#88. Eating Disorders Beyond Western Stereotypes - Dr Bailey Rose

Dr. Bailey Rose (Ngāti Maniapoto), Clinical Psychologist at Ora Toa Mauriora, New Zealand, joins us for a conversation on eating disorders, culture, identity, and mental health care.

We explore how eating disorders are often misunderstood through a narrow Western lens, and why that can leave Māori and other underserved communities unseen, misdiagnosed, or excluded from support systems. Bailey shares insights from both her clinical work and research, discussing the cultural meaning of food, barriers to care, stigma, social media pressures, and the limitations of relying too heavily on measures like BMI.

The episode also dives into:

•  Māori perspectives on food, care, and wellbeing 
•  How culture shapes experiences of eating disorders 
•  Emotional regulation, shame, and relationships with food 
•  Misconceptions around who “gets” eating disorders 
•  The impact of beauty standards and social media 
•  Ozempic and the growing conversation around weight-loss medications 
•  Why culturally responsive mental health care matters 

Transcript

0:03

Hello and welcome back to the SmoothBrain Society. uh Today we'll be talking about eating disorders. When people hear the term eating disorders, there's often an assumption that we all mean the same thing, the same symptoms, the same experiences, the same pathways into care. But an increasingly important question being asked around this is, what if that understanding doesn't reflect everybody? Because for some communities, the way eating disorders are experienced, understood and responded to can look quite different. Shaped by culture, identity, and whether the systems around them feel accessible or even relevant. That's where our guest comes in today. We're delighted to be joined by Dr. Bailey Rose, clinical psychologist and researcher at Ora Toa Maori Ora in Wellington, Aotearoa, New Zealand, whose work focuses on improving mental health outcomes for Maori and other underserved communities. Her research explores the experiences and needs of Maori with eating disorders alongside her clinical and community work in this space. So join us for a conversation about how we understand eating disorders, how culture shapes care, and what it means to build services that actually work for the people they're designed to support. Bailey, great to have you with us. Welcome to the SmoothBrain Society. Thank you. And ah Alex is back to co-host with us. So thanks, Alex, for joining. um for inviting me again. Awesome. Bailey, first question we ask all our guests. Could we go a little bit, get a little bit of a backstory or an origin story into you, how you ended up becoming a clinical psychologist and working in this space? Yeah, well, for starters, thank you for having me. I guess my Haerenga all my journey into this kind of space in terms of research and in terms of my uh clinical psychology, there are kind of two components to it. First being whanau kind of family exposure to mental health. I have whanau members navigate various forms of mental health and mental distress from suicidality and depression. And from a young age, I guess I was trying to make sense of what was going on for them also observed and continue to observe uh barriers to accessing care. uh and in particular barriers to accessing care that meets cultural needs in addition to clinical needs. So I guess I saw a real big gap there. then specifically in relation to my research kaupapa of eating disorders or ngā mauiwi kai, I grew up in the Waikato which is very close to the west coast and so the environment that I grew up in I was very much immersed in this culture where the norm was dragging nets uh or kaimoana or seafood, going fishing with my whānau and I guess I grew up in a whānau where A big way that we show love for each other and monarchy and care for each other is through food or kai. And so that's the kind of view of food that I had instilled in me. And then I guess as I navigated different spaces, I attended an all girls Anglican school and that was quite an interesting experience. And I observed increasing kind of pressures to look a particular way. and something that I found helpful for myself was this view of kai that I had instilled in me. The importance of nourishing myself and that kai is something more than just food and nutrition. It's again, it's how we show love and care, it's how we celebrate, it's all these wonderful things. And then, like he says, I continued on. I came to university and I studied psychology in my undergrad. And it was there that I saw a number of other Tauwira actually navigating eating disorders. So in my first year alone, there were a number of other people. with eating disorders. So I don't have lived experience myself, but it was in those kind of experiences that I began to piece together, hey, what might it be like to be Māori, to have uh a view of kai instilled in you, to then experience a disorder that is really marked with a disruption in your relationship with kai and food and your body. And then from that I went and I searched and what I found was there wasn't a whole lot of my hair, a lot of research there. And so I was like, hey, this might be my thing. And then it became my thing. So yeah, that's my origin story. No, awesome. It feels like a general trend with almost every researcher who we've spoken to, who speaks particularly in terms of like indigenous communities. So your flatmate and friend of ours, Ellie, for