In a recent article published in The New York Times, author Jillian Weinberger recalls the fear she felt when she was told by the ultrasound sonographer that her daughter looked ‘perfect.’ She referred to that moment as ‘somewhat comforting but possibly the worst adjective the stenographer could throw at an anorexic obsessed with the concept of perfection.’
The word ‘perfect’ can be a trigger. What does ‘perfect’ really mean? As the author shared, being deemed perfect can feel like immense pressure for any new mom. When you layer in a decades-old battle with Anorexia Nervosa (AN), the theme around perfection for the author, Jillian, instantly becomes more complex.
Barbie and The Perfect Female
The concept of ‘perfectionism’ has been front and center lately thanks to the release of the 2023 Barbie movie. The movie’s theme focuses on the trap of attempted perfection and dissecting the artifact we’ve built around Barbie as a symbol of idealized femininity. What about perfectionism remains enticing, even when we know it’s fruitless?
Barbie is a plastic paradox. She’s a narrow vision of womanhood, and she is also an everywoman. Barbie is more than 60 years old and, eternally, a young 19. She’s a child’s plaything, with influence felt widely on adults. She is the perfect woman who never lived.
Greta Gerwig’s attempt through the Barbie movie to eradicate the ridiculous notion of a standardized perfect woman’s body, dismantle toxic masculinity, and inspire authenticity has taken the country by storm. The Barbie moving won’t eradicate this idealism around body perfection, but at the very least, it’s opening a door to broader thinking.
Body Image and Mental Health
And this shift couldn’t come at a better time. Today, eating disorders afflict approximately 24 million people in the United States, according to the National Association of Anorexia Nervosa and Associated Disorders. Moreover, eating disorders are among the deadliest mental illnesses, second only to opioid addiction, resulting in approximately 10,200 deaths each year.
It’s no surprise that a new mom who has lived with Anorexia is nervous about her own child. There is a robust genetic component to AN. Twin studies have long since confirmed AN’s heritability, and AN frequently presents within the context of a familial background.2 Moreover, research conducted in recent years has shed light on discrete AN-linked genes. But genes are not destiny, and Weinberger has learned that, too, writing, “. . . whether any one person will develop the disease is difficult to predict because of the complicated relationship between genes and environment.”1
Gene Expression and Risk Factors for Anorexia
In this, she is 100% correct. Thanks to ongoing advances, we have learned that the presence or absence of a certain gene rarely “guarantees” a specific health outcome. A vast array of biological and environmental factors influences gene expression – the process, or the regulation of the process, by which information contained within genes is used to synthesize a functional product.
Put another way: if a gene is a “recipe,” gene expression is the process of “cooking,” i.e., following instructions in the recipe to make something, like a protein or enzyme.
So, concludes Weinberger in her New York Times article, it is perhaps better to think of her daughter’s health – and any potential AN risk she may have – as a deck of cards (an analogy introduced by Dr. Cynthia Bulik, one of the lead researchers in the 2019 Nature Genetics study)1:
There are four suits. Say the genetic risk factors, like the ones discovered in [Bulik’s] study, are the clubs. Then there are probably as-yet undiscovered protective genetic factors. . . those protective factors are the spades.
Then there are environmental risk factors, the diamonds. . . and finally there are the hearts, the protective environmental factors: a parent who eats intuitively, a coach who values strong, healthy bodies.
Those cards come together to create an individual’s risk hand.
This is true, but the above mentioned “deck” lacks a critical card.
Nutrition and Mental Health
For anyone who has been through our functional medicine training programs at Psychiatry Redefined, you have listened as I have identified malnutrition as universal among eating disorder patients and the critical role nutrition and micronutrient supplements play in preventing and treating eating disorders.
According to Dr. Mariela Podolski, a child psychiatrist focusing on children and adolescents with eating disorders, “I have learned that prioritizing patients’ nutritional needs provides a positive clinical impact. Just as the ingredients in a cake recipe are crucial for its success, micronutrients are the essential ingredients for neurotransmitters. This allows for better brain chemistry, which translates into decreased symptomatology.”
Stress, childhood experiences, and trauma have all been heavily implicated as risk factors for AN. Most people would agree that there are environmental exposures precipitating psychological dysfunction, i.e., injury to the intangible mind.
