We need to understand the biological origins of anorexia, bulimia and binge eating to develop effective treatments, says psychology professor Dr Cynthia Bulik.
To better understand how genes can predispose people to these conditions, she's working with The University of Otago on a worldwide study.
The Eating Disorders Genetics Initiative (EDGI) is researching how both genetic and environmental factors influence the development of an eating disorder, Dr Bulik tells Jesse Mulligan.
"Down the line, we're gonna use that biology to inform treatment, to inform prediction and to inform prevention."
Although it can be said that environment "pulls the trigger" on an eating disorder – "our societal valuing of thinness and fitness and leanness and muscle tone" – biology "loads the gun", Dr Bulik says.
In anorexia nervosa, for example, a person's metabolism can make them more vulnerable.
The experience of 'negative energy balance' – when the body is expending more energy than its consuming – is something most people don't enjoy, yet those prone to developing anorexia can get a high and even a sense of reduced anxiety from this state, she says.
"People who are predisposed to anorexia tend to be pretty anxious in [their] baseline. When they go on that first diet and have that first experience of negative energy balance, it makes them feel more calm. Their body sort of responds positively to starvation."
This is an example of how an environmental trigger can activate an underlying genetic predisposition, Dr Bulik says.
Understanding that biology can "perpetuate and maintain eating disorders" helps loved ones understand why recovery can be so hard, she says.
"Eating disorders aren't a choice. We wouldn't say to someone with asthma 'Can you please just breathe better?' … [These people] need help."
Dr Bulik is confident that once we better understand the underlying genetics of specific eating disorders, medications will be developed and used for treatment alongside psychosocial interventions.
In the meantime though, we must reduce the stigma around eating disorders, which is the biggest barrier to people receiving care.
People are more likely to speak to others about problems with substance use or depression than eating, she says, and due to shame most people with eating disorders never seek treatment.
If someone in your life seems to be struggling with an eating disorder, the most important thing to do, Dr Bulik says, is to acknowledge the problem and address it in a "firm but compassionate" manner.
"Let them know you care and go with them to get an evaluation – this is the first step and an essential step in getting treatment for an eating disorder.
"Let them know you care, stand by them, stick with them, because ultimately – this is what our patients tell us – the most important variable in recovery is actually relationships, someone who cares for you, who sticks with you through thick and thin, and who acknowledge [your struggle] and walks with you hand in hand, knowing that recovery is an uphill fight against your biology."
The Eating Disorders Genetics Initiative is conducting a survey of New Zealanders 16 and over who have experienced an eating disorder. You can participate here.
Where to get help:
If you think you might have an eating disorder, the first step is to tell your GP, Dr Kennedy says - even if that's difficult.
The Eating Disorders Association of New Zealand (EDANZ) has a website and a helpline - 0800 2 EDANZ / 0800 2 33269.
Need to Talk?
Free call or text 1737 any time to speak to a trained counsellor, for any reason.
Lifeline: 0800 543 354 or text HELP to 4357
Suicide Crisis Helpline: 0508 828 865 / 0508 TAUTOKO (24/7). This is a service for people who may be thinking about suicide, or those who are concerned about family or friends.
Depression Helpline: 0800 111 757 (24/7) or text 4202
Samaritans: 0800 726 666 (24/7)
Youthline: 0800 376 633 (24/7) or free text 234 (8am-12am), or email firstname.lastname@example.org
What's Up: online chat (3pm-10pm) or 0800 WHATSUP / 0800 9428 787 helpline (12pm-10pm weekdays, 3pm-11pm weekends)
Kidsline (ages 5-18): 0800 543 754 (24/7)
Rural Support Trust Helpline: 0800 787 254
Healthline: 0800 611 116
Rainbow Youth: (09) 376 4155
If it is an emergency and you feel like you or someone else is at risk, call 111.