Thin is definitely not in -- especially during Eating Disorders Awareness Week.
The importance of the week becomes increasingly obvious as photos of bone-thin celebrities crowd magazine pages.

The condition, which is actually a mental illness, affects more than just the rich and famous: The American Psychiatric Association estimates that 8% of women suffer from either anorexia or bulimia.

A study of Ontario girls aged 12 to 18 showed that 27% of them engaged in problematic food and weight behaviours. And according to the Canadian Paediatric Society, eating disorders are the third most common chronic illness in teen girls.

Eating disorders are complex and include anorexia nervosa (an obsession with controlling one's food intake), bulimia nervosa (cycles of binging and purging), anorexia athletica (compulsive exercising), and binge eating (overeating to comfort oneself or to compensate for having gone on an extreme diet.)

"There is a belief that eating disorders are a choice, rather than an illness," says Dr. Kelly Klump, associate professor of psychology at Michigan State University.

"You'd be hard-pressed to find people who thought that a mental illness such as schizophrenia was a choice. But there are plenty of people who say that eating disorders are -- that there isn't any biological risk for that disorder and that it is just about girls who want to look skinny."

Unlike other illnesses, eating disorders don't prompt much sympathy: "Why doesn't she just eat?" is a common response to hearing that someone (and it's usually a woman) is dangerously thin.

The field of eating disorders has had a history of parent-blaming, Klump adds. "But new research tells us that there is a genetic component to eating disorders and regardless of what you may have done as a parent, your child may have an increased risk brought about by lots of different factors."

The media has also been attacked for promoting ideals of beauty: To be thin is in, and is reflected in celebrities, fashion models, dress sizes (there is now a size 0), the diet industry and body image pursuits that include ballet and gymnastics.

Klump, who is also past president of the Association of Eating Disorders, an international group of experts who do research and advocacy work in the field (see www.aedweb.org), says that the nature versus nurture argument as to what causes an eating disorder is ongoing.

"When we say there are genetic factors for eating disorders, we mean that some individuals have an increased probability because they have a certain set of risk genes," Klump explains, adding that her own studies into twins have shown that identical twins are more alike in either having or not having an eating disorder compared to fraternal twins.

"Genes set the stage and if that person encounters environmental factors -- let's say she starts ballet age three, then there's pressure on her to be thin as a teen -- then those environmental factors may trigger the genetic predisposition to an eating disorder."

Whatever the cause, Anne Elliott, director of programming at Toronto's Sheena's Place, says that people are often reluctant to admit they have a problem. "Sheena's Place offers a weekly drop-in for people to learn more about eating disorders and our services," she says; theirs is a holistic healing model that integrates mind, body and spirit.

Eating disorders affect people of all ages, and recovery programs at Sheena's include body image, support, expressive art and skill building groups. "Once people find their way to Sheena's, they feel part of a healing community," says Elliott.

"We know that the sooner someone can seek help, the better their chance for an early recovery."

Marilyn Linton, The Toronto Sun, February 17, 2009