
00:05:25
00:08:40
00:10:00
00:17:00
00:21:25
00:25:45
00:28:00
00:30:40
00:35:25
00:40:55
00:42:05
00:43:20
00:48:09
00:52:30
Links
00:00:00
Chris Sandel: Welcome to Episode 86 of Real Health Radio. You can find all the links talked about as part of the show at the show notes, which is located at www.seven-health.com/086.
Welcome to Real Health Radio: Health advice that’s more than just about how you look. Here’s your host, Chris Sandel.
Hey all, thanks for joining me for another episode of Real Health Radio. Today it’s another interview show, and I’m sitting down with Andrea LaMarre.
Andrea is a PhD candidate and Vanier Doctoral Scholar at the University of Guelph in Canada. Her dissertation research is focused on the experiences of people in recovery and their supporters. She is a blogger and activist engaged in the eating disorders community, both online and offline, and is a member of a number of organizations for eating disorder professionals, including the Academy for Eating Disorders and Eating Disorders Association of Canada, and she volunteers for the National Initiative for Eating Disorders in Canada.
I first came across Andrea after a podcast subscriber recommended her to me. I’d sent an email a while ago asking for guest suggestions, and Andrea’s name was one of the people that came up. I started reading her writing at Science of EDs, and I really liked what I was seeing. This was a website that I hadn’t previously been aware of. Something similar that I had regularly been reading was Your Eatopia, which is Gwyneth Olwyn’s website, which has recently been rebranded as The Eating Disorder Institute. I see that there’s lots of similarities from my perspective between Gwyneth’s website and the Science of EDs because of its focus on research – writing blog posts that had research studies as the backbone, and then making statements and recommendations that were evidence-based.
With this conversation with Andrea, I wanted to talk to her about the research around eating disorders – or, as we discovered, in many cases the lack of research that is available. We talk about the idea of recovery and what this means, and this is what Andrea has written her Master’s thesis on, or at least part of, and it’s what she’s doing her PhD on – again, or part of. She is someone who is well-versed in this topic.
We also cover some of the options available as part of eating disorder treatment and where this could be better. Privilege is a big determinant for who receives treatment, so we discuss this. We look at the difficulties in recovery given the stigma around weight and how the same basic behavior can be seen as good or bad depending on how much someone weighs or someone’s history with an eating disorder. We also cover a recent petition that Andrea started in response to calories being added to food menus.
This is a really great show. If you’re interested in the science and the state of research and care in respect to eating disorders, I think you’re going to get a lot out of it. Without further ado, here is my conversation with Andrea LaMarre.
00:03:20
Chris Sandel: Hey, Andrea. Thanks for coming on the podcast.
Andrea LaMarre: Thanks for having me. I’m really excited to be here.
Chris Sandel: Awesome. I guess to start with, for those who are unfamiliar with who you are and what you do, are you able to give a bit of background on yourself? This can be both professional and personal, but whatever you think is relevant.
Andrea LaMarre: Sure. I am a PhD candidate at the University of Guelph in Canada, and my research focuses on eating disorder recovery. I’m better known for my Twitter presence and my writing on the Science of Eating Disorders blog as well as being a member of the Board of the Association for Size, Diversity, and Health and a member of the Social Media Committee for the Academy for Eating Disorders.
I tend to write about eating disorder recovery, I write about the research around eating disorders. I tend to focus mostly on qualitative approaches and broadly spreading awareness about the need for timely, appropriate, and comprehensive treatment for eating disorders.
Chris Sandel: If we go back to when you were a child or a teenager, was science something that you were always big into?
Andrea LaMarre: No. [laughs] I thought I wanted to be a lawyer. For a long time, I was focused on being a lawyer, and actually my first two years of university were focused around international development. Then my own eating disorder got really bad at that time, and I ended up dropping out of school, going to treatment, and essentially changing my whole career path to become an eating disorder researcher after that. I went into sociology, did my undergrad in sociology, and then I focused on eating disorders for my Master’s, and I’m focusing on it again for my PhD.
Chris Sandel: So a real change in direction from what you had originally anticipated.
Andrea LaMarre: Yes, definitely.
00:05:25
Chris Sandel: You mentioned there about struggling with an eating disorder, and obviously that’s had a huge impact on your career path. How did that start, when did that start?
Andrea LaMarre: I suffered from my eating disorder from when I was about 15 until I was about 20. It started mostly focused around exercise and using exercise as my only coping mechanism, and then obviously restricting as well. It kind of waxed and waned over a couple of years. It was one of those eating disorders that wasn’t particularly visible to people who didn’t know me very well, so it was able to exist very under the surface if I didn’t talk about it with people.
