- Nicole Fong, Martin Kueh

A growing body of evidence suggests a connection between obesity and eating disorders, challenging the conventional notion of treating them as distinct conditions. According to recent data, up to 39% (about 1.9 billion) of the global adult population is overweight, and 13% (about 650 million) live with obesity. Various forms of disordered eating behaviour patterns are frequently associated with increased weight. This article explores the different types of eating disorders, the connection between eating disorders and obesity, and ways to address these challenges. 

According to recent data, up to 39% (about 1.9 billion) of the global adult population is overweight, and 13% (about 650 million) live with obesity. Apart from the health complications linked to obesity, it is also associated with various forms of eating disorders and disordered eating behaviour patterns. This article aims is to explore the different types of eating disorders, the connection between eating disorders and obesity, and ways to address these challenges.

What are eating disorders?

Eating disorders encompass more than just a fixation on food; they are complex brain-based conditions that necessitate medical and psychological interventions. Contrary to popular belief, everyone of all body shapes and sizes can struggle with eating disorders. Notably, most of those affected by eating disorders are not visibly emaciated. While healthcare professionals rely on established guidelines such as DSM-5 (Diagnostic and statistical manual of mental disorders, 5th Edition) to diagnose eating disorders formally, eating disorders exist on a continuum. It's worth noting that individuals may experience distressing and potentially harmful eating habits that can affect their physical and psychological health, even if the specific eating disorder criteria are unmet. 

Eating Disorder Vs Disordered Eating

Eating disorders and disordered eating are distinct but related. An eating disorder is a clinical diagnosis, while disordered eating is a broader term covering abnormal relationships with food, exercise, and body image. Disordered eating doesn't always meet specific diagnostic criteria but describes abnormal eating behaviours in individuals who don't fit those criteria.

Disordered eating often serves as a coping mechanism for emotional distress, with individuals focusing on weight and calorie intake to distract from feelings of inadequacy or seeking happiness through achieving a specific weight goal. Symptoms can include binge eating, extreme dieting, irregular bingeing and purging, selective food consumption, or skipping meals. While not a diagnosable condition, disordered eating should be taken seriously as it can contribute to developing an eating disorder. The subtle nature of its symptoms can make recognition challenging.

Types of Eating Disorders

1. Anorexia Nervosa 

   Anorexia nervosa is a reversible disorder characterised by severe energy intake restriction and significantly low body weight. It involves a distorted body image, intense fear of weight gain, and behaviours that hinder weight gain. There are two subtypes: restricting and binge eating/purging. The restricting type primarily uses methods like dieting and excessive exercise to lose weight, while the binge eating/purging type alternates between bingeing and purging behaviours. However, weight alone should not be the sole criterion for diagnosis. Anorexia nervosa can harm the body, including bone thinning, infertility, and organ failure in severe cases.

2. Bulimia Nervosa

    Bulimia Nervosa involves binge eating followed by purging or compensatory behaviours like vomiting, laxative abuse, and excessive exercise. These episodes occur at least once a week for three months. Unlike anorexia, weight tends to remain relatively stable. The adverse effects include throat inflammation, tooth enamel erosion, acid reflux, dehydration, and hormonal imbalances. It can disrupt essential electrolyte balance in severe cases, leading to complications like strokes or heart attacks.

3. Binge-eating disorder  

   Binge-eating disorder is characterised by recurrent episodes of consuming large amounts of food quickly with a sense of loss of control over overweight eating. Binge-eating disorder involves frequent episodes of uncontrollable overeating, where individuals rapidly consume large amounts of food, disregarding the body's signals of fullness. Feelings of depression, shame, and guilt often accompany it. Unlike other eating disorders, no compensatory behaviours such as purging or excessive exercise exist. This disorder is associated with poor nutritional choices and may lead to obesity and other metabolic diseases. 

4. Avoidant and restrictive food intake disorder 

   Previously referred to as “feeding disorder of infancy and early childhood”. It is characterised by inadequate calorie intake, resulting in significant weight loss, nutritional deficiencies or interference with daily functioning. Unlike other eating disorders, avoidant and restrictive food intake disorder does not involve weight or body shape concerns. There may be sensory aversions to food texture, temperatures, colour, and smells or exhibit extreme selective eating. It goes beyond typical picky eating and is unrelated to food availability or cultural practices. 

