Eating Disorders Were Created Equal -- So Why Don't We Treat Them That Way?

We tend to see eating disorders, our general cultural anxiety about food and weight and skyrocketing obesity rates as separate problems with separate solutions. Instead, we need to recognize that they all stem from the same root. Obesity isn't the opposite of anorexia (or bulimia or disordered eating or just distorted thinking about food). It's its twin.
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"It's hard...emerging from a decade of severe food restriction, to look around me for examples of how to eat normally."

In her first column for Women In The World, journalist Emma Woolf wrote a dispatch this week not just from London, where she's based, but from the outskirts of an eating disorder.

Like an expat returning to the country of those who feed themselves, Woolf came home to a startling reality that the negative feelings about food and weight she thought belonged to her illness pervade "healthy" life.

The truth is, I'm not the only woman who has starved herself skinny, or tried to; many of us feel guilty, worthless, or out of control around food. I'm not the only one who has calculated each day what they will and will not eat; or wondered "if I eat whenever I'm hungry, will I ever be able to stop?" No matter how feisty or feminist you think you are, I bet there's a part of you that would like to be slimmer... As Western levels of obesity soar, profoundly disordered eating and body dysmorphia also proliferate."

What Woolf hits on in her piece is that we tend to see the three phenomena -- eating disorders, a general cultural anxiety about food and weight and skyrocketing obesity rates-- as separate problems with separate solutions. Instead, we need to recognize that they all stem from the same root. Obesity isn't the opposite of anorexia (or bulimia or disordered eating or just distorted thinking about food). It's its twin.

Part of the reason for the false, harmful dichotomy is the perceived competition between the two ends of the spectrum -- and the fact that we rarely talk about the daily struggles of those somewhere in the middle. Not long ago documentaries, TV news magazine reports, talk shows, reality shows and after-school specials focussed on eating disorders -- anorexia, bulimia and others in the group of mental illnesses that involve supplying the body with less than it needs. More recently attention has shifted to the reality that excess consumption is a growing public health crisis.

Almost 70 percent of American adults are overweight, we are told, increasing their risk of early death. At the same time, obesity-related medical spending is higher than the amount spent on the consequences of smoking.

Next to those numbers, the fact that around 10 percent of the population has clinically disordered eating at some point in their lives sounds less urgent, no?

That false distinction between the diseases that make us too thin and those that make us too fat also persists because we describe these conditions so differently. The story of the anorexic is still alluring, partly due to the prurient interest we have in tales of self-destruction -- see rehab lit, A&E's 13-season reality series "Intervention," various celebrities' selfie-spewing decline -- but also because anorexics seem to accomplish what to many Americans is a superhuman feat: to live not just without nutrition but to live beyond food's emotional highs and lows, to live without the threat of fat. This is an illusion -- most people with anorexia are obsessed with food and convinced consuming small amounts of it will make them huge. But their struggle with food elicits sympathy in part because it reads not like a struggle but like the ultimate victory.

Fat people don't elicit the same interest or sympathy. As blogger and National Eating Disorders Association rep Claire Mysko, who once grappled with eating disorders, discussed in a brilliant piece on The Frisky earlier this year, the eating disordered person who remains thin gets sympathy and praise during her recovery, or at least anonymity. Even though she has a mental illness, she is not described as diseased. Mysko wrote:

I get to maintain my recovery in a thin body... I am in no danger of being judged harshly because of my weight. If I feel like sitting on a park bench to eat a greasy New York slice, there is no danger that I will go home and see myself on the six o'clock news with my face blurred or my head cut off as the anchor cites some dramatic statistics about The Terrible, Horrible, No Good, Very Bad Obesity Epidemic... Even though I hated on my body hard, I was the only one doing the hating.

As Mysko notes, stories about overweight people are very different. They are often pictured as faceless perpetrators of the crime of being fat. On talk shows and game shows, they are only allowed to tell one story, of their desperation to lose weight. No one on Dr. Phil or "The Biggest Loser" confesses accepting his or her body exactly as it is. Then there is also the narrative fat people are told by bystanders, that they are lazy and so in need of fixing that they deserve public harassment.

The story of obese people is almost never that they could be caught in an emotional struggle of the same intensity as anorexia or bulimia, even though binge eating disorder, which often results in excess weight or obesity, was recently admitted to the DSM-V and even though the National Institute of Health website states that those who suffer from it -- about 2.8 percent of the U.S. population at some point in their lifetimes -- "experience guilt, shame and/or distress about the binge-eating, which can lead to more binge-eating." We almost never acknowledge that even though socio-economic factors and corporate and political forces play huge roles rising obesity rates, overweight people can be eating disordered, too.

And for those who suffer in the middle, those Woolf observes carrying on unhealthy relationships with food that never rise to the level of a diagnosis, there is not story. It's so constant, it's a non-event. Invisible. The status quo.

The most compelling reason to start thinking differently about eating issues -- to make the unseen visible, to understand that people who eat too much often have the same reasons as people who eat too little -- is that our current way of thinking hasn't solved the problems. Exalting the thin, shaming the fat and ignoring everyone in between hasn't reduced eating disorder or obesity rates, and it hasn't made anyone feel better about food.

What if we started reading our eating issues as part of the same story, of a culture's broken relationship with food and a resulting body image crisis? What if we viewed all people who use food and weight to cope with challenges in their lives as worthy of compassion, whether they are fat or thin? What if we closely regulated the way food and especially diet products are advertised and ran PSAs providing nutrition information and encouraging children and adults to value what their bodies do rather than how they look?

Yes, the incredibly complex task of repairing our relationship with food will also involve cooperation between opposing interest groups and making healthy food more affordable and readily available. But until we work to change our beliefs about what food and weight mean about us, until we start to tell a different story, nothing will change.

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