I wasn’t diagnosed until I was about 18 and I was away at university. It was one of those things that had carried on for quite some time and was causing me a great deal of distress, but to the outward eye I was doing very well for myself – which was very confusing for me, I think, in terms of knowing whether I should get help or whether I was just doing the healthy thing. My parents were concerned about me, but very few people knew about it other than them.
Chris Sandel: Was there something that then triggered getting that diagnosis? Had things started to spiral or get so bad? How did you end up in that position?
Andrea LaMarre: I think after years of very much abusing my body through over-exercise and undereating, I hit rock bottom and I was having lots of dizzy spells and fainting spells and my physical health was declining quite a bit, to the extent that it was quite untenable. I was also having near daily panic attacks, which was very much interfering with my life.
At a certain point, I tried to go back to school for my third year of university and just completely crashed and had to come home and live at home and seek treatment at that point.
Chris Sandel: How was your recovery experience? I know recovery is something that you spend a lot of time researching and writing about, but can you talk about your own personal experience with it?
Andrea LaMarre: Sure, definitely. I would say at this point that I had a fairly straightforward path to treatment and recovery – which is not to say that it was easy for me, but it is to say that because of a number of privileges that I have, it was easier than it is for a lot of people who are marginalized.
I live in a relatively affluent area of Canada. We have provincial healthcare that’s provided for us, so I was able to access a treatment center and only waited about 3 months on a waitlist. I attended day hospital treatments every day for 8 months, and they were very caring people. This is one of those weird things – I was able to follow the rules of treatment, and that is what got me back on a physically healthy path. Then I’d say over the past 8 years that I’ve been in recovery, I’ve been doing a lot of the other work of recovery after treatment.
00:08:40
Chris Sandel: When did you then transition into or make that decision of “I really want to get into this research and then I want to make this my career”?
Andrea LaMarre: I was really hesitant at first to do anything related to eating disorders because I didn’t want to talk about the fact that I had been through an eating disorder. I wasn’t sure if it would be healthy for me to engage with the subject area. So I took a couple years where I was just doing a general sociology program. I was doing theory and thinking about other issues.
It wasn’t until I started my Master’s about 3 years after I had been in treatment that I decided that I really do want to do this research. The more that I started researching eating disorders from the scientific perspective, the more that I was very, very comfortable in my recovery and became comfortable talking about my experiences and also recognizing, I think, that things could’ve been much worse, and actually my path was a lot easier than others.
So I became quite passionate about trying to make others’ experiences better with healthcare systems. So many people are in and out of treatment, so many people are not able to access treatment or are not recognized as having legitimate disorders, and I think that was really what ignited my fire.
00:10:00
Chris Sandel: One of the big parts of your research, if I understand what you did your Master’s on and now what you’re doing your PhD on, is around recovery and what the definition is with recovery. I know this can be very blurry, but are you able to talk a little bit about what the definition for recovery is or what it could possibly look like?
Andrea LaMarre: Absolutely. There is no consensus definition for what eating disorder recovery actually is, which is one of those strange things about the eating disorder field that people seem to ignore a lot of the time. We don’t have a shared definition amongst people who are doing research in or treating eating disorders about what it actually means to be recovered.
I’ve approached this on a number of different levels. As a member of a group – I’m actually a member of a work group of the Academy for Eating Disorders, and we’re working on trying to establish that kind of consensus definition for recovery.
There is a broad understanding that eating disorder recovery is about more than simply just gaining weight or stopping symptoms, but that area of what the “more” is, is very much undefined. What we’re interested in as the work group is surveying people who’ve had eating disorders, clinicians, people who’ve cared for people through the process of recovery, and other stakeholders – even insurance companies and things like that – in terms of determining what that extra part, beyond just weight gain and “normalized eating,” what recovery looks like. So that’s one project that I’m working on.
For my own work, I take a much more smaller qualitative study approach. For my Master’s, I only interviewed 11, but for my Ph.D. I’ve interviewed 21 people in recovery and 15 supporters of people who have gone through recovery. I’ve talked to them about what recovery means to them and whether they actually relate to the idea of recovery, because there are certain things about recovery in the way that it’s represented online, for instance, or in popular literature about eating disorders, that is a bit tricky for people to navigate personally in terms of how they feel about that definition.
Chris Sandel: When research then says that this is science-backed or science-led suggestions for how we should be doing treatment, what is that based on? Is it just every person has a separate definition of what recovery means so they can make that statement?
Andrea LaMarre: You mean when a treatment facility says their program is evidence-based?
Chris Sandel: Yeah.
Andrea LaMarre: That’s the tricky thing. Usually, it’s just according to whatever they’ve defined as their outcome measure. Interestingly, in a lot of the literature, they don’t mention the word “recovery” at all. They’ll mention the word “outcome,” they might mention the word “remission.” I’ve reviewed a lot of treatment studies over the years, and they don’t share a singular definition.
