When you think of eating disorders, do you picture someone with anorexia nervosa?
The truth is that there are many types of eating disorders. And obesity can be among them – but not all the time.
In this blog post, we will answer the question: “Is obesity an eating disorder?”
You’ll learn about what qualifies as an eating disorder and who has one. We’ll also talk about how obesity contributes to an eating disorder called binge eating disorder (BED).
Please note: I have some problems with the word ‘obesity’.
BMI determines obesity and I despise BMI not least because of all the body image issues it entails! But this post isn’t intended to discuss the cultural implications of the word ‘obesity’.
Today we’re talking about whether obesity causes an eating disorder!
Who Has An Eating Disorder?
The truth is that most people who have an eating disorder are women, even though more men and children than before seem to be developing the illness.
Common estimates report 2-3% of the American population has an eating disorder diagnosis.
That’s an estimated 15 million adults suffering from a diagnosable eating disorder in the United States.
This includes medical conditions like bulimia nervosa (BN) and binge eating disorders [BED] as well many others not yet named!
But how many people actually have an eating disorder? Well, the true number is much higher.
You know how if one person raises their hand in class, it means a bunch of other people have the same question?
The same is true with eating disorders. For every person who receives a diagnosis there are 10-30 more people who go undiagnosed. Hence the reason Overeating Anonymous groups are so common!
This is because eating disorders are so insidious, and difficult to diagnose.
Many Struggle With Food But Don’t Have A Disorder
Eating disorders are complex. For example, let me tell you about my friend.
Then you tell me afterwards whether he has an eating disorder.
So my good friend actually overeats and feels guilty sometimes but not all the time. He doesn’t think he loses control.
He’s obese or at least overweight, but does he have an eating disorder?
He doesn’t think about food after he’s finished eating. He doesn’t have body image problems either and actually thinks he’s quite handsome!
He is a great salesman and enjoys his job, but he is pretty isolated. But he does play sports and his weight never holds him back.
Does he have an eating disorder?
I would say no.
- For one thing my friend isn’t preoccupied with weight loss.
- He also doesn’t think about food too much (except the occasional guilty thought; see below).
- Plus he likes to eat and isn’t afraid of food!
Yet I would also say my friend has some problem with food. I know he feels guilty about his eating habits, so right there I sense some problem.
But how severe a problem? And does this mean he has a disorder?
The Arguments Against My Friend Having A Disorder Are Many:
- His life isn’t greatly harmed by food
- He thinks of himself as handsome (no significant body image problems)
- He plays sports and does other activities – his body weight ain’t holding him back!
- He doesn’t diet or think about weight loss
So food is a problem for him, yes, but not that big of a problem.
Usually when someone has an ‘eating disorder’ you think it’s pretty severe. If you have ever had an eating disorder then you know how all-consuming the “I have an eating disorder” voice can be.
My friend is not THAT severe. But he does have some symptoms of BED.
So Is Obesity An Eating Disorder?
Yes, and no.
It looks like a lot of people find that confusing, which isn’t surprising! Let me explain what I mean in more detail:
Obesity is related to eating disorders. But this needs more context.
Are there other symptoms common to eating disorders? If other common symptoms are also present, then an obese person can have a disorder too.
Common signs of eating disorders include:
- losing control
- obsessive thoughts about food, body or weight loss
- body image or body shape concerns
- anxiety / depression
- impaired performance at work
But being obese doesn’t necessarily entail any of these things! Like my friend.
He’s obese. But his situation is NOT the same thing as having body image problems or other types of eating disorder behaviors.
My official opinion is simple:
My friend doesn’t have an eating disorder. However, it’s a sad fact that this is not the norm.
Many people with obesity have problematic eating habits.
But you can’t say just that because someone is obese, they have an eating disorder. It’s more complicated than that.
What Does Health At Every Size Mean?
There is a popular health and social justice movement called Health At Every Size.
Health At Every Size is a science based approach which recognizes bigger body sizes do not automatically mean worse health.
To learn more about Health At Every Size you can watch this interview here:
Why Obesity Is Often An Eating Disorder
Obesity relates to two common eating disorders:
- Binge Eating
Why Do Many Obese People Also Have Binge Eating Struggles?
