In Depth with Prof. Bryn Austin: Harvard’s secret weapon fighting the diet industry

Bryn Austin  00:05

We’ve known for decades how harmful the consumer marketplace can be with diet culture and dieting, industry, diet pills, all the negative body image pressures that come through media and now through social media, through advertising.

We’ve known about this for years. People have been writing for decades about this. But what hadn’t happened, was really connecting the dots with what was happening in consumer culture and what corporations were doing to exploit that for profit.

Sam Ikin  00:38

Brynn Austin is a social epidemiologist and behavioural scientist at the Harvard Chan School of Public Health. She’s a doctor of science, and her research focuses on public health approaches to eating disorders.

She also helped launch the Australian National Eating Disorder Strategy for 2023 to 2033, where she praised Australia’s role as a worldwide leader in eating disorder prevention and treatment. And we were lucky enough to catch up with her shortly after that event.

Bryn Austin  01:04

Eating disorders are common, they are deadly, and they’re expensive. We were able to estimate that eating disorders cost the US economy, nearly US$65 billion every year. Now, this is a recurring cost. When I’m talking to policymakers, I make sure to emphasise that this is not a one time cost every single year U$65 billion is the cost to our economy.

Eating Disorders actually are over 1% of the total cost of illness in the United States. If we were to combine everything, cancer, heart disease, all kinds of illnesses, and their impact on the economy, eating disorders alone is 1.2% of that total, what we call burden of disease.

That’s what the economists call it that is burden of disease, for something that many policymakers and people out in the community don’t realise how common they are, how deadly they are, and how much they pack people’s lives.

A couple of other points that are so important for community advocates and for policymakers that we found through this report is that actually, two thirds of those costs are what we call productivity losses. That is, effecting employers, workplaces, and government and families, of course.

Two thirds of those costs. And the reason nearly half of people who have an eating disorder experienced that before age 30. And 83% of people with eating disorders are in the prime of their working years. So that’s different from other illnesses that maybe are more likely to come on later in life, in terms of how it affects the economy.

Eating disorders are right on during the prime of people’s working years. And that has a cascading effect on employers on families on basic household solvency, education, employment, being able to hold a job, there’s all these ripple effects. And our report was able to shine a light on how many they are.

Bryn Austin  02:00

Are we talking eating disorders, like the broad category of eating disorders? Are all of the diagnoses incorporated in that?

Bryn Austin  03:09

Yes, our report encompassed all eating disorders except ARFID. Avoidant, restrictive food intake disorder is such a new diagnosis, that there wasn’t enough data for us to work with. That’ll need to be a future report. We need to have more economic research in that area, then that would be able to be included.

Sam Ikin  03:43

The other thing that I’ve heard you speak about was trying to make some of these harmful products that people with eating disorders look for more difficult for them to get or incentivising them not to use them, I suppose. Can you take me through what you’ve been doing?

Bryn Austin  03:59

In the eating disorders field and body image, we’ve known for decades how harmful the consumer marketplace can be with diet culture and dieting industry, diet pills, all the negative body image pressures that come through media and now through social media, through advertising.

We’ve known about this for years people have been writing for decades about this. But what hadn’t happened, was really connecting the dots with what was happening in consumer culture and what corporations were doing to exploit that for profit, and then targeting those commercial actors.

So, we’re talking about the commercial interests behind diet culture. That hadn’t happened in a way that we’ve seen, for instance, in public health around tobacco, or around alcohol, or some of these other consumer products were for, you know, a century, half a century, we’ve had really concerted public health  focus on protecting communities waning and commercial actors that are exploiting people to make profit off of addiction, for instance.

Sam Ikin  05:13

How did your knowledge and your experience of public health policy in relation to tobacco and other similar industries influence your work in eating disorders?

Bryn Austin  05:25

This actually, the idea of doing this, it came to me actually, during a presentation. It was probably, it could have been 12 to 15 years ago. I was giving a presentation in front of a group where there were some really expert food policy folks in the audience.

One of them was a lawyer, who I knew who did a lot around food policy, not related to diet culture, but thinks a lot about those commercial actors and what options we have for policy. And I was talking about, “Oh, these diet pills, kids are using them, they’re very common, they can buy them anywhere.”

She raised her hand in the audience, she said, “It doesn’t have to be that way. Just like we dealt with tobacco, we don’t have to sell diet pills to kids, we can move these products behind that counter, we can put get regulation in place to ban the sale of these products to children.