5. Other specified feeding and eating disorders 

   An eating disorder that doesn’t fit neatly into the established categories involves disordered eating behaviours like restricting food intake, purging and/or binge eating.  One common type is atypical anorexia nervosa, where individuals exhibit all the signs of anorexia, but their weight remains above a certain threshold despite significant weight loss. 

Untold truths about obesity and eating disorders

1. A biological struggle, not a personal failure

   Obesity should be recognized as a distinct disease, challenging the misconception of it being a personal failure. Biology, psychology, social dynamics, and economic circumstances influence weight. It's a complex disease affecting both body and mind. Hormonal changes during weight loss increase appetite and hinder metabolism, making it challenging. The obesogenic environment with cheap, energy-dense food and limited physical activity opportunities further contributes to obesity. Contrary to the past beliefs that eating disorders exclusively affect individuals with low body weight, it is now well-established that these disorders can impact individuals of all body types and weights. In fact, pre-existing obesity is a potential risk factor for disorders such as bulimia, binge-eating disorder, and atypical anorexia. Acknowledging this fact is crucial, as individuals with higher weights are often overlooked when it comes to diagnosing eating disorders. While these disorders can also occur in those with low or normal body weight, binge-eating disorder, in particular, is associated with weight gain over time and a higher chance of developing diabetes and other metabolic problems. Factors such as weight stigma and the media's portrayal of ideal body standards contribute to negative self-image and disordered eating behaviours. Internalising these ideals raises the risk of developing eating disorders. Remember, weight is beyond what meets the eye and is not your fault.

2. Transforming perspectives away from self-blame

   Weight stigma unfairly discriminates against individuals based on their body weight, significantly affecting their well-being. Individuals with higher BMI often face stigma, leading to emotional overeating, avoidance of healthcare, and social isolation. Weight stigma also plays a role in developing disordered eating behaviours and increases the risk of eating disorders. It persists because society tends to blame individuals rather than address the multifaceted factors contributing to weight. The belief that stigmatisation motivates healthier habits is misguided and harmful. We need to recognize its existence and the harm it causes to combat weight stigma. Eliminating stigmatising language, such as using neutral terms like "person living with obesity," creates a supportive environment where individuals feel accepted and can openly discuss their experiences without shame. 

3. Weight and eating disorders management should be approached holistically

   A holistic perspective is crucial in managing weight and eating disorders. Recovery is unique to each person and requires a personalised approach. Focusing solely on weight restoration is insufficient for full recovery, especially with obesity and eating disorders. Therapy (individual, group, and family counselling) provides vital support, medication may be used when necessary, and skilled dietitians help restore a healthy relationship with food. Recovery goes beyond numbers on the scale, involving the interplay of physical and psychological factors. Embracing a comprehensive approach unlocks the potential for a future free from eating disorders.

4. Empowering change in eating disorder recovery empowers lives

   In the journey towards recovery, seeking help and support is paramount. It may be daunting to share your struggles and ask for help, but know that reaching out is never a sign of weakness – it’s an act of strength. Full recovery from eating disorders and obesity is possible, especially when we acknowledge and address the concerns early on.

Conclusion

Let’s dispel the misconception: eating disorders are not phases or choices; they are rooted in biology and can be hereditary. We must understand the gravity of their negative consequences. We can rely on the expertise of healthcare professionals who specialise in eating disorders - obesity; they are equipped to guide and support you every step of the way. But remember, helping hands can only be extended if we take the courageous step and reach out. 

References

1. World Health Organization. Obesity and overweight [Internet]. Who.int. World Health Organization: WHO; 2021. Available from: https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight

2. Fuller K. Difference Between Disordered Eating and Eating Disorders [Internet]. Verywell Mind. 2022. Available from: https://www.verywellmind.com/difference-between-disordered-eating-and-eating-disorders-5184548

3. Resources - Academy for Eating Disorders [Internet]. www.aedweb.org. Available from: https://www.aedweb.org/resources/about-eating-disorders

4. Learn about 6 common types of eating disorders and their symptoms [Internet]. Healthline. 2022. Available from: https://www.healthline.com/nutrition/common-eating-disorders#other-types

5. https://www.worldobesityday.org/assets/downloads/Healthcare_professionals_statement.pdf

6. MPH CA MD. Weight stigma: As harmful as obesity itself? [Internet]. Harvard Health. 2022. Available from: https://www.health.harvard.edu/blog/weight-stigma-as-harmful-as-obesity-itself-202206022755

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