Thursday, September 27, 2012

Obesity and Eating Disorders

Today during my talk as part of the awesome Golda Poretsky’s HAES Masterclass Brittany asked about how we deal with eating disorders and weight. Our culture has a disturbing tendency to forget that “obesity” is defined as a ratio of weight and height and that eating disorders are a complex combination of physical and mental symptoms. I recently saw a study that compared brain circuits of obese women with brain circuits of women with anorexia.

This is essentially comparing apples to bowling balls, fat is not the opposite of anorexia nor is it the diagnosis of an eating disorder. Our cultural tendency to conflate weight and health can be deadly when it comes to eating disorders. Eating disorders happen to people at all sizes. Unfortunately when a fat person develops an ED they are often encouraged to continue and even step up the behaviors, even if they can get to the point that they are aware that they are sick and are actively asking for help. Our society is so convinced that thin by any means is better than fat, that sometimes I’m a little surprised they don’t just pass out cocaine to all the fat people.

Some eating disorder diagnoses require very specific criteria which includes weight and that has led to a group of diagnoses known as “EDNOS” or Eating Disorder Not Otherwise Specified. This is important because a fat person who develops an under-eating disorder can die before becoming underweight and so if we assume that someone who is fat can’t suffer from an under-eating disorder then we make a very grave error.

Even professional are susceptible to this mistake. I have taught dance and movement at a number of eating disorder treatment centers. At one that worked almost exclusively with patients who were very thin and dealing with undereating disorders. I happened to come in the day that they got a fat patient, one of the therapists said “I’m glad you’re here, [first name] really needs to exercise.” I asked her how much exercise she had been doing previous to starting treatment and she responded that she assumed none. I insisted on a work-up. It turns out that the girl had been overexercising for a long time and, based on her profile, had she not been fat they would have immediately recommended a period without exercise. I’ve also had a Binge Eating Disorder specialist tell me that, in her “vast experience” there was nobody who got to my size without suffering from BED.

We all know the adage that if all you have is a hammer then everything looks like a nail. We also know that when a healthcare professional sees a problem repeatedly in their patients they can inappropriately extrapolate to everyone who looks like their patients (like when Dr. Oz says that every fat person he operates on has heart problems and tries to say that means that all fat people have heart problems. Of course in reality one would hope that every person he operates on, fat or thin, has heart problems, otherwise what is he doing cracking their chest? Just like people come to him for heart problems, people come to a BED professional for BED treatment.) But I think this goes deeper. I think that this is what happens when society tells people incessantly that you can and should make assumptions about what people eat and how much they exercise just by looking at them.

Eating disorders can be deadly so we have to get this right. Eating disorders happen independent of weight. There are fat people who have anorexia and bulimia, there are thin people who have binge eating disorder. There are very fat people who do not have an over eating disorder. There are very thin people who do not have an under eating disorder. Calling someone “anorexic” is not a substitute for calling them very thin, and while we’re talking about this how about we just stop talking negatively about other people’s body sizes altogether?

I think that the best thing we can do when it comes to eating disorders, and healthcare in general, is take the focus off of weight and put it on treating people based on what is actually happening – their symptoms and situation. It sure beats a treatment plan based on just making guesses based on body size.

If you know someone regardless of their size that has an eating disorder please help them get the help they need. It is never ok to assume and think you or they can fix the problem on their own.

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