Monthly Archives: March 2010

Is Obesity an Eating Disorder?

One of the best things about this blog are the comments and questions I get from my intelligent and insightful friends.  Recently, a friend of mine sent me the following question via Facebook:

“eating disorder awareness week: does this include obesity?…given that it at least appears to be an eating disorder, as well as the impact it has on American health and well-being, i thought it might qualify…………”

So, is it?

Currently, the DSM-IV (the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, aka the therapist’s bible) lists 4 eating disorders: Anorexia Nervosa, Bulimia Nervosa, Rumination Disorder (a disorder I actually was completely unaware existed and involves regurgitation in infants and young children) and Eating Disorder Not Otherwise Specified (otherwise known as ED-NOS; this is diagnosed when an individual meets some of the criteria for both Anorexia and Bulimia but does not meet all the criteria for one or the other.  I was diagnosed with this.) 

The fifth edition of the DSM, which is coming out in 2013, is considering making Binge-Eating Disorder a separate diagnostic entity.  So, to answer my friend’s question, it is being considered an eating disorder, if one assumes that binge-eating is the precursor to obesity.

And to shock the pants off of all of you, I have an opinion about this.

When my friend first proposed this question, I immediately became very protective and defensive of eating disorders as separate from obesity (hello?! terminal uniqueness.).  I shot from the hip with the response that obesity is touted in the spotlight constantly as “bad, disgusting and ugly”, while stick-thin celebrities, models and athletes promote an image we are supposed to lust after.  One extreme (thinness) is idolized while another(obesity) is frowned upon.  That’s fucked up, because eating pickles and fresca daily can stop your heart quicker than years of binge-eating can.  So, shouldn’t we, as a society, categorize mental illness as a pattern of behaviors that mirror an unhealthy balance in society that society itself can’t recognize?  (In other words, it can recognize obesity is bad, but cannot recognize being too thin as unhealthy.  Thus, disordered.)

But, don’t I argue that this is a society of extremes, of all-or-nothing thinking?  By that token, either extreme should be unhealthy, and perhaps considered a mental illness.  One can drown their sorrows one of many ways – by starving themselves until they are a being that has no needs or emotions, by regurgitating unneeded feelings, or by bingeing on carbs until they can feel no more. 

In the end, here’s what I think: it has nothing to do with the way people look or the weight they reside at.  For a long time, bulimia nervosa was discounted as an eating disorder because many of the individuals who suffered from it maintained a “healthy” weight.  Like I stated in previous posts, one can be 134 pounds (I hate using numbers, but I have to) and have completely sick, eating disordered thinking.  So, with that thinking…yeah.  Either end of the spectrum is an eating disorder.  Perhaps eating disorders are more like substance abuse addictions than we think – perhaps they are more self-diagnosable than, say, the current four criteria that are required for a sound diagnosis of anorexia nervosa.  Perhaps one doesn’t need to be at 75% of their ideal body weight to know their constant body-checking and weighing is getting in the way of their happiness.  Perhaps one doesn’t need to be at the line of obesity to know their binge-eating is out of control.

What do you think?