Literature Review

20 million women and 10 million men have suffered from a diagnosed eating disorder at sometime in their life in the United States. (Wade, Keski-Rahkonen, & Hudson, 2011) Anorexia Nervosa is a mental illness. According to the National Eating Disorders Collaboration (n.d) the illness is not simple and can have many attributing factors including genetic predisposition, environmental factors, and also cultural/social factors. The reason behind the illness varies depending on the patient. For example, one may develop anorexia in an attempt to gain control in some aspect of their life and having a particular body image can help. The illness may be a way to cope with serious anxiety. Extreme dieting and exercise can also in some cases lead to the beginning of the illness. Sadly, the media is to blame for many cases of eating disorders in the US today due to the numerous unrealistically thin or muscular icons that many feel the pressure to strive to be like. (National Eating Disorder Collaboration, n.d) (National Eating Disorder Association, n.d)

There are a few main factors that define a person as Anorexic. A person with Anorexia Nervosa is unable to maintain a healthy weight or gain weight. If the person continues to lose weight, eventually their vital organs and natural processes will shut down. Another defining factor is the fear of gaining weight. Though this person is unhealthy, they will still constantly fear and obsess over the thought of gaining. Possibly the most terrifying factor is the person’s disturbed body image. A person with Anorexia can attest most, if not all of their self worth to how their body looks. The scary part of this factor is that no matter how underweight or physically unhealthy the person may get they will still see themselves as fat. They are physically unable to see the truth in their appearance. (NEDC, n.d) (NEDA, n.d)

The significance of the health issue roots in the idea that this illness is just a phase or a choice. Anorexia is not a lifestyle. If the disorder goes untreated the person is at risk for numerous additional health conditions including kidney failure, osteoporosis, heart problems, infertility, intestinal problems, anemia, and decomposed immune system. Ultimately, if this illness is untreated over time it will weaken the body’s natural processes. The person will eventually starve to death from malnutrition or their body will stop working in result of a health condition developed from the Anorexia. Another symptom of the disorder is depression or suicidal thoughts/tendencies. Suicide is another factor of Anorexia that can result in death. (NEDA, n.d)

The target audience of eating disorders is teenage females. While females are most common, males also make a large contribution to the statistics but many cases go overlooked due to fear of judgment. "The most important thing to recognize is that these are real disorders that require treatment" (Insel, 2008). Any eating disorder can very easily go undiagnosed and untreated. As most eating disorders develop in a person’s adolescent years, it is important to recognize the illness and get them help as early as possible.

Adolescents are surrounded by all kinds of media. In addition to the genetic contributions, media influence has been classified as the cause for many cases of Anorexia and Bulimia. There are tons of unhealthy images of models and celebrities that can contribute to a teenager's negative self-image. During the adolescent years bodies are going through hormonal changes. In addition to the judgment of peers, the added pressure from the unrealistic role models can influence the development of an eating disorder. Primarily, entertainment media covering eating disorders will portray the sufferer as an adolescent female. Generally, the influence of the thin ideal is more prevalent for females. Girls being told how to look during their adolescent years can be traumatizing and bring down their self-image immensely. It is so important that these issues be recognized earlier on, at first sign of developments. (Franco, 2008) (Spettigue, 2004)

Anorexia and eating disorders is a highly covered topic in entertainment media as it is relatable to much of the target audience of the media and the illness. Its prevalence in media has increased dramatically since the 1990’s. Before then the only media attention Anorexia received was in result of Karen Carpenter, a female singer who died from the illness. (Mitchell, 2007) In the 1990’s the disease became much more integrated into media. Many celebrities at this time including Paula Abdul and Geri Haliwell of the Spice Girls admitted to suffering from eating disorders. (Mitchell, 2007) The celebrity connection to the disorder in the 1990’s still resonates today in the media’s portrayal of thinness as beauty.

This connection caused the illness to be glamorized. Celebrities in real life and on TV sensationalized it. Entertainment media also presents eating disorders as glamorous. For example, on the show “90210” the character Kelly had an eating disorder. The show does not note the possible dangers of the illness. The show turns the mental illness into a fad of the young and popular. Kelly’s character glamorizes the illness and makes it appear to be a trendy disease that almost appears cool to have. (Klein & Horvath, 1992).

