By Kelly Harvard

This summer I sat on my bed and watched as my sister tried on numerous outfits, changing over and over again, each time citing something “wrong” about her body and weight. I would respond by providing compliments praising her appearance. Perhaps you are envisioning this scene among young sisters, but I am 38 and my sister is 35.

My sister and I grew up in Marin during the early 2000s — a time when, as writer Michelle Konstatinovsky aptly describes, millennials “weren’t taught that skinniness was just the standard of beauty but the physical manifestation of discipline, dedication, and effort. We were told … that weight was somehow correlated with morality and value.”

It dawned on me, as I listened to my sister lament about her body, how we had absorbed and carried these body image ideals well into adulthood. I would have never questioned — or even noticed — this common interaction had I not started learning more about negative body image and its link to eating disorders.

I am a Marin County public health professional primarily focused on promoting the health and well-being of adolescents. Last spring, our program completed a local needs assessment which identified negative body image and adolescent eating disorders as a priority concern in the county.

At a focus group discussion, a teenager shared that her friend was currently in and out of treatment programs for an eating disorder; she felt this was a widespread issue among her peers, but no one was talking about it. Turns out she was right.

Any person, at any age, may experience negative body image, however it is especially common in adolescents. A survey found that 77% of adolescents as young as 12 years old dislike their bodies.

The daily pattern of obsessively criticizing your own body can take a toll on your mental and physical well-being. People who experience body dissatisfaction are more likely to suffer from low self-esteem, depression, anxiety, isolation, substance use, self-harm and eating disorders.

The peak period for the onset of two major eating disorders — anorexia nervosa and bulimia nervosa — is between 12 and 25 years old.

While there is no single cause: Body dissatisfaction is one of the best-known contributors to their development.

It is estimated that nearly 29 million Americans will be affected by an eating disorder in their lifetime. These disorders have the second-highest mortality rate of any mental illness.

Experts warn that these disorders often hide in plain sight — a combined result of the secretive and isolating nature of these illnesses, stigma, and many misconceptions. For example:

• Men represent up to 25% of people with eating disorders.

• LGBTQ+ youth are three times more likely to have an eating disorder when compared to their straight peers.

• Those identifying as “Black, Indigenous and people of color” are affected by eating disorders at similar rates as their White peers but are about half as likely to be diagnosed.

• Only 6% of those who met criteria for eating disorders are “underweight.”

Eating disorders occur across all ethnicities, cultural and socioeconomic backgrounds, among people of all body types, ages and genders, including particularly high rates among gender nonbinary and transgender people.

As Eating Disorder Awareness Week begins, I urge parents and caretakers to take time this week to learn more about this critical health issue, its many misconceptions and about the resources available to support early recognition and intervention.

Maybe you will also find opportunities to end the negative self-talk we so often participate in with friends, partners, and even your sister the next time she comes over to borrow a dress.

If you feel that you or someone in your life may be experiencing body image or eating disorder concerns, seek professional help.

Reach out to your primary care physician or pediatrician. You can also connect with eating disorder experts from the National Association of Anorexia Nervosa and Associated Disorders at ANAD.org.

Kelly Harvard works for the Maternal, Child and Adolescent Health Program in the Marin County Department of Health and Human Services.