example, um also spoke about perfectionism and not there not being much research, but I feel even when you talk to people from Indonesia or Chile, they say the exact same thing that there's hardly any research in this space. for all the publications that you find on Google Scholar, kind of shows that there's so many things which haven't actually been addressed. Absolutely. When I started out my journey, if I recall correctly, there were two papers out there all together. And when you would search Māori eating disorders online, was there wasn't really anything there. And then when we think about broader uh research that had been done in Aotearoa, Mardi would only comprise such a small portion of the samples as well. Awesome. So shall we start there then? I think maybe we take a step back and I guess ask a very basic question of what are eating disorders? What do we consider eating disorders? And then maybe we can talk further from there. Yeah, so I guess if we think about eating disorders in a more Western sense, we think of them being a grouping or a collection of syndromes that are marked by a disruption of eating and eating related behaviors that impact one's absorption or consumption of food or kai. So that's a really broad way of talking about eating disorders. And then I guess in thinking about what that might look like um from a te ao Māori, from a Māori perspective, part of my mahi alongside my research was exploring what would a uh appropriate framing or kupu or uh names be for eating disorders. And I worked with a really amazing rōpū of Māori who work practice and research in the field of eating disorders and together with the assistance of Kere Opai, one of our amazing te reo Māori rangatira, with the assistance of a hymn, we came together and created the kūpū ngā mauiwi kai. And uh if I break that down for you, mauiwi, eh when we hear that we typically think uh unwellness, but actually when we put it together, when we explore that further, it refers to a temporary state of imbalance or unwellness. And so Ngā Mauwiwi Kai refers to a temporary state of imbalance in relation to kai or food. And something that was really key in our framing and our conceptualisation of this kūpū was that we didn't want it to be this fixed state. We wanted to signal that these are difficulties and challenges that are recoverable. So it was really important for us to capture that in the framing, so it being a temporary state. No, I think that's a very nice framing. instead of kind of saying this is a disorder, this is a like a permanent label, you're kind of framing it more as like it could be a period of transition in a way. Is my understanding correct on that? Yeah, yeah, no, absolutely. yeah, estate and I guess the key part is I guess the imbalance. So in Te Ao Māori, kai, again, as I mentioned, serves so many functions. But one thing it helps with is kai can help us transition between tapu. and no stay so topic more sacred and restricted spaces to normal neutral spaces. So when we go through a Tangihanga process or following the loss of someone telling we do after we have a kai we eat to transition us to to make us uh move to this more neutral space. And so I think when we think about the framing and the role of foods and how it helps serve that balance, we might see that someone with Ngāi Māori Wikai is in that imbalanced state. OK, so we've we've established we've established a few things here. ah So then can we talk about your research then? So you already said that. when you started out, there were only two papers on this. So kind of what was the what was the process like of going about wanting to look at this and then actually actioning sort of research around? Yeah, eating disorders, That was really hard actually because of how little there was out there. And it's so easy to be ambitious and be like, I want to do it all. And then you have to rein it in and go, actually, this isn't a life's work. This is just a couple of years. And so trying to pin down what's going to be most beneficial to the community. And I... I guess when beginning to look at the literature beyond Aotearoa, what stood out was just the prevalence of research in those weird populations. So Western educated, industrialized, rich and democratic populations. So even to the point that prevalence data in itself was limited beyond Western. cultures. Due to that, I guess everything about what we know for the most part has been framed from that lens and I found that really challenging because I didn't want to start this thesis or this entire framing from in a way that just positions this as up here. So I went, hold on a minute, how about I speak to our kaumātua and and start with that. So kaumātua, our elders, our knowledge holders, and I just thought it'd be fantastic to speak to kaumātua and hear from them about what exists in terms of do we have beauty ideals within te ao Māori, what are they, what do we know about eating disorders. Did these exist historically for our tipuna, for our ancestors? Are they a new thing? Or if they did exist, in what ways did they come up? And then in that way, I I could start by the centering of our own knowledge as opposed to this comparison kind of thing of this is the Western and we're different in these ways. It's actually again centering. So I started with that and I guess what really stood out to me and what took me by a real surprise was A lot of the kaumātua that I spoke to had their own exposure to eating disorders, or ngā mauiwi kai, whether that be their own lived experience or through whānau members. And I guess that does, again, totally by real surprises, we have these such prominent stereotypes about uh who has eating disorders. And that's typically that skinny white affluent girls that swag stereotype, that swag acronym. So to hear that our kaumātua, so 60 and up, have ever had lived experience or knew someone. And another thing that stood out to me was that... Even our kaumātua continue to experience and uh face pressures in relation to how they should look. And they had this incredible framing of navigating two worlds. And they shared that, you know, even for our uh whānau who have grown up in a really embedded way, so growing up going, attending, full immersion, kura kaupapa. and risked in our culture, even they exist within a space where we are constantly having to navigate pressures about how we should look. There were so many other elements that came into around, you we were never going to look that way because there's colorism. Our skin isn't that color or our bodies are never going to look like the ideal. So the constant othering. uh And yeah, there were so many things that came up in that study that really surprised me. uh another being the idea of our own beauty ideals. So we have so many whakatauki or whakatauki are our kind of pithy short kind of sayings that are ways that we disseminate or pass down values or pieces of knowledge. and we have all these whakatauki that actually communicate what our beauty ideals are and one of them for example speaks to the raupa of our ringa or the calluses in our hands so they speak to actually the importance of pursuing a partner who is hard working or there's ones that are like marry the warrior of the garden So actually what we strive for and what is seen as beautiful to us is service and dedication to people and to the community of Whānau. So I thought that was just beautiful. For sure, because listening to uh the other side of the world, it's so far away that I'm starting to learn things which I've never thought I'd learn before because it's so far, so we don't really see, hear or speak about that side of the world. it's fascinating that also Bailey is incorporating Maori words. So ah I've never heard anybody speak like this before. So I got a couple of questions, if that's okay. So a question that I wanted to ask you is, do you feel like in your research you saw multiple pressures, like Western pressure, Maori pressure within the people you talked with? Absolutely. I guess a reflection I had and I continue to have even post my thesis was around how body image or the way that we can think about our body is not a fixed thing. It's so fluid and that changes from actually environment to environment. Something that came out through talking to people with lived experience was the way in which perhaps being in Māori spaces, they observed that it did not bear the kind of same pressures to adhere to more Western than ideals. But that, uh Again, even those that grew up really immersed, embedded within the culture still felt this tension around, I'm still experiencing these pressures. And so it's a navigating experience. And I've actually, I framed my overall PhD as tangata whai ora as ngā kai whakatere and kai whakatere. means navigators because I see I guess tangata whai ora or people with eating disorders is literally navigating these pressures or these barriers to care, to being hurt. Understood. And you did mention that you had also the religious experience. You saw with your own eyes that religion or like the religious school you attended, you started seeing some signs. Would you say that part of the pressure on the Maori community that comes maybe from the West has a religious element to it? So when I attended high school, it uh was not like a Māori specific school. So the large majority of the students there were Pākehā or non-Māori. And what I did see in my research is there were participants who shared how their experience of pressures within their religion to present a certain way, created against additional pressures in terms of their body and how they should look, in particular pressures to cover their curves, and a false sense that it isn't okay to have large boobs, to have curves. Yeah. And was there the concept of fasting mentioned ever people going days without eating but not for like detox but in the name of religion? No, that did not come up. However, I have heard of fasting being used within uh Māori culture for various reasons. In particular, I've heard mentioning of uh grieving processes where people have fasted. I uh just a couple of follow ups. You spoke about sort of Namawii Kai and your elders talking about it. Were there representations or their ideas of what eating disorders were or their representations of it of like the behaviors any different from what you might see in younger people were people from our generation. guess we're all now generation X or alpha or whatever is younger now. But yeah, were there any generational differences is basically what I was getting at. Well, it was really interesting because, again, kaumātua shared maybe their own experiences with eating disorders or disordered eating from behaviors that were kind of described, it appeared consistent with what we might think of as like bulimic type behaviors, so purging behaviors. And there was also mention of Pūdāko, so different iwi or different stories that whānau had around their tepuna