Pat Hartman | Childhood Obesity News

The Nine Truths and Mortality

Pat Hartman April 24, 2025 No Comments

Again, the document of interest here is a very inspiring piece of scientific journalism titled “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders”, which predicted the directions in which research proceeded after its publication. Among the foundations of this branch of the science, we have reached Truth #6 — and this is major: Eating disorders come along with increased risk for medical complications, as well as suicide, making premature death the most significant outcome in which an eating disorder may result.

A seemingly inexplicable link

Over 20 years ago, researchers who dove more deeply into this found that for females between the ages of 15 and 26 afflicted with anorexia nervosa (AN), “the mortality rate is 12 times higher than the death rate of all other causes of death.” Overall, amid the multitude of psychiatric illnesses, the self-starvation route notoriously claims one of the highest death tolls. Even that statistic is equivocal because “one in five deaths in AN is attributable to suicide.”

In fairness, it would seem that, if any of them are deemed to be suicide, they all should be. It’s just that hanging or shooting oneself takes a lot longer than pure, classic starvation. At any rate, here is a shocker:

A large clinical study found that 35.6% of eating disorder patients had attempted suicide at least once, and patients with binge eating and/or purging behaviors were associated with an elevated risk for suicide attempts compared with patients without such behaviors.

Back then, scientists suspected a genetic basis for the “co-occurrence of eating disorders and suicide,” which is intriguing enough to break off from reviewing the past, to look up some more recent news, and indeed it is very current.

About two months ago, Cambridge University Press published a paper with a remarkably long Conclusions section. Here is an excerpt:

On a phenotypic level, we identified a common latent factor contributing to susceptibility to eating disorders and suicidal ideation, both of which also presented substantial proportions of independent variance. These findings suggest a moderate degree of shared genetic architecture, supporting the hypothesis that these conditions are partially influenced by overlapping genetic factors.

By combining observations from the genetic, neurobiological, and psychological perspectives, researchers identified in patients markers of the shared risk for eating disorders and suicidal ideation. Like never before, it became possible to begin understanding shared neurocognitive deficits. In addition, both eating disorders and suicidal ideation are influenced by environmental factors.

Among many other questions, the exploratory teams wanted to discover if eating disorders lead to suicidal ideation, or vice-versa. If there is nothing resembling a causal relationship either way, that strengthens the possibility that they “emerge concurrently from shared vulnerabilities.”

The interested scientists hoped to find numbers of individuals with “elevated genetic predisposition for the general susceptibility factor” and conduct longitudinal studies which ultimately reveal protective factors that could be used to reduce the risk of both eating disorders and suicidal ideation. This type of knowledge is expected to have powerful ethical, social, and clinical ramifications.

As if that were not enough

The following month (last month, as of this writing) saw the publication of “Genetic links between eating disorder symptoms and suicidal ideation” by Bryony Doughty, which summarizes the latest news on the heritability of eating disorders, in conjunction with suicidal ideation and behavior. Not surprisingly, the newest reports are hardly more informative than the ones a decade old or more. The whole subject has turned out to be an incredibly tough nut to crack. As an action plan, it is suggested…

[…] that mental health professionals should routinely screen for suicidality in patients with any disordered eating symptoms, even if they aren’t showing symptoms of mood disorders… For individuals struggling with an eating disorder, understanding that suicidality may have a genetic root can be validating.

Your responses and feedback are welcome!

Source: “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” NIH.gov, October 2017
Source: “Genomic links between symptoms of eating disorders and suicidal ideation,” Cambridge.org, 02/19/25
Source: “Genetic links between eating disorder symptoms and suicidal ideation,” MQMentalHealth.org, 03/17/25
Image by morganharpernichols/Pixabay

The Nine Truths, Again

Pat Hartman April 22, 2025 No Comments

The final line of the previous post mentioned “biologically-driven maintenance patterns that impede recovery,” which can be quite troublesome. Today’s post continues to examine the sections of a very long and explicit paper about nine distinct areas of concern in the overall subject of eating disorders.

This publication from the Academy for Eating Disorders, titled “Nine Truths about Eating Disorders,” points out that where hazards are concerned, sexual maturity raises the stakes much higher.

Actually, two different and contrary reactions have been observed. In acute cases of anorexia nervosa (AN) and bulimia nervosa (BN), many women have reported that during pregnancy, their illness improved or even temporarily disappeared. But at the same time, anorexic women who had already been in remission have reported that pregnancy brought on relapse.

The gravid state is also one in which binge eating disorder (BED) may present itself for the first time; and even in the absence of pregnancy, BED symptoms may fluctuate according to the menstrual cycle. Less estrogen and more progesterone might increase or even initiate the symptoms of disordered eating. Even more disconcerting for women who just want some peace, menopause can make an eating disorder come back or even start for the first time.

It is all very confusing, and if little is understood about how these processes work in females, the masculine situation is even more mysterious. Males are more elusive to study, partly because they tend to not seek help. If they do start psychological therapy or another sort of healing program, they are more likely than women to drop out.

In both sexes, with the advent of sexual maturity, the chemistry becomes incredibly complicated, and in many cases, each new discovery throws up another question, or several. To get a sense of how convoluted the whole subject is, here are a few ideas the authors proposed for further research:

— examining neuropsychologically-based treatment approaches and outcomes
— treatment matching based on phenotypic psychobiological profiles
— evaluation of childhood behavioral and neurobiological traits
— systematic reviews on altered response to food and exercise in eating disorders and brain function
— additional investigation of neurotransmitter availability and function in eating disorders

Just those few suggestions have subsequently led to deep work in the areas of the measurement and function of cerebrospinal fluid, positron emission tomography (PET scans), magnetic imaging spectroscopy, the role of neural circuitry in eating disorder risk, and postmortem brain analysis. Moving on, what these authors deem Truth #5 is a biggie:

Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socioeconomic statuses.

That’s right, age provides no protection against eating disorders, which impartially strike children, elders, and everyone in between. Not surprisingly, it has been observed that “divorce, loss of family members, or somatic illness could serve as triggers.”

Researchers have meta-analyzed reports from at least 30 different countries and found that eating disorders do not discriminate against people of any particular race and ethnicity, but happily afflict people of every sort. In America, with its lavishly variegated population, some distinctions have been found. In contrast to non-Latino whites, members of ethnic minorities seem to favor binge eating. White people tend slightly more toward AN, and other small irregularities have been found, but on the whole, any eating disorder is an equal-opportunity destroyer.

Eating disorders occur in individuals of all shapes and sizes, although some unexpected oddities in the statistics do occur. Overweight and obese adolescents are prone to BN. On the other hand, “Individuals with BED are commonly overweight or obese… [Y]et a substantial minority of individuals with BED are normal-weight, particularly early in the course of illness.” Again, every answer seems to spawn more questions, some of which get stuck for a long time in the category of appearing unanswerable.

Another area of extreme complication exists in the realm of sexual orientation and gender. Even socioeconomic status insists on being a mystery, with “no consistent association” between fiscal security and eating disorder occurrence. The numbers may be there, but the reasons for them are often obscure. Just when researchers seem to have something figured out, along comes another study to upset the academic applecart.

As research findings shift like the ever-changing patterns inside a kaleidoscope, certainty remains elusive. One thing the authors know for sure is that, in quite a few areas, many more longitudinal studies are needed, and they of course cannot be arbitrarily hurried, so a lot of answers are destined to remain cloudy for quite some time.

Your responses and feedback are welcome!

Source: “Source: “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” NIH.gov, October 2017
Image by geralt/Pixabay

The Nine Truths, Continued

Pat Hartman April 17, 2025 No Comments

Moving on to the third major point made in a very thorough article, first mentioned in the previous post, we need to understand that while an eating disorder may appear to be only a minor personality dysfunction, it might need to be looked at more closely. The issue could either already be — or could have the potential to blossom into — a serious health threat “the effects of which disrupt functioning beyond immediate complications of the eating disorder.”

Especially in uncertain times, it is important to understand that, treated or untreated, an eating disorder will be expensive. When people reach an age where reproductive health becomes an issue, more costs are involved, both financial and otherwise. Still, many negative outcomes can be avoided — which is why, for instance, Childhood Obesity News is interested in alerting parents and professionals to the potential benefits of Brainweighve, because, let’s face it, prevention is so much more efficacious than cure.

Did someone say “multifactorial”?

Truth #4 on the Academy for Eating Disorders list reminds us that no one chooses to suffer from an eating disorder. Even when they themselves may believe they volunteered for it and are consciously running the show, the problem is now understood to be basically organic.

In vulnerable individuals, biological drives towards automaticity can provoke rigid habits to the point where individuals struggle to regain control over their dysregulated eating and physical activity.

We are also reminded that the miraculous human mind can mess with its owner 24 hours a day for years without ever taking a vacation. Still, not everything operates in the psychiatrist’s realm. The authors here state that eating disorders, other habit-related malfunctions, and addiction all are generated by “some shared neurobiology.” Biologically and genetically influenced risk factors are associated with fundamental personality traits and cognitive styles.

Despite how sincerely they might believe they are the captains of their own fate, people affected by these problems are generally kidding themselves, and do not actually have a choice. They may need to pretend to themselves and others that it is all voluntary, because that is less frightening than to acknowledge that all semblance of control has been lost.

In diagnosing and treating these disorders, the authors mention underlying conditions as variations in individual neurobiology, such as “dysregulation in neurotransmitter availability and function.” In other words, an unrecognized factor or factors could be messing with the production of such essential substances as dopamine and serotonin. Here is the problem:

These systems are central in rewarding aspects of food, motivation, executive functions, and the regulation of mood, satiety, and impulse control.

There are differences between people who suffer from active eating disorders, and those who do not. Brain anatomy might be a factor, and so might various aspects of the brain’s operation, affecting emotional processing and cognition, among other functions. This applies especially to teens because:

A maturing brain may be particularly vulnerable to the insults caused by extreme food restriction or excessive exercise resulting in negative energy balance or highly variable energy consumption (binge-fast cycles).

The intellectual workers in this field are comfortable with the idea that the tendency toward eating disorders is biologically influenced, because in animal research subjects it is so obvious. Sure, humans are more complicated than lab rats, but sometimes not by much. Throughout the kingdom of warm-blooded creatures, brain structure and function are responsible for “biologically-driven maintenance patterns that impede recovery.”

Your responses and feedback are welcome!

Source: “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” NIH.gov, October 2017
Image by actaylorjr-6170605/Pixabay

Nine Truths to Build On

Pat Hartman April 15, 2025 No Comments

A few years back, the Academy for Eating Disorders published a list of nine facts about such ailments. While, of course, plenty of work has been done in the interim, and many discoveries have been made, it is interesting to look back on this document created by 19 authors from three institutions of higher learning, two of them European and one American.

The very first fact mentioned is that many people who suffer from eating disorders may appear healthy, as in “no big deal,” while they are nevertheless quite sick. The problems exist in three different areas: the body, the mind, and the person’s interactions with society in general. To break it down even further, the somatic risks show up in “multiple organ systems including the cardiovascular, gastrointestinal, musculoskeletal, dermatologic, endocrine, hematological, and neurological,” while psychological/psychiatric difficulties present further potential for malfunction.

To complicate matters even more, the affected person’s appearance is not always a clue to the underlying problem. Someone who engages in restrictive eating might look emaciated; on the other hand, their physique might be quite hefty. Neither bulimia nor binge eating can be deduced from an individual’s looks, either. It is important to not make assumptions without evidence.

Another fact is that the majority of people troubled by eating disorders cope on their own, or simply give up, and never even seek treatment. They might keep the problem a secret for years, fooling family members, friends, medical personnel, and even themselves.

Old assumptions die hard

Premise #2 is, no one should leap to the conclusion that family malfunction is the cause. Fault does not always lie with the parents, and, in fact, a child’s eating disorder, especially if it becomes life-threatening, can bring a lot of stress into the family dynamic. Caregivers may be in for a rough ride, especially when the troubled person is anorexic. Parents might suffer “higher levels of distress than individuals caring for patients with psychoses.”

On the other hand, once the “identified patient” is under treatment, attention must also be paid to educating the caregiver/s in self-care, to prevent further erosion of the overall situation. This sounds distressing, but it is very positive news because, in contrast, the historical fact mentioned in a recent post, a “parentectomy” is no longer considered the first, best course of treatment for anorexia.

Start with the positive

In fact, family-based treatment has proven to be very effective, particularly in cases of anorexia. The first step is to help the older members recognize the knowledge and skills they already possess as a strong basis on which to build. When the affected person is an adult, a couple-based intervention can be successful, and might begin with teaching the well partner how to overcome the fear of making the situation worse with inappropriate actions or words.

Up to that point in the history of understanding such illnesses, family-based success had mostly been achieved in cases of anorexia. The study’s authors urged much more research into how BN (bulimia nervosa) and BED (binge eating disorder) could be affected. Still, no matter how good the intentions and how ambitious the family-based treatment may be, the functioning of the family as a whole, in addition to the well-being of individual members, cannot help but be affected.

In particular, there may be an unavoidable financial burden. For teenagers, dealing with these matters as either the identified patient or as a relative can add extra stress to the already multitudinous problems of adolescence. For adults, the more obvious areas of difficulty are intimate relations and reproductive health, as well as adaptation to the theory and practice of new parenting skills.

This should go without saying…

In the realm of family, it ought to be very obvious that prevention is much preferable to intervention. To raise healthy children is such a difficult undertaking, parents ought to have access to comprehensive training — early and often. If for any reason such education is not provided by official entities, perhaps this is a signal that groups of other types need to step up and take responsibility for offering solid advice and practices under which children can flourish.

Your responses and feedback are welcome!

Source: “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” NIH.gov, October 2017
Source: “Identified Patient Psychology: Unraveling Family Dynamics and Treatment,” NeuroLaunch.com, 09/15/24
Image by pixelRaw/Pixabay

Around the World With BED

Pat Hartman April 10, 2025 No Comments

Binge Eating Disorder has made some astonishing strides in the past few years. First, we go back a decade to an article titled, “11 Countries with the Highest Rates of Eating Disorders in the World.”

At that point in time, it was already impossible to ignore the influence of media on the behavior of people, especially young ones. The author noted that about 50% of teen girls and 30% of teen boys were restricting their diets in some way, with weight loss as the goal. Of those dieters, it was estimated that around one-quarter of them eventually wound up with eating disorders. Worse yet, at best guess, most of them never tried to get treatment.

As one of the 11 countries most troubled in this way, the piece surprisingly named Bangladesh, which had in 1974 attracted world attention and aid because of famine conditions that killed as many as a million and a half people. Given that history, it stretches the imagination to picture the inhabitants suffering from any sort of eating problem other than starvation.

Really?

That Vietnam, Pakistan, and Indonesia would be named as prominent eating disorder hotspots is also disconcerting. Another surprise to find in this category at the time was Brazil, with around 37% of its teenagers into binge eating, and almost one-quarter of them being “serial dieters.”

At around the same time, a WHO survey of world mental health noted that very few countries other than the United States even kept track of Binge Eating Disorder (BED), and that fewer than half of either BED or bulimia nervosa sufferers ever received treatment. Apparently, BED was not at the time regarded as a very serious problem, but the authors of the document warned that in terms of public health, it mattered at least as much as bulimia. They added,

Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.

In 2021, a specially-purposed world map designed to indicate the spread of only two disorders, anorexia nervosa and bulimia nervosa, was published. It showed Australia as the undisputed winner, with about 2% of the country’s population suffering from one or the other.

All over the place

When researchers want to know about the prevalence of binge-eating disorder in various parts of the world, a number of questions immediately present themselves. How should the areas be differentiated? Strictly by national borders? That would be the easiest way, because research tends to be done, if at all, by a particular country’s academic and scientific establishments. Or does it make more sense to categorize unhealthy people by race? By political dogma? By religion? By language? By gender and/or sexual orientation?

A recently published cross-cultural study, with the goal of setting up a standardized framework for assessing Binge Eating Disorder, stated that it…

[…] aimed to evaluate the reliability and validity of the Binge Eating Disorder Screener-7 (BEDS-7) across 42 countries and 26 languages, assessing its reliability and validity […] in diverse cultural contexts.

The researchers note that BED, which is associated with non-trivial risks to psychological and physical health, is ”often underdiagnosed across diverse cultural and clinical settings.” Furthermore, most people who have it do not seek treatment directly for the condition itself, but look first for help with other physical and mental disorders. Along with depression and anxiety, individuals with BED also tend to have histories of substance use (or abuse). The authors note,

When translating and applying questionnaires measuring eating disorders across different cultural contexts, challenges arise due to varying cultural norms related to food, body image, and mental health, which can affect how individuals interpret and respond to questions.

Additionally, there is the fact that many people with disordered eating behaviors do not know it. Women may think it is perfectly normal to obsess over their bodies. Men may believe it is unmasculine to even think about such issues. Researchers also find that, depending on which country information is gathered from, certain groups are under-represented. People with more education and less self-consciousness about their sexuality, for instance, tend to show up for surveys and reply to questionnaires.

Your responses and feedback are welcome!

Source: “11 Countries with the Highest Rates of Eating Disorders in the World,” InsiderMonkey.com, 06/12/15
Source: “The prevalence and correlates of binge eating disorder in the WHO World Mental Health Surveys,” nih.gov, 05/01/14
Source: “Eating disorders prevalence, 2021,” OurWorldInData.org, 2021
Source: “Cross-Cultural Validation of the Binge Eating Disorder Screener-7 (BEDS-7) Across 42 Countries,” Wiley.com, 03/05/25
Image by Mohamed Hassan/Pixabay

Binge Eating — What’s the Problem, Anyway?

Pat Hartman April 8, 2025 No Comments

Why is binge-eating disorder such an easy trap to fall into? An argument could be made that this is how humans were naturally trained to eat, far back in antiquity. When hunter-gatherers roamed the earth, there was no other choice. If a large animal could be brought down, sliced up, and cooked, everybody had to gobble up as much of it as possible, right there on the spot.

There were no refrigerators, and even people who never went to college can figure out that after a while, meat goes bad and makes them sick. Gathering, or reaping fruit, vegetables, and grains worked the same way. When some fruit was in season and people found a tree full of it, what else could they do but grab as much of the bounty as possible and keep their systems stoked with it until the next lucky find appeared? When food presented itself, hungry people ate while the eating was good.

It probably should not be surprising that many humans feel the ancestral urge to fill up whenever we can. Some of us are still in the situation of being forced to eat whatever is available, because of uncertainty over when another chance will occur. But millions upon millions of us are not in dire circumstances, and do not have to gorge just in case there is nothing to eat tomorrow. So let’s look at why this habit is so destructive.

Registered dietician Elyse Resch lists seven excellent reasons why anyone embroiled in a binge-eating pattern would do well to get a clue and make the effort to stop the habit. A very valid reason is that it interferes with sleep. First, it might take longer to fall asleep, but then you might wake up feeling thirst, or the jabs of acid reflux, or the simple local discomfort of a distended belly.

The second reason is very important because a condition is created in which we cannot trust the signals sent by our own bodies via the appetite hormone ghrelin or the fullness hormone leptin.

Studies show people who frequently binge-eat have lower levels of ghrelin and have difficulty responding to hormones in general. Binge-eating on a regular basis makes it harder for your body to figure out if you’re still hungry, or satiated.

The third reason is that the postprandial surges of glucose and insulin can interfere with the body’s immune system and make us more vulnerable to colds and other infectious conditions.

Next, the American Psychological Association has determined that, as with alcohol and some drugs, a food overdose can put the brain into a state of oblivion that allows the eater to escape self-awareness. Needless to say, this happens at a time when the brain most needs to be asking, “Hey, what the heck am I doing?”

The binge eater’s goal is to induce a state of peaceful relaxed bliss, but the body knows enough to reach for homeostasis, or balance. It attempts this by producing stress hormones, which in turn speed up the heart rate and produce anxious sweat, along with unpleasant irritability, and lethargy — an emotion qualitatively different from peaceful relaxation.

After consumption of a bunch of simple carbohydrates and sugar, the pancreas leaps into red alert mode trying to compensate by producing enough insulin to cope. This is a further deterrent to the body’s preferred state of homeostasis.

A reasonably balanced meal induces the brain to release dopamine, which is fine, but after overeating becomes habitual, the brain struggles to catch up and needs more and more fat and sugar input to pump out the dopamine reward. Gradually but inevitably, overeating becomes over-overeating and over-over-overeating.

Bonus list

Also from BestHealthMag.ca, here are the warning signals that a person is consuming too much sugar. Does anything strike a familiar note?

1. An acne breakout
2. A mid-day energy slump or headache
3. Dental cavities
4. High blood pressure
5. High cholesterol
6. A post-exercise energy crash from using simple sugars for fuel
7. Clothes that used to fit are too tight
8. Depression caused by systemic inflammation
9. The body doesn’t get the message that food has been taken on board, and doesn’t “feel full.”

Your responses and feedback are welcome!

Source: “7 Reasons to Stop Binge-Eating,” BestHealthMag.ca, 07/16/19
Source: “9 Clear Signs You’re Eating Too Much Sugar,” BestHealthMag.ca, 01/03/17
Image by The Digital Artist/Pixabay

Monkey See, Monkey Do

Pat Hartman April 3, 2025 No Comments

In an earlier post, the question about learning came up. Does someone with an eating disorder discover the lifestyle on their own, spontaneously? Or do they absorb the concept, either covertly or openly, from an older relative, or from a peer, or from the older relative of a peer? Or read about it in a novel, or see a TV show?

Of course these questions are already archaic, because now this dangerous information is easy to pick up from social media and other internet sources. But in the old days, how might someone have stumbled onto the idea of, for example, habitual vomiting as a method of weight control?

In the close confines of the family environment, a child can hardly avoid noticing behaviors associated with eating disorders. The thing about children is, they not only notice things, but assume that what they see at home is how things are supposed to be. By and large, it is helpful to society for children to make this assumption. Babies are born fully prepared to look at and imitate the older humans in their environment who take care of them. Parents, older siblings, and other relatives are expected to be role models, who demonstrate to babies how to form themselves into people.

Children have eyes and ears

In the past, a typical one-family home or apartment would only have one bathroom. What on earth was Aunt Cindy doing, spending so much time in there? How many moms spent extra moments in the basement, next to the wringer washing machine, throwing up into the utility sink?

What other behaviors could be discovered or learned? How many teenage girls have appreciated the convenience of making unwanted food disappear into the mouth of the family dog? And if kids don’t pick up eating disorder behaviors from grownups, how do those notions originate? For instance, is throwing up after meals, like masturbation, a behavior that any child can eventually discover on their own, without witnessing a demonstration?

A bit of history

Bulimia nervosa has been described as “insatiable waves of overeating followed by compensatory methods,” driven by the irresistible urge to overeat that is in constant conflict with the fear of obesity. Once bulimia was formally introduced into the medical literature, many more cases were identified and diagnosed, as might be expected. In successive editions of Diagnostic and Statistical Manual of Mental Disorders, as well as other literature, definitions were characterized according to the frequency with which patients employed compensatory behaviors. This fine-tuning allowed cases to be sorted into the categories of mild, moderate, and extreme.

It appears that bulimia usually kicks in at the age of 16 or 17, and the author mentions the unexpected detail that “the rates are highest among the Hispanic/Latino population, second highest among African-Americans and lowest in non-Latin whites.” (Anorexia, on the other hand, is most prevalent among non-Latin whites.) Elena Bowie writes,

Studies have found that eating disorders are inheritable, in addition to several other parental factors that can influence the susceptibility of developing an eating disorder, like parental mental illness or parents with negative views of weight…

To diagnose bulimia may be difficult because patients “are likely to hide their symptoms and physical signs are usually absent.” Often, the evidence is provided by parents or other people in a position to notice changes in behavior. Some of them notice the signs because they have had personal experience with an eating disorder, and have overcome the urge to make it a lifestyle. The author cautions,

The most important thing to take note of is that recovery from Bulimia is not a one size fits all approach and requires careful planning of the physical, psychological, and social needs to create the best possible chance for recovery.

Your responses and feedback are welcome!

Source: “History of Bulimia nervosa,” Emory.edu, 04/01/21
Image by Shutterbug75

Eating Disorders at Home

Pat Hartman April 1, 2025 No Comments

Historically, the relationship between food calories, energy expenditure, and fat was not thoroughly investigated or catalogued. But even before the reign of the enormous British monarch Henry VIII, it was understood that eating a lot made people grow large. Rather than a cause for criticism, obesity was social currency, proof that a breadwinner was indeed prosperous enough to overfeed himself and his family. Such people were looked up to as role models. Now, we know better, but don’t always do better.

In an essay about the societal ramifications of eating disorders, eating disorder therapist Kate Sutton wrote,

Social interactions play a significant role in the development and maintenance of eating disorders through various mechanisms…

Then she went on to give examples. At any type of gathering, there are others to whom a person can make self-comparisons. Even for kids with a restricted upbringing, whose only contacts are made in homes and at church, and maybe not even at school, there is still plenty of opportunity for comparison and judgment. Those factors of course lead inevitably to self-judgment, and from there, to seeking a way to change the self in order to be more acceptable to the majority.

Adults of course play a huge role, particularly with regard to children and youth. The relentless pressure of influence is out in the open, because of the presumption that grownups are supposed to be teaching, through every possible means, at every moment. With adult peer pressure, the methods and effects are more sly and insidious. Among a group of young people, peer pressure can go either way, advocating either conformity or non-conformity.

… Or else!

At any age, the pressure is felt in various forms. Some people can give you a look that just makes you want to sink through the floor. Others may talk about you, or to you. The message is delivered loud and clear: You are inadequate and you need to change, before the situation reaches the point where no one wants anything to do with you. Peers and random strangers are bad enough, but when a family member starts picking on you, even with alleged best intentions, it’s the worst. There is no escape. You live in the same house with this person whose eyes critically weigh you every day, and who keeps track of every bite you put into your mouth.

Obviously, in recent decades inescapable media influence has changed the culture immensely, with magazines, advertisements, television, movies, and the internet relentlessly illustrating exactly how thin human beings are “supposed to be.” The cultural pressure from those multiple sources has been documented extensively.

But even before media saturation, even before that influx of visual overload, some segments of the population were relentlessly pressured about excess weight because of professional requirements. As Sutton wrote,

In certain sports and professions where appearance and weight are emphasized, such as ballet, gymnastics, modeling, swimming, and wrestling, there is a heightened risk of developing eating disorders due to the pressure to maintain a specific body type.

The insidious factor, as “Counselor Kate” reminds readers, is that the family is where an environment is easily created that normalizes disordered eating behaviors, ranging from mild to severe, for no good reason (as ballet training, for instance, might be excused as), but just because.

As we have seen, entertainer Marc Maron describes his mother as a former obese child and a “functioning anorexic” who reacted with panic to the presence of overweight people, and whose main mission in life was to keep her own weight below 120 pounds. He in turn was indoctrinated to be phobic about butter, cheese, and double chins.

This type of upbringing is a constant reminder, “There’s good enough, and there’s not good enough, and you are very close to the edge.” Relentlessly delivered day after day, a message of this sort can be extremely damaging. In this respect, a person with the career of professional comedian is very fortunate, because there is somewhere to “put” the trauma.

Your responses and feedback are welcome!

Source: “Understanding How Eating Disorders Affect Friends and Social Circles,”
CounselOrkate.com, undated
Image by Pixabay/Free for use under the Pixabay Content License

The Rise of Bulimia

Pat Hartman March 27, 2025 No Comments

A recent post asked the question, “When did bulimia become “a thing”? The short answer is, more recently than anorexia.

Back in the Middle Ages, the phenomena that we today identify as eating disorders had religious overtones. People who refused food as a form of spiritual discipline, known as ascetics, were sometimes revered and sometimes persecuted. A condition known then as “wasting disease” probably encompassed what later came to be known as anorexia. The term “anorexia nervosa” was coined in 1874 and “bulimia nervosa” was named more than a hundred years later.

In the earlier part of the 20th century, anorexia was an upper-class disease, but in the 1970s it became more democratic. It has been called the most deadly of any psychiatric disorder because even though it may take years, many of the victims do succeed in eventually starving themselves to death.

Over the years, knowledge about anorexia and bulimia grew hand-in-hand. For Psychology Today, Emily Deans, M.D., wrote,

Bulimia (binging and then purging via exercise, vomiting, or laxatives) is first reliably described among some of the wealthy in the Middle Ages, who would vomit during meals so they could consume more. Apparently this behavior did not happen in ancient Rome despite a common conception otherwise.

Plain old binge eating disorder does not include purging or indeed any other effort to avoid obesity. Of the obese individuals who look for medical help today, about one-third of them are binge eaters. Quite recently, purging disorder has also been recognized as a separate entity.

Dr. Emily Deans also wrote,

The eating disorders also appear to be genetic, perhaps related to inherited differences in serotonin receptors. Much of the natural progression of anorexia can be explained by disordered thinking about body image combined with the process of starvation itself.

Anorexia afflicts about 0.5% of women and 0.1% of men. Bulimia around 1-3% of women (also 0.1% of men), and binge eating disorder 3.3% of women and 0.8% of men.

Now to back up a little, Britt Berg, M.S., compiled for the Eating Recovery Center a comprehensive history of eating disorders that fills in more details. Binge eating used to be called Night Eating Syndrome until psychiatrist Albert Stunkard clarified that it can occur at any time of day, changing the name of it to the more familiar Binge Eating Disorder, shortened to BED.

Anorexia nervosa, over time, underwent a transition from signifying “a pursuit of spiritual perfection to a pursuit of bodily perfection,” to identification as a distinct disease. Also, in due course, the medical profession realized that women were not the only sufferers of any of the disorders, because men are also affected. An interesting detail about the evolving state of the art is:

“Parentectomy” was considered an appropriate treatment for anorexia nervosa well into the 20th century. Essentially, a person with an eating disorder would be separated from their parents as a “cure.”

In the 1970s, in the United States, England, France, and Germany, eating disorders of every kind increased dramatically. Over the years, as successive editions of the Diagnostic and Statistical Manual of Mental Disorders were published, descriptions of the various conditions became more detailed and differentiated. Just over 10 years ago recognition of BED as a distinct entity allowed victims to obtain insurance coverage for treatment.

Berg notes that now, the available treatment for eating disorders includes a range of care levels including inpatient, residential, partial hospitalization programs, intensive outpatient programs, and virtual intensive outpatient programs. Consequently many therapeutic approaches are employed, including:

Acceptance and commitment therapy (ACT)
Cognitive behavioral therapy (CBT)
Dialectical behavior therapy (DBT)
Exposure and response prevention (ERP)
Emotion-focused family therapy (EFFT)
Family-based treatment approaches (FBT)

Next: More questions and answers.

Your responses and feedback are welcome!

Source: “A History of Eating Disorders,” PsychologyToday.com, 12/11/11
Source: “Bulimia Nervosa/Purging Disorder,” NCBI.NLM.NIH.gov, April 2017
Source: “Let’s Get Real About the History of Eating Disorders,” EatingRecoveryCenter.com, 07/13/23
Image by Alexa/Pixabay

The Obesity-Related Addiction That Isn’t Even Fun

Pat Hartman March 25, 2025 No Comments

People with bulimia have a lot going on. It’s not simply that they can’t see themselves accurately. Visual hallucinations are only one aspect of an entire array of sensual experiences. An anorexic person can eat a teaspoonful of rice and feel full. Looking bloated is not the worst nightmare; feeling bloated is.

Just like other types of enthusiasts, some folks who cherish and cultivate their eating disorders have favorite slogans that they live by. A person may be horrified by the concept of foreign matter being inside her or his body, even if that intrusive substance is food. They don’t like excess fat on their communication, either. Why say “Emptiness is freedom” when “Empty is free” conveys the message so eloquently?