Usually, it’ll be something along the lines of weight restored status and no longer measuring within a certain number of standard deviations from the norm on clinical questionnaires, like the Eating Disorder Examination Questionnaire or the EDI. That’s what they’ll be using.
Chris Sandel: Is there a real push to get a consensus on what that term should mean?
Andrea LaMarre: Oddly, I don’t see that much of a push to focus on recovery in a lot of the scientific literature. Right now I would say that a fair chunk of the scientific literature is more concerned with the origins of eating disorders, that etiology part, so why do eating disorders happen, is it possible to prevent them, is there a shared genetic basis for eating disorders, is there something that we can do in terms of brains to make eating disorders go away, and there’s not as much focus on understanding what it means to be recovered.
I think this is born out of a desire to immediately help people be out of the extreme danger that can be associated with eating disorders, not out of any kind of lack of concern for people. I think it’s just a very immediate focus on we need to get people back to a healthy weight if they’ve been underweight, or normalize their eating if they’ve been eating chaotically and it’s been impacting their physiology. I would say there has been less of a focus on the after.
So there’s that immediate “let’s get people into treatment and out of treatment so that they are physically healthy, and then we’ll worry about the rest later.” But unfortunately, because there are so few resources in the eating disorder research and treatment world, that what happens after piece, that later piece, tends to get left aside. Not because of any researcher not being amazing or wanting to help people, but because we have to decide what the priorities are in the immediate term with limited resources.
Chris Sandel: For a lot of the clients I work with, a lot of the people I speak to, that kind of sums up their experience when they were an inpatient somewhere. Like, “it did enough or it was there to help me get out of a real specific danger zone so my organs aren’t shutting down,” that kind of thing, but apart from that in terms of looking at really where this is coming from or looking at real coping skills or the bigger picture things that can help someone really move on with their life, that piece is often not dealt with. People then can stay in that limbo land, just recovered enough but not getting to that point of being “normal” and getting back to a place where it’s genuinely not affecting them.
Andrea LaMarre: Yeah, definitely. I think it becomes so tricky because everybody’s life is so different, so it’s hard to generalize what recovery might look like because people come from such different circumstances.
It’s kind of a gargantuan task in terms of research to really establish a definition. The people that I’ve talked to have lived such different and diverse lives and they face such different challenges that sometimes it feels a bit impossible to really say what recovery actually is. I end up saying, glibly, “recovery is life,” because that’s honestly what I believe. But then, unfortunately, I find myself in the position of writing a PhD dissertation about the meaning of life. [laughs] Yeah, it’s a bit tricky.
00:17:00
Chris Sandel: Definitely. So you write for Science of Eating Disorders. It might sound obvious by the name, but what is the goal of the site, what is the aim of the site?
Andrea LaMarre: We actually are no longer active. We recently have become more I would say an archive, just because the woman who started it has gone away from the eating disorder community, and then myself, I’ve become involved in writing my PhD dissertation and I’m no longer able to consistently blog there.
But what we did basically was take peer-reviewed research and explain it in a bit more plain language – although I’m told it’s not exactly plain language, it’s plainer language than you might find in the eating disorder literature canon. We would take any sort of study ranging from – she would often do the more genetic and neurobiological studies or the “hard science” studies and explain them in a way that people might understand. And then I would tend to do more of the qualitative studies and explain those in less theoretical terms, I would say, in a way that people might be able to understand some of the relationships between eating disorders and various scientific nuances.
Chris Sandel: When did you start writing for them?
Andrea LaMarre: I think 2013 or 2012. I think 2013. I wrote about 80 posts at Science of Eating Disorders.
Chris Sandel: And how did that all come about? How did you start writing for them?
Andrea LaMarre: I actually saw that Tanya, the woman who ran it, had just posted a call asking for people to write for the blog. I emailed her and we started chatting, and it ended up that she actually lives in Toronto and we became quite good friends.
She originally would edit my posts and make sure that I’d done them the way that she was happy with, but eventually, she started just letting me do what I wanted and post things when I wanted to, gave me more access in that way. Then I actually started editing some other folks’ posts as well, so we developed a team relationship. She always ran the Twitter, so she would do the publicizing of the posts, and I would just write and sometimes edit.
Chris Sandel: Do you miss not having that as an outlet to write for, or you’re just so busy that it’s not that big a deal that you’re not doing the writing?
Andrea LaMarre: In a way I miss it. I’m very much involved in writing other things. I do have a blog of my own now where I blog more generally about feminism, social justice, eating disorders, that sort of stuff. I’ve just started that up recently. But it’s a bit more flexible in terms of it’s not always about a research study, for instance. It’s more just my musings. So I like that as my outlet.
Science of Eating Disorders was absolutely amazing, and I feel like so many more people have read things that I’ve written for Science of Eating Disorders than will ever read any of my research papers, so that’s kind of fun. We’d get 1,000 page hits a day from people, and people would send us amazing letters and tell us how our posts had helped them. I think that was my favorite part about it, really just engaging with people and talking to the people who this could really matter for.
