Most fat people maintain their larger than average size by eating a normal amount of food. Despite popular misconceptions, being fat does not constitute having an eating disorder. Nevertheless, it is possible for a fat person to have an eating disorder, particularly since some symptoms of eating disorders are the direct result of attempting to lose weight. A number of eating disorders have been identified:
Bulimia nervosa involves recurrent episodes of binge-eating. Binge-eating is defined as eating an amount of food that is definitely larger than most people would eat during a similar period of time. When it occurs, the person feels out of control. In bulimia nervosa, binge-eating is followed by some form of purging (e.g., vomiting, laxative abuse, and/or diuretic abuse) to prevent weight gain. Depressed mood is a common feature associated with bulimia nervosa.
Binge-eating disorder involves engaging in binge-eating episodes and feeling a loss of control, but this is not followed by purging (vomiting, laxative abuse, or diuretic abuse) "Compulsive overeating" is another term that has been used to denote binge-eating. It implies that the binge-eating has a psychological cause (i.e., compulsion); however, there is little evidence to support this notion for most fat people who binge-eat.
Anorexia nervosa involves an intense fear of being or becoming fat, associated with maintaining an emaciated body weight. Thus, by definition, anorexia nervosa does not occur in fat people. About 50% of anorexia nervosa patients also resort to self-induced vomiting and/or laxative abuse.
Most experts view eating disorders as having many possible causes. A major cause of eating disorders is drastic or chronic reduction of food intake (i.e., restrictive dieting). Given social pressure to be thin, it is no surprise that so many people try to diet.
There are also psychological, biological, and familial factors that may either act alone or may combine with each other in different ways, leading to the development of eating disorders. There have been many theories regarding psychological or personality attributes that may increase the risk of eating disorders. Factors that have been identified as leading to eating disorders are low self-esteem, feelings of effectiveness, poor body image, depression, emotional instability, rigid thinking patterns, and perfectionism. Unfortunately, one of the problems of determining which traits may cause eating disorders is the fact that weight loss itself, or failed dieting, can cause many psychological disturbances to develop.
Because binge-eating is such a common feature of eating disorders, it is important to keep in mind that this behavior is often a direct consequence of dieting. Restrictive dieting can lead to strong cravings for foods (particularly those that have been forbidden by the diet), and these cravings, in turn, may lead to episodes of binge-eating. These are often followed by self-blame, guilt, and shame which may lead the person to intensify restrictive dieting or perhaps take even more drastic action, such as purging. This leads to a vicious cycle and, in some cases, to the development of an eating disorder.
If you suspect you have an eating disorder, and you have been on a weight reduction diet or have been maintaining a weight lower than that which is natural for you, you may be able to recover from your eating disorder simply by stopping the weight-reduction efforts. The strong food cravings may persist for many months but will eventually subside. You may need professional help in coming to terms with your body shape or size. Some people need additional help from professional therapists or support groups; it is important to select a treatment that does not encourage restrictive dieting.
NAAFA offers support and information on size acceptance as well as educational programs, up-to-date reading material, and a list of health and mental health providers whom you may consult. You may also want to contact the Association for the Health Enrichment of Large People (AHELP), which is an organization of health/mental health/nutrition and fitness professionals who work with fat people without advocating dieting. You may contact the NAAFA office for further information.
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