Madam Chair and members of the committee, thank you for the invitation to be part of your meeting today. It is truly an honour.
My name is Noelle Martin. I am a private practice dietitian and also a part-time professor at Brescia University College at Western University in London.
In my private practice, I have worked with individuals across the lifespan. However, more recently I have worked solely with university-age clients. I have had an interest in eating disorders for over 20 years, but my direct work as a dietitian with individuals with eating disorders has been done over the past seven years. I feel that I have learned as much from my clients as I have from reading research articles and books, attending conferences, and touring treatment facilities.
In the world of eating disorders, we often talk about “the voice of ED”. ED is the voice that tells a person with anorexia nervosa that they would be a better person if they could just cut their food intake down a little lower or if they could have a flatter stomach. The problem is that ED is never satisfied; it is never enough, to the point of death. Anorexia nervosa has the highest mortality rate of any mental illness. It is estimated that 10% of those diagnosed with anorexia nervosa will die within 10 years of diagnosis.
For a person with bulimia nervosa, ED is the voice that punishes them for giving in to eating after a time of restriction, resulting in a purge that's usually through vomiting or exercise. There are endorphins released when we vomit or when we exercise. For a person with bulimia nervosa, there is a—quote, unquote—stuff-and-release phase. The binge phase is the stuff, and the vomit or the exercise is the release. As endorphins are released in the brain, the individual feels calmer, and for a moment, everything is okay. Eventually, the binge phase may disappear and the purge phase is used over and over again, because the brain needs more and more endorphins released as it is desensitized to the original amounts.
When looking at the prevention of eating disorders, we're looking to never let the voice of ED be heard. In treatment, we try to empower the client to have a stronger voice than ED.
As you may have heard from previous witnesses, the cause of eating disorders is multifactorial. Eating disorders are mental illnesses related to one's relationship with body, food, and others. We know that there's often a genetic link that I think of as a ticking time bomb. Then, we have social, cultural, and environmental factors that may cause the gene to be expressed. For example, it could be a comment from a parent, friend, coach, or teacher that triggers a new thought in one's mind. It could be an article in a magazine, a commercial, or the content of a movie or a show. It can be obvious, or it can be very subtle.
We cannot pinpoint just one thing that is the cause for eating disorders. Because of this, we need to look at prevention strategies that target a variety of areas.
We can use our learning and attitudes about other illnesses when looking at eating disorders, from prevention, to causation, to treatment.
For example, if we only targeted cigarette smoking in cancer prevention, we would only be increasing awareness that smoking may lead to cancer. Instead, we see programs to raise awareness around many possible causations, as well as possible prevention strategies. We need the same for eating disorders. In this light, a diagnosis of cancer cannot always be blamed on the same factor, or on one factor alone, similar to what I have just described with eating disorders.
Thirdly, when a person is diagnosed with cancer, people do not say that “it's all in your head” or to “just get rid of it”, as we sometimes hear with the diagnosis of eating disorders. Rather, they're encouraged to pursue treatment and are offered support. We need the same response and attitude for those who are diagnosed with eating disorders.
With respect to treatment, it is a patient's choice for all illnesses—or at least most—as to what route they will take. Eating disorders are included in this.
If one is diagnosed with cancer, one may be given treatment options such as surgery, chemotherapy, radiation, etc. The person is usually motivated to try to beat the disease if possible. For a client with an eating disorder, this choice is hard. It is difficult to realize that the disease is killing them, because at first it gives them such a sense of control. The loss of control that follows can give them a sense of despair, leaving them unsure about where to turn or what they can do.
The voice of ED is so loud at times that it governs all of their decisions, including whether to choose a path that will lead to a longer and healthier life. It is a heartbreaking battle to watch. In light of the analogy mentioned above and the multifactorial causes of eating disorders, when we look at prevention of eating disorders we need the spectrum to be open beyond reaching those who may develop an eating disorder. Educating parents, coaches, and teachers is essential.
For example, education about ways of how to talk to children in a positive manner with respect to normal growth patterns, the normality of differences between all bodies, and the importance of nourishing our bodies respectfully.... Further to this, as a society we need to focus on getting a better relationship with food and with ourselves. Simple things like not looking at food as good or bad, but rather choosing healthy food more often and treats in moderation.... Phrases such as, “I was so bad today, I had a brownie,” leave the impression that we are a good or a bad person based on what we eat. This is not a positive message for ourselves or our upcoming generation. Because we have such an extreme focus on the rejection of obesity in Canada we very unfortunately have girls and women of healthy body weights who think they need to lose weight.
We need messages about obesity balanced with messages that support healthy body weights and that eating is a necessity for good health. I would love to see campaigns to eradicate what I call “fat talk”. Fat talk would be a statement such as, “I feel fat today.” Fat is not in fact a feeling. When one says that they feel fat they are truly saying that they have a negative emotion inside. We should be asking, what is the true feeling? Fear? Sadness? Anger? Frustration? Then we can get at what is underneath. If we are able to get more in touch with our emotions then we can see a reduction in all mental illnesses, including eating disorders.
Finally, we need to target the upcoming generation directly with similar messages that we are asking parents, coaches, and teachers to deliver regarding usual growth patterns and embracing different body sizes as acceptable. In addition we need to deglamorize fad diets. It appears that more young people understand the dangers of smoking and driving after drinking. There are also deadly dangers in fad diets as they can lead to the development of disordered eating and eating disorders. Therefore attention is needed.
I could speak for hours about my thoughts on this topic and I am truly grateful for your time this afternoon. I am also very excited about the attention that is being given to this topic by your committee. It is valuable and life-saving work. I would be pleased to answer any questions you may have about what I have said or offer any clarifications in the area of disordered eating and eating disorders.
Thank you.