By: Kelsey H., Lagniappe Wellness Dietetic Intern

So what exactly is an eating disorder?

Inconsistent with mainstream belief, eating disorders (ED’s) are characterized by behaviors, rather than anthropometrics (one’s general measurements) alone. When assessing individuals for a potential  eating disorder diagnosis, doctors use terms such as, but are not limited to bulimia, binge eating disorder, anorexia nervosa, etc. In order to hone in on the purpose of this post, it is important that we focus on the bulimia and binge eating disorder.  

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Bulimia Nervosa

According to the National Institute of Mental Health [5],  those experiencing the effects of bulimia nervosa (BN) have “recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes”. This style of disordered eating is followed up by compensatory behaviors such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors [2]. It is nearly impossible to diagnose someone with BN merely based on their size, as this aspect amongst sufferers varies within such a wide range. 

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Binge Eating Disorder

Moreover, binge-eating disorder (BED) is a condition in which individuals lose their sense of control while eating and continue having reoccurring episodes of eating unusually large amounts of food [1,4]. Binge eating disorder differs in the absence of compensatory behaviors listed above. With that, physical determinants come into play much more efficiently and therefore those suffering from the effects of this disorder appear to be overweight or obese— terms of which I may add are fairly arbitrary given the mountains of information proving its inaccuracy in determining health.

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Society’s Idea of Eating Disorders

Society looks, hears, and talks about eating disorders through one lens— one that’s focusing only on anorexia nervosa (specifically the restricting type). Social media, early education, and day-to-day interactions amongst friends gravitate towards the idea that thinness past social acceptance equates to eating disorders, and that their aversion to food is what categorizes someone as having an eating disorder. According to this same idea, there’s absolutely no way that someone with an eating disorder can weigh any higher than the “normal” weight justified by the bogus Body Mass Index (BMI)!

The Facts 

According to NEDA [5], the National Eating Disorder Association, only 14.5% of all eating disorders are diagnosed as anorexia nervosa. This is extremely low compared to the incidence of bulimia nervosa at 21.5% and binge eating disorder at 51.9%! In fact, 80% of eating disorders go undetected or never receive treatment. 92% of frontline clinicians admit in hindsight to potentially missing an ED diagnosis. Additionally, 3 out of 10 individuals seeking weight loss treatments inevitably show signs of experiencing BED. According to research, individuals with a binge eating disorder and those who classify as ‘obese’ exhibited a significantly higher BMI, waist circumference, hip circumference, waist/hip ratio, and fat mass, and a lower lean mass as compared with non-BED ‘obese’ individuals [3]. As previously mentioned, it is possible to live in a larger body while battling an eating disorder. Through copious amounts of research, it’s been found that this specified population is actually susceptible to more complications than in those living in smaller bodies. 

My Clinical Rotations at an Eating Disorder Treatment Facility

As a recent graduate of Johnson and Wales’ Dietetics and Applied Nutrition program, I can honestly say that I left with very minimal interest on the subject of eating disorders. There’s such a massive amount of research around eating disorders— so much so that it’s shocking to have not learned nearly as much during my undergraduate education! While conducting research on eating disorders during my Medical Nutrition Therapy (MNT) rotation of my internship, I was shocked to realize how both society and my own undergraduate education had actually encouraged disordered thoughts and behaviors around food!  It is not to diminish the academic excellence provided by my alma mater when I say that eating disorders were merely glanced at in comparison to other dietetic-related specialties. In fact, many dietitians I had previously spoken to will agree with that statement even after having completed their undergraduate education elsewhere. So during my MNT rotation located at an ED treatment center, I took this opportunity to better understand some of the thoughts that develop in conjunction with an eating disorder. The insight that I had gained just by sitting in on and leading group discussions with clients was able to transform my own preconceived notions around eating disorders (more specifically the true functions behind them!)

Challenge Your Own Misconceptions Around Eating Disorders!

I’m writing this post in hopes of eliciting just a quick moment of reflection around some of your own misconceptions around eating disorders. Consider why the question “I thought you had an eating disorder?” is wildly incorrect and principally rude.  Just like plenty of other diseases, eating disorders are not solely defined by the way that an individual may present, but rather the behaviors that they participate in. With that, it is important to move forward without any predisposed judgements if approached by an individual sharing their experience of having an eating disorder. 

References

1. From the Department of Medical and Surgical Sciences (ES. (n.d.). Obese patients with a binge eating disorder have an… : Medicine. LWW. Retrieved October 9, 2022, from https://journals.lww.com/md-journal/fulltext/2015/12280/obese_patients_with_a_binge_eating_disorder_have.5.aspx
2. Kuntz, L. (2021, October 15). A life and death measure: Eating disorder treatment. Psychiatric Times. Retrieved October 9, 2022, from https://www.psychiatrictimes.com/view/a-life-and-death-measure-eating-disorder-treatment
3. Nicoletti, C. F., & Delfino, H. B. P. (2019). Role of eating disorders-related polymorphisms in obesity pathophysiology. Retrieved October 10, 2022, from https://www.researchgate.net/profile/Heitor-Delfino/publication/332059782_Role_of_eating_disorders-related_polymorphisms_in_obesity_pathophysiology/links/5c9d587892851cf0ae9e2345/Role-of-eating-disorders-related-polymorphisms-in-obesity-pathophysiology.pdf
4. Palavras, M., Hay, P., Filho, C. A., & Claudino, A. (2017). The efficacy of psychological therapies in reducing weight and binge eating in people with bulimia nervosa and binge eating disorder who are overweight or obese—a critical synthesis and meta-analyses. Nutrients, 9(3), 299. https://doi.org/10.3390/nu9030299 
5. Statistics & Research on Eating Disorders. National Eating Disorders Association. (2021, July 14). Retrieved October 9, 2022, from https://www.nationaleatingdisorders.org/statistics-research-eating-disorders
6. U.S. Department of Health and Human Services. (n.d.). Eating disorders. National Institute of Mental Health. Retrieved October 9, 2022, from https://www.nimh.nih.gov/health/topics/eating-disorders