Kelly’s eating disorder in “90210” can also fall under the category of a quick fix solution. The quick fix is another way the media presents eating disorders. In many TV shows characters that show symptoms of eating disorders are often cured within the span of one to a few episodes. This is extremely unrealistic, deceiving and dangerous. An example of the presentation is found on an episode of “Glee” when the character Rachel Berry is feeling insecure about her weight and appearance. Rachel is seen going into a bathroom stall and attempting to purge her body by inducing vomiting. She realizes that she is unable to go through with it and that is all that is covered of the topic. If a person really were struggling with the development of Anorexia or Bulimia it would not be considered just one time. (Murphy, Falchuk & Brennan, 2009). Another example of this unrealistic quick fix presentation of an eating disorder was on the TV show “Full House”. The character DJ shows signs of the restrictive subtype of Anorexia by exercising excessively until she passes out in an attempt to look good in a bikini. Her character also admits that she hasn’t eaten in 3 days. After a serious talk with her father Danny, DJ is convinced to eat again and has no further occurrences with the illness. (Franklin, 1990).

Another way eating disorders are presented in the media is as a choice to not eat. The portrayal of an eating disorder as a choice may make the character seem powerful and undermines the severity of the illness. This type of presentation has been found more frequently on shows catering to younger adolescents and preteens. Examples of this presentation can be found on Disney Channel shows including “Shake it up” and “So Random”. On the show “Shake it up" a character says, “I could just eat you guys up, you know… if I ate.” (Beck, Hart & Zimmerman, 2011). In the show “So Random” a character makes a joke about how you will not get a part if you eat a lot of calories. (Marmel, 2011)

The covering of eating disorders in entertainment media can be a very touchy topic for many. One of the main causes behind the illness is the effects of media and unrealistic body role models. For some, just watching the topic being covered can be a “trigger”. A trigger for an Anorexic can send them into a downward spiral and make them reengage in behaviors or increase their current behaviors. According to the National Eating Disorder Association (n.d) covering the topic can lead to many viewer health outcomes. The findings have shown that graphic images of extremely Anorexic characters can trigger a viewer to want to lose weight more quickly to be like them. Another finding states that including numbers in calories, pills, or even eating disorder “trends” can provoke a viewer to try these harmful ideas. If the viewer sees a teenage girl on a show eating 400 calories a day she may try to emulate her, or shoot for an even lower goal. There are also two major findings regarding the attitudes toward characters suffering with an eating disorder. The sufferer of Anorexia on a TV show should not be glamorized or deemed with amazing self-control. Anorexia is an illness; the person cannot physically stop starving him or herself. They don’t have extraordinary will power to not eat food; rather they have become obsessed with being thin and weight loss. They feel in control of their body by depriving it. The viewer should not feel empowered by the character. The entertainment media may show a person with an eating disorder dealing with their illness alone or in secret. This can instill an idea in the viewer that they do not need medical help, which is anything but true. It is an illness and needs to be handled by a medical professional. (NEDA, n.d)

Critiquing the Media Product

The entertainment program “Red Band Society” plot revolves around a group of adolescents who have a primary residence in a hospital due to chronic, or long-term illnesses and diseases. The program attempts to integrate the adolescents’ everyday life with the health issue they are suffering from. One of the main characters in the program, Emma, is suffering from Anorexia. The program attempts to integrate the illness into the plot by showing Emma’s weigh-ins, eating habits, and social struggles with the illness.

The program does not demonstrate a realistic portrayal of the consequences that a sufferer of Anorexia would face. The two nurses that care for Emma, nurse Jackson and nurse Brittany, seem to be missing for all of the crucial moments. For example, before weigh-in Emma drinks glasses of water and stuffs her bra with coins in order to “gain weight”. Nurse Brittany, who regularly weighs her, never seems to check her for additional weighted items or monitor her liquid intake. It seems extremely unprofessional that a RN would not consider all small tricks of the trade. Emma is often praised for this false weight gain and does not receive any consequences. Another example of lacking consequences would be that Emma never seems to be monitored while eating and is often seen throwing food away. The program does glamorize the illness, as Emma’s character appears to be fashionable, well put together, and extremely intelligent. Some of the most common physical symptoms of Anorexia would be rapid weight loss, lethargy, extreme tiredness, fainting, dizziness, fine hair all over the body, constant coldness, and loss of menstruation for females. She does not demonstrate any of the symptoms besides extreme thinness.