or their ancestors and how we have these stories of experiences in a disruption of our relationship with food. So one story or one Pūdāko that was shared was around how historically when our tipuna were maybe taken as prisoners and were treated as people with little mana, treated as inadequate, as yes, as having little mana, they actually refuse to eat because they refuse to be treated in that way. So in that way we have these kind of framings of uh these changes in the way that we eat and that particular framing was something that continued to come up in various nuanced ways throughout the research and that often people or whai ora that I spoke to, their relationship with their food changed when maybe they experienced something that made them feel less than or inadequate or like they had their mana whaka eat eat or made to feel small. And I think when we think of eating disorders or ngā mawiru kai in that way, it takes away the stigma of these being these superficial disorders that are all about appearance. There's a lot more to it. That's very, very, very well put. I mean, I not. think you also see it in. I don't want to be little, but in a day to day sense, like your emotions can change the amount you are willing to eat or want to eat. So like there's that link already there. Even for people who don't necessarily, I would say, experience eating disorders that certain times, if your mood is down, you don't feel like eating and. So you can see the link if you think about it. Absolutely, that whole whakaro, that thinking actually was raised again by kaumātua around, you know, it's not surprising that eating disorders are as common as they are because often we are raised or we grow up in systems where the only skill or emotion regulation kind of A skill that we have in our kete is food. We know food makes us feel good. And so it's unsurprising that there are times and there are people who may experience it at a greater intensity in a way that's really harmful. But I guess that framing around, know, we are not eh deprived of emotions. There's a lot of emotions and also we know that Māori are... There's so much statistics around Māori experiences of adversity. I guess a very, a very prevalence-based question from me to follow up this ah is sort of what uh kind of the rough statistics around it are like Maori generally more likely to have eating disorders, more less likely to get help. Is there anything like that out there just on a pure statistical point? Yeah, so as you might expect, prevalence data is really limited when it comes to eating disorders for Māori. We don't know a lot, but what we do have is really, really dated. Maybe 10 or so years old, if not longer now. But what... that showed us anyway is that eating disorders were at least as common in Māori compared to non-Māori if not more common. And if we think about the transition and how times have changed since then, we can look at some key time points such as the period of COVID. We know that there was a global increase in eating disorders during that time. The sample where that previous prevalence kind of statistics comes from only looked at age 16 and up and we also know that that time point around 16 in those teenage years is quite a critical risk period so even then that sample likely misses a real key part of the population considered at risk. When we think about What about the uh population receiving eating disorder treatment and care? Lacey and colleagues, Cameron Lacey, he is a Māori psychiatrist and he and some of his colleagues did a piece of research looking at the population engaging in eating disorder treatment and they compared that to existing eating disorder prevalence statistics and what they showed is that there's a major discrepancy between uh Māori prevalence of eating disorders and Māori engaging in services which indicates that there's a real significant uh unmet need for Māori and that is really congruent with what I observed in my second study as well where I spoke to Māori with lived experience. So the process of uh trying to access care was incredibly difficult from internal barriers to then uh external barriers. So stereotypes within services. not actually being assessed for an eating disorder. Yeah, so many things. Did you happen to also notice bullying having a role in developing 18 disorders? I'm not sure if bullying itself came up, but definitely the experience of broadly receiving critical and hypocritical comments in relation to the body and the experience of really stressful experiences and trauma. something that Firewater shared was that their eating disorders often arose in times of really... uh big stressful times and out of a desire to gain control. And so one of my themes is actually friend is control among the chaos and. It was emphasized a few times that it wasn't about how their body looked at the time. It wasn't about trying to gain the thin ideal to aspire for that. And perhaps it wasn't until later, once they lost weight, and then that weight loss was reinforced by people in their world that continued to, I guess, perpetuate that cycle of weight loss. Yeah, real, real key part was that it was trying to gain some sense of control over everything that was going on around the world. Did you also happen to notice, for example, because New Zealand is also mixed, we can say, countries. We have people of many ethnicities and cultures. uh I was wondering if the Maori people have certain dishes, foods that maybe they were