The Show Must Go On—Eating Disorders Among Musicians

A recent study, published in the journal Eating and Weight Disorders -Studies on Anorexia, Bulimia and Obesity, investigators surveyed over 300 musicians, including amateurs, music students, professionals and retired musicians. Two thirds of the participants were female and the average age was 31.

The assessment of eating disorders (ED), as well as physical and mental health, was attained by utilization of specific evaluation instruments, including the Eating Disorder Examination Questionnaire (EDE-Q), the Depression Anxiety Stress Scale (DASS-21), a perfectionism inventory, and Body Mass Index (BMI). Demographic data and information regarding their musical career, lifestyle, eating habits and health were also attained for analysis.

It has been previously established that performing artists such as actors, celebrities, and of course fashion models, are at greater risk for ED when compared with age matched controls. Yet, musicians, as a group, have not been specifically assessed for increased health risks. One probable reason is that musicians are a very diverse group of artists. A first seat cello player in the Boston Philharmonic would seem to have little in common with a drummer in a heavy metal band in London. Yet the research yielded numerous risk factors and incidence data among all subsets of study participants.

The EDE-Q Global Score (EDE-QGS) revealed current pathological values in 18.66% of the musicians and a 32.3% lifetime prevalence. Interestingly, median BMIs were within the normal range and there were no discernable differences between the various subsets of musicians. This suggests episodic periods of pathological eating or weight management strategies are more common than chronic eating disorders among musicians. However, stress, depression and anxiety scores were severe across all subsets and there was no significant difference on the EDE-QGS between various subsets of musicians. However, music students, professional musicians, soloists and those required to travel overseas, were at greatest risk for pathological eating and perfectionism scores were highest among classical musicians. Lastly, perfectionism, depression, anxiety, stress, perceived peer pressure, and social isolation were all correlated with eating disorders, but the correlation, while statistically significant, was low.

While the study mentioned overseas travel as a predictor of ED, there was no mention of sleep disorders. Moreover, depression, anxiety, stress and sleep disorders are bi-directionally correlated and predictive of numerous pathologies. Plus, the cumulative effect of multiple stressors is not linear. It is much more complicated and requires extensive evaluation. This, of course, is always problematic with performing artists, who often accept the consequences of their career as just part of the business. Dr. Marianna Kapsetaki, the study’s lead author and a concert pianist, concludes, “The mental and practical strains arising from an unpredictable work schedule and constant travel may draw professional musicians into ‘a vicious circle of unhealthy eating’”.

Why Does This Matter?

Like many occupations in a fragile economy, stress to perform and to keep one’s job is a constant companion. For musicians, who are mostly self-employed, or seasonally contracted, these stressors are exasperated and often chronic. Prolonged stress is a predictor of depression and anxiety, as well as numerous physiological pathologies, including eating disorders.