How many of these people have an eating disorder? (photo by cesarastudillo)
How can you find a solution to a problem without really knowing the problem? This is the question plaguing physicians, psychologists, therapists, dietitians, and other professionals who treat patients with disordered eating. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a book that lists and defines all psychiatric disorders, patients can be classified as having anorexia, bulimia, or an Eating Disorder-Not Otherwise Specified (EDNOS).
The clinical definitions for anorexia and bulimia are so rigid, that over half of the patients with eating disorders cannot be diagnosed as one of those and instead are diagnosed with EDNOS. There is a wide range of patients who are given this diagnosis, but as researchers point out, conditions vary greatly and many patients can identify more with the symptoms and criteria of anorexia or bulimia.
This leads to several problems. First and foremost, there is little research that discusses how clinicians should treat EDNOS patients. From a patient perspective, some insurance companies will not cover medical expenses related to this diagnosis.
I have a problem with how the term “not otherwise specified” can be misinterpreted as a less serious eating disorder, or not quite an eating disorder yet. This notion may cause patients to be less motivated in participating in their own treatment, or cause loved ones to dismiss it. Even though all psychiatric disorders include a not otherwise specified diagnosis, the percentage of patients with this diagnosis is far less than the astonishing 50% of EDNOS diagnoses.
So what can be done? And why? Many professionals believe that reducing the stringency of the anorexia and bulimia definitions would allow more patients to be diagnosed as one or the other, and maybe even both. Experts also see a need for a defined binge eating disorder and a separate purging disorder for patients who purge but do not binge.
Why is it important to have these clear diagnostic criteria available?
These changes may seem small, but once a psychiatric condition is listed in the DSM, there is an increase in research of the condition, as well as an increase in the general awareness. As a result, clinicians will be able to better treat patients with disordered eating, and patients will take their diagnosis more seriously and will be more accountable for their recovery. Additionally, Insurance companies may reimburse for more diagnoses, and there could be an increase in the coordination of care among health care professionals because there will be a standardized language for the various diagnoses. With these changes, patients will definitely see an improvement in the level and quality of their care.
In a recent study, researchers found a significant bias in healthcare professionals who treat overweight and obese patients. This includes, but is not limited to, nurses, doctors, dietitians, and physical educators. Weight-based discrimination among healthcare providers has increased 66% over the past decade. This type of prejudice has a significant impact in the care that may be provided to the patient.
Lead author Dr Kerry O’Brien, from The University of Manchester, UK, said: “One reason for the high levels of obesity prejudice is that people only hear that obesity is due to poor diet and lack of exercise, which implies that obese people are just lazy and gluttonous, and therefore deserve criticism. But, uncontrollable factors, such as genes, the environment and neurophysiology, play an important role.
“Weight status is, to a great extent, inherited. It’s crucial that health professionals, such as nurses, doctors, dieticians and physical educators, are aware of these other influences, as well as their own potential prejudices, and don’t just blame the individual for their weight status.
“Those tasked with providing health services to obese people may become frustrated with patients when they do not lose weight following counselling and treatment, but the research shows that weight loss is extremely difficult to maintain long term. Obese people are constantly fighting their physiology and the environment. If professionals keep this in mind it may help in not stigmatising their clients.”
Researchers found that by administering a tutorial about additional factors in weight status, they could effect a 27% decrease in the bias. The tutorial focused on causes beyond the control of the patient that contribute to weight. When only given training regarding the influence of eating and exercise on weight, the bias increased 27%.
Obviously this fatism is not limited to those in the healthcare field. This is a widespread issue in our culture. People assume those who have weights outside of ‘normal’ (67% of the population) lack the will to control themselves. This is despite the obvious success and achievement in all other areas of the individual’s life (ie. Oprah).
The assumption that the entire issue is how a person eats and moves actually contributes to increased rates of overweight/obese as well as eating disorders. There is obviously a strong genetic factor in set point weights, and there is also the issue of disordered eating or binge eating disorder. Advising people who struggle with these issues to simply ‘diet and exercise‘ does a tremendous disservice to them.
Moreover, the CDC has found the category of ‘overweight’ actually has the lowest mortality rate. Only those in the morbidly obese category experience a potentially shorter life, but actually to a lesser degree as those who fall in the underweight category. In fact, research has shown it is the losing and regaining of weight that may cause many of the medical issues such as high blood pressure, diabetes, etc.
Based on those figures, the net U.S. death toll from excess weight is 26,000 per year. By contrast, researchers found that being underweight results in 34,000 deaths per year
Think there will be a bias on being underweight? Or maybe even a national War on Underweight? Probably not–the bias is widespread and not subject to being swayed by logic.
Demi Moore recently discussed the end of her lifelong struggle with her body image. She stated she has come to realize externals do not bring happiness. I am so encouraged to have famous women discussing their real thoughts about their bodies. This further emphasizes the point that body image has nothing to do with how you look. It is a mental state.
It would be hard to argue that Demi Moore is unattractive. Yet she felt that way. I’m pretty sure you feel that way sometimes too. But in your case, you think it is justified. Well, she did too. Body Image is a mental state often used to distract you from real feelings under the surface.
You see, if you just focus on your body (instead of work or boyfriend or finances, etc.), it feels like something you can control. You will just get to the gym everyday and eat less. Voila! That should make you happy–to have the body you always wanted.
Have you ever said, “When I get to X number of pounds, then I will LOVE my body”? If you actually got there with your methods, I’m pretty sure you found what everyone, including Demi, finds: you are still not happy. Well, maybe you haven’t lost enough–there are still some trouble areas. Wrong. It will never be enough, because changing your body is not the solution. You need to change your attitude about your body. You need to see body image thoughts for the emotional cover-up they are.
So Kate Beckinsale has also recently stepped out discussing her previous battle with anorexia. She decided she was either going to die or be a real person. Not everyone is faced with such a straightforward decision because not everyone is on the brink of death with their disordered eating. However, if you have a bad relationship with food, you are not really living. You would benefit from choosing to be a real person as well.
Portia de Rossi is releasing a memoir chronicling her struggle with an eating disorder. Every time a celebrity comes out of the closet about their eating disorder, my heart leaps in my chest. I am just so grateful that women and girls who try to look like celebs can see it is not healthy or realistic. Even celebrities cannot do it–because that is not how people are really ‘supposed to look’.
Next time you turn on the TV or open up a magazine, remind yourself of two things. First, all of those pictures have been retouched. Those people do not look like that–you certainly shouldn’t try to. Second, many of those people are struggling with eating disorders and body image issues. That’s right, the people you want to look like don’t even like the way they look. Love the real you–honor your genes, not your jeans.
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