Nothing tastes as good as skinny feels except brownies, pizza, gravy, mashed potatoes, cake, ice cream and life.
Anorexia Nervosa is classified as an eating disorder in the DSM; the Diagnostic and Statistical Manual of Mental Disorders. Anorexia is intentional self-starvation. In order to receive the diagnosis, however, an individual must have a BMI that is essentially near death. As well, BMI is not a consistent or reliable measure of weight or severity of the distress a person may be experiencing as a result of not eating. A person may be restricting food, fearful of weight gain, over-exercising or obsessing about intake but not ‘qualify’ for the diagnosis. This has been a problem for years both for therapists and individuals seeking help.
Before the DSM-5’s release the only other eating disorder diagnosis available were Bulimia Nervosa (bingeing, purging or exercise bulimia), Eating Disorder Not Otherwise Specified (EDNOS; a diagnosis used when a person has a difficult relationship with food and/or body image but doesn’t meet criteria for Anorexia or Bulimia), and Pica; a diagnosis that often indicates an underlying medical condition like anemia in which a person craves non-food substances such as a desire to eat dirt or clay. This isn’t a complete explanation of all the diagnosis where food or body image issues might come up but for the sake of time let’s get to your question about obesity.
Obesity is a symptom. Let me say that again: Obesity is a symptom not a disorder. It’s often linked to compulsive overeating or bingeing that is not always but sometimes accompanied by purging, compulsive exercise or cycles of restricting after bingeing or periods of normal eating. It’s also sometimes accompanied by guilt, shame and secretive behaviors to hide the need or desire to continue to overeat. Not acknowledged anywhere in the DSM is the role of a feeder; a person or persons who support a compulsive overeater by purchasing, preparing and sometimes physically feeding an individual who may be so obese they cannot perform these tasks without the assistance of a feeder; much like an enabler in other forms of addiction.
Ongoing controversy between medical researchers, the FDA and food corporations to classify white sugar and certain man-made food products and additives as addictive substances contributes to complications with eating disorder diagnosis and treatment. This would require foods like certain cereals, cookies, chips, basically all boxed or ‘fast foods’, juices, sodas etc. to come with a warning label with information about how those products are linked to an increased risk for diabetes, obesity etc. Overeaters Anonymous has been prescribing a sugar-free, whole foods diet as part of helping people manage compulsive overeating for over 50 years because they acknowledged many of us use those foods as a coping substance. If such labeling were approved binge eating and possibly other eating disorders may have moved into the addictions section of the DSM which could lead to requiring insurance companies to pay for eating disorder recovery treatment the same way they cover services for other forms of addiction. As it stands, Binge Eating Disorder appears to blame the individual for an inability to stop eating, as opposed to acknowledging that we may under or overeat because of unaddressed medical issues, trauma, laundry, toddlers, traffic, bills, bosses, bake sales, Super Bowl Sunday and probably Thanksgiving.
Meanwhile the battle rages on; diabetes and other obesity related medical conditions continue to rise and people are not receiving the informed help and care needed to combat behaviors which are rooted in the need to feel safe and a part of the world.
In short, we overeat, starve, purge and compulsively exercise to cope with life in the same way a person might turn to drugs or alcohol. It is not our fault and we can recover from these behaviors, if we want to, using a combination of medical care, mindful self-compassion, therapy and sometimes appropriate medication. Many man-made food products are addictive substances which have been proved by validated research which our government and food corporations refuse to endorse in favor of profit, just like alcohol and tobacco companies had done for years. Knowledge is power. While we continue to advocate for truth and validation we can take personal responsibility and seek alternative forms of help. Overeaters Anonymous is a great, free 12 step resource that has helped many people heal thier relationship with food.
From the APA: “In a letter to the editor published in Psychiatric News in 2005, Chodoff proposed a new diagnostic entity for DSM-V that he titled “The Human Condition.” The diagnostic criteria included, among other symptoms, “dissatisfaction with one’s looks and sexual performance” and “getting upset when things go wrong” (Chodoff, 2005). The diagnosis, he wrote, would facilitate insurance reimbursement, eradicate the problem of comorbidity, and “encourage the quest for a drug to cure the disorder of being human.”(He was kidding.)
Fun controversy about the DSM-5, big pharma and the government: