The Nine Truths and Mortality

Again, the document of interest here is a very inspiring piece of scientific journalism titled “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders”, which predicted the directions in which research proceeded after its publication. Among the foundations of this branch of the science, we have reached Truth #6 — and this is major: Eating disorders come along with increased risk for medical complications, as well as suicide, making premature death the most significant outcome in which an eating disorder may result.

A seemingly inexplicable link

Over 20 years ago, researchers who dove more deeply into this found that for females between the ages of 15 and 26 afflicted with anorexia nervosa (AN), “the mortality rate is 12 times higher than the death rate of all other causes of death.” Overall, amid the multitude of psychiatric illnesses, the self-starvation route notoriously claims one of the highest death tolls. Even that statistic is equivocal because “one in five deaths in AN is attributable to suicide.”

In fairness, it would seem that, if any of them are deemed to be suicide, they all should be. It’s just that hanging or shooting oneself takes a lot longer than pure, classic starvation. At any rate, here is a shocker:

A large clinical study found that 35.6% of eating disorder patients had attempted suicide at least once, and patients with binge eating and/or purging behaviors were associated with an elevated risk for suicide attempts compared with patients without such behaviors.

Back then, scientists suspected a genetic basis for the “co-occurrence of eating disorders and suicide,” which is intriguing enough to break off from reviewing the past, to look up some more recent news, and indeed it is very current.

About two months ago, Cambridge University Press published a paper with a remarkably long Conclusions section. Here is an excerpt:

On a phenotypic level, we identified a common latent factor contributing to susceptibility to eating disorders and suicidal ideation, both of which also presented substantial proportions of independent variance. These findings suggest a moderate degree of shared genetic architecture, supporting the hypothesis that these conditions are partially influenced by overlapping genetic factors.

By combining observations from the genetic, neurobiological, and psychological perspectives, researchers identified in patients markers of the shared risk for eating disorders and suicidal ideation. Like never before, it became possible to begin understanding shared neurocognitive deficits. In addition, both eating disorders and suicidal ideation are influenced by environmental factors.

Among many other questions, the exploratory teams wanted to discover if eating disorders lead to suicidal ideation, or vice-versa. If there is nothing resembling a causal relationship either way, that strengthens the possibility that they “emerge concurrently from shared vulnerabilities.”

The interested scientists hoped to find numbers of individuals with “elevated genetic predisposition for the general susceptibility factor” and conduct longitudinal studies which ultimately reveal protective factors that could be used to reduce the risk of both eating disorders and suicidal ideation. This type of knowledge is expected to have powerful ethical, social, and clinical ramifications.

As if that were not enough

The following month (last month, as of this writing) saw the publication of “Genetic links between eating disorder symptoms and suicidal ideation” by Bryony Doughty, which summarizes the latest news on the heritability of eating disorders, in conjunction with suicidal ideation and behavior. Not surprisingly, the newest reports are hardly more informative than the ones a decade old or more. The whole subject has turned out to be an incredibly tough nut to crack. As an action plan, it is suggested…

[…] that mental health professionals should routinely screen for suicidality in patients with any disordered eating symptoms, even if they aren’t showing symptoms of mood disorders… For individuals struggling with an eating disorder, understanding that suicidality may have a genetic root can be validating.

Your responses and feedback are welcome!

Source: “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” NIH.gov, October 2017
Source: “Genomic links between symptoms of eating disorders and suicidal ideation,” Cambridge.org, 02/19/25
Source: “Genetic links between eating disorder symptoms and suicidal ideation,” MQMentalHealth.org, 03/17/25
Image by morganharpernichols/Pixabay

Motion Sickness and Metabolism: Surprising Brain Circuit Discovery

Motion sickness is an all-too-familiar nuisance for many travelers — affecting roughly one in three people — but what if the queasiness you feel on a bumpy ride could hold clues for something far more impactful, like obesity treatments? That’s exactly what a team of researchers from Baylor College of Medicine and their collaborators have begun to uncover.

In a new study published in Nature Metabolism, scientists have identified a previously unknown brain circuit that links the sensation of motion sickness with how the body regulates its temperature and metabolism. This unexpected connection could open the door to entirely new strategies for tackling obesity.

A personal curiosity turns into groundbreaking research

The research was sparked by a simple, personal question. Dr. Longlong Tu, a postdoctoral fellow highly susceptible to motion sickness himself, proposed studying the brain circuits behind it. His mentor, Dr. Yong Xu, professor of pediatrics and associate director for basic sciences at the USDA/ARS Children’s Nutrition Research Center at Baylor, initially wasn’t sold on the idea. Dr. Xu says,

[…] I was not very excited about the idea because it’s not one of the main interests of my lab… However, I became more interested and supported Tu’s idea when he explained the emerging evidence suggesting a link between motion sickness and metabolic balance, which is one of my research interests.

