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Eating Disorder Awareness Week Interview 3: Dr. Amanda Raffoul

Megan: Why is eating disorder awareness important?

Dr. Raffoul: Eating disorders awareness is important because there are still so many myths and stereotypes about who can be affected by eating disorders, what aneating disorder actually is, or what it entails. And because of those stereotypes, it makes it harderfor some people to recognize that they have aproblem or that someone around them might be struggling,and it makes them more reluctant to get help.So awareness is not the total sum or the most importantpiece, but is one important piece of trying to prevent eatingdisorders and the work that we do at STRIPED.

Megan: How are you involved in the work of STRIPED and what is kind of your role here? And why did you first get involved with STRIPED?

Dr Raffoul: I'm a researcher with STRIPED! I joined in September 2020 as a postdoctoral fellow, and I do research about how we can use public health policy or public policies generally to help prevent eating disorders, especially among adolescents and young adults.

I first got involved in working on eating disorders when I was a teen myself. I did community-based eating disorder programming starting when I was 19 years old. I was just in my undergraduate degree, and I got involved with information fairs. I would set up booths during EDAW, which makes it a really special time for me because it makes me nostalgic for when I would set up a booth in a mall just to give people brochures and resources, or when I would go into classrooms and talk to younger kids or even high school students who are just a few years younger than me, talking to them about body image and self-esteem and all these factors related to eating disorders. And so from a fairly young age, before I even started doing research, I was doing community-based work. I cared a lot about prevention, I cared a lot about youth involvement. And as I spent more time working in schools, spent more time exposed to folks in treatment centres, I started to feel a lot more passionately about prevention and how we can scale up prevention so that it's not just me going in to talk to a classroom full of students, but it's more systemic and structural change built into the way we do policy.

So after that, I decided to go into public health for my graduate studies, and working with STRIPED was just a natural extension of all of the work that I've been doing for so long.

Megan: What is something the public doesn't really know about eating disorders right now that you think they should know?

I think most people don't know how common eating disorders are. I mean, there are a lot of really pervasive myths about who eating disorders affect or what an eating disorder is. But I think for me, what I'm always surprised by is talking to folks who are outside of the field who say, "well, it's not that common, is it? I might know one person or two people."

And that's because eating disorders and many other mental illnesses really thrive in secrecy, again emphasizing why awareness is so important.

The one thing I would try and emphasize for folks is that eating disorders are actually incredibly common. Some really great work from STRIPED in the past few years has highlighted how common eating disorders are. And if we can all be a little bit more accepting of the fact that folks around us might be struggling, then we might have accomplished our mission of raising awareness.

Megan: Yeah, exactly. I feel like also the stigma, especially about what an eating disorder is and how common it is. I live in an East Asian household, and I've been through an eating disorder, and lots of people were like, "Oh, no, you don't have one. You're making it up."

Dr. Raffoul: I think that yeah, and there's definitely a strong cultural component.I grew up in a Middle Eastern household, and we never talked about eating disorders within our community. And every culture has different ideas around beauty and appearance that can really feed into and play a unique role in how eating disorders look within those cultures. And I know that even within my community, the Arab community in particular, there's quite a bit of emphasis similar to some other cultures, on the value of appearance and weight for marriage. And that means that it plays a really important and different role in cultures. And in some of those cultures, that might not be the awareness of how an eating disorder plays out or how common it can be.

But of course, as research has shown us, and experience in listening to folk stories, everyone is affected or can be affected in certain ways.

Megan: Yeah. Also with men, lots of people are like, "Oh, men can't have eating disorders." I think we really need to break the stigma that only a very certain type of race, gender, or ethnicity can have eating disorders, I guess. Could you in one sentence summarize how serious or dire the current ED landscape is?

Dr. Raffoul: I just want to emphasize how serious it is, I guess. Of course, I would say that eating disorder treatment and identification and prevention resources have always been really scarce, and folks within our community have always struggled to make sure that the right people are being identified and treated as early as possible. But the COVID-19 pandemic exacerbated our need for greater resources. And I think that we're at a really critical time point for how folks are paying attention to the needs of the eating disorders community and how resources can be allocated to making sure that folks get the treatment that they need.

Megan: That actually really ties in well with my next question, which is how had COVID kind of changed the landscape of eating disorders and also us making policy change?

Dr. Raffoul: Yeah, the COVID-19 pandemic made existing cases of eating disorders among folks who are already struggling more severe. Public health researchers will frequently cite that emergency department visits and hospitalizations among adolescent girls during the pandemic doubled for eating disorders. But when we take a look at other clinical research that's come out, because now some of the dust has settled, especially from the first two years of the pandemic, more and more research is showing that the clinical severity of eating disorders really significantly increased during the pandemic that folks who might have been struggling with some disordered eating might have had an increase in concerns around their weight and shape as well. The pandemic, in addition to making mental health a higher priority overall because of the distress that it had for a lot of people, really made eating disorders a bigger issue, I think.

Megan: How do you think that restricting the sale of diet pills and supplements (which is what STRIPED's main goal is right now) would help reduce the occurrences of eating disorders both nationwide as well as around the world?

Dr. Raffoul: So restricting the sale of weight loss and muscle building supplements and diet pills to minors does a couple of things.

The first is it gets those products literally Out Of Kids' Hands, which is what the campaign is called. We know that early use of those types of products is associated with an eventual increased risk of an eating disorder. And so we're not going to be able to prevent all eating disorders, but we might be able to prevent some eating disorders amongst some vulnerable youth who might choose to take those products, and then engage in really harmful weight-related behaviour.

But the second thing it does is it'll be one of the first policies globally that restricts the sale of these types of products.And I think it will set a really important precedent for policymakers to see that researchers, advocates, youth and constituents themselves really care about preventing eating disorders.

So the bill does a lot, and will do a lot of great work to prevent eating disorders, but I think it'll also raise more awareness and increase policymakers' will to actually do something about this really serious issue.

Megan: How can people support STRIPED and other causes in eating awareness? And also, how can they themselves get to promoting eating disorder awareness?

Dr. Raffoul: When it comes to engaging in advocacy and eating disorders, I always say that you don't need to do the work alone and that there are already people doing the work out there. And so one great example is to get involved with advocacy organizations like the Eating Disorders Coalition or to get involved with STRIPED and engage in some of the ongoing advocacy that we have already. In terms of getting involved with STRIPED.

If folks live in one of the states in which the legislation has already been introduced, then of course they can join on and commit in whatever capacity that they feel comfortable. Whether that's just contacting their elected representative, letting them know that they care about the bill, that's a vote of support and that's a form of advocacy. If folks want to get more involved, they can offer to meet with their elected representative and discuss why the bill might be important to them. If you're in a state where a bill hasn't been introduced, we're always happy to collaborate with folks and provide resources that would allow you to contact elected representatives, ask them to sponsor, cosponsor, and even introduce the bill itself. And so we have so many resources, including resources that are freely available online, such as the STRIPED Advocacy Playbook that teach you howto become an advocate essentially, and how to get involved a little bit more.

Megan: I've definitely used the playbook and- just- a ton of the resources on the STRIPED network to help with my own advocacy. So I think those will be really interesting and important for people to learn about.

Dr Raffoul: I think that it's really incredible that youth are so actively engaged in the advocacy work that STRIPED does because it shows how much you care about getting involved, but also their capacities as leaders and as advocates in and of themselves. You, for sure, as youth, are making a difference because the policymakers listen to you more than they do the rest of us.

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