As a PhD candidate with the Division of Anthropology at the University of Malta, I conducted an ethnographic study, a qualitative and comparative investigation on eating disorders in Malta and Italy, to shed more light on such aspects.

The study took place in 2012 and lasted a year, during which I spent four months conducting daily research at an Italian public residential centre for people suffering eating disorders with a reputation due to its innovative holistic approach.

Since the 1980s the phenomenon of eating disorders (anorexia nervosa, bulimia nervosa and binge-eating disorder) has become a matter of increased attention in Western societies, with a consequent widespread social concern.

This is not surprising, considering that before 1970 anorexia nervosa was considered by physicians simply as a curiosity and rarity.

The category of eating disorders classifies a number of illnesses characterised by gross disturbances in eating behaviour due to a strong fear of gaining weight or becoming fat.

Even though anorexia nervosa and bulimia nervosa have the highest mortality rate among all the psychological illnesses, they have been considered as illnesses only recently.

Anorexia nervosa was officially described as a psychological condition for the first time in 1873. Bulimia nervosa and binge-eating disorder, on the other hand, officially became mental disorders respectively in 1980 and 2013.

Despite the proliferation of scientific studies, as well as the different treatments and approaches towards eating disorders, the success rates of psychological and medical treatments are still low, due to the fact that medical establishment tends to underestimate the socio-cultural factors determining the incidence and meaning of eating disorders.

The importance of understanding the cultural role in the onset of so-called eating disorders becomes apparent when considering that the majority of people diagnosed with an eating disorder are women and that this phenomenon does not seem to exist in certain societies.

Being thin does not simply mean being beautiful. It often appears to be the best option to gather confidence and acceptance

During my fieldwork in Malta, I interviewed 20 people with an eating disorder and a number of experts in the field. I also conducted online fieldwork to better understand people with eating disorders in a space they could consider as safe and anonymous.

Even though there seems to be a relative similarity in case rates in Italy and Malta, social reactions to eating disorders, the level of awareness and information, as well as available treatments are markedly different.

When I started my research, there were 172 public institutions in Italy (one per 352,479 citizens) treating eating disorders in four ways (ambulatory services, day-hospital services, hospitalisation and residential rehabilitation).

On the other hand, there were no specialised centres or institutions treating eating disorders in Malta. While the biomedical and psychological approaches are the most authoritative in both countries, different state policies led to two completely different situations.

Not only do available treatments greatly differ but the perception of eating disorders is also different.

My informants’ perception regarding their relation towards food, as well as their understanding of eating disorders more broadly, are the result of the different State-level strategies adopted in Malta and in Italy.

My Italian informants spoke of eating disorders reflecting the biomedical perception on the subject, while most of my Maltese informants did not have a precise idea about eating disorders.

Despite these differences, the people involved in the study claimed to have actively and deliberately adopted specific behaviours in relation to food and body in order to become thin. They all admired thinness to the extent that their life is (or was) entirely devoted to it.

However, they hardly ever used a language of aesthetics when referring to thinness. Those involved mostly attributed positive moral and social values to thinness, while fat bodies were perceived as symbols of social and moral failure.

Their point of view reflects a broader perception of body sizes in our societies. In consumer capitalist societies where food is overabundant, a slender body represents self-control, will power and determination. Slender people are admired, while being fat invalidates a person. Different studies have revealed that obese people are likely to experience social exclusion, bullying, depression and discrimination in employment practices.

In this view, being thin does not simply mean being beautiful. It often appears to be the best option to gather self-confidence and self/social acceptance.

Gisella Orsini’s research work was partially funded by the Strategic Educational Pathways Scholarship (Malta), which is part financed by the EU – European Social Fund under Operational Programme II – Cohesion Policy 2007-2013, ‘Empowering people for more jobs and a better quality of life’.

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