Building a mouse model for motion sickness (without the vomiting)

Studying motion sickness in mice presented a challenge: Mice can’t vomit. But the researchers found a clever workaround. Both humans and mice exhibit a drop in body temperature — hypothermia — when subjected to motion stimuli, such as back-and-forth horizontal movement. Using this as a measurable response, they developed a mouse model that could simulate motion sickness through temperature, activity, and brain monitoring.

The team discovered that motion-activated specific neurons — glutamatergic neurons — in a brain region called the medial vestibular nucleus parvocellular part (MVePCGlu). These neurons are responsible for initiating the body’s thermal response to motion, and when they were activated, body temperature dropped. What’s more, the anti-nausea drug scopolamine blocked this temperature drop, validating that their model accurately mimicked motion sickness responses.

A new frontier: The brain’s role in metabolic health

The study took an exciting turn when researchers started manipulating these neurons beyond motion stimuli. When they inhibited MVePCGlu neurons in stationary mice, the animals’ body temperatures and physical activity levels rose. Even more compelling: These mice ate more food but gained less weight and showed improved glucose tolerance and insulin sensitivity — key indicators of better metabolic health. In other words, targeting this brain circuit could potentially boost energy expenditure and protect against obesity, even in the context of increased food intake.

Rethinking the role of the vestibular system

Traditionally, the vestibular system — the part of the inner ear and brain that helps control balance and eye movements — hasn’t been a focus in metabolic research. But this study changes that narrative. “These results highlight the underappreciated function of the brain’s vestibular system in metabolic balance,” said Dr. Xu. It suggests a fascinating new angle for obesity research: treating metabolic disorders by targeting the same brain regions that trigger motion sickness.

Looking ahead

For Dr. Tu, the study is more than a scientific breakthrough — it’s personal. He hopes that better understanding of the neural basis for motion sickness could lead to improved treatments for his own condition. But now, his personal quest has the potential to impact millions of people facing challenges with obesity and metabolic diseases.

This study is a powerful reminder that sometimes the most unexpected questions lead to the most profound discoveries. And in this case, a queasy stomach might just hold the key to a healthier future.

Your responses and feedback are welcome!

Source: “Unexpected New Clues to Fighting Obesity: Scientists Identify Brain Circuit That May Help Burn Fat,” SciTechDaily.com, 4/19/25
Source: “Motion sickness brain circuit may provide new options for treating obesity,” Baylor College of Medicine, 3/24/25
Source: “Vestibular neurons link motion sickness, behavioural thermoregulation and metabolic balance in mice,” Nature Metabolism, 3/21/25
Image by Anna Shvets/Pexels

The Nine Truths, Again

The final line of the previous post mentioned “biologically-driven maintenance patterns that impede recovery,” which can be quite troublesome. Today’s post continues to examine the sections of a very long and explicit paper about nine distinct areas of concern in the overall subject of eating disorders.

This publication from the Academy for Eating Disorders, titled “Nine Truths about Eating Disorders,” points out that where hazards are concerned, sexual maturity raises the stakes much higher.

Actually, two different and contrary reactions have been observed. In acute cases of anorexia nervosa (AN) and bulimia nervosa (BN), many women have reported that during pregnancy, their illness improved or even temporarily disappeared. But at the same time, anorexic women who had already been in remission have reported that pregnancy brought on relapse.

The gravid state is also one in which binge eating disorder (BED) may present itself for the first time; and even in the absence of pregnancy, BED symptoms may fluctuate according to the menstrual cycle. Less estrogen and more progesterone might increase or even initiate the symptoms of disordered eating. Even more disconcerting for women who just want some peace, menopause can make an eating disorder come back or even start for the first time.

It is all very confusing, and if little is understood about how these processes work in females, the masculine situation is even more mysterious. Males are more elusive to study, partly because they tend to not seek help. If they do start psychological therapy or another sort of healing program, they are more likely than women to drop out.

In both sexes, with the advent of sexual maturity, the chemistry becomes incredibly complicated, and in many cases, each new discovery throws up another question, or several. To get a sense of how convoluted the whole subject is, here are a few ideas the authors proposed for further research:

— examining neuropsychologically-based treatment approaches and outcomes
— treatment matching based on phenotypic psychobiological profiles
— evaluation of childhood behavioral and neurobiological traits
— systematic reviews on altered response to food and exercise in eating disorders and brain function
— additional investigation of neurotransmitter availability and function in eating disorders

Just those few suggestions have subsequently led to deep work in the areas of the measurement and function of cerebrospinal fluid, positron emission tomography (PET scans), magnetic imaging spectroscopy, the role of neural circuitry in eating disorder risk, and postmortem brain analysis. Moving on, what these authors deem Truth #5 is a biggie:

Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.

