What about 'obesity'?
These days many people are worried about 'overweight’ and ‘obesity.' It is impossible to talk about eating disorders without facing this issue: eating disorder patients are often terrified of weight gain at the same time the public believes thinness is related to health, attractiveness, and self-control.
Parents need to know:
The fear of obesity in eating disorder patients is not the same as for other people. Weight loss does not relieve the fear, and fear exists at all weights.
A distorted body image is a real brain condition, not vanity. A person who experiences Body Dysmorphia (BDD) will often say that his or her body looks and feels "fat," and intolerably large. This is a real brain condition; the brain is processing visual and internal sensations differently in BDD from the rest of us. People with BDD literally see and feel their bodies are a distorted shape, often hugely larger than they look to us. Assurances to the contrary are met with disbelief and distrust. Malnourishment can make BDD much worse. It is important to know that even if the person looks too thin to us, that person may literally see a very large person in the mirror. This is brain-based and not useful or helpful to argue about.
If the patient continues to experience BDD after weight-restored the condition can be treated with certain drugs and a special type of talk therapy called Cognitive Behavioral Therapy. As frustrating as it can be, parents and caregivers need to know that when they try to tell someone with BDD the truth – "you are not fat" "you are not gross" "you are beautiful, not ugly" – it doesn’t help that person. It actually has the reverse effect, and makes the person feel worse, and serves to validate weight prejudice. It is important because the person can’t stop thinking these negative thoughts; each time you respond, you keep them thinking the thoughts. It’s often more helpful to distract them away from the thought onto something else. Another reason is until their brain is healed, or they have learned how to cope with these thoughts, what you say may feel dishonest because their perception is real to them.
There is an active debate in the nutrition and medical fields about weight and health. Many believe weight and body size are determined by one's genes. Trying to maintain a weight that is not natural can lead to mental and other medical harm. A growing number of professionals in the field question whether higher weights are always unhealthy and whether lower weights are always healthier. Despite a powerful industry selling weight loss ‘solutions,’ there are no known weight-loss diets that work permanently. Constant dieting and weight changes are, however, a known health risk.
Body Mass Index (BMI) was not meant to be used to diagnose the health of individuals. BMI is a measure of the ratio of a person’s weight to their height. It was developed as a way to measure the nutritional intake of populations. BMI cannot tell you anything about health all by itself. However, recent data from the National Health and Nutrition Examination Survey (NHANES) does show a link between the EXTREMES of BMI (<18.5 and >35) and higher than expected mortality. This means that people in those categories are more likely to be very sick than the rest of us. It does not mean that, all by itself, a very high or very low BMI leads an individual to die when they shouldn’t have.
Restrictive eating (including dieting) is seen in all eating disorders, including binge eating disorder. Eating less food, types of food, delaying meals, and overexercise all cause an 'energy imbalance' that our bodies are designed to fight. Some people who try to diet will trigger a cycle of even more extreme dieting. Others will experience an instinctive compulsion to binge eat - and/or get rid of food by purging.
Experts agree that children should not engage in activities or diets with the goal of losing weight, though children of all sizes need environments that offer physical activity, regular sleep habits, and wholesome nutrition provided by adults.
In a 2008 Position Paper, AED Guidelines for Childhood Obesity Prevention Programs, the Academy for Eating Disorders made the following recommendations, among others:
- Interventions should focus on health, not weight
- Focus not only on providing opportunities for appropriate levels of physical activity and healthy eating, but also promote self-esteem, body satisfaction, and respect for body size diversity
- Weight is not a behavior and therefore not an appropriate target for behavior modification
- Avoid the language of “overweight” and “obesity”
- Focus on making children’s environments healthier rather than focusing solely on personal responsibility
- Determining normal or abnormal growth in children should be dependent on the consistency of their growth over time and not just the percentile at which they are growing
- Interventions should honor the role of parents in promoting children’s health and help them support and model healthy behaviors at home without overemphasizing weight.