We could tax them,” which is something else that public health has done around some commercial products that were harmful.

So we that was the light bulb went off. And ever since then we’ve really run with it because it’s such a perfect parallel with other very successful strategies from public health.

Sam Ikin  06:37

It’s interesting that a lot of the time we see the diet culture, especially in this field, a lot of people compare the wellness or the diet industry to tobacco to big tobacco, and while, it’s still there, it’s not nowhere near as big as it was. Is that a fair comparison, do you think?

Bryn Austin  06:55

The companies that are selling these toxic diet pills are taking a page right from tobacco. They are following their lead.

They’re not as successful yet. And hopefully, they never will be because we’re, we’re fighting them everywhere we can. We built a campaign, working with partners through the community in now 10 states in the United States.

We’ve gotten bills filed in the state legislatures in the US to ban the sale of toxic diet pills to children. It’s really common sense. And it should be a no brainer, in a sense that you’ve got a toxic product, it has no medical evidence to support use, it can be very harmful in the immediate sense because of dangerous ingredients, and it’s well documented how it’s linked with eating disorders.

Common sense protect children from this product. Lawmakers understand that and that’s why in 10 states in the US state lawmakers have filed the bill to take action on these companies. These companies are going to keep pushing to profit off of kids body image struggles profit off of eating disorders, we have to push back and we are.

Sam Ikin  08:06

You have got a pretty good track record of getting the attention of US lawmakers, particularly with one of the examples you gave about bringing in some celebrity grunt. Can you take us through that campaign?

Bryn Austin  08:20

There’s been a couple of changes that have been so important to this campaign to bring attention to this issue and to make sure lawmakers are paying attention.

One of them is to get the attention of celebrities who are very well known, very articulate and passionate about this issue. I mean, Jameela Jamil is one of the best out there, very articulate, strong voice in advocacy.

I had the opportunity to meet her and when she found out about our campaign, she came to Boston, she wanted to be there with us to go to the State House, be there for our State House briefing and went around the State House with us and met with the President of the Senate, met with the commissioner of the state public health department.

They all wanted to meet her and one of them even asked for an autograph for their child, which is very funny. But they heard her message and they are our message. These are doors we were never able to open before.

So we’re grateful to the advocacy for folks who, who are able to amplify the voices of so many who just don’t have the same audience that they do. Another turn of fate for us that has been so important for this campaign has been what happened in response to the pandemic.

So as we all know, when the pandemic started so much shut down, kids got sent home so they couldn’t go to school in person anymore. For young people their lifeline was often through online. Schools through online their social groups in that way. There’s lots of out that that we hope never have to to repeat.

However, one thing that came out of that is young people became very facile at finding what they were interested in and reaching out all over the world to get involved online in organising or activities in that way.

So by January of 2021, we had teens, high school teens from all over the country in the US, and actually here in Australia, and then in the UK, Canada, India, getting in touch with us saying they wanted to get involved in our policy advocacy.

They wanted to learn how does policy advocacy work? What are the skills they need? They’re passionate about this issue, because they are bombarded by the ads, the influencers, all of the harmful messaging for toxic diet pills.

They’ve seen it heard their friends, some of them have been harmed by these. They found us and they said, find a way to integrate us into your plan. Like okay, well, the same time that kids went online, and everyone else did, so did lawmakers. The state houses all across the country, they all were then doing meetings online, their hearings were online, being able to testify was taken online.

All of a sudden, the playing field was levelled between us the community advocates that our high school students working with us and those well heeled lobbyists who work for the diet pill industry.

They used to have us beat in state house after state house because they had so much money to fly there to spend the night in a hotel to send their staff there. We couldn’t compete with that.

Once everything went online, levelled the playing field and instant. Now we can have high school students testifying before New York, in Massachusetts, California hearings. They can meet with lawmakers face to face over Zoom and tell their stories. That was never before possible at the scale that we’re able to do now.

Sam Ikin  11:52

That’s amazing. It opened up so many doors, and some of the students who you’re working with, have taken to social media themselves. That was a pretty interesting story as well, where there was a concerted campaign by some of the people who didn’t like what you were asking.

Bryn Austin  12:09

California was one of the first states where we were really picking up steam, we’re having a lot of success in the California State Legislature. We got a lawmaker to pick it up. We got hearings, a lot of support from lawmakers there. We had done really well in one of the first hearings we had in the state legislature all virtual, and then we were getting ready for the next hearing.

So the bills move from one committee to the next one until they go to a full assembly or Senate vote. So we were at a very important committee vote coming out. Well, up to that point, we had been running an online youth survey, and this was youth led youth had put a survey out online to ask other youth in California, “Well, how are you affected by these products? How easy is s it for you to buy them? Has any adult ever even told you that they’re toxic?”

And our survey was getting a huge response from youth all across California, and youth, by and large, very much in support of the bill, speaking out against these predatory companies. And then all of a sudden, within about it was probably about 48 hours before the hearing, that online survey was getting flooded with responses.

They’re like, “No, let’s keep the products. Let’s oppose the bill. We’re not bothered.” All of these surveys coming in, right before that hearing. Well, the youth we work with are incredible. They saw that, they saw what was happening there real shift in the messaging just a couple of days before the hearing, and they did a whole forensic analysis of the response pattern. These are scientists, budding scientists to be able to do this and forensic scientists.

They discovered all of these oddities about the response patterns that didn’t line up from what we were getting from real youth up until that point. And so they were able to identify, we didn’t have proof of whose computer was coming from, so we don’t know for sure it was coming from the lobbyists.

But we know those lobbyists in California are working hard to defeat our bill. And it was very suspicious. It’s possible that it was due to bots, as happens online with surveys. But either way was very suspicious.

Sam Ikin  14:24

Wow. I mean, I’d love to say that that was surprising. But of course we know what happens when vested interests, money, power collide. So was there anything you could do about it?

Bryn Austin  14:36

The youth weren’t going to let it let this get them down. They put together this incredible Tik Tok triptych, so three short videos about how they discovered the problem, what the issues were how they discovered through their forensic analysis, that they’re that the survey had been compromised by nefarious actors of some type.

And then they spoke out and said this is important. We want to see this through and put it out through Tik Tok, which got a lot of pickup. And they’re just so ready to take on the, no matter how big the opponents are, they are ready to fight for justice to fight for equity to fight diet culture, they are right there in the trenches ready to do this.

Sam Ikin  15:25

It’s very odd, though, that you would think that kids would be coming up with responses like they did. Like it just didn’t make much sense. I was really interesting story, but the fact that they would put so much time and effort into an online survey like that, this is a nefarious sector or industry?

Bryn Austin  15:45

Yes, absolutely it is a nefarious industry. Make no mistake, these are predatory products. Over the counter diet pills and muscle building supplements are predatory products.

They are preying on young people’s body image struggles, eating disorders, body dysmorphia, to make a profit. That’s all that they’re about. Their products don’t work. They’re not safe, they’re not medically recommended. But they want to make money off of harming children. And that’s what they’re able to get away with. We won’t stop till they’re till we can put it into that.

Sam Ikin  16:18

I’m sure there’s lots of about this campaign that we could talk for ages. But I wanted to ask you a couple of more broader questions about where we’re at. If we look at over the past 20 years or so. How far have we come? Because I’ve heard a couple of clinicians and a couple of researchers that saying that we’re still not making a whole lot of headway in terms of prevention, treatment as well, and how that the the industry works as a whole. Because we still don’t understand a lot about these illnesses. What’s your take on that?

Bryn Austin  16:56

I would say in the last 20 years, 30 years, we’ve made a lot of progress, but we have a long way to go still.

The part of the issue is that when we develop effective, whether it’s an effective treatment or effective prevention programmes, it’s very difficult to take that leap, then to scale up to get something adopted system wide in a health system or in a community system and make changes to make treatments or make provincial programmes accessible.

Also a lot of the research really didn’t have in mind accessibility across income groups, across race, ethnicity groups, or diverse cultural groups, neurodivergent communities, LGBTQ communities.

That wasn’t all part of the equation from the beginning. And so when we have our treatments or prevention programmes that have a strong track record, in a more limited population, but important, important, important work, but we haven’t made as much progress as we need to to have accessible programmes accessible, whether it’s treatment and prevention in that way.

The other piece is that in, I’ll speak to prevention in particular, eating disorders, prevention really arose out of the clinical profession. And it makes sense. Who was seeing eating disorders, it come into their office? People in need of treatment for eating disorders coming into their office? It’s clinicians. They were seeing it up close, they were the first ones to identify eating disorders, and they brought the best of their training to the question of prevention.

I’m sure that many clinicians have gotten to a point where they’re dealing like “We can’t treat our way out of this epidemic, we have to be going upstream and looking and earlier in the path to figure out how to prevent these conditions, we can’t get enough people trained in treatment to really take care of it.”