That’s right, age provides no protection against eating disorders, which impartially strike children, elders, and everyone in between. Not surprisingly, it has been observed that “divorce, loss of family members, or somatic illness could serve as triggers.”

Researchers have meta-analyzed reports from at least 30 different countries and found that eating disorders do not discriminate against people of any particular race and ethnicity, but happily afflict people of every sort. In America, with its lavishly variegated population, some distinctions have been found. In contrast to non-Latino whites, members of ethnic minorities seem to favor binge eating. White people tend slightly more toward AN, and other small irregularities have been found, but on the whole, any eating disorder is an equal-opportunity destroyer.

Eating disorders occur in individuals of all shapes and sizes, although some unexpected oddities in the statistics do occur. Overweight and obese adolescents are prone to BN. On the other hand, “Individuals with BED are commonly overweight or obese… [Y]et a substantial minority of individuals with BED are normal-weight, particularly early in the course of illness.” Again, every answer seems to spawn more questions, some of which get stuck for a long time in the category of appearing unanswerable.

Another area of extreme complication exists in the realm of sexual orientation and gender. Even socioeconomic status insists on being a mystery, with “no consistent association” between fiscal security and eating disorder occurrence. The numbers may be there, but the reasons for them are often obscure. Just when researchers seem to have something figured out, along comes another study to upset the academic applecart.

As research findings shift like the ever-changing patterns inside a kaleidoscope, certainty remains elusive. One thing the authors know for sure is that, in quite a few areas, many more longitudinal studies are needed, and they of course cannot be arbitrarily hurried, so a lot of answers are destined to remain cloudy for quite some time.

Your responses and feedback are welcome!

Source: “Source: “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” NIH.gov, October 2017
Image by geralt/Pixabay

The Nine Truths, Continued

Moving on to the third major point made in a very thorough article, first mentioned in the previous post, we need to understand that while an eating disorder may appear to be only a minor personality dysfunction, it might need to be looked at more closely. The issue could either already be — or could have the potential to blossom into — a serious health threat “the effects of which disrupt functioning beyond immediate complications of the eating disorder.”

Especially in uncertain times, it is important to understand that, treated or untreated, an eating disorder will be expensive. When people reach an age where reproductive health becomes an issue, more costs are involved, both financial and otherwise. Still, many negative outcomes can be avoided — which is why, for instance, Childhood Obesity News is interested in alerting parents and professionals to the potential benefits of Brainweighve, because, let’s face it, prevention is so much more efficacious than cure.

Did someone say “multifactorial”?

Truth #4 on the Academy for Eating Disorders list reminds us that no one chooses to suffer from an eating disorder. Even when they themselves may believe they volunteered for it and are consciously running the show, the problem is now understood to be basically organic.

In vulnerable individuals, biological drives towards automaticity can provoke rigid habits to the point where individuals struggle to regain control over their dysregulated eating and physical activity.

We are also reminded that the miraculous human mind can mess with its owner 24 hours a day for years without ever taking a vacation. Still, not everything operates in the psychiatrist’s realm. The authors here state that eating disorders, other habit-related malfunctions, and addiction all are generated by “some shared neurobiology.” Biologically and genetically influenced risk factors are associated with fundamental personality traits and cognitive styles.

Despite how sincerely they might believe they are the captains of their own fate, people affected by these problems are generally kidding themselves, and do not actually have a choice. They may need to pretend to themselves and others that it is all voluntary, because that is less frightening than to acknowledge that all semblance of control has been lost.

In diagnosing and treating these disorders, the authors mention underlying conditions as variations in individual neurobiology, such as “dysregulation in neurotransmitter availability and function.” In other words, an unrecognized factor or factors could be messing with the production of such essential substances as dopamine and serotonin. Here is the problem:

These systems are central in rewarding aspects of food, motivation, executive functions, and the regulation of mood, satiety, and impulse control.

There are differences between people who suffer from active eating disorders, and those who do not. Brain anatomy might be a factor, and so might various aspects of the brain’s operation, affecting emotional processing and cognition, among other functions. This applies especially to teens because:

A maturing brain may be particularly vulnerable to the insults caused by extreme food restriction or excessive exercise resulting in negative energy balance or highly variable energy consumption (binge-fast cycles).

