About 30 million Americans will experience some form of disordered eating in their lifetime. The conditions include anorexia, bulimia, and binge eating, and they affect about twice as many women as men, according to the National Eating Disorders Association. Researchers still debate why these patterns develop, but many agree on one gap. It is not only about psychology. It is also about communication.
Ashleigh Shields, an assistant teaching professor of communication studies and public health and health sciences at Northeastern University, argues that public health needs a stronger communication lens. She studies how cultural messages about food and bodies shape behavior. She also studies why people often keep disordered eating private, even when they are struggling.
In a new paper published in the Journal of Eating Disorders, Shields interviewed 15 people with a history of disordered eating. Their stories point to recurring sociocultural pressures. They also reveal why disclosure can feel risky, or even impossible.
Social Media, Diet Culture, and the Pressure to Perform
Participants described social media as a major driver. Many said they saw trends that celebrated certain foods while shaming others. They also described content that praised certain body types while mocking others. Over time, these messages can create a loop. Shame drives behavior. The behavior then creates more shame.
Shields said the impact can be especially strong for younger people. Many have spent formative years online. That can make constant comparison feel normal. It can also make extreme messaging feel like advice. In that environment, a person may start to measure self worth through appearance. They may also feel watched, even when alone.
The interviews also highlighted popular diet fads. These pressures can come from social media. They can also come from friends or family. Shields refers to this dynamic as “diet culture coercion.” She describes it as pressure that goes beyond casual dieting. It can normalize unhealthy restriction. It can also normalize overexercise. When expectations are not met, frustration can intensify self criticism.
Shields emphasizes that these influences are not just personal choices. They reflect shared cultural messaging. The same messages can appear in jokes, compliments, and “health” talk. Over time, they can shape what people think is acceptable, or expected.
How Small Comments Can Leave Long Shadows
Another theme was the power of everyday remarks. Participants described offhand comments from relatives, partners, or peers. Some remembered statements from childhood with striking clarity. Shields said it was notable how many people recalled words spoken at age 10, even when they were now in their 50s.
These comments were not always framed as insults. Some were presented as concern. Others were presented as advice. But participants described them as sticky and lasting. Even a single remark can become a reference point. It can shape how a person interprets their body. It can also become fuel for rigid routines.
The study suggests that communication patterns matter as much as content. Repeated body focused talk can teach someone to scan themselves for flaws. Praise tied to weight loss can send a message about value. Silence can also carry meaning. If a person feels no one wants to hear about it, they may stop trying to speak.
Why Many People Do Not Disclose, Even When They Need Help
Shields found that non disclosure was common. Participants shared several reasons. Many felt shame about the behavior. Some did not want attention. Others believed no one would care. A few described feeling that the disorder had become part of identity. In those cases, recovery felt like losing something familiar. That fear could keep them stuck.
Barriers also appeared in the medical system. Some people do not meet criteria for a formal diagnosis. That can affect access to care. It can also affect insurance coverage. Shields noted that many people never seek diagnosis at all. That likely contributes to underreported rates.
Even routine clinical settings can feel stigmatizing. Participants and Shields pointed to the role of weight centered interactions. Shields argued that some practices can be adjusted. For example, weight checks are not always necessary for every visit. When weight is relevant, she suggested a consent based approach. She gave an example question: “Would you like to know your weight?” She said that open ended questions can reduce distress and increase a sense of control.
What This Means for Public Health Conversations
Shields’ work points to a broader issue. Disordered eating does not grow only inside a person. It also grows inside a culture. It is shaped by what gets praised, what gets mocked, and what gets repeated. It is shaped by how health is discussed. It is shaped by what people think they must hide.
The study argues for more careful communication in homes, schools, clinics, and online spaces. It also suggests that reducing stigma can support earlier help seeking. Shields frames this as public health work, not just personal work. In her view, improving how people talk about body image and health can change what people feel safe to share.