I think sometimes in academia, the stuff that I write, as I mentioned, doesn’t get widely read and is sometimes in language that’s appropriate for academia but not necessarily that interesting for the average person. And it’s an 8,000 word paper versus a 1,000 word blog post.
Chris Sandel: Yeah, I do think there is a real skill but also market for taking research and explaining it in layman’s terms so that people can then use that in a practical sense as opposed to academics writing for academics, where nothing really happens for the majority of people based on that writing.
Andrea LaMarre: Absolutely.
00:21:25
Chris Sandel: One of the big areas that you focus on is advocating for system-level change of eating disorders and approaching them from a fundamentally social justice-related issue. That’s from your website. This is something that I’d really love for you to chat about, maybe starting with what are the recovery options currently? What do they look like for different people?
Andrea LaMarre: It kind of depends where you are, I think. In Canada, we have mostly publicly funded treatment centers. Last time that I checked – this could be a completely inaccurate number at this point, but the last time I checked thoroughly there were about 39 inpatient beds across the country for people to access with eating disorders, which is pretty small considering the fact that about half a million people in Canada suffer from eating disorders.
There were about I think 12.5 full-time equivalent psychiatrists who specialize in eating disorders, and just very little funding for eating disorder treatment in particular. We’ve been doing a great job I think advocating nationally to try to change this state of affairs, but as it currently stands, there’s not a whole lot of treatment options. Pretty much you’ll go inpatient if you’re at a certain physical level or you can access day treatment if you are able to get to and from treatment.
There are some provinces where there’s really not a lot in terms of intensive treatment. You might just be able to access a psychiatrist or psychologist. Sometimes out of pocket, sometimes paid. There’s a little bit more in terms of adolescent treatment, but still, we do send people to the States sometimes if we don’t have adequate services for them here.
So there aren’t a ton of services I know in the States there are more services, but the insurance coverage is not always amazing. So sometimes people will be in treatment for about two weeks and then their insurance provider will be like, “yep, you’re done.” They don’t really understand eating disorders and the amount of time it can take to stay in treatment, so then people are out on their own, trying to access limited community support.
So I’d say the main deficit in both Canada and the States would likely be community-level support that is affordable and accessible for folks.
Then there’s also a very, very big lack of training for doctors, especially those who are not in the mental health field, around what eating disorders look like, how to diagnose them, what type of people get eating disorders – everything that would allow them to appropriately refer for eating disorders.
Because of that lack of training and some of the stereotypes that persist around eating disorders – things like the notion that only young, white, cisgender, thin, able-bodied women get eating disorders – leads doctors and others to misunderstand that really anybody can get an eating disorder. Men can get eating disorders, queer people can get eating disorders, disabled people can get eating disorders. Basically anybody can have an eating disorder. People of color, obviously. I think sometimes this leads to people not being diagnosed. And if they’re not diagnosed they often can’t access treatment.
Really, we have a situation in which people are suffering, but they’re being told that their suffering isn’t legitimate. Even if they are told that their suffering is legitimate, sometimes the treatment that’s available isn’t what they want or isn’t accessible to them without a year or two of being on a waitlist. So essentially we have a number of different barriers to treatment.
Then even in terms of access for adolescents to things like family-based treatment, that’s a very parent-involved form of treatment where we find families having to move across the province, people having to quit their jobs to take care of their kids if their kid has an eating disorder and they need to be intensively involved. Financially that can be very challenging, and obviously emotionally as well.
Essentially we just have a lot of people who are suffering and we don’t have a lot of options for how we can treat them, and when they do enter treatment, what their experience might be like.
00:25:45
Chris Sandel: Is a lot of the research you’re doing or what you want to focus on providing information about how this could then be done better and feeding that back to the government or whoever then can act on that information?
Andrea LaMarre: That is my hope. In terms of my actual PhD research right now, I would say the most useful question that I asked people was, “If you could envision the ideal form of treatment, what would it be?” I had them look back on their trajectories of getting to whatever treatment they did or didn’t access and what could’ve been improved along the way. So I’m hoping to put that into some sort of format that would be appealing to perhaps those in a position to make change.
I would say more so in terms of advocacy is where I’ve been trying to make a difference here. I’ve been working with the National Initiative for Eating Disorders here in Canada, and they, with a couple other organizations – the Eating Disorder Association of Canada, the National Eating Disorder Information Center, and the Eating Disorder Foundation of Canada – have been putting together what we’re calling a national strategy for eating disorders, and that is a strategy that is organized around a number of different pillars – research, education, outreach, prevention, those sorts of things, training.