The portrayal of the illness in “Red Band Society” has been overall similar to the findings from previous examples. The program does glamorize the disease. Emma appears to be a very well rounded and trendy teenager. She dresses well and has love interests. The viewer does not regularly see the true struggle of the illness. The idea of choice is also prevalent in the storyline. Her boyfriend Leo, who is recovering from cancer, yells in one episode, “No one pities you Emma, you don’t have to be in this hospital” (Shukert, 2014). He is suggesting that her Anorexia is her own choice. The quick fix story is less prevalent as the show is about the patients getting better over time.

The social comparison theory states that people have the tendency to compare themselves to others. There are two types of comparisons that can be made, upward and downward comparisons. The idea of upward comparison is the idea that when a person compares himself or herself to another person with traits that they desire, they will try and emulate them to be like them. This upward comparison can leave a person feeling more negatively about their self-image. (Mass Media and Body Image, 17)

A downward comparison is the idea that when a person compares himself or herself to a person that they perceive as having less valuable traits, it will positively impact their own self-image. They will have their self-value boosted by the people they perceive as less valuable. Celebrities and media characters are considered to have more value than the average person has to desire. Many people who desire to emulate these celebrities or characters intend to “close the gap” and become more like these desirable people. (Mass Media and Body Image, 17)

There is a specific scene in “Red Band Society” that deals with the social comparison theory. Emma goes to a high school homecoming with some of the other patients. Emma is seen surrounded by a two girls asking her about her dress. “Well, it's just that we've never seen a size triple-zero before in the flesh”(Krebs & Krinsky, 2014). Emma explains to them that she has an eating disorder and the girls respond, “You’re so committed, I just don’t have the discipline for that”(Krebs & Krinsky, 2014). In this episode, girls without eating disorders desire to emulate Emma in order to achieve her physical traits. They have formed an upward comparison with Emma; they feel worse about their own body image and desire to be thinner. The entertainment media is not only presenting portraying an upward comparison in the show but the character is receiving praise for having a mental illness.

Just as the girls in the show are compelled to compare themselves to Emma, viewers will also be influenced to compare their own body to hers. Emma is a media character. Therefore, according to the social comparison theory, her traits are more valued. Viewers may find elements of Emma’s physical traits desirable. If a specific viewer is self-conscious of their arms or thighs they can form an upward comparison with Emma showcasing their need to have thinner arms or thighs. This upward social comparison a viewer may form with her character is unhealthy because Emma is suffering from an illness. The viewers desire traits that are the direct result of an eating disorder.

The portrayal of the media will produce extremely negative health effects. The comparison that the audience will form with Emma’s character is extremely unhealthy. The viewer is not seeing the presentation as a documentation of the struggle and recovery of living with Anorexia. Rather they will desire to emulate her thin and unhealthy body. These effects can be tremendously harmful on the adolescent viewer's (mostly prominently females) body satisfaction. The upward comparison will make the viewer feel less positive about they body and self image. It can drastically lower their own body satisfaction, influencing them to want to change. The viewers will desire to close that gap that separates their own body traits to the character. If the viewer acts on their desires in an attempt to improve their body satisfaction, they could develop unhealthy or harmful behaviors, which could ultimately progress into an eating disorder.

Improvement/Modification

Emma has been deemed in the program as the Anorexic girl who is supposed to be getting treated but seems to be making no progress at all. Her character is seen in the second to last episode of the fall season of the program going to a therapist and receiving the news that she is going to be released from the hospital based off of the combination of lies she has been telling and fake weight she has put on. Emma is completely shocked, and the viewer understands that she was lying to try and just get better like everyone else thought she was capable of. Emma is sent home making no progress and is seen having a mental breakdown, inducing vomit after trying to eat at home. She then passes out and the audience is left wondering what is going to happen.

