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Obesity. Is it an eating disorder?

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Like most things, obesity is a complex phenomenon about which it is dangerous to generalize. What is true for one person is not necessarily true for the next. Nevertheless, we shall try to make sense out of conflicting theories and give answers to people who struggle to maintain self-esteem in a world that seems to be obsessed with youth, thinness, and the perfect body -- whatever that may be.

  • What is obesity?

A person with anorexia nervosa may define obesity as a weight gain of five pounds, from 89 to 94. A grandmother past menopause may call herself obese because she carries 165 pounds on her large-boned, muscular body. A modelling agency may talk about obesity when one of the women on the payroll puts 135 pounds on her 5'10" body.

None of these women is clinically obese. The anorexic and the model are underweight.

Men are split in their personal definitions of obesity. Many are just as concerned about overweight as women are, while others, frankly rotund, believe they are just fine, perfectly healthy, and universally attractive to potential romantic partners.

Physicians consider a person to obese if s/he weighs more than 20% above expected weight for age, height, and body build. Morbid or malignant obesity is weight in excess of 100 pounds above that expected for age, height, and build.

In recent years, the definition of expected, or healthy, weight has expanded to include more pounds per height in view of research that links reduced mortality (longer lives) with more weight than is currently considered fashionable.
    • Consumption of more calories than are burned through work, exercise, and other activities. In the late 1990s, Americans ate about 340 more calories per day than they did in the mid-1980s, and about 500 more calories per day than in the 1950s. The extra food was often some kind of refined carbohydrate (white flour or sugar) combined with fat, saturated fat in the unhealthiest cases. (University of California Wellness Letter, January 2002)
    • Inexpensive, tasty, plentiful food and a combination of passive leisure pursuits, sedentary lifestyle, TV, and other "activities" that require little or no physical effort.
    • Attempts to numb or escape emotional pain and distress. For various emotional reasons, including loneliness and depression, some people eat when their bodies do not need food. For more information about compulsive eating or binge eating disorder.
    • Diets and prolonged caloric restriction. When people try to make the body thinner than it is genetically programmed to be, it retaliates by becoming ravenous and vulnerable to binge eating. Ninety-eight percent of dieters regain all the weight they manage to lose, plus about 10 extra pounds, within five years. Yo-yo dieting repeats the cycle of weight loss followed by ever-increasing weight gain when hunger ultimately wins.
    • Some individuals are obese because of specific biological problems such as malfunctioning thyroid or pituitary glands. Others may have physical problems or disabilities that severely limit or prohibit exercise, strenuous work, and other physical activity.
    • Studies published in the New England Journal of Medicine (March 2003) indicate that certain genetic processes are an important and powerful underlying factor in the development of obesity and binge eating.
    • Researchers believe that in most cases obesity represents a complex relationship between genetic, psychological, physiological, metabolic, socio-economic, lifestyle, and cultural factors.
    • Miscellaneous factors.
      • The children of overweight parents are more likely to be overweight than the children of thin parents.
      • If friends and family members offer comfort in the form of food, people will learn to deal with painful feelings by eating instead of using more effective strategies.
      • Poor folks tend to be fatter than the affluent.
      • People living in groups that frequently celebrate and socialize at get-togethers featuring tempting food tend to be fatter than those who do not.
      • Some individuals eat great quantities of food, exercise moderately or not at all, and never seem to gain weight. Others walk past a bakery and gain ten pounds. No two people are the same, and no two obesity profiles are identical.

  •  Other problems associated with obesity
    • Sleep disturbances, including sleep apnea (breathing stops for several seconds; then the person rouses, gasps, and struggles to catch breath. Episodes may continue through the night)
    • Inability to fully participate in recreational activities
    • Inability to compete effectively in sports and athletics; being picked last, or not at all, for team sports
    • Inability to perform some jobs; reduced job opportunities
    • Prejudice and discrimination in school and the workplace
    • Restricted social opportunities
    • Restricted opportunities for romantic relationships
    • Low self-esteem and body-image problems, related at least in part to prejudice and discrimination encountered in school, at work, and in social settings.

  • One important piece of good news 

Obese people do not seem to have any more psychological problems, or more serious psychological problems, than folks of normal weight. The problems they do have are more likely a consequence of prejudice and discrimination than a cause of overweight. In fact, several studies have suggested that the obese are significantly less anxious and depressed than normal-weight peers.

  •  What can be done about obesity?
    •  The simplistic answer: eat less and exercise more.
    •  The realistic answer:
  • Work with a physician to identify and correct any underlying medical, biological, or            metabolic problems contributing to excess weight.
  • Check with a counsellor to see if you are using food for a purpose food cannot fulfil: love,   comfort, escape, an antidote to boredom, and so forth. If you are self-medicating with food,    work with the therapist to come up with better ways of managing stress, painful emotions,        and problems.
  • Don't ever diet or restrict calories when you are legitimately hungry. If you do, you will set     yourself up to binge later.
  • Eat normal, reasonable, moderate amounts of healthy foods. Emphasize fruits, vegetables,      and whole grains. Don't cut out sweets and fats completely. If you do, you will crave and sneak them. Besides, your body needs the nutrients found in fats and carbohydrates. Just don't overdo it.
  • Most important: Exercise consistently. Get regular amounts of moderate, self-loving       exercise. Start with a few minutes of walking and slowly extend the time until you can do        30-60 minutes a day, 3-5 days a week. If you haven't exercised in a while, be sure to check      with your doctor first.
  • Find a support system. Friends are great; so are support groups. There are both online and in-person opportunities.
  • Be gentle and realistic with yourself. If everyone in your family is round and sturdy, chances          are you will never be a super model -- but you can be happy and healthy. Also remember that healthy, realistic weight loss takes time. Losing one-half to one pound a week isn't very glamorous, but if you go any faster, you will make yourself hungry, and hunger will inevitably    make you overeat.