And plus, that means waiting till a lot of suffering has happened if you wait till someone needs intensive treatment. So they brought their insight on how critical it is to develop prevention for eating disorders. But they’re bringing in the toolbox of clinicians and not what has been done in the other areas of prevention.

Meanwhile, in my field and public health, they were completely ignoring eating disorders altogether. And in fact, in the field of public health isn’t so great on mental health broadly, and then even worse with eating disorders. So when I started my career, there was almost nothing happening in public health around eating disorders.

Sam Ikin  19:33

So where did you get involved in prevention strategies and initiatives and all the things you’ve been talking about?

Bryn Austin  19:39

Probably five, eight years after I graduated, I was at the American Public Health Association Conference, which is our big national public health, it covers every topic. And I was back at the hotel room with a colleague after having spent one of the days there and I said, “You know what, there’s nothing on eating disorders here, same last year same the year before.”

She was like, “Stop complaining and do something about it.” And that was one of those lightbulb moments, I realised, Oh, this isn’t going to change unless we can address the pipeline in public health to get people thinking about prevention and bringing them into the field.

And that’s what led to the creation of my programmes STRIPED. Strategic Training Initiative for Prevention of Eating Disorders. We call it a public health incubator.

And it’s the the the first programme like this dedicated to prevention, research and training at a public health school with a full on, really both feet in public health, bringing a new perspective to how we do that, and we’re very focused on training because it’s not just about what we do, it’s about helping to build the next generation, who can bring public health approaches to prevention.

And the reason this is so important is no matter how good your intervention is, whether it’s for treatment or prevention, if it can’t be scaled up, if it is not considered something that’s practical, acceptable, cost effective by communities, it’s going to have no future, which means nobody’s going to benefit from it, other than through the original research that’s done. We have to be thinking about, how can how can this idea this programme, how is this going to work out in the real world?

Sam Ikin  21:24

Yeah, I love that. Now, you were involved in Australia’s National Eating Disorder and Prevention Strategy, your work was cited in it and you spoke at the launch in the second half of 2023.

Over the next 10 years, how much hope do you think people with lived experience, and the sector generally can take from this new framework?

Bryn Austin  21:45

No country has done something like this as far as I’ve ever seen. Australia is leading the world by coming out with a national strategy like this. It’s very encompassing, but there’s a couple of things about it, I want to call attention to that are just so groundbreaking, it’s so important for Australia and for other countries to be paying attention to.

It is not just focused on programmes to make kids more resilient. Now, that is very important, we want kids to be more resilient. We want programmes that can help kids manage the toxic environment around whether it’s media, social media, commercial actors, all of that.

But we need to be changing that environment. And again, and again, throughout this report is talking about working across sectors across sites, whether that’s media, schools, commercial environment, health care systems, discrimination.

This is something we’re getting more and more research on how harmful discrimination is whether it’s around weight based discrimination, or now we know other kinds racist discrimination, LGBTQ anti gay kind of discrimination, anti transgender discrimination. These impact body image in a very harmful way that increase the risk for eating disorders.

But we don’t want to just make kids resilient to being discriminated against or resilient to fat shaming. We want to change that environment.

And one of the things I love about this strategy, it’s really a whole community strategy, getting everybody involved in everybody’s responsibility to create healthier environments. That’s that’s one of the the the gifts that Australia is giving the rest of the world is a model for how do we envision a better world to prevent eating disorders.

Sam Ikin  23:28

Thank you so much for sitting down with us for a little while. We appreciate it very much.

Bryn Austin  23:34

Thank you. It’s such a pleasure.

Sam Ikin  23:38

If you’re struggling with an eating disorder, or you think you might be or you think someone that you care for it might be, the best thing that you can do is reach out. The Butterfly National Helpline is 1 800 ED HOPE that’s 1 800 33 46 73.

Or you can go to butterfly.org.au, where you can chat online or just look at some of the resources and find out a little bit more about what it all means or who you can go to for help in your local area.

I’d also encourage you to have a look at the website for the Australian and New Zealand Academy for Eating Disorders, particularly if you’re a clinician or a professional working in the sector. Butterfly: Let’s Talk is produced for Butterfly Foundation by Ikin Media, with the support of Waratah Education Foundation, we really appreciate your support. Our executive producer is Camilla Becket. And as always, if you’d like to help out, please just leave us a comment and a rating in the app while you’re listening to this podcast. That on its own is massive for us. We’d really appreciate it. I’m Sam Ikin, and thank you so much for your company.