Obesity, dieting and eating disorders

It was exactly a month ago when headlines started shrieking that formerly obese adolescents and teens are at high risk of developing an eating disorder. Even worse, they were less likely to get proper eating disorder treatment, because, you know, they used to be obese, as classified by body mass index (BMI) charts.*

The first thought the went through my head was, “How horrible.” The second thought was, “My thesis…” You see, my thesis has to do with family based interventions for child obesity. Were the kids in the study now more likely to develop an eating disorder?

My first step was to locate the scientific journal article that was raising all the media ruckus.** I found it quickly, and it made me a little mad. Why? Because the article wasn’t a high-quality research article, it was a write up of two case studies. Two case studies, two individuals. That is hardly the sort of thing that you can extrapolate to the general population, no matter what the health problem. Keep that in mind whenever reading articles in the general media about health/medical/scientific “findings.”

In any case, these two teens were classified as obese, they did develop eating disorders, and those disorders were “missed” by family, teachers and healthcare providers. However, these teens put themselves on unhealthy, restrictive diets and punishing exercise regimes. They were also apparently predisposed to developing an eating disorder (there is a genetic/hereditary link). Unfortunately, many eating disorders go unchecked for far too long, among people of all body weights, in part because the people around them don’t see, or don’t want to see.

Next, I did a review of the scientific literature. In a nutshell, I found that dieting is sometimes associated with eating disorders, but that it’s not always clear which comes first (the dieting or the eating disorder), and that structured child obesity interventions that focus on building healthy eating and activity habits, and don’t place significant focus on weight itself,  are highly unlikely to lead to eating disorders. Whew!

While I’m glad that some attention has been drawn to the fact that, yes, it’s possible to be a 200-pound anorexic, especially in light of emerging research that obesity and anorexia may have neurological links, specifically related to activity of certain hormones that govern appetite and how the brain’s reward centers respond to food.

Suffice to say that most dieters are not going to go on to develop an eating disorder. However, this doesn’t mean that dieting, especially chronic dieting, doesn’t lead to “disordered eating.” In other words, a messed up relationship with food. More on that, tomorrow.

* It is an unfortunate, even tragic, misconception that someone can’t have an eating disorder if they are overweight or obese. Just because a person has excess body fat doesn’t mean that it’s impossible for them to be starving themselves.

**I liked Yoni Freedhoff’s writeup on this issue.