misunderstood and as a result developed an unhealthy relationship with the food, with their cultural food because of that? there was no particular dishes that came up or But, kai is a real key part of our culture. Food's really, really important. And so there was this really interesting kind of experience for whaiora with eating disorders because there is this whole kind of idea that, you're Māori, you love food. And then we had Māori who have this really difficult relationship with food. and actually a whāora that I spoke to. um I guess the framing that I came to was this idea that for Māori with eating disorders, their eating disorder actually separated them from the very things that as Māori facilitate healing. So kai is healing and the spaces that we as Māori come together at are often revolving around food. They separated. are people from whānau. So all the great things that were really healing. But at the same time, when whānau were able to engage in those spaces again, there was something so therapeutic about that. And I think... something that is really missing when we think about assessment of eating disorders but also intervention and treatment is. someone, a Māori person with an eating disorder. When we think about assessment of dysfunction, how is a particular disorder impacting someone's life? think about work, social, etc. Day-to-day living. We also need to think about the impact of that person to engage in their culture. So treatment needs to move beyond actually this person's restored their weight or they're not purging anymore. We need to go beyond that actually be like, how do we support you to feel confident to reenter spaces that we know are going to be really therapeutic for you? Or on the flip side, an assessment. Is it hard for you to engage with your whanau? uh Perhaps previously were you able to attend the marae and that's really hard to do now. because for example uh one participant I spoke to shared an example of attending a hakere which is a big feast, they happen at birthdays or celebrations all sorts of different things and one of the whaiora shared that they were having a hakere for a family member and she walked in there and she just felt so overwhelmed with emotion and she couldn't exist in that space and that was incredibly difficult and it was in that point that she had that bit of a turning point in her framing. I like I can't exist in these spaces that are really important to me, into my culture. know, Te Ao Māori, our world is a place of feeling and inviting and I can't exist in that. Yeah. ah I mean, I have two very separate questions to ask. Maybe I'll go with this one first. So you mentioned a few themes, like we've been slowly picking. And in all your answers, you say, in study two, I did this, or one of these themes came up. Maybe it'd be a good idea to talk, if I could ask you what sort of themes came out of your work. ah And then we can go from there, because it gives more of an idea. I guess one theme one notable theme was, I framed it around, but Māori don't get eating disorders. And this thing really draws together the experiences of participants and facing compounding lack of recognition and barriers to having their eating disorder recognised. so many shared that in efforts to having their eating disorder recognised, for example, maybe presenting at their GP to have an assessment there. eating disorder was dismissed, perhaps misdiagnosed and they shared how that fed the denial, fed the eating disorder and the way that it convinced them that actually hey, if the GP, if this medical professional doesn't see this as an issue, then it can't be an issue and therefore what I'm doing must be okay, must be acceptable. And as that continued on, it meant that uh whai ora or participants... really didn't think they were deserving of care and support until they had a feeding tube up their nose. They actually, at the point at which they thought they were deserving of care was so far along and so severe due to the compounding lack of recognition. Yeah. think it's very important to ask you as a clinical psychologist, ah and I guess for GPs, what are sort of the criteria for diagnosis? Because I feel eating disorder misdiagnosis in certain cultures might have something to do with size, body shapes, body weight, which are different from the traditional Western European concept. Yeah, so we have like the obviously DSM diagnostic criteria and a lot of challenge I have, an issue I have is around the disproportionate value placed on BMI, the body mass index and we know that the background of the body mass index was that it was never developed with the purpose of determining weight or any kind of classification for an individual. It was designed for determining population level health. And then we've taken this tool and then we've slowly slipped away. And now we use it for something that was actually designed for something very different. And... A challenge I have is that we put a lot of value on the body mass index, the BMI, and it can actually be a barrier for uh people accessing care. Yeah, no, I just I guess that makes sense. It was just one of the things which I was thinking as reasons for misdiagnosis. I know there's multiple, but I was just thinking that one because most mental health conditions, usually you talk about personality behaviors, but I felt like for eating because we conceptualize it with like being thin or being this or hitting sort of marks, which might not be possible in. There