The epidemic of a culturally induced disease is upon us. How have we, as a society, allowed the ideals of thinness and disordered eating to pose a significant threat to the adolescent population–now and in later life? The advertising of weight loss, extreme fitness and diet regimes, elective surgeries, and, of course, the help of editing tools, has perpetuated an unhealthy and unrealistic standard. Disordered eating as a socio-cultural phenomenon can be largely attributed to modern-day media and beauty standards, but it can also be accredited to the systems of capitalism and patriarchy through external pressures to achieve social and political rewards. Thinness in the media dates to the 1900s; however, as adolescents spend a considerable amount of time scrolling through various forms of media, advertisements of extreme beauty standards become unavoidable and consistent. With Anorexia Nervosa (AN) affecting 0.3%-3% of women, making it the third most prevalent chronic disease in women, it is important to identify the leading causes of the disorder and mitigate these sources to minimize the number of women who will suffer from the health consequences later in life.

Anorexia nervosa is a psychiatric illness indicated by abnormal eating habits resulting in considerable weight loss. Diagnostic criteria include failure to maintain weight above 85% of the ideal, distorted body image, denial of low body weight's seriousness, fear of weight gain, and amenorrhea, the absence of a menstruation cycle. There are three prevalent subtypes of AN: the restrictive type, characterized by a significant reduction in food intake, the binge and purge type, characterized by self-induced vomiting, misuse of laxatives or diuretics, or intense physical exercise. Eating disorders cause persistent protein-energy malnutrition, contributing to severe illness and an elevated mortality rate. Complications extend more severely with outcomes such as cardiovascular failure. These complications are provoked by decreased lower left ventricular mass (LVM), referring to the size and strength of the ventricle, an indicator of weak, deteriorating cardiac muscular function. Cardiovascular failure can also be a result of systolic dysfunction, characterized by the inability to contract during systole, the phase of the cardiac cycle in which the heart pumps blood to the rest of the body. 

Eating disorders provoke a large range of complications and health threats. Other than cardiac complications, long-term consequences include pregnancy complications, osteoporosis (decreased bone mass and fragility), diabetes and thyroid disorders, and gastrointestinal problems. Anorexia nervosa leads to neuroendocrine disruptions impacting reproductive health, due to imbalances in hormones that regulate physiological processes. These disruptions include impaired gonadotropin releasing hormone (GnRH) secretion and alterations in hypothalamic neuropeptide activity, resulting in hypoestrogenism. GnRH, a hormone produced in the hypothalamus, regulates the release of other hormones that control the menstrual cycle and ovulation in females. When GnRH secretion is disrupted, it can provoke irregularities in the menstrual cycle and fertility. Changes in neuropeptides, small proteins that act as neurotransmitters, further impede hormone release as the signals are disrupted. These factors can cause hyperestrogenism, a deficiency of estrogen, which causes various female reproductive and health complications. Weight loss of 10-15% leads to menstrual cycle cessation and amenorrhea in 15-30% of affected women, and women with AN experience higher rates of obstetric complications during pregnancy. Overall, maternal AN, whether active or past, is associated with babies of lower birth weight and higher rates of premature labor due to various pregnancy complications.

Patients with AN or a history of AN report cardiovascular failure and electrocardiographic abnormalities. These include bradycardia which decreases the speed of the heartbeat, and a reduced QRS amplitude, suggesting that the electrical signal generated by the heart muscle during the contraction period is weaker than normal. These factors contribute to arrhythmias, irregular heart rhythms, which are dangerous and can potentially lead to sudden death. Decreased left ventricular (LV) mass is a possible consequence of severe malnutrition which reduces cardiac workload, lowering blood pressure and volume load. In a study done, anorexic patients were found to have a smaller LV chamber dimension and thinner ventricular walls than control subjects. Reduced LV mass could be a marker of protein malnutrition in AN patients, leading to severe outcomes and possibly death.

The aforementioned complications of anorexia nervosa contribute to a lower life expectancy for patients with AN. Women diagnosed with AN at age 15 are expected to have a lifespan of 25 years shorter than the general population, and women diagnosed at age 20 have approximately 36 years remaining as opposed to the 60 years expected for the average population. Additionally, mortality rates for patients with AN are 6 times higher than the general population, and 5% of patients die within the first 4 years of diagnosis.

The prevalence of anorexia nervosa and its associated complications highlight the urgent need for societal reflection and action. The pervasive influence of the media, beauty standards, and socio-cultural pressures perpetuates unrealistic ideals, leading to a concerning rise in disordered eating behaviors among adolescents. The detrimental effects of AN extend far, impacting reproductive health, cardiovascular function, and overall mortality rates. It is imperative that we address the root causes of this epidemic to prevent further harm to individuals and future generations. Only through collective efforts to dismantle harmful ideologies and support holistic health can we mitigate the devastating impact of AN and foster a culture of acceptance and empowerment for all.  

Lily Kiaei

B.S. Human Biology & Society – Class of 2026