Post No.: 0553
Some quirky eating rituals are normal, such as the order you choose to eat the food on your plate. Well really, the immediate culture decides what rituals are considered ‘normal’, such as eating dessert after the main course – nothing says it cannot be eaten before.
Eating disorders, however, don’t even feel right to the person with them – they may feel anxiety or panic if they don’t adhere to the habit, feel guilt or disgust afterwards if they do, and/or they’re often carried out in private or the habit is disguised. Eating disorders are also simply damaging to health.
Anorexia nervosa involves starving oneself, sometimes as a way of exerting control or due to image pressures. Bulimia nervosa involves binge eating followed by inappropriate compensatory behaviours such as vomiting, using laxatives, diuretics, fasting and/or over-exercising. And binge eating disorder (BED) involves eating uncontrollably until one feels uncomfortably full but without purging afterwards. These disorders can gradually creep up on people through reinforced fears or habits. No one is born with an eating disorder, even though individuals can be genetically predisposed to them and a history of eating disorders within the family appears to increase the risk.
If someone constantly spends time worrying about their weight or body shape, eats very little, exercises too much, avoids social occasions where food might be involved, and/or deliberately makes themselves sick or takes laxatives after they’ve eaten – they might have anorexia or bulimia. With BED, the binges are often planned in advance and ‘special’ binge foods might be bought. Someone with bulimia or BED might not appear to change in weight much thus these disorders aren’t always obvious to external observers.
In the early stages of an eating disorder, eating becomes central to how one defines happiness and achievement. In the middle stages, the self-regulating cues that control under-eating or bingeing are lost. And in the late stages, secrecy plays a greater role, which is where the greatest danger lies.
Anorexia and bulimia are about harmful ways of controlling one’s weight – it’s not just about fasting and starving or bingeing and purging but things like using laxatives or over-exercising too. The first trigger could be a cruel comment about one’s weight or the pressures of looking slim because of one’s job. Yet it’s not really about the eating or exercising but something deeper – such as a history of abuse, trauma, insecurity, or controlling one’s weight because one’s weight seems like something one can control in a life that one cannot otherwise seem to control.
Like addiction, there can be a denial that there’s any problem whatsoever, or a claim that one can stop the habit if and when one wants to but one simply doesn’t want to. (The behaviour is usually kept a secret where possible – but why would one feel like one needs to keep it a secret if one believes that one’s behaviours aren’t problematic?) Like OCD, there can be compulsive feelings, to purge or train for at least a certain amount each day. Like self-harm, it could be a way of punishing oneself, as if one doesn’t deserve any food. And like depression or anxiety, there’s a social stigma and self-stigma around it, especially for men.
Anorexia is accompanied by a harsh, self-critical voice, and despite other people trying to tell anorexia sufferers that they’re not taking too much space and how they seem to be so much kinder towards others than towards themselves – this doesn’t quite work to convince them that they’re beautiful. If we cannot help them to like the way they look then perhaps the approach should be to not make it primarily an issue about the way they look, whether they or anyone thinks they’re fat, thin or whatever? Their size and weight shouldn’t be the focus of their life and they should instead focus their mind on other, healthier, pursuits they may have, whether they like dancing, singing, being amongst animals, plants or whatever.
There’s a higher rate of anorexia and bulimia amongst elite sportspeople. In sports where it’s about one’s power/strength/endurance-to-weight ratio, many believe that continually getting lighter will improve results. It tends to start after just wishing to lose a bit of weight but then it becomes an obsession. Top athletes are generally known for their almost single-minded obsession with training and their diet, and their competitive mindset might not help in this context of losing lots of weight. It might get them some extremely short-term gains but the long-term costs may include early osteoporosis or infertility.
Sporting bodies should therefore perhaps implement rules that prevent anyone who’s flagged with having an eating disorder from representing their countries. They shouldn’t be just dumped from a team but thoroughly supported in their recovery to make it back onto the team one day. However, some countries, like the UK, currently fund sports based on which are more likely to achieve medals for their country in a winner-takes-it-all manner. But it’d be more far-sighted to have athletes that inspire and encourage everybody to be in sustainably good health than athletes who merely win medals.
Pro-ana and pro-mia groups may appear as loving and supportive but they spread harmful advice to others who are vulnerable to developing an eating disorder or already have one. They can appear as benevolent one moment but then the next make people feel negative about themselves and push others to compete in reaching unhealthy goals with damaging rules. They tell people that their harmful behaviours are down to their choices rather than because they’re ill, which can lead to the illness becoming more reinforced and difficult to break away from.