Emma’s character is a negative role model disguised as a positive one. Her character does not make any progress on the show. Rather, when she does eat anything it sends her into a downward spiral of panic attacks and depression. Her character needs to be changed into more of a transitional role model. The way the program is set up glamorizes her illness and has not shown one situation in which she makes a step towards recovery. The message of her as a transitional character would be even more powerful if there were added negative and positive role models going through the same treatment. Her character is going through a battle without the support of others who understand what she is dealing with. The other patients usually judge Emma. Other role models on both sides of the spectrum would help Emma’s character become a transitional role model, making impact on viewers more positive and helpful. Viewers would feel inspired by her message as a transitional character getting treatment and slowly getting better, rather than seeing a character that is so affected by her illness that she leaves the hospital without making any progress. Her storyline as a negative role model tends to glamorize the disease and sends the message that treatment does not work and she does not want to get better.

The producers of “Red Band Society” should make the health issue of Anorexia appear more realistic in the show. Sadly, the main storylines with Emma are not focusing on her treatment of her eating disorder but rather her love life, other relationships, or the ways she “tricks” the RN’s and physicians. The lack of monitoring Emma receives is worrisome for a patient dealing with an eating disorder.

The producers can make Emma’s treatment more realistic by integrating the actual steps of treatment into the storyline. Without the visual understanding of what she is going through in the hospital, her treatment seems like a high end boarding school that just happens to take place in a hospital. Also, the show lacks Emma having support from any other person dealing with the illness. She should be going to support groups with other teens suffering from eating disorders who will understand why she is the way she is. If her character were less alone and more supported in getting better, this message would transfer to the viewers. Someone that may be struggling with their body satisfaction or developing an eating disorder can feel they will be supported and should get the help they need. The show could also close with the number or website for eating disorder help if they feel connected to Emma’s desire to want to help herself.

The program should also give the viewer a bit more of an inside look to what Anorexia is. Without making the program a medical PSA, the producers should integrate realistic facts about the illness into the storyline. They should touch on the causes, symptoms, and behaviors of the illness. The viewers should been given the tools to make a more realistic connection to the reasons Emma is not eating or why she is so thin. Without proper explanation, the character is more likely to be emulated in order to achieve the “glamorous” characteristics of the illness. A more realistic and medical explanation can help the viewer make a negative connection with the illness, and understand it is not something to desire.

By adding more explanation of the illness into the plot the producers will be able to maximize the integration of the health issue into the program. If an episode covers Emma’s reaction to a type of psychotherapy treatment the show would still capturing her emotional reactions and responses while integrating more reality of the illness into the program.

The program should capture more of the health consequences of the illness. “Red Band Society” attempts to show social consequences but it ends up taking away from the importance of the health issue. Emma does not physically display any of the traits a person suffering from Anorexia would have. The lack of the physical consequences the illness can have on the body does not allow the viewer to see the severity of the suffering. The program should also focus on presenting the consequences Emma receives when she fails to make real progress in her treatment. The viewers should see the strict realistic treatment Anorexic patients have to undergo, rather than sensationalizing ways to fake weight gain at weigh ins. The show typically portrays the consequences the illness has on her relationships. Other characters do not understand that she is not choosing to be ill and have a hard time pitying her illness. While social consequences are important, the program should focus its attention on the personal medical consequences. In order for the sufferer to get better, it needs to come from inside them. The viewer needs to see the patient succeeding and taking small steps to influence a more positive idea of recovery.

This new media can result in positive effects on the viewers' own health outcomes. The media will break down the glamorization of the illness and show how terrible the consequences can be. The viewer will be left with a better understanding about the illness and its treatment. The viewer will hopefully have less of a desire to emulate these traits in order to achieve a better body satisfaction. Proper information integrated into the media can break down the notion that eating disorders are a lifestyle choice and are not something that can be easily fixed. If the viewers are having destructive thoughts or are struggling with an eating disorder, the positive portrayal of treatment may influence them to get help. The phone number or website will make it extremely accessible and simple. This new product will aim to educate the viewers that do not understand eating disorders and also positively influence those who may relate or suffer with the illness.