The intellectual workers in this field are comfortable with the idea that the tendency toward eating disorders is biologically influenced, because in animal research subjects it is so obvious. Sure, humans are more complicated than lab rats, but sometimes not by much. Throughout the kingdom of warm-blooded creatures, brain structure and function are responsible for “biologically-driven maintenance patterns that impede recovery.”

Your responses and feedback are welcome!

Source: “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” NIH.gov, October 2017
Image by actaylorjr-6170605/Pixabay

New Canadian Guideline Promotes Patient-Centered Care for Childhood Obesity

A newly released guideline for managing obesity in children and teens encourages a patient-centered approach that prioritizes behavioral and psychological support — with a focus on outcomes that matter most to young patients and their families.

Published in the Canadian Medical Association Journal, the guideline is based on the latest research and was developed by Obesity Canada after a four-year collaborative effort. The process involved adolescents, caregivers with lived experience, health professionals, researchers, and more than 50 experts from various fields. It couldn’t come soon enough, too, since the last guideline was published in 2007.

Dr. Bradley Johnston, co-chair of the guideline committee and associate professor of nutrition and health research methods, explained that the goal was to support shared, informed decision-making by providing clear summaries of scientific evidence. The team prioritized outcomes such as mental health, quality of life, cardiovascular risk factors, and avoiding harm.

Pediatric obesity is recognized as a complex, chronic, and often stigmatized condition that can lead to more than 200 related health issues. In Canada, nearly one in four children under 12 and one in three teens between 12 and 17 have a body mass index (BMI) considered overweight or obese. Globally, severe obesity in youth is on the rise.

Dr. Sanjeev Sockalingam, scientific director at Obesity Canada, emphasized that long-term success depends on accessible, family-focused care that helps children build and maintain healthy behaviors. When appropriate and available, this may include medications or surgery.

The guideline outlines 10 core recommendations, covering nutrition, physical activity, psychological therapies, technology-based tools, medications, and surgery. It also includes nine good practice statements, with an overall recommendation to combine at least two intervention types for the best outcomes.

Lisa Schaffer, executive director of Obesity Canada, stressed the urgency of early intervention. She said:

Delaying care until adulthood increases the risk of complications and deepens the effects of living with a stigmatized chronic condition.

To support implementation, Obesity Canada has created educational tools such as infographics and videos to guide healthcare providers and families in choosing the most effective treatment paths for children struggling with obesity.

This is where GLP-1 receptor agonists also come in

Simply telling kids to “eat less and move more” doesn’t work on its own, says Dr. Sockalingam. He says obesity should be treated like any other complex chronic disease — with a range of tools.

Among those tools are medications like GLP-1 receptor agonists — including Ozempic, Mounjaro, and Wegovy — which mimic a natural hormone to help manage appetite and blood sugar. While only some of these are approved in Canada for obesity, the guidelines suggest they could be considered in specific cases, along with bariatric surgery, especially when serious health complications are involved.

Dr. Jill Hamilton, who co-authored the new guidelines and leads endocrinology at the Hospital for Sick Children, acknowledges more research is needed — particularly around the safety of medications like GLP-1s for younger patients. Ultimately, treatment decisions must respect the values and preferences of families.

Your responses and feedback are welcome!

Source: “Treat childhood obesity by reducing stigma, adding options, say new Canadian guidelines,” CBC News, 4/14/25
Source: “Health Matters: Child obesity treatment guide updated,” Global News, 4/14/25
Source: “A patient-centered approach for managing obesity in children and adolescents,” Medical XPress, 4/14/25
Image by Наталия Игоревна/Pexels

Nine Truths to Build On

A few years back, the Academy for Eating Disorders published a list of nine facts about such ailments. While, of course, plenty of work has been done in the interim, and many discoveries have been made, it is interesting to look back on this document created by 19 authors from three institutions of higher learning, two of them European and one American.

The very first fact mentioned is that many people who suffer from eating disorders may appear healthy, as in “no big deal,” while they are nevertheless quite sick. The problems exist in three different areas: the body, the mind, and the person’s interactions with society in general. To break it down even further, the somatic risks show up in “multiple organ systems including the cardiovascular, gastrointestinal, musculoskeletal, dermatologic, endocrine, hematological, and neurological,” while psychological/psychiatric difficulties present further potential for malfunction.

To complicate matters even more, the affected person’s appearance is not always a clue to the underlying problem. Someone who engages in restrictive eating might look emaciated; on the other hand, their physique might be quite hefty. Neither bulimia nor binge eating can be deduced from an individual’s looks, either. It is important to not make assumptions without evidence.