We’ve been focusing around these pillars to try to come together as a country to address the gaps in the continuum along all of these pillar lines, fill those gaps in, and connect people to the appropriate people they would need to talk to or services that they would need. We’ve been working to talk to government about this.
Actually, recently, on Eating Disorder Awareness Week, we went to Parliament Hill and we met with Sophie Grégoire Trudeau and the Speaker of the House and a couple of other MPs, and we managed to get one of the MPs to table the motion in the House of Commons to support the national strategy for eating disorders. So we’ve been talking at a fairly high level with the Canadian government to try to get some support here.
00:28:00
Chris Sandel: One of the things you mentioned was that on the research you’ve been doing, there’s a question of “How could your treatment have been better?” or “in an ideal world what could’ve happened?” What are some of the responses? And if you were to give your response to that of what would make the perfect treatment, or if it could be done, what could be changed, what would your response be?
Andrea LaMarre: Most people that I talked to just basically said that it would’ve been nice to be able to access treatment sooner, and also that it would’ve been nice to be a bit more heard in treatment. One of the main things that’s coming out of my PhD data is just the idea of being listened to and being understood and being treated in a very compassionate way that understands that life circumstances can get in the way of doing recovery exactly as expected.
I think basically there’s just a yearning for more support on the longer term, especially in terms of transition from treatment. We just don’t have a lot that helps people figure out, once they’ve left this intense treatment environment that’s very controlled, and you’re essentially told how you’re supposed to eat and everybody takes care of that for you, and then all of a sudden you’re out in the world without any sort of guidance in that respect and you’re expected to just be better – but once again, at that point you’re dealing with the life stressors that might’ve contributed to your eating disorder in the first place, that might make life challenging for you, that might exacerbate your anxiety, and you don’t have anyone there to support or to help you.
So I think it’s that transition phase that can be really challenging. Also if people can’t quit their jobs and go to treatment full-time, there’s a lack of affordable and accessible community support that people were noting.
Then in terms of supporters, they’ve been talking a lot about how it’s really hard to get support as a supporter and find others who you can relate to who might be able to give you some guidance as you help your loved one through this really challenging time. They were saying that if treatment options could be a bit more integrating of their perspectives and perhaps provide more in terms of peer support or even one-to-one time with therapists, that would be very helpful.
And especially if those supporters aren’t the person’s biological family, because sometimes my participants didn’t have a great relationship with their biological families, but they had chosen family who they would’ve loved to integrate more into their treatment, but were not allowed to be there because they weren’t biologically related to them.
00:30:40
Chris Sandel: I know you commented earlier on about training up doctors and letting them understand better about what eating disorders really look like. What would be – and this can be either from working with these type of people or from just spending so much time going through the research with this stuff – what are some of the biggest misconceptions about eating disorders that society at large has, or within the medical field or with doctors?
Andrea LaMarre: I think one of my biggest pet peeves about the way that eating disorders tend to be framed is that it tends to be that anorexia and obesity tend to be positioned as two opposites on a continuum. A body size is mistaken for a psychiatric diagnosis, and there’s a lack of understanding that people with all sorts of eating disorder behaviors can exist in bodies of all different sizes.
There’s this misunderstanding that somebody who’s in a larger body, if they have an eating disorder, must necessarily have binge eating, which is not necessarily true, or that a thin person can’t be somebody who binges. I think that can really lead to misdiagnosis, particularly in people in larger bodies who perhaps have been very, very restrictive in what they’ve been eating, but haven’t been showing what we think of as the classical physical signs of an eating disorder, that emaciated look.
Another pervasive one is there’s quite a lot of racism in treatment systems in general, I would say, in terms of thinking that black women and men can’t get eating disorders or women and men of Latina and Latino descent or Asian women – all of these different ethnicities, these people are seen as not being able to have eating disorders somehow because there’s a lack of understanding of what might be culturally specific to their experiences of eating disorders.
There’s the assumption, for instance, that black women don’t get eating disorders because there’s a different body ideal in African American communities. That would be amazing if black women didn’t get eating disorders, obviously, but unfortunately, that’s not the case. Anybody can get an eating disorder. So I think sometimes that can be a really problematic assumption that gets placed on people.
Also, there’s an odd myth around queer women also being immune to eating disorders because they’re not seen as wanting “the male gaze,” which is stereotypically associated with eating disorders and is also a problematic stereotype. First of all, the idea that people with eating disorders are somehow vain and that’s why they’ve developed an eating disorder, which is itself false, and then the idea that because of that, queer women couldn’t possibly have an eating disorder because they’re not trying to appeal to men.
So there’s a lot of simplistic orientations to who might develop an eating disorder, and those, I think, get taken up in the medical imagination to lead people to believe that certain people couldn’t be suffering from an eating disorder, so if they’re showing that kind of distress, it must be related to something else.
