Eating Disorders Affect People of All Weights

In college—away from her family, overwhelmed by the responsibility of creating her own meals and absorbed in a culture that stresses weight loss and thinness—Marianne Kirby stopped eating. Sure, there was the occasional dinner party with friends, but most days she'd down a bag of chips and a can of soda and figure that was enough. "I would think, chips are really high in calories, so this is all the food that I need for a day," she says. "I just didn't prioritize food." And the fact that not eating would lead to weight loss? All the better. "Intellectually, you know that once you go under 1,200 calories a day, things break down," she says. "But then there's the overwhelming pressure of if you diet and exercise, eat less and exercise more, that emotional knowledge overwhelms anything you know about the numbers, so you end up thinking it's a good idea to eat one meal a day." Finally, after a year of this extreme diet, Kirby collapsed while at an amusement park with friends. That lead her to reevaluate her eating habits and make healthier choices. Her foray into disordered eating is common among many college women. But because Kirby, coauthor of Lessons From the Fat-o-Sphere: Quit Dieting and Declare a Truce With Your Body, is almost 300 pounds, her problem wasn't always recognized as such: a doctor recommended a similar daily calorie target years later as a way to lose weight.

Eating disorders are often thought to manifest themselves largely in the very thin. But people of all sizes can be affected by the pathology, control issues, and low self-esteem that breed these problems. "These behaviors are really remarkably common in people of all weights, and they certainly are common in people who are overweight, and that's not every surprising. People who are overweight often have issues with body self-esteem and are so concerned and focused with losing weight that it's not uncommon to try some dangerous and unusual techniques to lose weight," says Rebecka Peebles, an instructor in pediatrics at Stanford University and director of The WEIGHT Lab at Lucile Packard Children's Hospital.

A study NEWSWEEK reported on last year found that 40 percent of overweight college-age women and roughly 20 percent of overweight college-age men engaged in disordered eating behaviors in an attempt to get thin, statistics that clinicians say could apply to the rest of the adult population. "An anorexic you can tell is an anorexic, and anorexics in the throes of their illnesses—they are very thin," says Lynn S. Grefe, CEO of the National Eating Disorders Association. "People who are struggling with bulimia, you can't tell by looking at them." In fact, most eating disorders, including bulimia, night bingeing, and eating disorders not otherwise specified (EDNOS), appear in people of average or above-average weight. (Only anorexia nervosa has a weight qualification for diagnosis: sufferers must be at 85 percent of a healthy weight or less for their height.)

Binge eating disorder, an eating disorder that affects primarily fat men and women, will be recognized as a formal diagnosis in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), its editors reported earlier this month. One way to think of BED is bulimia without the vomiting or excessive exercise: it's characterized by patterns of severe overeating coupled with depression, anxiety, and other mental afflictions. Just as some people get headaches and others get migraines, all of us overeat at some point, but BED has the added pathological behaviors, like depression and anxiety, that accompany the often ritualized bingeing sessions. Someone with BED requires treatment for those pathologies, rather than the standard advice about diet, exercise, and a healthy lifestyle, in order to get well. The good news, says Douglas Bunnell, clinical director of The Renfrew Center, a women's mental-health center and eating-disorder treatment facility, is that with proper intervention, BED responds well to treatment.

The bad news? Many clinicians still have trouble recognizing BED. Hopefully, the inclusion in the DSM-V will help change that. "BED accounts for three times the number of people suffering from anorexia or bulimia combined," says Chevese Turner, founder and CEO of the Binge Eating Disorder Association. "It's the largest number and the one we hear the least about, in part because it didn't have its own [official] classification."

For years, Turner would go to the doctor and come home with a diet plan and renewed resolve. But before she knew it she would find herself in the middle of a massive meal, full of depression, despair, and feelings of worthlessness. Her weight climbed, the prescription stayed the same, and the feelings of failure intensified—and with them her ritual overeating. It wasn't until she sought therapy that her weight and moods stabilized. A 2004 study in the journal Current Opinions in Psychiatry notes that 25 percent of overweight Americans who have tried to lose weight suffer from binge eating disorder. Citing a study published in the Journal of Biological Psychiatry, Turner says that 30 percent of those who suffer from BED have what is considered a healthy BMI—though of course, these people are not healthy. (Turner says that learning more about this latter group, which is often overlooked when discussing BED, is crucial to better understanding the disease and obesity in general.)

Anyone who feels pressure to lose weight can wind up on a path to an eating disorder, though of course not everyone who diets will develop one, since eating disorders are a complex mix of genetic, environmental, and social cues. "These are illnesses about how we feel about ourselves," says Grefe. "This is how we express our anxiety, our OCD; it starts out in an attempt to control: 'I'll control how I look.' It looks like an initial desire to be thin, but it's a mental disorder."

That's why the eating-disorder community often finds itself at odds with other health advocates who warn of the dangers of obesity. "There's a lot of concern…about the increased anti-obesity messaging; [it] makes sense on a lot of levels," says Bunnell, but it can create an environment that triggers people prone to eating disorders.

But as obesity experts and advocates of increased focus on eating disorders are beginning to understand, the solution to both problems may be the same. "I think there can be a marriage of our desire for a healthy body image and healthy eating in the patients that we serve regardless of our weight," says Peebles. "Getting more active, losing processed foods, changing one's behavior slowly over time…but you have to be zen about wherever your body lands is where it lands."