April 22, 2012 Nataliya Schafer

Hard to Swallow

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Should there be media guidelines in Canada for reporting on and discussing eating disorders?

Aimee Moore, a 28-year-old woman from Stratford, Ontario, walks on to the stage of the Dr. Phil show in January 2008. Just before Moore came onstage, the crowd was shown a long tape of what a day in her life is like. In the tape they saw Moore gagging and vomiting into a garbage can, poking and prodding at her nearly naked, emaciated body, and weeping in a hotel bed as she describes her daily binge-purge routine.

Dr. Phil McGraw asks Moore how many times she hadthrown up that day. “About 40,” she says quietly. “You’ve purged 40 times today?” McGraw looks at his watch. “And…we’re not to noon yet.”

Conversations about dieting and weight loss surround us in the media. But Moore’s tale, and others like hers, is not a success story about weight loss and willpower. It is a narrative about eating disorders, a serious mental illness. They affect an average of 3.5 percent of Canadian women between the ages of 15 and 25, and have the highest mortality rate of all mental illnesses—between 10 and 20 percent die from related complications.

When talking about eating disorders, we have to seek out the uncomfortable, personal details in order to tell the whole story. But sometimes these accounts can turn into dangerous tools if they come into the wrong hands, like somebody struggling with a mental illness.

Where does that leave journalists? We have an obligation to share the little details, but what are we to do when they could possibly cause harm?

When not covered with care and attention, stories on eating disorders can unintentionally glorify certain behaviours without analyzing the causes and the bigger issue. They can also provide “useful” tips and tricks to people who may be at risk of developing an eating disorder, according Julie Notto, a program manager at a community-based support centre, Sheena’s Place, in Toronto, for individuals dealing with eating disorders and those close to them.

The Canadian Psychiatric Association (CPA) and the Canadian Mental Health Association have both published guidelines for the media about how to report on suicide, in the hopes that they will reduce the risk of copycat incidents.

The guidelines say not to sensationalize suicide by showing dramatic photos, to avoid technical details about the suicide, and to avoid presenting it too simplistically. Yet, often in stories about eating disorders there are stark images of a skeletal person accompanied by details about how many calories she eats a day or how much she weighs. If not reported with care, articles about eating disorders can suggest the issue is a simple desire to lose weight.

The similarities between the concerns about reporting on suicide and eating disorders raise a question: Should there be guidelines in Canada for journalists about how to responsibly cover eating disorders?

Sandy Ace, a registered dietician and nutrition counselor at University of Waterloo, thinks so. “To me, it’s like providing suicide tools for someone who is suicidal when you report about someone’s diet. You’re not reporting on how someone committed suicide because you don’t want to give anyone who may be in that framework any more ideas; you should be doing the same thing with eating disorders.”

Those with eating disorders have a high suicide rate and the highest mortality rate of all people with mental disorders, a fact that became all too real for Ace several years ago when she lost a student she was counselling to suicide. “People with eating disorders are either passively killing themselves by starving, or some are killing themselves actively by committing suicide. The results are just as deadly.”

Notto of Sheena’s Place has noticed the lack of official guidelines released in Canada for reporting on eating disorders. “There are standards when it comes to reporting on suicide, but when it comes to eating disorders we’re still blaming the victim.”

Guidelines do exist in other countries. In the United Kingdom for example, Beat (Beating Eating Disorders), a national charity, has published guidelines that are similar to the CPA’s for reporting on suicide, in that they recommend against oversimplifying and focusing on more graphic details, and also challenge the media to dispel the myths and stigma that surround eating disorders.
“People with eating disorders speak about being ‘triggered’—how their eating disorder behaviour and negative mental state can be stimulated, encouraged or reinforced by certain words, images or situations,” the guidelines say. They also recommend omitting specific weights, amounts eaten, images, oversimplification, dramatic portrayal of eating disorders, and/or portraying them as indicative of a certain kind of character (manipulative, deceitful, vain, et cetera).

Eating disorders associations in Ireland, Australia, and the United States also have guidelines on their websites, but none have received significant support from the media in any of their respective countries. Kathy English, the public editor at the Toronto Star, says that’s not because they are a bad idea, but that it’s a bit of a grey-area issue for journalists.

“Journalists deal with specifics and specific details. The debate here is [when discussing specific actions or details], that’s a fact, that’s what happened. That’s also in conflict with how we tell journalists to get as much detail as possible because the story is in the details. We’re not in the business of hiding facts.”

When any guidelines are issued regarding reporting on any topic, media outlets and reporters are not under any obligation to follow them. Whether a reporter adheres to any guidelines, even when reporting on suicide, depends on her editor or her employer’s standards and policies. “What’s more important is that all of the qualities of responsible journalism are followed and aligned with journalistic standards around fair and accurate coverage,” says English.

Every reporter and her editors struggle to find that balance between informative reporting and being sensitive in any story about a stigmatized subject. But every editor has different views and, as a result, what is deemed appropriate for a certain publication is pointedly subjective, says Joanna Frketich, a health reporter at The Hamilton Spectator.

As an example, she cites Beat’s guidelines, which advise against printing photos of someone with a severe eating disorder and writing about her weight loss and daily caloric intake. Frketich says including these elements can actually help to erase stigmas associated with certain topics.

Frketich and English also say the key to writing about any mental illness is putting things in context. For example, when writing a story about an eating disorder that includes details about that individual’s calorie consumption, how much weight she lost, and what she did in order to lose that much weight, journalists must also describe the effects that lifestyle had on her physical, mental, and emotional health; what it did to the people around her; why this person behaved the way she did; and how eating disorders develop and their long-term effects. The same rules should be followed when reporting on any health issue that can or used to be stigmatized like suicide, schizophrenia, depression, or cancer.

“A lot of stigmas come around from people not really understanding a topic or an issue. So I think when you show a picture of someone that looks like a skeleton and you write how much weight they lost and how few calories they eat a day, and the ravaging effects that had on their bodies, and then you tell people that when that person looked in the mirror, they still saw fat…. That really drives home to you that this is an illness,” says Frketich.

She adds, “It always comes back to who are you writing for, and without a doubt that’s just the way it is in journalism. There will never be a perfect match between what organizations would like to see [in the media] and what journalists do because we serve different purposes.”