Chris Sandel: Yeah. With the first one that you mentioned in terms of issues around people not appearing to have an eating disorder because they are sitting at a higher weight than what we would think about, because they don’t look emaciated, I guess this also speaks to the culture and the society that we live in.
If someone is at that point where they are emaciated, there’s this “oh, they’ve taken it too far.” But someone who is living in a heavier body, they’re praised for restriction or for exercise or basically doing the exact same things that someone does who ends up with “an eating disorder,” whereas for the other person it’s just them keeping “healthful behaviors” or taking up healthful behaviors.
Andrea LaMarre: Absolutely. There’s this quote that Deb Burgard often says, which is “we diagnose as eating disorders in thin people what we prescribe in fat people.” Basically we’re telling people in larger bodies that they need to be restricting and they need to be over-exercising because that’s how they perform health, whereas for people who are diagnosed with eating disorders, it’s the opposite.
I’ve written a paper about this as well. It’s the opposite expectation when you’re in eating disorder recovery, that you’re somehow supposed to always eat food that would be framed as unhealthy for the rest of the population.
00:35:25
Chris Sandel: Yeah. I think there was another thing that you said that I feel like relates to that. In another interview, you said, “people in recovery are asked to hold themselves to a higher standard around body acceptance than the rest of the population.” This was something that really struck a chord with me and made me reflect on conversations I’ve had with other clients. Are you able to explain a little more about what you meant by that statement?
Andrea LaMarre: Sure. There’s this idea of surveillance, like being watched, in eating disorder recovery. An example that I usually like to give about this is that whether somebody knows that you’ve had an eating disorder or not usually colors the way that they look at you eating.
For instance, if you’re out for dinner with a friend who knew that you were struggling for a long time and watched you go through that and watched you come out “the other side,” and you decide that you really just feel like ordering a big salad with protein for your dinner, that behavior might be interpreted by that person who knows the experiences you’ve been through as somehow reflective of you continuing to have an eating disorder or exhibiting disordered behavior, when really that might just be what you want to eat that night, and you’ve had a cupcake at lunchtime and it’s fine.
Whereas if you go out to eat with somebody who has no idea that you’ve had an eating disorder and doesn’t know you that well, they might say something like, “Oh, look at you. You’re being so good, you’re being so healthy.” It’s the exact same behavior; it’s just responded to differently depending on who you’re with. I think that shows some of these contradictions in terms of how we frame health for people in general and how we frame health for people in recovery.
Chris Sandel: When I was thinking about that comment, I was also reflecting on a lot of conversations I have around body acceptance or body love or that kind of thing with someone who is in recovery. I realized that I talk about stuff where I’m asking them to get to a place, or with time expecting or hoping that they can get to a place, that the majority of the population, regardless of if they have an eating disorder or not, doesn’t typically get to.
Whether a woman or a man has an eating disorder, typically there’s a disdain for their body or not feeling great within their body, etc., yet when someone has had an eating disorder or is in part of the recovery, we start to ask them to get to a place of body love that a lot of people never get to and that we don’t expect of others.
Andrea LaMarre: Absolutely. I think that was one of the hardest things for me to come to terms with. Occasionally I’m going to have a day where I’m not super jazzed about my body, and that doesn’t mean that I’m not recovered. It just means that I’m having a bad day, or my anxiety is strong that day or something like that.
I live in a very privileged body, so I can imagine that for somebody who doesn’t live in a privileged body, that can be even worse. Society is essentially telling you that your body is unacceptable, so of course, sometimes you’re going to feel like your body is unacceptable. I think we don’t leave a lot of space for people in recovery to ever feel bad about themselves. We have to perform perfection in terms of body love, which I think can be really hurtful for people. I’ve had participants express how troubling that can be and how it makes them feel like they’re not doing a good enough job of being recovered, which makes me really sad.
Chris Sandel: Yeah. I would also add, you’re wanting someone to recover, but at the same time you’re like “but don’t put on too much weight.” There’s recovery, but we still want to keep you at this low end of the band because that’s “healthier.”
Andrea LaMarre: I know. That’s even replicated in the research literature, which is one of the things that I started to notice because I’ve done a comprehensive literature review of what exists out there in the eating disorder recovery literature. So often, eating disorder recovery, if it’s defined, is defined as being “between a BMI of 21 and 24.” Which is absolutely absurd, if you ask me. So if you’re over a BMI of 24, you’re no longer considered recovered? I just find that so baffling that that would actually be something that’s written into the research literature.
Chris Sandel: I work a lot with women who have got hypothalamic amenorrhea or HA, and often it’s born out of the fact that they’ve been restricting or they’ve been over-exercising, and with some of the research around that, the defining point often with BMI is somewhere around about 23 or 24 before periods start to return. If you’re then saying that someone who is at a BMI of 21 is now effectively healed, even from just a physiological perspective, there’s some problems with that definition.
