Researchers Compile Scientific Evidence Behind “Nine Truths About Eating Disorders” Ahead of National Eating Disorder Conference

To better educate the public and physicians on what is and isn’t true about eating disorders, UNC’s Cynthia Bulik and fellow researchers delved into the science to substantiate the “Nine Truths About Eating Disorders.”

Researchers Compile Scientific Evidence Behind “Nine Truths About Eating Disorders” Ahead of National Eating Disorder Conference click to enlarge Cynthia Bulik, PhD, FAED

Media contact: Carleigh Gabryel, 984-974-1153,

November 3, 2017

CHAPEL HILL, NC – You can assert something that’s true, but it doesn’t mean that you’re going to be believed – evidence helps. That’s the main reason why a group of prominent eating disorder researchers, including UNC Chapel Hill’s Cynthia Bulik, PhD, FAED, released a new document detailing the scientific evidence supporting the Academy for Eating Disorder’s “Nine Truths.”

“I think the term ‘truth’ has become a little bit unstable. A lot of things are being forwarded as truths that are not substantiable. And we really wanted to make sure that we really had a water-tight document,” said Bulik, director of the UNC Center of Excellence for Eating Disorders and the Center for Eating Disorders Innovation at Karolinska Institutet in Sweden.

Bulik helped develop the “Nine Truths.” She said “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” is a collaborative effort by authors from five different countries and six different institutions. The systematic analysis was published online in the November issue of European Eating Disorders Review.

The “Nine Truths” were released in mid-2015. Bulik and her co-authors started digging into the supportive science behind the truths in December 2015. They finished their analysis this August. Bulik said the depth at which they dug into the truths took some time, and they enlisted others to help them decipher the data.

“We made sure that we had an expert from each of the areas that we were looking be involved,” said Bulik, Distinguished Professor of Eating Disorders in the Department of Psychiatry in the UNC School of Medicine.

Those experts helped break down the “Nine Truths” into “sub-truths” and detail the research underlying each claim. At the end of each section, these sub-truths were assigned a grade based on the strength of the supporting data.

Bulik and her co-authors wrote the document for a wide variety of readers.

“Our goal was to write it at a level where families can use it, but where physicians, scientists, other health care providers, and mental health care providers can also use it.”

The areas covered in the document vary widely, from how genetics play a role in developing a disorder, to the physical toll an eating disorder can take on the body. Bulik said she’s proudest about expanding upon Truth 5: Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.

“When you say ‘eating disorder’ to most people, what they still conjure up in their head is anorexia nervosa, and usually a white, female adolescent as well,” said Bulik.

Bulik went on to say the stereotype they encounter most often for eating disorders is a very thin person with a sickly appearance.

The document, citing the Journal of the American Academy of Child and Adolescent Psychiatry, explains why that’s false: “In a sample of over 3,000 adolescents, eating disorders were present in all BMI categories.”

The authors also said, “A review of community studies from 30 countries found no systematic association between ethnicity/race and eating disorder occurrence,” referencing an article from Clinical Epidemiology.

While anorexia nervosa is the most lethal psychiatric disorder, other eating disorders can cause patients and families distress as well, a fact emphasized by the Binge Eating Disorder Association (BEDA). For the first time BEDA is co-hosting an annual conference on binge-eating disorder with the National Eating Disorder Association (NEDA) in New York on Nov. 2-4.

Not only is this the first time the two associations have held a joint conference, it’s one of the first times they’ve worked together to broaden the scope of how eating disorders are perceived. Both NEDA and BEDA have endorsed the “Nine Truths” and NEDA Program Director Lauren Smolar said the release of the science behind the truths will only further help their cause.

“The ‘Nine Truths’ are things we think are very important for people to know across the board about eating disorders,” said Smolar.

She added that the “Nine Truths” are facts well-known within their community, but challenging to impress upon people with limited knowledge or experience with eating disorders, especially when misconceptions are already entrenched.

Such misconceptions extend beyond the patients who are struggling with eating disorders and can often touch their families too.

 “We still, after all these years of trying to change public opinion, run into parents who say that they are blamed for their kid’s eating disorder,” said Bulik.

This is the kind of misconception that wide distribution of the “Nine Truths” is designed to overcome. Bulik points to Truth 2: Families are not to blame and can be the patients’ and providers’ best allies in treatment.

Bulik and her co-authors substantiate the truth with findings from multiple clinical trials and studies.

While nearly every truth had moderate to high confidence ratings, a few will require further research. Two “sub-truths” had low confidence ratings under Truth 8: Genes alone do not predict who will develop eating disorders. Bulik said the evidence is still being collected to back up the claims that “many cases of eating disorders are sporadic” and “genes and environment may co-act to influence risk for eating disorders.”

“We know these things are probably true, but in order to get real data on gene-environment interaction we need huge sample sizes that include both genomic and environmental data. We’re only getting those samples now.”

Bulik hopes to correct any low confidence ratings in the future.

While the “Nine Truths” have been widely accepted by organizations like BEDA and NEDA, Bulik and Smolar say the information still needs to be more widely disseminated among the medical community at large. ­­

“A lot of health care providers currently practicing might have had one lecture about eating disorders in medical school, if they were lucky,” Bulik said.  “And if they’re older they probably had no lectures about eating disorders in medical school. If they did, they were probably taught a lot of erroneous information that has since been debunked.”

Both Bulik and Smolar hope “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders” will serve as a teaching tool in medical schools and provide a blueprint for future research.

The “Nine Truths About Eating Disorders” has been translated into 30 different languages and is used as a teaching guide around the world. Bulik said “The Science Behind” the truths is the first big collaboration between UNC-Chapel Hill and Karolinska Institutet, and without the organizations’ resources the document would not have been possible.

National Institute of Mental Health (NIMH) funded this work.

Here is our previous story on the Nine Truths.

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