Eating disorders (ED) and disordered eating have a long history. Historical descriptions of overeating date back to 700 BC during Caesar’s time, where rich ancient Romans would stuff themselves at lavish banquets, then purge to return to the feast. This was labelled as an eating disorder, “Bulimia Nervosa” (BN), by British psychiatrist Gerald Russell in 1979, millennia the behaviours were exemplified at Caesar’s banquet table. Russell referred to BN as “powerful and intractable urges to overeat” in combination with “a morbid fear of becoming fat”.
Historical Context:
Since the 1980s, awareness of anorexia, bulimia, and binge eating disorder has substantially increased. Despite major advances in ED diagnosis and treatment, recognizing and treating ED remains challenging due to its complexity. It can manifest in individuals of any weight, shape, or size, challenging the conventional perception that it is solely related to being underweight.
Definition of Bulimia Nervosa:
According to the DSM-5, BN is characterised by recurrent episodes of binge eating and compensatory behaviours to prevent weight gain. A clinical binge involves eating a significantly larger amount of food than what most individuals would eat under similar circumstances, experiencing no control over what or how much one is eating. For example, eating two Big Mac set meals at one go followed by one pint of ice cream, a chocolate bar, and a full bag of potato chips. This often leads to feeling uncomfortably or painfully full and extremely guilty, triggering compensatory actions like starving the next day, self-induced vomiting, misusing laxatives, or excessive exercising. In binge eating disorder, the bingeing behaviour is present without the compensatory behaviours.
Objective vs Subjective Binge:
Many individuals suffering from an ED would report their meals as bingeing. It’s crucial to differentiate between clinical binges (objective) and self-reported binges (subjective), often triggered by breaking self-imposed food rules. For instance, eating an avocado toast or a piece of fried chicken is considered a binge because they are not supposed to have oil or fat in their diet. Subjective binges often reflect one’s rigid food rules that govern their ED, like an oil/fat-free diet in this instance.
Danger of Rigid Food Rules:
Rigid food rules may offer a false sense of security but can be misleading. We often internalise our life experiences and attach the “bad” labels to food, regardless of their nutritional values and functions. For example, we vilified carbs as bad, but they are our body’s primary and most efficient energy source, being converted more readily into glucose than proteins or fats. Carbohydrates are an essential fuel source for our muscles, central nervous system, and brain. Our brain cells prefer to run on glucose, but our brains can’t store a supply of glucose. Therefore, we need a regular supply of carbohydrates to ensure our brain runs properly.
Carbohydrates have been the villain in diet culture, and we are encouraged to restrict or eliminate them from our diet. But when we view carbs as “bad,” we add emotional charge to this deprived food group, making it more interesting or tempting than it should. This could potentially lead to a bingeing episode.
On the other hand, labelling food as “good” gives it a ‘halo effect’ and adds pressure or guilt if one cannot sustain a diet with all “good food.” In reality, our interest and satisfaction from eating a particular food (even “bad” food) will inevitably wane if we continue to consume them. If we restrict ourselves to only eating “good” food, we end up physically full yet not emotionally satisfied. This unfulfilled “emotional hunger” can also lead to increasing food craving, which is our body’s natural instinct to achieve balance in your body. It is natural for our body to seek out pleasurable and satisfying foods. Know that there is room for less nutritious choices in the context of an overall healthy diet and lifestyle.
Working towards Body Acceptance:
“But what if I lose control and become overweight?” This is a common fear before we learn to trust our body and its wisdom. Research suggests that each human body has a weight range that it is genetically predisposed to maintain. This natural weight range is called your “set point”. Every individual has a different “set point,” which is what nature intends for us.
The human body uses regulatory mechanisms to keep its weight within this natural set point range. If you eat a little more than you need to maintain your body weight, your body temperature will typically rise, and your metabolism increases to burn off the extra energy. Another regulatory mechanism is hunger – if the body is not getting enough energy, you will feel more hungry and/or think more about food.
Your weight is expected to fluctuate within the set point weight range, if you typically eat a balanced diet and exercise moderately. Your weight may fluctuate up or down temporarily if, for example, on a holiday or falling ill. However, once you resume your normal pattern of eating and movement, your body will be inclined to naturally return to the set point weight. These mechanisms were developed through evolution to protect us from starvation. Trying to keep your body below its natural set point weight range results in a losing battle against nature. No amount of psychological treatment will remove your food obsessions unless weight is regained to a healthy, normal range for your body.
Conclusion
Learn to trust in your body and tap into the wisdom you were born with. If nature intends for you to have a higher set point than what you would like or what others (peers, media, family) are telling you, consider seeking therapy to help you work towards body acceptance.
Your “ideal” body weight should be one that allows you to feel energetic, strong, and functioning in a normal and healthy life. In our quest for inclusivity, embracing size diversity should be our next societal goal.
To meet with a professional psychologist or counsellor, call The Other Clinic at 8809 0659 or email us hello@theotherclinic.sg.
Resources:
- DSM-5: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- History: https://www.eatingrecoverycenter.com/blog/eating-disorders-history
- Centre for Clinical Intervention: https://www.cci.health.wa.gov.au/Resources/Looking-After-Others