Another fact is that the majority of people troubled by eating disorders cope on their own, or simply give up, and never even seek treatment. They might keep the problem a secret for years, fooling family members, friends, medical personnel, and even themselves.

Old assumptions die hard

Premise #2 is, no one should leap to the conclusion that family malfunction is the cause. Fault does not always lie with the parents, and, in fact, a child’s eating disorder, especially if it becomes life-threatening, can bring a lot of stress into the family dynamic. Caregivers may be in for a rough ride, especially when the troubled person is anorexic. Parents might suffer “higher levels of distress than individuals caring for patients with psychoses.”

On the other hand, once the “identified patient” is under treatment, attention must also be paid to educating the caregiver/s in self-care, to prevent further erosion of the overall situation. This sounds distressing, but it is very positive news because, in contrast, the historical fact mentioned in a recent post, a “parentectomy” is no longer considered the first, best course of treatment for anorexia.

Start with the positive

In fact, family-based treatment has proven to be very effective, particularly in cases of anorexia. The first step is to help the older members recognize the knowledge and skills they already possess as a strong basis on which to build. When the affected person is an adult, a couple-based intervention can be successful, and might begin with teaching the well partner how to overcome the fear of making the situation worse with inappropriate actions or words.

Up to that point in the history of understanding such illnesses, family-based success had mostly been achieved in cases of anorexia. The study’s authors urged much more research into how BN (bulimia nervosa) and BED (binge eating disorder) could be affected. Still, no matter how good the intentions and how ambitious the family-based treatment may be, the functioning of the family as a whole, in addition to the well-being of individual members, cannot help but be affected.

In particular, there may be an unavoidable financial burden. For teenagers, dealing with these matters as either the identified patient or as a relative can add extra stress to the already multitudinous problems of adolescence. For adults, the more obvious areas of difficulty are intimate relations and reproductive health, as well as adaptation to the theory and practice of new parenting skills.

This should go without saying…

In the realm of family, it ought to be very obvious that prevention is much preferable to intervention. To raise healthy children is such a difficult undertaking, parents ought to have access to comprehensive training — early and often. If for any reason such education is not provided by official entities, perhaps this is a signal that groups of other types need to step up and take responsibility for offering solid advice and practices under which children can flourish.

Your responses and feedback are welcome!

Source: “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” NIH.gov, October 2017
Source: “Identified Patient Psychology: Unraveling Family Dynamics and Treatment,” NeuroLaunch.com, 09/15/24
Image by pixelRaw/Pixabay

Around the World With BED

Binge Eating Disorder has made some astonishing strides in the past few years. First, we go back a decade to an article titled, “11 Countries with the Highest Rates of Eating Disorders in the World.”

At that point in time, it was already impossible to ignore the influence of media on the behavior of people, especially young ones. The author noted that about 50% of teen girls and 30% of teen boys were restricting their diets in some way, with weight loss as the goal. Of those dieters, it was estimated that around one-quarter of them eventually wound up with eating disorders. Worse yet, at best guess, most of them never tried to get treatment.

As one of the 11 countries most troubled in this way, the piece surprisingly named Bangladesh, which had in 1974 attracted world attention and aid because of famine conditions that killed as many as a million and a half people. Given that history, it stretches the imagination to picture the inhabitants suffering from any sort of eating problem other than starvation.

Really?

That Vietnam, Pakistan, and Indonesia would be named as prominent eating disorder hotspots is also disconcerting. Another surprise to find in this category at the time was Brazil, with around 37% of its teenagers into binge eating, and almost one-quarter of them being “serial dieters.”

At around the same time, a WHO survey of world mental health noted that very few countries other than the United States even kept track of Binge Eating Disorder (BED), and that fewer than half of either BED or bulimia nervosa sufferers ever received treatment. Apparently, BED was not at the time regarded as a very serious problem, but the authors of the document warned that in terms of public health, it mattered at least as much as bulimia. They added,

Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.

In 2021, a specially-purposed world map designed to indicate the spread of only two disorders, anorexia nervosa and bulimia nervosa, was published. It showed Australia as the undisputed winner, with about 2% of the country’s population suffering from one or the other.

All over the place

When researchers want to know about the prevalence of binge-eating disorder in various parts of the world, a number of questions immediately present themselves. How should the areas be differentiated? Strictly by national borders? That would be the easiest way, because research tends to be done, if at all, by a particular country’s academic and scientific establishments. Or does it make more sense to categorize unhealthy people by race? By political dogma? By religion? By language? By gender and/or sexual orientation?