was some interesting research, I think, during the COVID period that showed that uh Māori were more likely to present at the hospital due to other comorbid issues. And it was through that experience that their eating disorder was recognised, which really demonstrates the actual barriers to getting there and to getting the support that perhaps it's easier to present with another. challenge that it is with an eating disorder is the primary issue. Is there any stigma if anybody goes and actually tries to get help? Are they shunned by the community or even by their medical professionals from that side of the world experience? I'm not aware of any stigma in relation to... the steps to help seeking, gaining support. I am aware of challenges um in terms of what you're actually presenting due to the prevalence of stereotypes again. including that, you know, it's not something that maybe people have realised that Māori experience, and in the same way that uh we might associate with eating disorders with smaller, thinner bodies. So in that way, stigma and stereotypes kind of shape that experience and the ability to get the assessment. Are there, um how should I say, people more likely to get help than other people from your experience? I'm just totally speculating here, but I suspect that I am. for an individual that may present in a thinner body, it could be easier to gain support. And I want to acknowledge that that's really important because there are serious risks associated with malnutrition and significant weight loss. So that's really important. I guess another point to add around how uh weight may influence the process of gaining support is an Aotearoa uh obesity is a massive health issue and it's a really prominent issue and I guess it's important for us to consider how obesity constrains the experiences of people with eating disorders who present in larger bodies. their ability to get support for the eating disorder. I have colleagues, have friends who work in the space and they've been referred by order to support them with maybe weight loss management. And then when giving them a real break eating disorder screener, they've found that actually this is someone with significant eating disorder needs and actually how the saliency of obesity overshadows the other needs of the individual. You brought up obesity in one way, it raised another question of eating disorders typically are associated with sort of either under eating behavior seen in anorexia or purging behavior seen in bulimia. But would you consider sort of over overeating as well as an eating disorder? Is that also a thing? And did that also show up in your research? Yeah, so I had a real range of presentations in my research, but absolutely more binge eating presentations. Absolutely about eating disorders. I was concerned with a whole range of presentations and actually in my recruitment for my Rangahau for the research, I did not constrain recruitment criteria to having a particular eating disorder diagnosis because we know that Māori are more likely to face barriers to have an assessment, let alone receiving an eating disorder diagnosis. And I also did not want to constrain Māori experiences of eating disorders to uh pre-existing kind of diagnostic criteria. But absolutely, overeating, undereating, losing control with one's eating, engaging in other behaviours, compensatory behaviours. all of them. Were there any trends that were circulating in New Zealand that really in shared toxic behaviors, dieting trends that were predominant and then somehow made their way into like the Maori communities and they started to also follow those trends? I didn't observe any specific dieting practices or trends beyond the classic pressure of the Western thin ideal. I do think that moving past the time point that I did my research, I think in the current climate, social cultural influences are really changing at the moment. There's an increasing pressure to be thin. And there is the introduction of other weight kind of measures at the moment. For example, OZempac. are all new kind of pressures. practices around looks, maxing and peptide use. So I do think there's this whole new wave of pressures going on at the moment. And so I just think that just signifies the importance of ongoing research in this space for Māori and beyond because I guess there's just so many pressures for young people and for people across their entire lifespan. to look the heavens in a way. I guess as a clinical psychologist, what's, oh what do you find most challenging about sort of working with clients or people who show different eating disorders or present different eating disorder symptoms? Yeah, so guess blending your research into sort of work experience. So I work in a primary service and eating disorders isn't, if we think about disorder eating, it isn't a presentation that comes through our service frequently. I suspect that when people present with eating disorders at the GP, they're more likely to be directed to an uh eating disorder specialist service. However, um I have worked with eating disorders in the community and one really challenging thing is, I guess... These are a couple of things. In terms of for the individual, they're really isolating component of the eating disorder and supporting the individual to open their world up because an eating disorder can make someone feel really small. So I think a key part is resourcing and supporting them to actually. How do you have a courted or how do you have a conversation with someone that's important to you to let them know what's going on? Because it can be a really lonely journey. And then I guess another part of it, and it is closely linked to why an eating disorder can make someone's world really small, is around the egocentonic nature of eating disorders. eating disorders, are egocentonic because they often align with someone's goals or motivations. So it might be a motivation to have control in one's life. It might be a motivation to change their body weight. And so because of that, it's really reinforcing. So supporting an individual to create change and motivate is really important. And I guess a real key one that I am missing is just how dangerous eating disorders are. They really, really require the input of multidisciplinary teams. So working alongside GP, uh dietician if possible, nurses, regular bloods. all sorts of other kind of medical input is so important because I observe that perhaps the community kind of knowledge around acne and disorders, people aren't aware just how deadly and dangerous these disorders can be. Are medicine like Ozempic accessible easily in New Zealand? So there's a real increase in the accessibility of medications like um Ozempic. And so one barrier to access is uh the financial costs. So they are quite expensive. However, Yeah, there's definitely I've observed an increasing use within the community. And I also want to acknowledge that these medications have their place. However, I am concerned about perhaps people using them when for reasons other than immediate weight loss needs due to really significant health concerns or... issue of not addressing the root cause. Understood. Awesome. Oh, awesome. Bailey, I guess for this last section we had and you saw this as well. We put out a question on our Instagram asking people if they had any questions for you. We received three questions and then there's two more questions to you always asked, I guess. So you'll be asked five in total. So if you're OK with that, ah I guess the first question was, so Dr. Rose, what do you think the roles of social media play in eating disorder? And does the role of social media in eating disorder impact differently based on different demographics, like someone's age or ethnicity? Well, first of all, I observe social media to have an incredibly significant impact on body image, eating disorders, etc. uh Social media really acts as the uh key disseminator, if you will, of beauty ideals, pressures. And it's just with how tapped in we all are with social media these days, it's almost constant, constant dissemination of pressures to look a certain way. also suspect that there are unique pressures in social media influences by age, ethnicity and gender. That being because there are almost like niches right for beauty ideals that exist for different time points, whether it's age or gender. As I mentioned briefly before, If we're thinking about tāne or male experiences, there has been a significant rise of uh male beauty standards and pressures in that space. For example, looks mixing and really extreme beauty standards and measures to the point that there are reports of people actually breaking bonds to restructure their jawlines. And I don't recall there ever being such extreme male pressures in standards. And in terms of culture and ethnicity, There are unique uh standards and beauty standards in different cultures and that includes things from what is the preferred skin color. So in my research, I observed and I came across research looking at the use of whitening, skin whitening products. And then if we even think about on the flip here in Aotearoa, we're tanning products. frequently used. that in itself, social media is another platform at which those pressures and even the business behind social media uh We are all basically target audiences for massive businesses. So, yes. Okay, thank you. Second question coming from Instagram for you is what's the state of research of eating disorders in men? Do triggers and conditions which lead to an eating disorder development differ by gender? That's a really great question and something I'm really interested in doing further research in. Tāne, men, broadly there just seems to be a real lack of research for men and I suspect for reasons due to the stereotypes about who experiences eating disorders. So again. perhaps they were traditionally thought to be something that were only experienced by women and for that reason research, education, uh treatment is only really been concerned with women. I suspect that men face increasing barriers to gaining access to care. in the same way that we might suspect Māori to do to stereotypes and stigma. There are also different beauty standards and beauty ideals for men and again, different niches. For example, in extreme uh kind of practices in a gym environment. steroid use. or extreme measures taken in high performance athletes. There's a number of different nations, which I suspect would all have their own kind of practices and concerns. But I guess a little bit of anecdotal evidence, even I recall. uh through family members, just hearing about the efforts that even high school age boys would take to lose weight so that they could meet particular weight categories for sports, that being rugby, ball league. So many different pressures, and so I think it was not a particular focus of mine. I recruited for all genders. but I do think it's an area that deserves its own space carved out. I unfortunately was unable to recruit any tāne in my research. And again, I think that just nods to the barriers there, the stigma, the additional stigma. And I think there's additional layers when we might think about if tāne, men generally experience additional challenges, stigma. What might that be like for Māori tāne? So tāne Māori, there's this whole nother level of barrier to overcome. So that is an area of mine that I'm quite interested in. mean, just just add a little bit of a joke. Probably the one area where men are less studied than women on when you when you look at things. All right. I guess next next question for you. uh What was your favorite part of the research process? So many, so many cool parts of doing the rangahau. I guess two, two are quite related. uh Firstly, privilege and the real privilege to be invited to our participants' spaces in their homes. and to be able to travel across the country and to be invited into their homes and spaces to uh conduct this research and to interview them, I think is a real... There's a real closeness that comes from being able to have such a raw kōrero in their place as well as opposed to online or in a university. And I guess the other component to that is that through this research, some of the participants I interviewed with lived experience, it was through this research that they learned that they weren't the only Māori person with an eating disorder. So for several of the participants, they thought they were the only one. They thought they were this uh outlier. And so for them to learn through this research, they actually, hey, I'm not alone on this journey. And to be able to have a kōrero, but not just any kōrero, it truly felt so therapeutic. both for myself and based on what they shared as well, to have the space and for some of them to share their experience of an eating disorder for the first time. So yes, for some of them, I was the first person they'd ever spoken to about the experience of an eating disorder. Yeah, was an incredible privilege, it was. That's awesome. Yeah, for sure. We're glad we have your research now on the table. And speaking of your research, if you had unlimited funds, what would your dream project be? I have a running kind of notes document on my phone. And whenever I just like have a little idea pop up or get inspired, I just jot down ideas. So I have so many, but when I was writing my discussion for my thesis, I got thinking about the idea to create a A kaupapa where um we bring together our traditional knowledge and whodākau around body image, around kai, create a bit of a wānanga space and invite people to be in that space and to learn and see how that influences and hopefully improves things like body image and their experience and relationship with po. So almost like if you want to call it an intervention study but I think that would be really incredible I think. to create a space to counteract all the diminishing messages that people are heard on a day-to-day basis through social media to be able to actually, you're amazing and we value you for all these reasons. actually we think that what's really important is how you treat others, how you care for the environment, how you care for your whānau. whether you're hardworking, all those things. I'm also really interested in food insecurity. So food insecurity is a really significant issue at the moment in Aotearoa and it has been for some time, however, even more so in the current climate. And we know that from international research. For those that are experiencing food insecurity, there is increased risk of eating disorder behaviors. and Māori are more likely to be food insecure. So I'd be really interested in looking at how we can better understand that intersection and also how can we better support and mitigate that potential risk there. Yeah. That's a lot. look, oh, a lot of these are very, very, what do you say, like reachable in terms of research goals and ideas. sometimes when we ask people unlimited funds, they say absolutely crazy things. so yours are quite reasonable and reachable. So I hope you actually get to do them. I hope so too, and I hope so for the community, That's why we do this, Mahi, that's why we do it. Yeah. Awesome. guess final question. uh So Dr. Rose, what's your heart's take about your field? To some this might not be a hot take, but actually from my experience going into the community and hearing the responses of me doing this research, I was like maybe it is a hot take and that hot take is that Māori experience eating disorders. Fair enough. guess because you started off with one of your themes being around the premise that people who understand that Maori don't experience eating disorders. I mean, fair way to flip it. Eating disorders isn't just a rich white girl thing. No, yeah, it is something that uh we as Māori experience and it's important that we recognize that and that for those in healthcare positions and those in positions related to supporting, people with eating disorders recognize that. awesome. Awesome, Bailey. Thank you so much for joining us. being a full, thoroughly enjoyed it. Awesome. um Yeah. All the best for all your work. um And yeah, everybody, thank you all for listening. Look forward to having more questions. I quite like the idea of putting questions on Instagram out now to see what people pull back. So thanks to those who responded. And yeah, until the next time, everybody, take care. Thank you, Ka kite!