Yet these events have all been proven to trigger measurable changes to the physical body, such as increased levels of pro-inflammatory signal molecules or spikes in levels of the stress hormone cortisol.
Malnutrition and Anorexia
The brain also relies on essential nutrients for optimal performance, including synthesizing neurotransmitters and myelin sheathing that insulates nerve fibers. Adequate nutrition positively impacts the body’s response to stress, enhances psychological functioning, and enables more effective engagement in therapy.
As I have advocated for over 20 years, correcting malnutrition is important to lasting recovery from AN. It is also the key to AN prevention – a variable that can help protect the body, brain, and mind against potential damage.
This is not to say that things like abuse, trauma, and genetics don’t tip the scales – of course they do! But we must recognize that nutritional status, more than any other factor, determines how far.
A body and brain that are well nourished are far more likely to navigate stresses and upsets, whether genetic, epigenetic, environmental, or psychological. Similarly, a brain well nourished and functioning optimally is far more likely than one malnourished to engage in and reap benefits from psychotherapy, a pillar of mainstream AN treatment.
Nourish the Brain, Nurture the Mind
At Psychiatry Redefined, we train clinicians in functional medicine and nutritional integration for AN treatment. By recognizing nutrition as a central pillar of recovery and a key factor in relapse prevention, clinicians equipped with this knowledge are helping patients achieve lasting recovery. Combining genetic, environmental, and nutritional factors, treatment becomes more comprehensive, enhancing the chances of successful outcomes.
With nutrition as an ace card for better treatment and a growing awareness of the importance of body positivity, one day, we can dream of a world, where like the Barbie movie suggests, all body types are celebrated as good enough.
While genetic, epigenetic, and environmental factors may predispose one to AN, if we blend recent momentum with continuing education and thoughtfully integrated treatment options, we can collectively nurture recovery and foster positive change — one patient and one perfectly imperfect body at a time.
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If you’re eager to learn more about treating AN, I encourage you to explore my book, Answers to Anorexia. In this book, you’ll learn how to complement and enhance the traditional psychological approach to AN with an easy-to-implement plan in which nutritional repletion is prioritized. This book provides a comprehensive system of care, accessible not only to doctors and therapists, but the parents, families, and friends of individuals struggling to break free from anorexia.
Ready to apply nutritional and genetic protocols to help your patients with eating disorders? Check out our popular Fellowship program to learn targeted approaches for treating mental illness.
- Weinberger J. The Fear I Felt When I Was Told My Daughter Looked Perfect. The New York Times. https://www.nytimes.com/2023/07/31/opinion/will-my-daughter-inherit-my-eating-disorder.html. Published July 31, 2023. Accessed August 2, 2023.
- Paolacci S, Kiani AK, Manara E, et al. Genetic contributions to the etiology of anorexia nervosa: New perspectives in molecular diagnosis and treatment. Mol Genet Genomic Med. 2020;8(7):e1244. doi:10.1002/mgg3.1244
- Watson HJ, Yilmaz Z, Thornton LM, et al. Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa. Nat Genet. 2019;51(8):1207-1214.
- Reynolds P. A devastating disorder, poorly understood. IEEE Engineering in Medicine and Biology Society. EMBS.org. https://www.embs.org/pulse/articles/a-devastating-disorder-poorly-understood/. Published December 14, 2020. Accessed February 10, 2021.
- Reynolds P. The biology behind eating disorders. IEEE Engineering in Medicine and Biology Society. EMBS.org. https://www.embs.org/pulse/articles/the-biology-behind-eating-disorders/. Published December 14, 2020. Accessed January 15, 2021.
- Onodera A, Kiuchi M, Kokubo K, Nakayama T. Epigenetic regulation of inflammation by CxxC domain-containing proteins. Immunol Rev. 2022;305(1):137-151.
- Uddin M, Koenen KC, Aiello AE, Wildman DE, de los Santos R, Galea S. Epigenetic and inflammatory marker profiles associated with depression in a community-based epidemiologic sample. Psychol Med. 2011;41(5):997-1007.
- Greenblatt, James. Answers to Anorexia https://www.jamesgreenblattmd.com/answers-to-anorexia/