Those posting such messages aren’t likely being intentionally malicious as they’re suffering from anorexia or bulimia themselves. These are complex mental disorders and it’s common for sufferers to hold contradicting or conflicting feelings about denying their behaviours are problematic yet wanting to recover from them. These groups are spaces where people can feel understood by others who are experiencing the same thoughts and feelings as each other – but pro-recovery groups are where one should gravitate towards if one has anorexia or bulimia for they offer that understanding, mutual support, community but also crucially the positive encouragement to recover too. Woof!
As with over-eating or addiction – the solutions are multi-faceted and require commitment and persistence. Cognitive behavioural therapy (CBT) is a common treatment. A tough conundrum for people with anorexia and their carers is that when they do as their carers say and eat their meals, they’ll realise that their next portions will get larger – thus to them, it seems like the more they comply and eat, the more ‘punishment’ they’ll receive (because they consider food as undesirable); which makes it difficult to get them to regularly eat properly. Classical or operant conditioning could be a solution here, by pairing the desired behaviour (getting the patient to eat their meals) with desirable unconditioned stimuli and reflexive responses (like Ivan Pavlov and the dogs), or by associating nice feelings and consequences with the eating experience (like B. F. Skinner and the rats). The solution will likely be individual from person to person. Good role-modelling and seeing the positive consequences of other people’s actions if they eat might help too (like Albert Bandura and the Bobo doll). The hopeful result is that the patient will learn to associate eating with positive experiences and consequences over time.
The issue of control seems to be central in many cases – under-eating issues seem to be a case of people exercising their control too much, whilst over-eating issues seem to be a case of people not exercising control enough. The underweight have an obsession with counting calories and exercise, whilst the overweight are more blasé about how much they consume and how much they move. Both sides have a distorted idea of portion sizes – too small for under-eaters and too large for over-eaters. It’s about finding that broad, healthy space inbetween these two extremes.
Healthiness is about staying within various ranges rather than seeking extremes in any direction without limits. (This suggests that the state of good health is always attainable for most people, unlike being financially rich where a millionaire would be considered poor in a land of billionaires, or a billionaire would be considered poor in a land of trillionaires i.e. the chase towards being the wealthiest you can be involves perpetually moving goalposts whilst the chase towards being the healthiest you can be does not.) Being healthy also comes in many physical body shapes depending on whether you’re a power athlete or an endurance athlete, swimmer or cyclist, for example. Women may wish to remain ‘feminine’ in form if they’re athletes, but if you’re healthy then you’re always beautiful, and any negative opinion only speaks about those who hold such opinions.
These eating disorders are complex and aren’t only about anxieties related to how people look (at least at their root). But this modern culture is sadly one of vanity and superficial judgements – people’s careers can depend on how they look, even though we ought to understand that it shouldn’t matter how, say, a politician looks. These caveperson instincts aren’t new but modern technology amplifies the problem. Manipulated marketing or modelling photographs and underweight models have been ‘inspiring’ young people as ‘ideals’ to aim for. Thinness is associated with ‘success’ and status (the halo effect). The sizes and shapes of mannequins in shops are typically underweight or unrealistic too.
So lots of people base their self-esteem on the way they look, and over-simplistically believe that their weight is the key indicator of their health. People who regularly read this blog will know that I think that we should focus on our physical performances rather than how we look – after all, one’s furry health is ultimately medically measured via performance measures, such as the performance of one’s heart or lungs. Visual measures are only indirect and aren’t always reliable. So select a sustainable diet and exercise lifestyle with the aim of achieving the more objective goals of personal/seasonal bests in performance, rather than for the shallow and subjective goals of one’s looks.
Losing some weight can potentially help one’s performance results, and purging can allow one to eat without gaining weight, but if the focus is on one’s performance and true health then one should beware of the point when performance levels will drop if one’s weight drops any further, over-training has negative effects, laxative abuse can lead to dehydration and mineral deficiencies, crash dieting can train your metabolism to slow down and thus harm your performances, and purging can cause a variety of problems in the digestive tract. When you start to get too thin, you also start to get weaker. The bone-density decreases may not be immediately apparent but may become irreversible. Menstruation may also stop for women, possibly because body fat levels have become too low and/or because of the effects of excessive levels of exercise-related hormones.
Abnormal neurotransmitter levels have been shown to exist in people with anorexia and bulimia. Nonetheless, a wider culture of promoting thinness, the teasing of overweight adolescents in school, and a culture of constant crash dieting, are powerful factors in causing risk genes to switch on during adolescence. Also – although it requires great determination and support – many sufferers have successfully recovered from these conditions, so we should never give up hope or the possibility of health and happiness in life even if something is partly hereditary or biological. Genes and environment combine to shape behaviours, and although we cannot change our genes, we can change our environment (the glass is half full) hence we can ultimately do something about it!
Woof. If you think you have anorexia, bulimia or binge eating disorder then please see your GP/PCP as soon as you can. The route to recovery will be individual for everyone and it’ll take time – but many have recovered to lead healthier lives.