Eating disorders, as a group, cover a range of abnormal eating patterns and are characterized by disturbances ranging from mild to severe in eating behaviors.
They can be classified generally as behaviors of overeating, undereating, abnormal patterns of eating, eating and purging, frequently by vomiting up ingested food.
Although overeating and obesity are not classified in the diagnostic manual as psychiatric disorders but rather medical disorders, this distinction is often semantic. By far, the greatest impact on the health of Americans is through overeating and various stages of obesity.
The reasons for all eating disorders are usually rooted either in our personal psyche, society’s visions of the perfect human form, or in our heredity.
The American population is made up largely of descendants of peasants. Peasants from Europe, Africa, Asia came to our shores either voluntarily or involuntarily, and brought with them their styles of cooking and eating. These patterns and traditions are treasured by the immigrant generations and passed down to subsequent generations.
A drive down any main street or mall in our country demonstrates the food remnants of many of these eating patterns. They are characterized by our fast-food industry, which replicates in various ways the food choices of our ancestors. Often these ancestral food choices were made by necessity. If our ancestors were working in the fields of Europe, Asia or Africa from daylight to sundown, they expended a great many calories. The goal was to supply as many calories as possible to replace the lost ones. Food choices emphasized carbohydrates, fat, and usually little in the way of meat or fish protein.
Most of us in the United States today live relatively sedentary lives. There are groupsof people throughout the country that work with their hands, work the land, and expend thousands of calories per day in that work. This is often reflected in their more lean, healthy body morphology. However, for those of us who sit on our butt most of the day, we need many fewer calories but consume often as many as those working physically throughout the day.
Those afflicted by undereating disorders are often influenced by the current trends in fashion, both in body style and in clothing. The phrase “you can never be too rich or too thin” characterizes our obsession for thinness. Despite this obsession, most of us are in fact overweight or obese rather than too thin.
However, for those who gaze in the mirror and see fat, when in fact they are undernourished, this problem becomes very serious and can be as life-threatening and even more so in some case than those with morbid obesity.
Numbers sometimes give us a clue. BMI (body mass index) can range from less than 15 in severe cases of anorexia to between 40 to 45 in cases of extreme obesity.
This number, computed by a mathematical formula involving height and weight in a complex formulation, gives us a clue as to where we fit on the spectrum.
Normal weight numbers, as evidenced by BMI, are between 19 and 25. Overweight is considered between 26 and 30.
Obese is defined as a BMI between 31 and 35.
Severe obesity is characterized by a BMI between 35 and 40.
Extreme obesity is any BMI over 40. This is sometimes characterized in medical terms as “morbid obesity,” that is a weight which is seriously endangering the individual’s health.
Eating disorders impair physical health or psychological functioning.
In the newest addition of the psychiatric diagnostic manual, criteria are provided for six eating disorders as opposed to two eating disorders in the earlier edition of the diagnostic manual. As taken directly from this manual, they are listed as follows:
Persistent eating of nonnutritive, nonfood substances. This could be paper or any other nonfood substance designed to give a feeling of fullness.
This disorder is characterized by repeated regurgitation of food which may then be re-chewed, re-swallowed, or spit out.
Avoidant/Restrictive Food Intake Disorder
This is characterized by an apparent lack of interest in eating or food. There is concern about aversive consequences of eating and failure to meet the appropriate nutritional and/or energy needs of the individual.
This is characterized by a refusal to maintain minimally normal body weight, intense fear of gaining weight, and significant disturbance in the perception of the shape or size of one’s body.
This is characterized by recurrent episodes of binge eating, followed by recurrent compensatory behaviors such as self-induced vomiting, misuse of laxatives, excessive exercise, or other medications or fasting to lose weight.
Binge Eating Disorder
This is characterized by eating more in a two-hour period an amount of food than most people would eat in a similar period of time and under similar circumstances. There is also a sense of lack of control over eating during the episode.
There are other atypical feeding or eating disorders that are related to the above but I refer the reader to the Diagnostic and Statistical Manual V of the American Psychiatric Association for further definition and description of eating disorders. The good new in all eating disorders is that help is available. As a small island in the middle of the Pacific, our resources are fewer than would be available in other parts of the country, but there are many excellent residential rehabilitation programs around the country to treat eating disorders.
Medical personnel are often the first people to diagnose eating disorders of undereating or overeating. The pediatricians on our island play a crucial role in diagnosing anorexia.
We have limited resources on Kaua’i but there are individuals on the island who have expertise in treating these often difficult disorders. They are able to do an evaluation and make a diagnosis and a referral to a residential program if that is indicated.
Gerald J. McKenna is medical director of the McKenna Recovery Center.