A recently published cross-cultural study, with the goal of setting up a standardized framework for assessing Binge Eating Disorder, stated that it…

[…] aimed to evaluate the reliability and validity of the Binge Eating Disorder Screener-7 (BEDS-7) across 42 countries and 26 languages, assessing its reliability and validity […] in diverse cultural contexts.

The researchers note that BED, which is associated with non-trivial risks to psychological and physical health, is ”often underdiagnosed across diverse cultural and clinical settings.” Furthermore, most people who have it do not seek treatment directly for the condition itself, but look first for help with other physical and mental disorders. Along with depression and anxiety, individuals with BED also tend to have histories of substance use (or abuse). The authors note,

When translating and applying questionnaires measuring eating disorders across different cultural contexts, challenges arise due to varying cultural norms related to food, body image, and mental health, which can affect how individuals interpret and respond to questions.

Additionally, there is the fact that many people with disordered eating behaviors do not know it. Women may think it is perfectly normal to obsess over their bodies. Men may believe it is unmasculine to even think about such issues. Researchers also find that, depending on which country information is gathered from, certain groups are under-represented. People with more education and less self-consciousness about their sexuality, for instance, tend to show up for surveys and reply to questionnaires.

Your responses and feedback are welcome!

Source: “11 Countries with the Highest Rates of Eating Disorders in the World,” InsiderMonkey.com, 06/12/15
Source: “The prevalence and correlates of binge eating disorder in the WHO World Mental Health Surveys,” nih.gov, 05/01/14
Source: “Eating disorders prevalence, 2021,” OurWorldInData.org, 2021
Source: “Cross-Cultural Validation of the Binge Eating Disorder Screener-7 (BEDS-7) Across 42 Countries,” Wiley.com, 03/05/25
Image by Mohamed Hassan/Pixabay

Social Media Encourages Eating Addiction

A new international review has shed light on the extensive and often subtle ways that social media platforms expose children and teenagers to ultra-processed food marketing, raising serious concerns about its impact on youth health and global childhood obesity trends.

Published in BMJ Global Health in February 2025, the study highlights how the digital environment is saturated with advertisements for foods high in sugar, salt and fat. These ads, frequently integrated into entertainment content, are designed to be persuasive and often go unnoticed by young audiences. From breakfast cereals and cookies to soft drinks and fast food, unhealthy food promotions are a constant presence in kids’ online lives.

The report examines 80 previous studies involving nearly 20,000 children and teens and shows a strong link between exposure to digital food ads and increased consumption of unhealthy foods. Children not only crave these items more but also pressure their parents into buying them. One study cited revealed that junk food promoted by influencers notably increased immediate food consumption among children aged 9 to 11, unlike healthy food promotions, which had little impact.

Unlike traditional media, social platforms such as TikTok, YouTube and Instagram tailor content using algorithms based on user behavior. Ads are cleverly disguised within games, quizzes and videos, making them difficult for young users to identify as marketing.The researchers noted,

Digital marketing strategies are nearly universally effective in shaping young people’s eating habits and encouraging the consumption of unhealthy foods.

Social media as a commercial determinant of health

The review adds to growing evidence that social media functions as a commercial determinant of health (CDoH), comparable to industries like tobacco and alcohol. These platforms not only facilitate food marketing but also shift public perception and promote corporate agendas.

In the U.S., over 95% of teens have access to a smartphone, and more than a third report near-constant social media use. In the U.K., most children have a phone by age 11, and even children as young as five to seven are active online. Australia recently introduced a ban on social media use for children under 16, reflecting rising concerns.

Researchers note that just like other health-harming industries, the food sector uses social media to resist regulation, co-opt health language, and reshape public discourse. For instance, Australian studies found that processed food companies actively lobbied against public health policies on Twitter while pushing for voluntary measures and using misleading narratives.

This review is the first to focus on how these marketing tactics target youth, deepening health inequalities and contributing to rising rates of non-communicable diseases (NCDs) such as diabetes and heart disease.

Youth flooded with food ads daily

The research team, made up of experts from the U.K., Canada, and New Zealand, analyzed 36 studies and editorials published between 2000 and May 2023. They found that exposure to digital food marketing differs by country, age, and gender.

For instance:

  • In Mexico, children were shown an average of 2.7 food ads per hour on weekdays.
  • Australian teens were exposed to roughly 168 food promotions weekly via mobile devices.
  • In Canada, 72% of youth ages 7-16 saw food marketing within 10 minutes of opening their favorite apps. Of all food ads on popular children’s sites, over 93% promoted high-fat, salty, or sugary products.

Boys were more often targeted with ads centered around sports and performance, while girls received more interactive content, such as quizzes and polls. The platforms often gather and sell user data to companies that harm public health, further complicating efforts to track or regulate ad exposure.

Teenagers, in particular, face the greatest risk, with many studies pointing to a correlation between food marketing, poor body image, and disordered eating patterns. Brands also quickly adapt their marketing strategies to current events. During the COVID-19 pandemic, 14 of the top 20 unhealthy food brands in New Zealand released pandemic-themed promotions to stay relevant.

 WHO and researchers call for stronger regulation

The World Health Organization (WHO) has long warned that aggressive food marketing negatively affects children’s dietary habits. In 2023, it urged countries to adopt strict mandatory rules to shield children from advertisements promoting foods high in sugar, salt, and unhealthy fats.

The current review echoes that call, emphasizing that voluntary industry standards have largely failed. Many current policies don’t reflect the complexities of digital advertising or cover adolescents, who are heavy users of online platforms but often fall outside regulatory definitions of “children.”

In the U.S., regulatory challenges are compounded by First Amendment protections of commercial speech, limiting the government’s ability to restrict harmful marketing practices. Tech companies are even pushing back against state-level efforts—such as Florida’s social media age restriction law — designed to better protect minors.

Researchers stress that traditional rules designed for TV and print media won’t work in today’s digital ecosystem. Instead, they advocate for updated approaches tailored to social media’s unique environment.

 Key recommendations from the study:

  • Define what counts as child-targeted marketing in digital spaces
  • Coordinate internationally to close legal and regulatory gaps
  • Introduce mandatory restrictions on unhealthy food ads targeting minors
  • Implement media literacy programs to build youth awareness
  • Establish better tracking systems for monitoring digital ad exposure

While parental involvement is vital — particularly in teaching children how to recognize and question digital marketing — the authors say structural reform is essential.

“Parents and caregivers should push for policy change,” the study concludes. “Social media is deeply woven into young people’s daily lives, and recognizing the health risks posed by the digital food environment is essential to improving outcomes for children and teens globally.”

Your responses and feedback are welcome!

Source: “Social media is fueling the childhood obesity crisis, global study warns,” U.S. Right to Know, 4/8/25
Source: “The impact of the social media industry as a commercial determinant of health on the digital food environment for children and adolescents: a scoping review,” BMJ Global Health, 2/19/25
Source: “Teens and Internet, Device Access Fact Sheet,” Pew Research Center, 01/05/24
Image by Tim Gouw/Pexels

Binge Eating — What’s the Problem, Anyway?

Why is binge-eating disorder such an easy trap to fall into? An argument could be made that this is how humans were naturally trained to eat, far back in antiquity. When hunter-gatherers roamed the earth, there was no other choice. If a large animal could be brought down, sliced up, and cooked, everybody had to gobble up as much of it as possible, right there on the spot.

There were no refrigerators, and even people who never went to college can figure out that after a while, meat goes bad and makes them sick. Gathering, or reaping fruit, vegetables, and grains worked the same way. When some fruit was in season and people found a tree full of it, what else could they do but grab as much of the bounty as possible and keep their systems stoked with it until the next lucky find appeared? When food presented itself, hungry people ate while the eating was good.

It probably should not be surprising that many humans feel the ancestral urge to fill up whenever we can. Some of us are still in the situation of being forced to eat whatever is available, because of uncertainty over when another chance will occur. But millions upon millions of us are not in dire circumstances, and do not have to gorge just in case there is nothing to eat tomorrow. So let’s look at why this habit is so destructive.

Registered dietician Elyse Resch lists seven excellent reasons why anyone embroiled in a binge-eating pattern would do well to get a clue and make the effort to stop the habit. A very valid reason is that it interferes with sleep. First, it might take longer to fall asleep, but then you might wake up feeling thirst, or the jabs of acid reflux, or the simple local discomfort of a distended belly.

The second reason is very important because a condition is created in which we cannot trust the signals sent by our own bodies via the appetite hormone ghrelin or the fullness hormone leptin.

Studies show people who frequently binge-eat have lower levels of ghrelin and have difficulty responding to hormones in general. Binge-eating on a regular basis makes it harder for your body to figure out if you’re still hungry, or satiated.

The third reason is that the postprandial surges of glucose and insulin can interfere with the body’s immune system and make us more vulnerable to colds and other infectious conditions.

Next, the American Psychological Association has determined that, as with alcohol and some drugs, a food overdose can put the brain into a state of oblivion that allows the eater to escape self-awareness. Needless to say, this happens at a time when the brain most needs to be asking, “Hey, what the heck am I doing?”

