Obesity or eating disorder?

Obesity. Eating Disorders. Both on the rise. Concerns discussed by public figures, paraded in the media: haunting parents, schools, and health professionals. In many people’s eyes, these are diametrically opposed conditions. But are they really?

Obesity is the physical condition of having a significantly higher weight and proportion of body-fat than the recommended healthy range. It is associated with increased likelihood of many medical problems, and some psychological. Eating Disorders are a form of mental illness, involving a disordered relationship to food and eating. They are a psychiatric disorder, resulting in many possible medical complications, and include amongst various possible symptoms extremely low body weight or – obesity!

Our society is an Obesogenic one (the proportion of seriously overweight people is steadily increasing). A combination of factors in modern life contribute to this: We have constant easy access to energy-dense, pre-prepared, addictive food, often quicker and cheaper than healthier options. Our economic structure means most adults work, in sedentary jobs, leaving less time for food preparation, or physical activity. We use time-and-labour-saving devices for routine tasks, burning fewer calories in daily life, and spend much of our leisure time sitting in front of screens. Enjoying food is a good and natural part of life and social giving - but within this framework, it can become problematic.

Not everyone in contemporary society is overweight though, and studies have shown there is much more to it than environmental practicalities. Genetics contribute susceptibility to storing energy this way, just as they influence the likelihood of serious addiction, or eating disorder. But we must go further to find why individuals actually develop these conditions…

Brendan Fraser, who recently portrayed an obese person with great sensitivity in The Whale, when researching his character was powerfully struck by what he heard from those who told him their stories. "Each [obese] person who told me their story had one thing in common: There was someone in their youth who was very cruel to them by the way they spoke to them, and it set in motion the rest of their life." 

Ondina Nadine Hatvany MFT who has extensively researched eating disorders, has observed: "I have yet to meet someone suffering from an eating disorder who does not also suffer from a relational trauma."

Perhaps here we have a key to the connection between Obesity and Eating Disorder: the relationship of emotion, trauma, and food.

Most of us have done ‘emotional eating’ at some point, and experienced the lack of appetite imposed by stressful feelings. Eating disorders usually begin by someone trying to cope with overwhelmingly difficult emotions and situations, without a healthy means of adequately processing what they are going through. They may try to stay in control by focussing on a perfect figure - or seek the comfort and release they cannot find, in food. Limiting calories suppresses emotional response and pain, whilst eating for pleasure gives a temporary high to medicate depression.

Even the physical manifestation: shrinking away or growing larger than average, can be a way of keeping the unwanted and feared attention of others away. Needless to say these desperate measures do not have positive outcomes, instead the negative patterns of thought and habit come to control the person who uses them, becoming all-consuming, even life-threatening.

Once you have an Eating Disorder, knowing that you are unhealthy or still unhappy does not mean you can just make it go away. It can take years of therapy and hard work to fully overcome the psychological damage and relearn a healthy way of relating to food and one’s own feelings. The sooner that journey is begun, the better.

The National Centre for Eating Disorders estimates that 50 per cent of people who struggle with being overweight, suffer from compulsive eating, consuming a large number of unwanted calories without being able to stop themselves. Whilst we are, as a population, growing larger, it is far from true that most of those who overeat do not know or do not care. Looking around, it is clear that body image and health issues dominate popular attention and interest.

People are very aware of what they ‘could’ or ‘should’ look like, and that it can be dangerous to be too heavy. Some of them may choose to ignore these expectations, but whilst an estimated 64 per cent of UK adults are overweight, 70 per cent say they are uncomfortable with their weight, and searches for how to lose weight top Google’s statistics.

If you do that search, you will come up with a host of fashionable food-limiting plans. If you are given medical warning to lose weight, you may be advised on a restrictive diet. But the most comprehensive study of these (BMJ Macronutrient Diets study 2020) showed that whilst 6 months gave some good results in terms of weight loss and reduced blood-pressure, at a year’s follow up, all candidates had regained what they lost, and medical benefits had disappeared.

By cutting calories you can certainly decrease your body mass, but if the pattern is not a sustainable one, whether for physiological or psychological reasons - it will not be successful in the long-term. Encouraging restrictive eating tends to lead to yo-yo dieting, or in the vulnerable, lead to eating disorders. To sustain a healthy weight, changes need to be gradual and welcomed by your body, and you need to overcome any emotional dependency which will lead eventually to self-sabotage.   

Whilst 6 per cent of the UK population may have an Eating Disorder – only about 2 per cent are underweight. Binge Eating Disorder, Bulimia, and Night Eating Disorder have all been associated with Obesity. All involve compulsive eating, alternating with periods of restriction.

Binge Eating which has the highest correlation involves eating large amounts in a short time, usually in secret, and being unable to stop even when you feel full. It is not regulated by physical appetite, and usually involves immense emotional pain and feelings of guilt and shame. Until recently it has not been widely recognised in public, or treated by medical professionals, and those who have it are often embarrassed to get help, or cannot find it.

They are more likely to seek treatment for Obesity per se, but unless the eating disorder is addressed, weight reduction is often unsuccessful, and their psychological condition may be worsened.

The most successful outcomes for sustained weight loss after obesity, have been found to be combining forms of Cognitive Behavioural Therapy (CBT) designed and delivered by Eating Disorder specialists, along with specialist dietary advice tailored to the individual’s needs and temperament, supported by other psychotherapy as required to treat underlying trauma.

If you need help, do not hesitate to ask for it. There are supportive groups, such as Obesity Action Coalition, and Support and Education for Eating Disorders – ‘SEED Lancashire’ provides free group sessions - and you should go and see your GP. Flourish Therapy Clinic is a Lancashire company which can provide all the aspects of support and specialist treatment for Obesity or Eating Disorder in one place, delivered by experienced professionals. If you would like to find out more you can contact them on 01772915735 or through their website: flourishtherapyclinic.co.uk.