Eating Disorders: Learn the Facts (cont.)

Just as it is important to eat in a reasonable way, it is important to exercise in a reasonable way. Most people realize whether they are driven to exercise because they are being pulled toward something positive, namely good health and vitality, versus being pushed away from something negative like weight gain. If a person believes they are exercising in excessive amounts or are driven to it in a compulsive way, they should get help so that eating and exercise fall into a reasonable pattern and neither one is done to extreme.

I am pleased you asked this question, because many people wish to know whether exercise is harmful or helpful.

MEMBER QUESTION: I have a tendency to binge eat, but I do not purge. Instead, I will try to exercise, but don't always have the time. My question is, do you ever truly overcome eating disorders or do you have to work at controlling it every day of your life?

BROWNELL: People have different levels of recovery from eating disorders. Some people manage the disorder but never completely get rid of the underlying psychological drive to control food intake in a way that helps minimize weight gain. Other people, particularly after a round of successful therapy, really do seem to be over the disorder and can move on in their lives.

Some people with eating disorders are very fearful at the thought of giving up the disorder. This is especially true for people with anorexia nervosa. It is important for such people to realize that they will be much happier, not to mention healthier, if they are free of the disorder and can go about living their lives. It takes courage, however, to seek out help when one is fearful of losing the disorder, but the bravest people are the ones who put themselves forward and do the hard work to get better.

MEMBER QUESTION: Would you please comment on whether bulimia is more of a physical disease or a mental disorder? And, if it's a mental disorder, how do you know if a patient is lying about changes in his/her behavior?

BROWNELL: Experts generally consider bulimia to be more of a psychological than a biological problem. With that said, the distorted eating and purging that goes on with bulimia can certainly have medical consequences. In addition, there may be biological vulnerabilities that make some people susceptible to eating disorders.

For the most part, eating disorders occur in private. People who are not ready to get help very often hide their behavior and will not be truthful when confronted. Sometimes a straightforward and candid talk with such a person can accomplish two things. It can open the door for them to be truthful but can also show your support. In the case of somebody who is engaging in dangerous behavior and the person's basic health is being threatened, a more direct approach can sometimes be helpful. In these cases parents might be told, or in the case of a student a school official may be alerted as well. In the case of adults with an eating disorder, they generally have to come to the conclusion on their own that they need help. But a caring environment can often make this easier.

MEMBER QUESTION: I seem to have fallen back into the eating-disorder rut. I was seriously anorexic but had recovered. Now I'm into binge eating/purging. I'm so frustrated. I can't figure out what is causing this. When I eat I can't stop and feel guilty. So I try to puke it all up and it makes me feel even worse.

BROWNELL: It is not uncommon for people to move back and forth between different eating disorders. So the fact that you were anorexic at one time and now struggle with the binge eating and purging problems is certainly something we see a lot in our own clinic.

Relapse into another eating disorder generally seems to occur when people are stressed in some way. People who are under stressful circumstances and feel their control is threatened, will sometimes revert to an eating disorder in order to re-establish control over at least part of their life. The fact that you recovered previously from anorexia is a very good sign, and suggests that with the right help you may be able to recover from what you suffer from now. I would be optimistic, but also I would seek help to try to speed your progress to recovery.

MEMBER QUESTION: I'm addicted to food the same way an alcoholic is addicted to alcohol. I know I need help but I don't know where to begin. I've asked for help from my doctor but his only advice was to cut back on calories and make healthy choices. If only it were that easy. It seems as though nobody takes me seriously and thinks it's something that I can just stop if I tried a little harder, but it's so much more than that. How and where can I get the help I need?


"Sometimes what lies between unhealthy and healthy eating is simply knowledge."

BROWNELL: For many years scientists believed there was no basis to the claim many people made that they were addicted to food. Recent studies in both laboratory and with humans using modern techniques of neuroscience suggests that there may be a biological basis for the claim that food can be addictive. Unfortunately, the work is so new that no interventions have been proposed based on these discoveries. Therefore, we have to do the best we can with what we know from the past.

I have several suggestions for you. One would be to pay particular attention to the foods that you find difficult to control and to see if you can substitute those foods in your diet with foods that do not trigger overeating. This may be easier said than done as well, in which case getting help from a therapist who really understands about eating and eating disorders may be helpful. It can be difficult to avoid the problem foods, but if one can make a commitment to specifically surrounding oneself with nontrigger foods, and to consider food an important way to nurture the body, sometimes progress is possible.

MEMBER QUESTION: I noticed that there is not as much focus on binge eating disorder. Why is this?

BROWNELL: Binge eating disorder is an important issue. It is defined as recurrent episodes of eating large amounts of food without the purging behavior that occurs in bulimia. In addition, people generally feel out of control during these eating episodes.