WEIGHT LOSS: WHAT IS AN EATING DISORDER?

According to the textbooks, an eating disorder is a pronounced disturbance in the way someone eats. “Disturbance” means a change from the person’s usual pattern, or a habit that poses a danger to health.

But such a definition isn’t very helpful. Do people who switch to a macrobiotic diet, for example, have an eating disorder? After all, they have changed their eating habits. Moreover, for some people at least, such a diet may provide insufficient amounts of calories, protein, and other nutrients, thus putting their health in jeopardy.

Although there is some overlap between obesity and the other eating disorders, specifically in terms of problems with body image and self-esteem, the causes and treatment of this disorder are sufficiently different to require a separate book of their own. Experts generally consider obesity a physical disorder, not a psychiatric one, although it may have a psychiatric component to it.

The question of what is and what isn’t an eating disorder is a common and sometimes baffling one. There are many areas of confusion and misinformation. In an effort to sort out this confusion, let me try to answer some of the most prevalent questions about eating disorders that I encounter as a physician specializing in the field.

Are eating disorders a recent problem?

No. Ancient Greeks and Romans wrote about abnormal eating patterns. Medical reports from three hundred years ago describe patients with anorexia. Only recently, however, have doctors tried to define these illnesses precisely, in order to better recognize and treat them. Bulimia, in fact, was only identified as a distinct disorder in the mid-1970s, although the problem existed long before then.

Don’t eating disorders affect only rich white people?

No. Patients can be black, Hispanic, Japanese. Many are by no means rich. A small number are male. In one sense, though, anorexia and bulimia are economic in origin. They occur where food is plentiful, as in the industrialized nations of Great Britain, France, the United States, Germany, and Scandinavia. The incidence in Japan, a “Westernized” nation, is increasing. In areas where scarcity of food is a problem, such as parts of Africa, eating disorders are extremely rare.

Are all anorexics and bulimics women?

Most are, but about 5-10 percent of them are male.

Is a man with an eating disorder gay?

Not necessarily. An eating disorder may be just one facet of a complex personality problem. Some men with these disorders struggle with issues of sexual identity, including homosexuality. Others feel pressure because thinness is highly valued in their professions, such as sports, dance, fashion, or entertainment.

Are eating disorders caused by parents?

Family problems can contribute to the onset and severity of an eating disorder. But they don’t cause it.

Aren’t all eating-disordered families alike: upwardly mobile, with dominating mothers, and no independence for the children?

No. Research has shown that children with eating disorders come from many types of families, including healthy, functional families. It is true, however, that after years of struggling, families may begin to develop problems because of the eating disorder.