By Dr. Mark Warren
Anyone with an eating disorder has been asked at some point or another "Why don't you just eat?" Most likely if you have an eating disorder you have asked yourself the same question. You might wonder "Why is eating so hard for me when it seems to be so easy for everyone else?" On one level the answer to this is incredibly simple, and on another level incredibly complicated. The simple level is biology. Having an eating disorder means having neurological or neuroanatomical organization of your brain that creates enormous barriers to eating normally. These barriers include visual and sensory distortions, impacts on reward centers and executive organization of the brain, distortions of senses of fullness and hunger, and over evaluation of body size and shape, in addition to other issues that may be present. The combination of all of these things makes eating incredibly hard to do. The complex answer comes from the interaction of all the issues above in addition to the fact that eating itself is an activity that is way more complicated than people give it credit for. Eating is not just about seeing food, grabbing food and putting it in our mouths. Eating is about being aware of what's happening inside our bodies, understanding and appreciating our sensations, knowing what gives us pleasure and how to eat in a balanced way. Add social eating and societal influence and its clear that eating is a complex activity on many levels. So the answer to why can't I just eat is that you have an eating disorder and that in fact is what the disorder is. It's what makes it such a scary, painful, and life threatening disease. Having an eating disorder is confronting the question "Why can't I just do something that ultimately may save my life?" It's also what makes recovery from an eating disorder so rich, full, and rewarding. Because when you are able to "just eat", you are able to embrace life in a way that had never felt possible before.
Peter's story: Excessive exercise, unusual eating habits
Josey is the parent of Peter. Josey is worried because Peter seems to have become obsessed with what he is eating and has become extremely committed to his martial arts class in a way that seems excessive compared to the class expectations. Peter is running in addition to 5x/week classes and asking Josey to buy special foods for him – low fat, low sugar, low carb, high protein kinds of foods. He doesn’t really eat with the family anymore, but that’s not so unusual because they are all so busy and often not home at the same time to eat together. He’s lost a significant amount of weight, but he was at a higher weight, so Josey isn’t sure if that’s a problem, or not. Peter is talking about wanting to get “six-pack abs” and seems unhappy with his appearance. Josey has even wondered if he might be throwing up after eating and has tried to watch for behaviors that might indicate that, but so far, she isn’t sure. Peter seems withdrawn and down, but irritable and anxious when engaged in conversation about his day. Josey is worried Peter might be developing an eating disorder, but she doesn’t want to overreact. But, as Peter’s mom, she just knows in her bones that something isn’t right.
Eating disorders affect approximately 30 million people in the United States and have the highest mortality rate of any mental illness. With the majority of that population using social media daily, it’s not hard to see why the use of social media can prompt or exacerbate disordered eating. With celebrities like Kim K. promoting thinspiration to “health” blogs pushing fitspiration, researchers sought to answer the question, “Does constant exposure to body image posts have a positive effect on fitness, nutrition, and making healthy choices?”
The passage of a federal mental health parity law nearly a decade ago was an important step in ensuring that people struggling with mental health issues received the insurance coverage they needed. More progress came in the form of the 21st Century Cures Act in 2016, which included the first instance of eating disorders language in legislation, clarifying that it is not acceptable to exclude eating disorder treatment—specifically residential programs—from insurance coverage.
Every day we are faced with “now or later” decisions. Should I buy that piece of clothing I want now so I can wear it right away or should I wait and hopefully get it on sale? These types of decisions involve the concept of immediate or delayed gratification. Brain research is showing that people’s tendencies in this area often end up being expressed in their eating disorder.