Andrea LaMarre: Definitely. I think it’s going to be so different for every person depending on what their set point weight is. You can’t expect that that set point weight is going to be within this socially acceptable, very, very narrow range.
00:40:55
Chris Sandel: Do you think that definition has been born out of the fact that the research is largely done on women who are, as you said, white, were already thin, etc.? So when they’re looking at it, they’re looking at this very narrow subset of what is actually going on in society with eating disorders?
Andrea LaMarre: For sure. I think it goes back to – most of the people who are in eating disorder treatment studies are people who’ve been able to access eating disorder treatment, and obviously because of the misconceptions that exist around eating disorders and because of all of these things that we’ve already talked about, there are only some people who are represented in those studies.
Then those studies get taken as representative of what an eating disorder is, as representative of what recovery is, and people still don’t find themselves represented. Then we replicate treatment structures and ways of talking about recovery that don’t include everybody who’s had an eating disorder because some people are still not seen as legitimately suffering – whereas if you ask me, if you feel like you’re legitimately suffering, you’re legitimately suffering. It doesn’t behoove me to decide what that point is.
00:42:05
Chris Sandel: Yeah. I know we chatted about misconceptions around eating disorders. Are there certain ideas or beliefs that you’ve had that have been changed by going through the research that you were either surprised about or differed from what you thought would be the case?
Andrea LaMarre: Things that I’ve learned by talking to participants, you mean?
Chris Sandel: Yeah.
Andrea LaMarre: I would say that when I started doing this research, I was a whole lot less aware of how the way that we talk about recovery can be super problematic for people.
In my earlier recovery, I think I was very much more along the lines of “recovery is amazing, everything is perfect,” blah, blah, blah. As I’ve gone through and I’ve talked to participants, I’ve learned how even that idea can be oppressive for some people and how maybe I think about recovery that way because I have a lot of privilege. I think that was a bit of a steep learning curve for me just in terms of even recognizing my own privilege and how that intersects with my recovery and my ability to talk about my recovery. That was I think one of the most important lessons that I’ve learned as I’ve been doing this research.
00:43:20
Chris Sandel: You started a petition to do with calorie counts on menus – I think it was to do with some governmental guideline changes or some law changes. Are you able to talk about this?
Andrea LaMarre: Sure. I started that in December, which was too late, because the legislation came into effect in January. Essentially what it does is makes putting calorie counts on menus mandatory for restaurants with more than 20 locations. I was asked by a number of people who have suffered from eating disorders and who found this really problematic to start this petition, so I was like, okay.
I decided to look into obviously the research, because that’s the first place I go when I’m curious about something, and I found that there wasn’t a whole lot of research supporting the intended outcome of the legislation, which was obviously to get people to eat less – which is not necessarily an outcome I would agree with in the first place. But even taking that as outcome that was desirable, there’s not a whole lot to support the use of these menu calorie counts, and there is reason to be concerned about how seeing calories on menus might impact people who have had eating disorders and are in recovery from eating disorders.
So I wrote a lengthy explanation of why this isn’t necessarily effective, how it might impact people with eating disorders, and we’ve got over 1,000 signatures now of people talking about the impact that it’s had on them and concerned about the legislation.
But as I mentioned, it was a bit too little, too late, and obviously the legislation came into effect. But I would say it was still a worthwhile endeavor in that it got people talking about eating disorders in a way that I had not previously experienced in the mainstream media.
I ended up talking to about 15 large news outlets about this, and I tried to use the time as an opportunity to raise some awareness about eating disorders and about the lack of available treatment because a lot of the response that I was getting to this petition was “These are just special snowflakes. Why should everybody else be not able to see their calories just because a couple people get triggered by it?” and those typical “everything’s triggering in society” type comments.
I was like, okay, that may well be, but if you’re going to say that people need to deal with their triggers, then you need to be providing them with resources that are going to help them deal with their triggers, because eating disorders are a serious mental illness and need to be treated as such and given appropriate resources accordingly.
Chris Sandel: Even if the petition didn’t change the law, did something good come from it? By having those conversations and appearing in those outlets, has there been some benefit?
Andrea LaMarre: I would say yes, in some cases. I think that it did start a conversation about eating disorders where it wouldn’t have existed.
Also, I ended up having a meeting with Health Canada about some potential changes to nutrition labels. That was while I was in Ottawa. We went and met with the powers that be there about some other forthcoming changes and were able to have the eating disorder voice represented, and they were incredibly receptive and willing to work with us as one of the stakeholders that had an opinion that matters. So I think in terms of perhaps informing future legislation, it might be more impactful than on this particular legislation decision.
Chris Sandel: What were your recommendations around the labeling in those other instances?
