WTF? Psychiatrists espousing eating disorders?

By Sarah McMahon

Picture source: SMH online

Occasionally we hear things that are hard to hear. On Thursday the SMH reported the unthinkable.

In the International Journal of Eating Disorders under the heading “An Idea Worth Researching” a research paper “Long-Term Weight Loss Maintenance in Obesity: Possible Insights From Anorexia Nervosa?”was published. In this paper, psychiatrists from Columbia University looked at what those with anorexia nervosa and those who maintain long-term weight-loss have in common. They found:

• They eat a diet low in fat and calories and a restricted variety of foods
• The longer they stick to a patterns of eating behaviour the more the behaviours “become ingrained and automatic”, which, they add, may explain why anorexia is so difficult to treat
• Deviation from this rigid diet is associated with weight regain, even among individuals who have maintained weight loss for several years
• [They] are physiologically primed for weight regain. Both groups have lower resting energy expenditure, lower levels of leptin (the satiety hormone) and thyroid hormone, and higher levels of ghrelin (the hunger hormone) than non-weight reduced BMI-matched controls. They have metabolic profiles that oppose further weight loss and promote weight gain, yet they override these powerful biological drives to maintain their weight loss

No duh!

Surely it doesn’t take a team of psychiatrists at a prestigious university to discover these findings? If they aren’t intuitively obvious then I think it is fair to say they are already well established facts.

As someone who spends a great deal of time trying to educate people about eating disorders, this paper is one huge step backwards. Seven reasons why I have a major concern about this paper:

1. It highlights the extent of fat shaming in our society: that anorexia, a serious psychiatric illness, would be upheld as an example for “the obese” to learn from- how patronising!
2. It completely misses the point that anorexia is a serious psychiatric illness
3. It undermines the concept that people can sit at higher body weights and still be healthy. Indeed, not everyone who is sitting at a low body weight is healthy either, some may be “thin” due to illness and others may be engaging in unhealthy weight loss practices that severely compromise their health. Surely anorexia nervosa is a case in point.
4. Having a report written by psychiatrists from a prestigious university and published in a prestigious journal normalises and even sends the message that anorexic behaviour is “OK” and should be celebrated and rewarded
5. It compares a psychiatric illness with a physical state (excess adipose tissue). This perpetuates misunderstanding about both conditions
6. Given obesity is a physical state, promoting anorexia as the antidote essentially blames “obese” individuals by perpetuating the myth that changing their behaviour (ie dieting well enough) will surely improve this state. Population risk factors in Australia for becoming overweight are well documented in literature such as the Australian Bureau of Statistics Social Trends, and the Preventative Health Task Force on Obesity in Australia. Some of the risk factors include: familial history of obesity; indigenous background; ethnic background (particularly an overseas birth, with the risk of becoming overweight increasing with tenure in Australia since migration); geographic areas of socioeconomic disadvantage; limited post-school education; low income households; and regional and remote locations.
   Furthermore, there are other individual factors that include poor nutritional literacy, medication and genetics. This information is totally lost by a paper such as this
7. Focusing on individual behaviour change distracts from a wealth of public health research that indicates that fixing “the obesity epidemic” is a socio-political issue. Public health reminds us that this is a complex issue that far exceeds the realm of individuals and families: the solution does not lie with the individual alone. The best outcomes are where every aspect of the community is engaged to ensure access to health. This requires a population wide, multifaceted and multi-sectoral response. Some of the population health interventions that have been proposed in Australia include:
   • Engagement of industries such as the food industry, retail industry, restaurant and catering industry to:
   • Provide better food and product labels
   • Ensure product placement of “healthy” products in supermarkets
   • Ensure accessibility and affordability of healthy foods
   • Regulating “adulterated”, “imitation” and processed foods, such as the amount of trans fats, saturated fats, salt and sugar which is likely to have a flow on affect to individual appetites, detection of hunger and satiety
   • Regulation of the weight loss industry
   • Specific, targeted and appropriately funded campaigns to improve health and nutritional literacy in vulnerable population groups, such as indigenous and ethnic communities and the socioeconomically disadvantaged
   • Ensuring accessibility of “healthy” food, particularly in rural, regional and remote areas (such as subsiding the transportation of such goods)
   • Regulation of food advertising to children, such as time-of day advertising prohibition of junk advertising
   • Improving nutritional literacy, such as clearer regulations on front-of-pack advertising and ensuring a national system of food labelling that supports healthier choices (and does not prescribe eating disorders)
   • Enabling schools, communities, workplaces and town planning to support healthy eating
   • Reshaping urban environments to improve access to safe and affordable physical activity such as trails, parks, bike tracks and recreational facilities
   • Improving access to public transport- each kilometre walked reduces odds of being overweight by almost five per cent
   • Improving quality of food eaten by pregnant women and encouraging breast feeding for newborns to eliminate epigenetic factors that contribute to people sitting above their natural body weight

I was privileged enough to speak on ABC radio on Thursday night, in response to this paper. You can listen to it here.

Indeed, the paper was a talking point for many media outlets. Perhaps the best outcome from this ridiculous paper is the community outrage which highlights increased awareness about anorexia and “obesity”.

At BodyMatters we work with people who sit above or below or even at their natural body weight, who engage in unhealthy weight loss practices, disordered eating or experience body image issues. Please contact us if you would like to find out how we can help you or a loved one.