EATING - Healthy or Hazardous: The Danger of Developing an Eating Disorder

by Susan Zonnebelt-Smeenge, R.N., Ed.D.

Use of Food...Healthy or Not?

Christmas. Weddings. Thanksgiving. Family Reunions. Anniversaries. Fourth of July. Can you imagine these celebrations occurring without food as an integral part of the festivities? In general, consider your perception of many social activities. Does food play a significant role in these gatherings?

It is interesting that typically in our culture much planning exists around what food to make or what restaurant to choose. We have developed a strong sense of the need to gather around food. True, we need food to maintain our physiological demands and to survive, but is that the primary purpose food serves? Or does it meet other needs as well?

In America, 80 million people are at least 10 percent overweight, and 1 out of 4 is more than 22 pounds over his/her ideal weight. It is difficult to pick up most magazines and not see advertisements or articles about dieting.

And yet, excluding medical problems related to weight gain, if we used food solely in a healthy way, we would not have to deal with being overweight and all of its negative ramifications.

What Is Healthy Food Use?

Mental health professionals who have investigated healthy food use determined that it's best to use food only to satisfy hunger needs to meet the body's nutritional requirements.

That means that ideally we would refuse food when we are not receiving cues from our body that we are hungry. On the flipside, we would not resist or deny ourselves food when there are physiological signs that our bodies are in a hunger state. These signs might include a hollow feeling in or growling of the stomach, a headache, light-headedness, etc.

We would be a culture that is more aware of distinguishing physiological needs from other needs that might cause people to eat. Using food like this leaves room for us to enjoy what we eat. It's healthiest when pleasure serves a complimentary role rather than being the primary focus of eating.

What Is an Eating Disorder?

Eating food becomes unhealthy when we use it to deal with emotional needs. We may numb out feelings of anger, frustration, anxiety, depression.

Eating may provide temporary emotional comfort. This means that when a person is feeling distressed, he/she avoids dealing with it directly and tries to appease or escape the unpleasantness with food. Other unhealthy food use includes it providing companionship for those who are lonely or serving as an activity for those who are bored.

There is a habit-forming component to using food for other than hunger needs. Eventually, it becomes an automatic behavior when one of the triggering factors arises.

When food intake seems the only way to make individual choices, some people restrict food or binge/purge as an unhealthy way to gain control in their life.

The Difference Between Unhealthy Food Use and Eating Disorders

Eating use/misuse fits on a continuum that ranges from the healthiest use of food to meet physiological needs to a problem of a potentially fatal form of an eating disorder. Although specific criteria determine a psychiatric diagnosis of one of the eating disorders, there are many variances between these two extremes of unhealthy eating patterns.

This is important because many people convince themselves that their eating behaviors are healthy because they don't fit the criteria for an accepted clinical eating disorder diagnosis.

We need to beware of that complacency. Frequently an eating disorder develops from an insidious process of moving from healthy to unhealthy food use without the individual's conscious intent or awareness of choosing to use food in that manner. A person with an eating disorder may be surprised to view the severity of his/her current problem compared to how innocently it began.

At-Risk Signs

1. Constantly thinking about or feeling fat
2. Fear of becoming fat or gaining weight
3. Thinking weight determines worth
4. Feeling guilt or shame after eating
5. Repeated and unsuccessful attempts at dieting
6. Binge eating = eating large amounts of food in a short period
7. Feeling self-conscious or embarrassed about eating/sneaking food
8. Self-induced vomiting, laxative/diuretic use, or compulsive exercise
9. Eating for emotional comfort to relieve stress or depression
10. Looking forward to when one can eat alone
11. Eating when not hungry
12. Eating sensibly in front of others and then making up for it when alone

Contributing Factors in the Development of an Eating Disorder

There are several factors that may play a role in an individual developing an eating disorder. These are: biological, family of origin, individual, and societal.

Evidence is beginning to show that some people genetically may be more prone to developing an eating disorder than others. This suggests a biological component involving a chemical imbalance in the brain similar to addictive disorders such as alcohol and drug abuse.

Early on, we learn the role of food in our lives from our family of origin. Our parents may use food as a way to provide comfort as well as to express love and caring. For example, a parent may provide a favorite food to comfort and soothe a child's feelings of hurt or rejection at school. The parent avoids starting a discussion to allow the child to express the feelings involved. The message conveyed is that food will make things better.This can become a lifestyle pattern as a person uses food to meet needs indirectly instead of taking care of those needs directly.