Andrea LaMarre: Basically the idea of don’t put an exclamation point or a green light or a red light on food. That’s going to be read in very black-and-white ways by people with eating disorders. So taking the focus as much as possible away from things that are “bad” about food and maybe focusing on things that are good about food and things that are nourishing about food and things that can feed us.
Chris Sandel: Which is really interesting. I did a couple of podcasts all about research done at Cornell University with their Food and Brand Lab, and one of the things that came up in the research a number of times is if you are genuinely wanting to promote health, you are much better talking about the benefits of certain foods as opposed to the negatives of certain foods, so encouraging people to have more of something as opposed to demonizing something.
Andrea LaMarre: Definitely.
00:48:09
Chris Sandel: Another area that isn’t talked about very often is men and eating disorders. It’s not something I have a huge amount of experience with, as most of my clients are women, but is there any relevant information or research that you can comment on in regards to men and eating disorders?
Andrea LaMarre: I can a little bit. I haven’t done any research myself into men and eating disorders, but I will say in general, it is very hard for men to talk about their experiences with eating disorders because eating disorders have been so feminized.
I think the idea of eating disorders being a women’s issue is not really helping anybody, men or women. I think that would be my main take-home point about men with eating disorders. There should absolutely be more space for men to be able to talk about it, and I think that until we stop framing eating disorders as only a women’s issue, that space is going to be quite hard to come by.
Chris Sandel: Has there been much in the way of research done around men and eating disorders? Or it is really just few and far between?
Andrea LaMarre: There’s a bit. It’s similar to trying to recruit people who haven’t been diagnosed with eating disorders or who face other sorts of barriers to treatment for eating disorders because the same issues exist in trying to recruit people as trying to access treatment. There’s just not a lot of space for those people to be out about their experiences without fearing a lot of stigma. So I think people are unlikely to volunteer for studies about eating disorders.
I would say there’s increasingly a focus on the fact that men can get eating disorders, at least online that I’ve seen, but the research still definitely lags.
Chris Sandel: Do you know – again, I imagine the numbers are going to be pretty hazy on this – the statistics around men and eating disorders and how prevalent it really is?
Andrea LaMarre: I don’t. I think the problem there, again, is that prevalence rates really only affect diagnosis rates, and I think that limits our ability to have any certainty around how many men get eating disorders. I’ve heard varied statistics, so I wouldn’t want to quote one in particular for fear of being wrong off the top of my head.
But I also think that awareness of eating disorders among nonbinary people is also really important. I know for instance, Trans Folx Fighting EDs has been an amazing resource for talking about people who get eating disorders who don’t identify as either men or women. I think that has been an amazing conversation that I’ve seen start to happen over the past couple of years.
Chris Sandel: With these different groups, is the hope that there’s recovery methods that are directed towards them, and it’s very tailored towards their situation?
Andrea LaMarre: Yeah. I think in general it’s just an idea of moving beyond even the feminization of eating disorder treatment. A lot of eating disorder treatment strategies end up focusing on women’s experiences and their bodies – and it’s important to talk about gender and gendered experiences, but it’s important that when we talk about gender and gendered experiences, we don’t make assumptions about how people relate to their gendered bodies based on how they’re presenting to us.
So I think talking to people about gender is incredibly important and does have a serious impact on the way that people experience their bodies. But I think that if we can leave the conversations quite open to whatever somebody might identify as in terms of their gender, we can have more productive conversations rather than assuming that all women want to be skinny or curvy for men, or whatever the case may be. There’s a variety of sexualities and gender presentations amongst people who get eating disorders, and we should be taking that into account.
00:52:30
Chris Sandel: Okay. Andrea, it’s getting late over here, so I don’t want to take up any more time. Before we wrap this up, do you want to tell people where they can find out more about you – website or social media or that kind of thing? I’m going to put everything in the show notes; just let the listeners know now, though.
Andrea LaMarre: My website is my name. It’s www.andrealamarre.com. My Twitter is @andrealala89. Those are the main two places that I can be found.
Chris Sandel: Awesome. Thank you so much for coming on the show today. It was lovely chatting to you this evening.
Andrea LaMarre: Thanks for having me.
Thanks for listening to Real Health Radio. If you are interested in more details, you can find them at the Seven Health website. That’s www.seven-health.com.
Thanks so much for joining this week. Have some feedback you’d like to share? Leave a note in the comment section below!
If you enjoyed this episode, please share it using the social media buttons you see on this page.
Also, please leave an honest review for The Real Health Radio Podcast on iTunes! Ratings and reviews are extremely helpful and greatly appreciated! They do matter in the rankings of the show, and I read each and every one of them.
Policies
Social
Copyright © 2012 – 2023
seven-health.com · All Rights Reserved.
It is a great information about health. People need such a kind of genuine information now a days to cope with modern diseases. We also to provide authentic and genuine information to people to make aware them about different disease and their causative agents.