When the originally-named Eating Disorders Coalition of Tennessee (EDCT) was founded in the early 2000’s by Dr. Ovidio Bermudez of Vanderbilt University (at that time; now with the Eating Recovery Center of Denver, CO), Reba Sloan, R.D., now-deceased Karen Silien, psychologist, and Nan Allison, R.D., among others, its stated mission was to create awareness and offer the community at large greater education, and for the victims greater avenues of support. Today called Renewed Support, the original EDCT had zero representation on its founding board by anyone in the fitness world. Hence, I was invited to participate by Karen and Reba though I knew virtually nothing of the disease at that time.
I was now one of 3 males on the board and was tasked with writing the copy for its first brochure, an inexpensive Kinko’s production to say the least. Being that my world view differed from that of the female therapists and dietitians and of Dr Bermudez who treated patients in the hospital, I ventured a proposition that immediately hit the skids: in addition to anorexia nervosa, bulimia nervosa and binge-eating disorder, all of which were listed as mental health diseases that could be covered by the insurance industry, I added “excessive” or “obsessive” overeating” as a category of eating disorder. I don’t recall which phrase I used but I do remember that I had to persuade my colleagues in the organization that we should do so. It got in there.
Mind you, no one disputed that overeating was an issue and that it could lead to obesity and its related diseases. But, unto itself, it was not deemed a disease; it was not listed in either mental health or allopathic medical journals or position statements as a disease, simply a behavioral pattern that could lead to disease.
That was many moons ago, before we learned the multiple and varied ways and mechanisms that predispose some people to overeating and becoming obese. We now know more about gut and appetite hormones like PYY, ghrelin and leptin that can be thrown off-kilter, genetically or through our own behaviors, that can lead us to overeat. We know more about gut microbiota, the bacteria in our intestines that help us digest foods but that can be altered and manipulated by the foods we eat to incline us to eat more than we should perhaps since we’re not absorbing nutrients as we should. We also recognize elements of food production, marketing and even access (food deserts, anyone?) that impact how and why some of us overeat to the point of obesity and ill health. And I’m hardly going to get into genetics as this is too obvious.
In other words, we have learned since I first proposed this to the board of the EDCT that obsessive overeating can be considered an eating disorder if not a valid disease.
However, the board and subsequent power players on it were opposed to my push, or was it a putsch, to have the organization include it in its marketing and education. My goal was not to push the original diseases from the forefront. Rather it was to leverage the healthcare crisis of our community and our state to garner more political and public support for our mission by including the one thing that most people were impacted by.
Belle Meade and Green Hills communities of Middle Tennessee and similarly high-income sections of other big cities of Tennessee were impacted by anorexia and bulimia to a greater degree than the outlying districts. But if we’re to be THE organization to reach all of Tennessee, let’s aim for that which affects the state as a whole: obesity.
So it was with great pleasure that I came across this article on obesity and addiction. While the researchers could not unilaterally declare it a mental health disorder, the evidence, based on personality profiles of 18,611 subjects, that “all addictions had very similar personality profiles, suggesting great behavioural overlap. Addictions were also behaviourally similar to uncontrolled eating. While obesity was also behaviourally linked to addictions, that link was considerably weaker. The scientists were surprised to find that obesity also shared behavioural overlap with mood disorders and certain personality disorders.” (Note the British spelling of ‘behavioural’.)
Why is this such a crucial matter, other than stroking my ego?
The answer lies in how we as a national or world health entity treat obesity. Do we continue holding those who are obese responsible and liable for their conditions? Do we hold cigarette smokers, alcoholics or drug users responsible for their addictions? Because, if that is the case, then insurance and political structures need not involve themselves in the care and treatment or even prevention of these conditions. Legally, manufacturers and distributors of addictive substances should not be held liable. And each person is an island unto him- or herself.
But that is not how we treat these addictions, is it?
Of course, you’ll argue that those are exogenous/outside-our-body’s-needs substances but food is essential. Those who smoke, drink or take drugs to excess are making a choice to risk addiction, but all of us have to eat. Fair enough.
Then how about those who choose not to eat or to eat to excess then puke it up? That is, addicts who, for psychological reasons choose to strive to stay or get real thin, pathologically so. Should they, too, be held to the same standard as those who drink, smoke or overuse drugs? If so, then they are not diseases that should be listed accordingly and be treated as such.
You see my point now, right? Many people who are overweight choose to put too much food in their bodies, or to consume the wrong kinds of food, and then to not exercise sufficiently to burn off those excess calories. Despite the hormonal, cultural, environmental, marketing influences that are at play, we deem these folks as responsible and liable but not those in the other categories of addictive behavior that do get and do deserve insured and public health-supplied health care services.
Perhaps it’s time to add obsessive overeating to the list of eating disorders, too, and to regard obesity as a disease unto itself on the same level as any addictive behavior. Then we can attack it with the full force and fury of a society that aims to be compassionate and caring.