Eating Disorders in Adult Women
Martina Verba, LCSW, MPH
Director, Cedar Associates, Mt. Kisco
It is important to determine whether the person presenting has BED. If it is determined that he or she does not, then the person’s struggle with weight needs to be dealt with in a compassionate and understanding manner. The person knows that he or she is overweight and has most likely tried many different methods to lose weight. Even when an eating disorder is not present, a person struggling with life-long weight issues would surely benefit from treatment. A nutritionist who specializes or understands eating disorders (even when no eating disorder is present) can offer a non-diet approach to weight loss and the sensitivity needed in working with individuals who are obese. It is estimated that 50% of those who are obese also experience depression. Many have been victims of teasing, bullying, and discrimination. Most have tried throughout their lives to lose weight. The goal would be to avoid putting an obese person on a highly restrictive diet. This would only set one up for failure and continue the cycle of shame.
When it is determined that a person has BED, it needs to be treated not just as a weight issue but also as an eating disorder. It is generally believed that a combination of psychotherapy and nutritional counseling is the most beneficial to deal with the underlying causes of the eating disorder as well as weight restoration. Many obesity experts feel that the weight needs to be dealt with first, (DeAngelis, Tori, 2002). How is this accomplished without understanding the reasons one is binge eating? Clinicians treating BED feel that addressing the underlying psychopathology of the condition decreases or eliminates the binge eating thus resulting in weight loss. In a study in the Archives of General Psychiatry, Denise Wifley, PhD, found that eliminating binge -eating through cognitive behavioral and interpersonal therapies had a significant impact on body weight.
In summary, there is a high correlation between obesity and BED. Neither condition benefits from restrictive diets or continuing the stigma that overweight people experience. A compassionate and non-judgmental treatment that involves both exploring the underlying causes as well as a realistic approach to nutrition is the healthy, long-term approach needed.
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There are a plethora of articles and portions of news programs dedicated to the growing problem of obesity in the United States. Fast food, lack of exercise for the average person, overconsumption of food and soft drinks and overabundant food portions in conjunction with the amount of television being watched have all contributed to the problem. However, a deeper issue is ignored - that at the heart of obesity can be a serious eating disorder.
Binge Eating Disorder (BED) has only recently been recognized as a distinct condition. The American Psychiatric Association’s DSM 1V lists diagnostic criteria for BED but does not yet give it a specific diagnosis. It’s being discussed currently whether to include BED and obesity as diagnoses in DSM V, which is due out in 2012. Despite the unclear diagnosis, BED is probably the most common eating disorder afflicting roughly 3% of the American population, (International Journal of Eating Disorders, March 2008). With obesity rates among U.S. adults nearing 34% more studies have been done in recent years. What is clear is the high correlation between obesity and BED. According to the Academy of Eating Disorders, approximately one-fifth of obese people seeking treatment meet the criteria for BED. There are many others suffering in silence who do not seek treatment due to feeling shame for their bodies, the stigma of obesity and the lack of access to health care.
A 2008 study conducted by Australian physician Paul Komesaroff, reveals that obese people often feel discriminated against and misunderstood not just by the public but often their physicians as well. The stereotypic perception persists that obese people are lazy, self-indulgent and lack willpower. Unfortunately, too often the prescription for obese and overweight people is a restrictive diet or exercise plan that may contribute to the feelings of failure that they already experience because very restrictive approaches have a high failure rate. In this study 25% of the participants report that they have gone to great lengths to lose weight, most often through starvation diets. It is well documented that very low- calorie, restrictive diets produce the physiological response of a desire to binge and a preoccupation with food.
Dr. Wendy Oliver-Pyatt, an expert in the field of eating disorders recently said, “Diets are the gateway drug to eating disorders.” It has been studied and documented in cases of both self-imposed restrictive diets and in times of famine. Binge eating is a physiological response to starvation. It is also an adaptive response to starvation. Throughout history in times of famine, mental pre-occupation with food and bingeing when one can get food kept a person alive.. So it is unrealistic to treat obese people with diets alone.
How can we move past the simplistic band-aid of diets given to so many who are suffering from an eating disorder? First, more needs to be written about the negative impact of dieting. Second, more discussion and public campaigns need to be put in place to combat the diet industry. Obesity rates have increased almost as quickly as the boom of the diet industry. Coincidence? Many of us, even those in the health care profession do not realize the devastating effects of dieting. Most importantly, we need to see obesity for the struggle that it is and how best to treat it.
