Eating Disorders Myths Busted- Myth #8: Genes are Destiny
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Eating Disorders Myths Busted- Myth #8: Genes are Destiny

August 17, 2019

Cynthia Bulik-GenesAren’tDestinyTranscript [intro music]>>Bulik: So the other thing we have to be
careful about though is this sense that somehow genes are destiny. Because, I think, part
of what I try to do in my world is figure out how best to take scientific information
and convey it to the public and use it in therapy and to teach families and patients
and advocates about how to talk about genetics–environment and genes are definitely not destiny. Hereditability
for any of these disorders is not 100 percent. If environment didn’t matter, heritability
would be 100 percent. It’s not. We’ve always got somewhere between 40 and 60 percent of
variance that’s unaccounted for, and that’s when we have to start looking at the environment–gene-environment
interaction epigenetic factors. So for eating disorders, the environment can have both positive
and negative influences. In terms of negative influences, environment can increase risk.
Some of the things we know about—perfect timing given that the Winter Olympics are
on: 1. Sports with an appearance or weight focus (Ski jumping—nasty. Ski jumping has
completely changed how they do their sport to decrease the number of people who develop
anorexia nervosa.) 2. Dieting–the number one thing that people talk about as the first
step toward developing eating disorders is “going on a diet.” We have to be so careful
in our obesity prevention efforts that we don’t give people like me more business. We
don’t want our obesity interventions to create more eating disorders and that’s why weight
stigma and obesity stigma is such a concern. 3. Modeling–being obsessed with looks. We’re
finding out more and more that so many people with eating disorders have teasing or bullying
histories–and not necessarily just about their physical appearance or their weight.
But teasing is one of these nonspecific risk factors that I think we all see in our populations
that many of these people have in their histories. But environment can also have positive influences.
Some of the things that may decrease risk for the development of eating disorders: 1.
Models for healthy eating—making sure that you really do model healthy eating, non-emotional
eating, and making sure that your family is a place where healthy eating occurs. 2. Being
able to separate body-esteem from self-esteem. The first thing people usually say about kids
is what they look like. I always tell Moms, for example, if someone gives your child a
compliment about especially her physical appearance, make sure you parrot right away with something
like “Oh yeah, and she’s also really great at playing the flute” or “She got an A
in Chemistry” or something like that so your daughter is hearing more than just physical
appearance–based compliments. 3. Role models for body respect. 4. Family Involvement. 5.
Supportive peers who value who you are, not just how you look. 6. But also letting parents
know that they can’t control everything. You can have all the stuff in place and your child
might still develop an eating disorder. Now this is one of the ways that I try to get
people to understand the complexity of risk for an eating disorder. People like simple
Yes-No, Black-White explanations, but we can’t give them that. In fact, the truth is much
more complex than the slide I’m going to show you. This slide at least breaks it down into
four risk and protective quadrants and it’s the way I like to help people think about
what is changeable and what is not changeable. These are some very colorful human chromosomes.
The first quadrant is genetic risk factors. So all of us are dealt a genetic hand of cards
when we are born. The things that you see up here now are all things that we know are
influenced by genetic factors. There’s not a gene for appetite regulation. There’s not
a gene for binge eating. But all of these things have been shown to be heritable. What
that means is that there are probably a whole slew of genes that code for a whole slew of
proteins that somehow influence that end phenotype. So the first quadrant is genetic risk factors.
The second quadrant, and this gets to the resilience question that we were talking about
before, are genetic protective factors. There are traits, for example, constitutional thinness
or someone who never has to go on that first diet. We know self-esteem is influenced by
genetic factors. How that works biologically I’m not so sure, but it is heritable. There
are probably a whole slew of other protective factors that are influenced by genes. Your
genetic deck of cards has both risk factors and protective factors. That then comes into
the mix of the third quadrant, which are environmental risk factors. These are Shakespeare’s “slings
and arrows about outrageous fortune” like teasing or dieting–things that are environmentally
mediated that might actually have the ability to activate some of this underlying genetic
risk. And then the fourth quadrant is environmental protection factors. Here we include: 1. Family
meals– because there have been a lot of data on family meals being protective against a
whole array of adverse outcomes. 2. Breastfeeding–because breastfeeding is good for just about everything,
and here, 3. This is a coach who was emphasizing strength and what your body can do rather
than a sort of “thin to win” mentality. Everyone has a different pattern of genetic
risk, genetic protection, environmental risk, and environmental protection quadrants. What
matters is not just the relative balance of those four quadrants but also the timing.
Some of these things might be–you might be more or less vulnerable to environmental activation,
for example, during puberty or during menopause–so that sort of cross-cuts those four quadrants,
the whole timing piece. And somehow people can often just begin to feel more comfortable
with complexity if you can break it down into these four quadrants. But the other thing
that you have to tell them is we can’t do anything about the genes yet. The only thing
we can do something about are the two environments. We can try to decrease the environmental insults
and increase the environmental buffers. [closing music]

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