Daniel Roe
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Poster: Daniel Roe @ Sun Apr 11, 2010 11:50 am
 A few weeks ago, I started a rotation at a remote inpatient resort-type hospital for people afflicted with eating disorders.
The man in the picture on the left is currently a patient at one of these type facilities. He is currently 40 years old, 5'9", and weighs 106 pounds--that's up 30 pounds from when he was brought into the hospital 6 weeks ago.
My time at the hospital has brought to light for me a whole aspect of dieting that should be scary to a lot of people, particularly those with certain personality types and personal issues that could make them susceptible to this vicious cycle of "diet addiction."
Obviously there are plenty of resources online about eating disorders and so I won't bore you with running down the particulars. I will say a few things that I think are overlooked:
* Why Starve?: Anorexia is self-perpetuating on a physiological level. If you starve yourself for about 3 days by going on a 0-400 calorie diet, by the 3rd day you will probably experience a kind of euphoria and empowerment. People with anorexia usually have an addictive personality to begin with, so this feeling reinforces this behavior. Moreover, eventually the lack of nutrition causes the body to go after the brain tissue, causing gross atrophy of the brain tissue that you can actually see on a CT scan of the head (later stages, usually). This causes delusional, irrational thinking that also tends to perpetuate the process.
* The Media?  Many feel anorexia is caused by society idolizing celebrities who are unrealistically skinny if not underweight. The counselors even talk about this at the hospital. This, I believe, is wrong. People afflicted with anorexia have a view of their body as fat. If you ask them to draw a full-sized outline of what they think they look like, they draw an outline of a morbidly obese individual that they could fit into two or three times over. I've seen them do it, it's dumfounding. It's not necessarily that their goals are unrealistic, it's mostly that that they get positive reinforcement for their eating disorder and to a lesser (but significant) degree that their sense of self is skewed. I don't see unrealistic expectations as the issue, as they commonly fall below their 'goal' weight and still feel dissatisfied.
* Like A Drug: Compulsive overeating, as well as Anorexia and bulimia nervosa are addictions to destructive behavior. They provide positive chemical and emotional reinforcement that the user becomes dependent upon. As such, these disorders should be viewed and treated similarly and from the point of view of an addiction. It doesn't matter what the addiction is for most addicts, just that the need is fulfilled. In fact, in many instances you can just feed a person with an eating disorder some Xanax and their disorder will be transformed into a Xanax addiction.
 * The Flip Side: Self-esteem issues are central to eating disorders, but that doesn't mean we should "let the fatties off the hook" for fear that calling them out will worsen their condition or cause them to have an eating disorder. First off, many already have an eating disorder, and second, you're not doing them any favors. You hear all the time about how we need to "accept people for who they are" and therefore accommodate the obese, as if it's within the normal operating specifications of human beings to be that large--their size isn't who they are, it's a pathology that needs to be corrected. We're taught never to confront people for being fat and yet to call-out other vices like tobacco like their users are the devil. Both approaches are wrong. People with eating disorders have core issues that will cause them to fall into any trap you can think of from gambling to alcohol to drugs to abusive relationships. The people who can live healthy and aren't should not be given a free pass to continue. Likewise, we need to identify those who need help and make them feel uncomfortable with their situation--but in a productive way. I'm not saying we should just make fun of the fatties, we should however encourage them to seek help and don't give them a moment's peace until they do. You are literally standing by and watching these people kill themselves by doing otherwise.
Around the world there's a growing anger against fashion shows and hollywood for portraying beauty as 5% body fat and perfect abs. European governments are even fining designer showcases that feature skinny women. The reality is that if a person can't watch a TV show without going on a demented death-spiral of over or under-eating, that person needs help. There are many addictions that can fill their need and can kill them faster than an eating disorder. By taking body-image fixation away (which unplugging the TV or banning skinnies in the media probably wouldn't even accomplish), at best all you're doing is pushing them into some other obsession. More often than not, the busy-bodies who make it a point to censor or decry the "dangerous body imagery" in the media have some sort of personal axe to grind and are totally ignorant as to what anorexia is. Helping your fellow man isn't always about knocking down doors, holding marches, and donating money. Sometimes it's just about sitting down with them and getting them to admit that they need to help themselves.
On an ironic note, my own personal diet is going awesome: Down 0.75 inches in 2 weeks.
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