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Thu, April 1, 2010
Eating Disorders & Obesity: How Are They Related?
“I hate eating in front of other people. I can tell they’re judging me, thinking ‘She’s so fat, why is she eating that?’” Guess the body size of the woman saying this statement. If you guessed she has a large-sized body you would be correct. You would also be correct if you guessed she had a thin body, or a mid-size body or anywhere in between.

Body dissatisfaction and shame and anxiety about food choices are becoming everyday experiences for females of all ages and a growing number of males in our country. When is the last time you gathered with friends for lunch or a social event when the subject of dieting or weight loss didn’t come up? How many of your friends are currently on a diet or saying they should start one or get back to the gym? Our collective body-shame and food-guilt has become so ingrained in our lives that you may hardly notice it.

On the surface, it may seem harmless or even that it might be beneficial for us to be thinking more about dieting and paying closer attention to what we eat. Yet, this trend toward increasing body dissatisfaction and a diet mentality underlies a disturbing increase in eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder and related disorders, in our country and around the globe. At the same time, the obesity rates have risen dramatically over the past few decades.

The World Health Organization (WHO) indicates that globally in 2005 nearly 400 million adults were obese, with rates increasing exponentially. The relationship between obesity and eating disorders and their relative causes is complicated, yet it affects each one of us and those we love on a daily basis in terms of how we think and feel about our bodies and the foods we eat. Understanding that relationship can empower us to take steps to push back against this trend toward obesity and disordered eating and protect our own health and the health of our families.

The Difference

Eating disorders and obesity overlap in some areas but there are important differences between them. First, obesity describes a physical state not a disease. Whereas eating disorders are serious biologically based forms of mental illness that are associated with one of the highest rates of medical complications and mortality of any psychiatric disorder, obesity is a weight condition that may be, but is not necessarily, associated with health consequences. In some cases, obesity is linked to an eating disorder, in particular binge eating disorder. But not every person who is obese or overweight has an eating disorder and not every person who has binge eating disorder becomes overweight or obese.

Similarly, anorexia nervosa—a disease commonly associated with an emaciated frame—can begin to develop in individuals who fall anywhere on the weight spectrum. Eating disorders, which include anorexia nervosa, bulimia nervosa, anorexic and bulimic behaviors, unhealthy diet practices, and binge eating disorder certainly can affect the individual’s weight. But, often, an individual’s body weight does not provide information about the existence of an eating disorder or its severity.

Similarities

Serious physical health risks are associated with both eating disorders and obesity. Both conditions also carry significant emotional burdens. The health risks associated with obesity include:
  • diabetes
  • osteoarthritis
  • some forms of cancer
  • cardiovascular disease
But not all individuals who are obese experience these health risks. While the cause of obesity is often due to an imbalance in energy input (amount/type of food eaten) and energy output (activity level), many obese individuals are active and eat healthily. What we have come to learn in the fields of obesity and eating disorders is that weight loss is not easy to accomplish. In fact, experts continue to debate about how to approach this issue. Restrictive diets and aggressive exercise plans, as demonstrated on programs like “The Biggest Loser,” are effective in the short-run. But research shows that these techniques typically do not produce lasting weight normalization.

Our bodies are built to resist the effects of restrictive dieting. When we tamper with our energy input and energy output in extreme ways, our bodies react as if we are exposed to famine. To survive a famine, our bodies are built to shift to a lower metabolic rate and trigger our brains to binge on the food that is available. The more we restrict and burn fuel, the harder our bodies will fight to keep our weight stable.

A new movement , Health At Every Size (HAES), www.healthateverysize.com, has emerged that teaches people how to work with their bodies to build health without engaging in the unproductive power struggle produced by restrictive dieting. This approach prevents the development of eating disorders and counteracts the health consequences of carrying excess weight.

Eating disorders are associated with a long list of health consequences affecting all systems in our bodies. In addition, eating disorders are associated with a significant mortality rate. Yet, eating disorders are not conscious attempts at self-destruction. They involve powerful, neurologically-driven thought and behaviors, triggered by dieting, that are startlingly uniform from one person to the next, across gender, ethnicity, age, culture and socioeconomic background. Recovery is possible through specialized treatment that includes psychotherapy, nutrition counseling and medical and psychiatric care.

The Blame Game

Unfortunately, obesity and eating disorders share a profound emotional consequence: shame and self-blame. Westernized culture is fat phobic and weight obsessed. The media promotes unrealistically thin bodies and perfect, computer enhanced images as well as a simplistic, trivializing view of obesity and eating disorders. And the public can’t get enough of it.

Our prejudice and ignorance about the causes of obesity provide fertile ground for products, programs, and services that exploit our fear of fat. National television programs like “The Biggest Loser” not only enjoy commercial success, they also spawn imitations in local media, businesses, and schools. Diet programs and products that can feature the weight loss of individuals like Valerie Bertinelli, Marie Osmond, or the Kardashian sisters enhance the celebrity of those stars while fattening the bank accounts of their stockholders. The belief that overweight and obesity can be overcome through self-discipline and willpower runs deep in our national psyche, obstinately resistant to the mounting evidence that dieting is an ineffective tool for treating obesity.

Public misconceptions about eating disorders are just as glaring. Magazines and celebrity news television programs religiously monitor the weight patterns of Hollywood “It” girls. If a young star loses too much weight, her frail frame will suddenly appear in every magazine and celebrity news show. Her fame will grow even as her health deteriorates. This type of media “weight watching” trivializes eating disorders and obesity, mocking those who are deemed to gain “too much weight” while deifying those who lose weight, especially an excessive amount. It turns weight loss and weight gain into a game.

These perceptions are rooted in a simplistic “blame the victim” mentality that assumes people allow themselves to become obese or to have an eating disorder. If we believe that a person chooses to get fat or develop an eating disorder, then we believe that they can make the choice to lose weight or get over the eating disorder. Simple. It is their fault.

This attitude also typically extends to include the families of these individuals. It is the fault of the parents for letting their children develop eating disorders or become fat. The wife should be controlling her husband’s diet or the parents should be controlling what their child eats. It’s easy. Just don’t let them do it. However, the reality of eating disorders and obesity is that they are caused by complex interactions between genetics and environment. There are some evidence-based guidelines for assessment, treatment and prevention, but, in fact, there are far more questions than answers in all these areas.

What We Can Do

Not one of us is untouched by the overwhelming prejudice and misinformation about eating disorders and obesity. Our own eating and activity patterns, how we feel about and judge our body shapes and sizes and those of our loved ones, is affected by the prevailing public opinions and beliefs about eating, food, and weight. Understanding how eating disorders and obesity are related, knowing the causes of these conditions and the latest research findings on effective treatments will help stem the spread of eating disorders and obesity. But, more than that, education about eating disorders and obesity can dispel our own misconceptions and improve the quality of each of our lives.

The following are 5 simple steps you can take to wage your own war against eating disorders and obesity by enhancing your body image and relationship with food:
  1. Use body-positive talk and thinking. Avoid critical comments about your own weight or the bodies of others. Try this for 24 hours—it is a challenge!
  2. Eat when you are hungry, stop when you are full.  Practice listening to your own physical signals of hunger and fullness. Remember—diets don’t work! Avoid skipping meals. Over-hunger triggers the physiological binge response.
  3. Play more. Move your body for fun rather than to lose weight or burn calories. Bring pleasure back to movement.
  4. Talk back to the media. Watch for misinformed, simplistic messages about diet and exercise on television or in magazines. They pop up everywhere! Talk back to these programs and articles.
  5. Learn more! Remember, conventional wisdom about obesity and eating disorders is anything but wise. Visit these websites to learn more about how to prevent and treat eating disorders and obesity:

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