Don’t let looks deceive you

Think you can “spot” someone with an eating disorder just by looking at them? Think again. There are individuals who meet the clinical definition of anorexia who do not look emaciated. Many people with bulimia are of average weight. Someone who is visibly overweight or obese could struggle with binge eating, compulsive overeating, bulimia or, yes, anorexia.

Much attention is given to the “obesity epidemic.” I would argue that there is an epidemic of unhealthy relationships with food, which may manifest in body weights on all points of the spectrum. The results of these unhealthy relationships may be relatively benign, such as chronic dieting, following food fads and orthorexia. They may also be deadly. Eating disorders are the leading cause of death of any behavioral disorder.

One unfortunate side effect of the focus on obesity is that it perpetuates the notion that losing excess weight is always a good thing, regardless of the means. A very visible example of this mentality is the popularity of “The Biggest Loser.” Why is it that the very behaviors–obsessive, excessive exercise and preoccupation with food and body weight–that are hallmarks of an eating disorder are “OK” when someone is obese? Ironically, the show is under increased scrutiny at the moment because of criticisms that its most recent winner may have developed anorexia. (Whether or not that is true, the whole kerfuffle also highlights the sad fact that we feel we have the right to publicly comment on women’s bodies, period.)

Eating disorders aren’t just about the food. They are complex conditions that have a strong psychosocial component. While dieting can trigger eating disorders in genetically susceptible individuals, not all dieters have an eating disorder. Someone doesn’t become anorexic simply because they want to be model-thin. Someone doesn’t become bulimic just because vomiting their dinner seems like a solid weight loss plan. Similarly, not all people who overeat have binge eating disorder, and people who do binge eat don’t do so just because they have a big appetite. Further, not all people who are obese binge eat…some even eat food portions that are reasonable by any objective measure.

Eating disorders serve a purpose for the people that struggle with them, and that purpose goes beyond food or weight control. That’s why they are a struggle, even once someone enters treatment. Effective treatment is a team effort, involving the person with the eating disorder, their family, a registered dietitian, one or more therapists, and medical doctors.

Here’s a link to a short video that discusses food as a coping mechanism. You can find this and other videos about eating disorders on the Academy of Eating Disorders website.