This is because they do not feel good about their bodies. They also have mental health like a poor body image or self esteem.
They may have emotional triggers which impact the amount that they eat, too.
Often people who are overweight start to diet to try and lose weight. But diets never work in the long-term and usually backfire, causing new weight gain!
Even worse, regaining weight ruins your mental health and can cause you to develop an eating disorder!
This leads to other types of disordered behaviors surrounding food intake like:
- starving oneself
- binging/purging after meals (or over the course of a day).
I can’t tell you the number of stories I’ve heard along these lines. For example, a client thinks back to high school when they first started dieting.
Back then this person thought they were fat. So they started dieting. But then like most people who diet, they ended up binge eating and regaining all their lost weight.
Sometimes this binge and diet cycle goes on for decades! And in the case of some clients, they look back and think of themselves in high school as skinny!
Why Obesity and Binge Eating Often Go Together
Often people may be obese, but spend most their days in some degree of hunger.
If you are hungry for too long then you will binge.
It doesn’t matter if someone has anorexia nervosa or how skinny someone’s body is. If someone severely restricts their caloric intake, it still counts even if this person is obese!
So sometimes obese people diet to lose weight, but then they eat more than their body needs, which worsens the obesity!
Overeating then causes chronic stress around foods, leading one down into mood swings.
You swing from highs at times due to getting what you are sugar craving, but then crashing low with guilt and shame.
The cycle of restricting followed by bingeing highs and lows of shame causes many other body and psychological problems!
You may start to fear food.
You may develop anxiety around food and stop going to social events where there is food. This in turn makes you depressed.
Getting into a negative spiral, you think losing weight is your only way out. You’re desperate so the next marketed diet sucks you in.
The disordered eating cycle begins.
You started out a bit heavier in terms of body weight back in high school, but then you got sucked into an eating disorder.
Do you see how obesity can be a contributing cause of an eating disorder? But saying point blank obesity is an eating disorder is unfair.
Here is the technical DSM-5 definition of Binge Eating Disorder:
What Qualifies As An Eating Disorder?
To summarize, we could say obesity is often a factor causing eating disorders.
Obesity can lead to eating disorders, but eating disorders and obesity are two different things and should be treated as one and the same.
Besides, from a medical perspective obesity is NOT an eating disorder.
The American Psychiatric Association classifies eating disorders into categories. The major categories are:
- anorexia nervosa
- binge eating
What do these three eating disorders have in common? These all have a psychological, mental disease at their heart.
How Obesity Can Contribute To Eating Disorders Like Binge Eating Disorder
Bingeing is a cycle that causes problems with weight and mood swings.
You start with restricting to bingeing food, followed by guilt or shame in the aftermath of this behavior (the high-low).
This pattern may lead you down more dangerous paths like anxiety around foods. This then leads into depression because you avoid social situations with food.
Your loneliness then makes you desperate enough for another diet so as not to feel depressed anymore!
So you start the diet and the bingeing cycle begins all over again.
Who Cares One Way Or Another?
What’s important is whether you are getting the help and guidance that will lead to a healthier life with less disordered eating.
The goal is never ONLY about losing weight – it should always be understanding your relationship with food.
This means taking into consideration how much time you think about food, not just what you eat!
Someone can be thin and feel like they are living in hell. It’s because eating disorders are in your mind!
What If You Are Obese With No Eating Disorder?
Obese people can benefit from eating disorder treatment even if they don’t have an eating disorder.
Many of the same techniques that work an eating disorder can work for ‘normal’ obese people.
Take the ‘cue / trigger’ strategy for people with binge eating disorder.
When I start to work with a person who has BED, we start by having them understand what is causing their binges.
After someone can see ‘why’ they are bingeing. then they can stop and eat normal amounts of food.
But this same strategy is also great for people who are obese but don’t have an eating disorder!
My friend who I mentioned earlier, the guy who struggles with food……
While he doesn’t have an eating disorder, he would benefit by learning about his cues and triggers!
Does this make sense? Let me know in the comments below what you think!