The binge eater’s goal is to induce a state of peaceful relaxed bliss, but the body knows enough to reach for homeostasis, or balance. It attempts this by producing stress hormones, which in turn speed up the heart rate and produce anxious sweat, along with unpleasant irritability, and lethargy — an emotion qualitatively different from peaceful relaxation.

After consumption of a bunch of simple carbohydrates and sugar, the pancreas leaps into red alert mode trying to compensate by producing enough insulin to cope. This is a further deterrent to the body’s preferred state of homeostasis.

A reasonably balanced meal induces the brain to release dopamine, which is fine, but after overeating becomes habitual, the brain struggles to catch up and needs more and more fat and sugar input to pump out the dopamine reward. Gradually but inevitably, overeating becomes over-overeating and over-over-overeating.

Bonus list

Also from BestHealthMag.ca, here are the warning signals that a person is consuming too much sugar. Does anything strike a familiar note?

1. An acne breakout
2. A mid-day energy slump or headache
3. Dental cavities
4. High blood pressure
5. High cholesterol
6. A post-exercise energy crash from using simple sugars for fuel
7. Clothes that used to fit are too tight
8. Depression caused by systemic inflammation
9. The body doesn’t get the message that food has been taken on board, and doesn’t “feel full.”

Your responses and feedback are welcome!

Source: “7 Reasons to Stop Binge-Eating,” BestHealthMag.ca, 07/16/19
Source: “9 Clear Signs You’re Eating Too Much Sugar,” BestHealthMag.ca, 01/03/17
Image by The Digital Artist/Pixabay

Monkey See, Monkey Do

In an earlier post, the question about learning came up. Does someone with an eating disorder discover the lifestyle on their own, spontaneously? Or do they absorb the concept, either covertly or openly, from an older relative, or from a peer, or from the older relative of a peer? Or read about it in a novel, or see a TV show?

Of course these questions are already archaic, because now this dangerous information is easy to pick up from social media and other internet sources. But in the old days, how might someone have stumbled onto the idea of, for example, habitual vomiting as a method of weight control?

In the close confines of the family environment, a child can hardly avoid noticing behaviors associated with eating disorders. The thing about children is, they not only notice things, but assume that what they see at home is how things are supposed to be. By and large, it is helpful to society for children to make this assumption. Babies are born fully prepared to look at and imitate the older humans in their environment who take care of them. Parents, older siblings, and other relatives are expected to be role models, who demonstrate to babies how to form themselves into people.

Children have eyes and ears

In the past, a typical one-family home or apartment would only have one bathroom. What on earth was Aunt Cindy doing, spending so much time in there? How many moms spent extra moments in the basement, next to the wringer washing machine, throwing up into the utility sink?

What other behaviors could be discovered or learned? How many teenage girls have appreciated the convenience of making unwanted food disappear into the mouth of the family dog? And if kids don’t pick up eating disorder behaviors from grownups, how do those notions originate? For instance, is throwing up after meals, like masturbation, a behavior that any child can eventually discover on their own, without witnessing a demonstration?

A bit of history

Bulimia nervosa has been described as “insatiable waves of overeating followed by compensatory methods,” driven by the irresistible urge to overeat that is in constant conflict with the fear of obesity. Once bulimia was formally introduced into the medical literature, many more cases were identified and diagnosed, as might be expected. In successive editions of Diagnostic and Statistical Manual of Mental Disorders, as well as other literature, definitions were characterized according to the frequency with which patients employed compensatory behaviors. This fine-tuning allowed cases to be sorted into the categories of mild, moderate, and extreme.

It appears that bulimia usually kicks in at the age of 16 or 17, and the author mentions the unexpected detail that “the rates are highest among the Hispanic/Latino population, second highest among African-Americans and lowest in non-Latin whites.” (Anorexia, on the other hand, is most prevalent among non-Latin whites.) Elena Bowie writes,

Studies have found that eating disorders are inheritable, in addition to several other parental factors that can influence the susceptibility of developing an eating disorder, like parental mental illness or parents with negative views of weight…

To diagnose bulimia may be difficult because patients “are likely to hide their symptoms and physical signs are usually absent.” Often, the evidence is provided by parents or other people in a position to notice changes in behavior. Some of them notice the signs because they have had personal experience with an eating disorder, and have overcome the urge to make it a lifestyle. The author cautions,

The most important thing to take note of is that recovery from Bulimia is not a one size fits all approach and requires careful planning of the physical, psychological, and social needs to create the best possible chance for recovery.

Your responses and feedback are welcome!

Source: “History of Bulimia nervosa,” Emory.edu, 04/01/21
Image by Shutterbug75

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources