Is The Term “Eating Disorder” Being Used Too Freely?


By: Malcolm Evans

There is a thin line in any awareness campaign between shouting too loudly and shouting the wrong things.

With the West seemingly gripped in general by a growing obesity crisis and with nervous parents constantly vigilant for signs of eating disorders in their children, there is greater confusion than ever before surrounding the entire subject of food and eating.

But whilst serious eating disorders are unequivocally horrible and frequently life-threatening, pushing too many problem eaters and hardcore dieters too hastily towards definitive eating disorder status may be causing harm.

Sending out the wrong cries for help can have limiting abilities for self-help and recovery.

Exaggerated claims about the extent of eating disorders, born of over-zealous diagnoses, risk fanning the flames of food distress.

One sees figures being bandied about that 30-50% of women will experience an eating disorder at some stage within their lifetime.

This author does not for one minute believe that up to half of women will suffer an eating disorder. But what isolated individuals believe matters not at all; if people expect themselves to be at risk in such contexts, then risk automatically increases and if that risk is quasi-medical, it assumes a certain inevitability.

This is pathologizing on a grand scale — the categorization of problems or conditions into diseases. Once issues have become concretized like this, the focus of remedy changes. It goes from being voluntary habit change to becoming treatment only by expert third parties.

In fact, the subject deserves another big word — somatisization. This is how individuals experience distress as symptoms. It is a process nowhere near as set in stone as one might think. For instance, there is such a stigma attaching to any form of mental illness in some Eastern cultures that people suffering from what would immediately be recognized in the West as depression may characterize their suffering as stomach pains.

It is equally clear that someone around whom the net of "disorder" is cast may feel herself trapped much more inescapably than another person who is advised to work through certain lifestyle issues.

Beyond this there is a credibility issue. It is incredibly easy to be condemned as reactionary or uncaring when criticizing the voices of any minority. However, history shows that any overstatement or inaccuracy risks damaging the core cause. One only needs to look back at the Gay Rights movement of the 1970's and 1980's to remember how perhaps over-enthusiastic estimates of the population's gay percentage led to opponents shifting the field of argument. With this one area of accuracy challenged, the otherwise overpowering case for equality and decency was less clearly advanced.

In a completely different context, the campaign to address the reported plight of Vietnam Veterans in the post-war civilian U.S. was blighted by subsequent highly-credible studies which undermined the reported numbers of individuals concerned, if not the problem issues themselves.

Moving back to eating disorders, definitions until quite recently have generally comprised Anorexia and Bulimia. Whilst there are various earlier references to self-starvation, particularly amongst young women, going back in to classical antiquity, it was not until the latter part of the 19th Century that a medical typology of Anorexia was constructed. Bulimia was first formally noted in 1979.

The research community has for some time been exploring 'Binge Eating Disorder' to capture the notion of repeated and out of control overeating. BED as a firmer concept is now ring-fenced with a considerable array of necessary behaviors, anxieties and obsessions to differentiate it from lesser overeating.

Despite the cautious progress of researchers in testing the boundaries, there is a less sophisticated eating disorders bandwagon creating a disruptive momentum. As ever in all matters eating problem related, the media is an avid recipient, presenter and sometimes creator of sensationalism...30ft slithers become 100ft plunges; an unease around eating become a panic...

Individual issues of self-image anxieties, overeating, continual dieting and obesity worries are being conflated into broad ranging and quasi-medical identities.

This is not in any way to downplay the dangers and distress caused by full-blown eating disorders, serious binge eating included (nor to point the finger in any way at the many responsible and research-driven advocacy groups).

But people can exercise far more control over what is personal and cultural than they can over what is seen as endemic and medical. Wherever the serious debate finally settles with some certainty in these areas, it is absolutely clear that there is too much hype seeping in at present.

The more that people are over-hastily pushed down the road of disease labeling, the lower their chances of establishing and maintaining a natural and relaxed relationship with food. Some eating disorder zealots — and sensationalist reporters — are doing a disservice to both the sufferers of major conditions and also those experiencing other unpleasant eating issues.

This article's author, Malcolm Evans, is the founder and secretary of weight-control charity The Weight Foundation. He has worked extensively with long-term dieters and with those who have suffered eating disorder. The Weight Foundation.

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