The quest for emptiness becomes grotesque and horrifying. An 80-pound person wrote:

i purge for 45 mins to 2 hours flushing over and over again
i am bloated (not as bloated as i was before purging my binge), and i feel like things are still inside me
i never feel empty, even when i restrict or when i get hunger pains after my b/p session

Another appreciates precision in distinguishing similar but not identical phenomena: “I frequently get the hunger feeling after purging, but never the truly ’empty’ feeling. I consider those two distinct sensations.” But wait, it gets worse, in the next entry:

Well yes, I do get the empty feeling. I purge down to my morning weight or less… When I get to the point that I taste literally just bile and it burns coming up, I feel pretty empty… When I push [on my stomach], it feels like there’s nothing in there at all. It’s not every time because I just don’t have the willpower to stand there all night and push it all out, but it does happen.

In looking forward to the day when they can live in their own place and make up the rules, a person might fantasize about “keeping the refrigerator and cupboards empty, and free of food.” (There’s that “f” word again.) Again and again, respondents mention the adjectives light, fresh, thin, empty, and free. One person says,

I get so frustrated seeing my parents bring a bunch of junk into the house. It’s very triggering having it just there… When I’m on my own I finally won’t have to worry about binging… And no one will be there to pressure me to eat.

People with these feelings may not even be able to define exactly what the emptiness represents freedom from, or what it replicates — but isn’t part of the ideal of freedom, the concept of not needing to explain your dream or its conditions to others? Shouldn’t it be a basic rule of human conduct, that each person is allowed the leeway to chase their own particular definition of the ideal life? The philosophical ramifications are deep and wide.

If someone wants to be very skinny, why should they not be allowed to pursue their vision of fulfillment (which paradoxically, in this case, is emptiness) — just like the person who aspires to drive a race car or climb a mountain? Those are, after all, life-threatening modes of existence, and the lucky drivers and mountaineers who make it through might win piles of money and acclaim.

Okay, maybe this line of thought goes a bit too far into the territory of the absurd. But people who are mentally or emotionally disturbed do not know that. They may deeply believe in their right to self-destruct, borrowing the reasoning of patriots and freedom-lovers everywhere, to rationalize their lifestyle to themselves and justify it to others.

But the person who binges and purges, what do they get in return for all that risk? Disapproval, scorn, and possibly torture (unwanted treatment) in a place with locked doors. This quotation illustrates the common tendency to regard doctors and other medical personnel as the enemy:

I got out of hospital today for refeeding syndrome (ironically not ED related) I have physical issues that cause malnutrition but also some food body issues that no one really knows about other than I have low self esteem/can’t see myself as others do. They haven’t connected those two, luckily.

Other respondents are eager to share thoughts like these:

I also have no interest in gaining back to a healthy bmi…
I know I would feel that way no matter how low it went so it’s completely illogical and unsustainable…
I have felt more confident in myself since being underweight. Even if I’ll never feel beautiful or thin I can rationalise the thoughts… So in a way I have a peace of mind…
just feel sad and lost and stuck…

So many questions arise, like, when did bulimia become a “thing?” Do the afflicted people discover the behavior by themselves, or learn it from peers or older relatives? Did people binge and purge during the two world wars? Did the disorder even exist then? During the Depression? Did bulimics rejoice that cupboards were bare and no one had enough to eat? Did banquet guests in ancient Rome really vomit on purpose just so they could gobble down more food?

Currently, is binging and purging an American phenomenon, or does it span the globe? If not for the cultural trend toward fat-phobia and fat-hate, would people choose to live this way?

Your responses and feedback are welcome!
Source: “ED Support Forum, EDSsupportForum.com, 06/06/20
Source: “ED Support Forum,” EDSsupportForum.com, 02/24/17
Source: “ED Support Forum,” EDSsupportForum.com, 11/01/22
Image by Gerd Altmann/Pixabay

The Nine Truths and Mortality

A seemingly inexplicable link

As if that were not enough

The Nine Truths, Again

The Nine Truths, Continued

Did someone say “multifactorial”?

Nine Truths to Build On

Old assumptions die hard

Start with the positive

This should go without saying…

Around the World With BED

Really?

All over the place

Binge Eating — What’s the Problem, Anyway?

Monkey See, Monkey Do

Children have eyes and ears

A bit of history

Eating Disorders at Home

… Or else!

The Rise of Bulimia

The Obesity-Related Addiction That Isn’t Even Fun

Profiles: Kids Struggling with Weight

The Book

About Dr. Robert A. Pretlow

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