Individually, then, a person may develop an unhealthy use of food by not learning how to directly resolve conflict through communication within the family. Many people with eating disorders have grown up in families that may have been overprotective of feelings and behaviors. The families provide little opportunity for them to make decisions, learn from their mistakes, and become independent.

Feeling a lack of control in life may compel a person to start controlling food intake and weight. This may be the one area over which the person has authority. A sense of control of one's life is important in the insecure transition from adolescence to adulthood.

Other families may want to appear perfect. Therefore family members don't deal directly with feelings, but internalize them so food use suppresses emotions. A person may have learned that a temporary escape is to head for the cupboard or refrigerator if there has been a disagreement with a partner rather than have a fight about the issue. Food, then, is a symbolic way to stuff feelings and give the illusion that there is peace and harmony at home.

An individual may develop an eating disorder as a means to evade the responsibility of adulthood, including issues of sexuality. By becoming anorexic, a person may delay the onset of puberty or slow the process by losing weight, which results in a loss of menstruation.

The final major component that adds pressure to people's lives (particularly females) is society's expectation that we appear thin, beautiful, physically fit, and successful. In response to this stressor, individuals often begin dieting as a way to get approval, attention, and worth. This may become the beginning of unhealthy food use. With the changing role of women today, there is the tendency to strive for perfection and to pretend that it is possible to attain super status in all realms.

What Is an Eating Disorder?

Eating disorders occur when the focus of a person's everyday life revolves obsessively around food and weight.

Some people try to starve themselves. This disorder is anorexia, an emotional illness in which a person refuses to eat to maintain a body weight normal for his/her height The word "anorexia" means without appetite, but this is a misnomer. These individuals may actually be extremely hungry most of the time.

Self-imposed starvation is a serious, life-threatening disorder. If left untreated, it has a mortality rate of 5-18 percent. Chiefly adolescent females (1 in 100 between 12- and 25-years-old) from middle to upper-middle socioeconomic status families develop the disorder. In the U.S., estimates say anorexia affects 1,000,000 people. Anorexia occurs 20 times more frequently in females than in males.

One third of those becoming anorexic may be mildly overweight before the onset of the illness. Individuals don't begin by trying to starve themselves. They may start dieting after a stressor occurs such as a breaking up of a relationship, parents divorcing, failing grades, or some other loss.

By restricting food intake through dieting, some people gain a sense of autonomy and control. Dieting is something they can do by themselves without asking anyone for help. In an overly close and protective family environment, it may be a way to rebel and take control.

Signs/Symptoms of Anorexia

1. Thinness; loss of 15 percent or more of ideal body weight
2. Continued dieting when not overweight
3. Distorted body image/preoccupied with body size
4. Preoccupation with food and calories
5. Denial of hunger
6. Excessive exercising
7. Frequently weighing of oneself
8. Loss of menstruation (amenorrhea)
9. Feeling nauseated or bloated after eating normal amounts of food
10. Intense fear of becoming fat

Other individuals compulsively overeat (binge) and then purge by vomiting, using a laxative and/or diuretic, or exercising excessively. This disorder is bulimia, which means "ox hunger." Uncontrollable periods of overeating occur as a means to suppress or numb out feelings. The act of purging symbolically flushes feelings away and produces a cleansing effect.

Often bulimia begins as a convenient way to eat whatever one wants and not gain weight because of the purging. What may have seemed an ideal dieting technique initially, becomes a pervasive, self-destructive, habit-forming emotional crutch with many medical problems.

Primarily women ages 13 to 40 develop bulimia. Thirteen percent of college-age women have this disorder. Typically people with bulimia desire achievement, perfection, and acceptance. This causes pressure and stress. Food serves as an escape and emotional anesthetic.

Signs and Symptoms of Bulimia

1. Binges, minimum twice a week for three months
2. Purging
3. Menstrual irregularities
4. Swollen glands
5. Frequent fluctuations in weight
6. Inability to voluntarily stop eating/feeling guilty or ashamed about eating
7. Depressive moods
8. Persistent overconcern with body shape and weight
9. Overeating in reaction to emotional stress

Eating disorders are a sign of the times. The 1990s consist of high levels of stress and many pressures. People often use food as a temporary, unhealthy way to soothe or divert attention from their problems. It is important to develop well-patterned healthy eating methods and not use food to handle life's stressors. Perhaps the most significant healthy means to cope is to learn to identify, express, and deal directly with feelings.

As a society, we must de-emphasize body size as a means to value people. We must rather accept and acknowledge individual strengths and uniqueness regardless of appearance and weight. Food, eating and weight do not make for a healthy focus. Let's work together to change that distorted perception.