Eating Disorders: Learn the Facts (cont.)

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.

Binge eating disorder was relatively late on the scene compared to anorexia and bulimia. A number of studies have now been done, however, suggesting good news. The same two treatments that are most effective for bulimia, namely cognitive behavior therapy and interpersonal therapy, are also the therapies most helpful for binge eating disorder.

An excellent book on binge eating, that can be helpful for people with either binge eating disorder or bulimia, is called Overcoming Binge Eating by Christopher Fairburn.

MODERATOR: You can read a transcript of our discussion with Dr. Fairburn in our archived transcripts.

MEMBER QUESTION: What is interpersonal therapy? And how is it used?

BROWNELL: Interpersonal therapy tends to focus on the key relationships in a person's life. It focuses less on the eating disorder, per se, than on the stress caused by difficult interactions with important people in one's life.

The therapy itself tends to discuss and analyze these relationships, but more important provides people with more constructive ways of interacting with others. The theory is that reducing stress caused by difficulties in relationships will relieve the need to eat in problematic ways as a means for coping with stress.

Cognitive behavior therapy, on the other hand, is more focused on the symptoms of the eating disorder itself. As I mentioned before, both treatments have approximately equivalent effects.

MEMBER QUESTION: To preface, I have been a clinical social worker for more than 30 years. I am writing this on the third anniversary of the death of a friend's daughter who died after a 10-year battle with anorexia. I have noted that many women who appear to be anorexic seem to have red hair. Over the years, I have become increasing aware of this characteristic. Am I just imaging it or could there be a genetic link to people with red hair and anorexia?

BROWNELL: I have not heard even of speculation that hair color is related to a person's likelihood of having an eating disorder. This does not mean that such a relationship does not exist, just that I have not heard anybody propose this before. Sometimes very important scientific discoveries come from an observation that someone makes in real life. So while we cannot say at this time whether hair color is connected in any way with an eating disorder it never hurts for scientists to ask the question.

MODERATOR: Is there any genetic susceptibility to eating disorders?

BROWNELL: More and more scientists are finding that genetics contribute at least in part to eating disorders. There are a number of methods scientists use to test this idea, and a number of them have shown at least some genetic contribution. What we cannot say quite yet is what specifically might be inherited. One could inherit psychological characteristics, specific brain chemistry, or other biological factors that make one vulnerable to an eating disorder. But even as this science gets completed, it is clear that because one has a genetic vulnerability does not mean that one is guaranteed to have an eating disorder. Irrespective of what the genetic studies will show, it will probably be the case that at least some people with no biological vulnerability will develop eating disorders, and that people with vulnerability do not. Understanding genetics will only help us understand a part of the picture.

MODERATOR: Having just watched the Oscars, I wonder about the effect someone like Renee Zellweger might have on a young girl with the potential to become anorexic. Zellweger looked scary thin and her dieting has been in the news. Do these images help legitimize the culture of obsessive dieting and lead to anorexia?

BROWNELL: I did not watch the Oscars and cannot comment specifically on the appearance of the actor you mentioned. It is the case, however, that people in our society, especially girls and women, are bombarded with images of ultra-thin women, stories of dieting, tales of eating disorders, and pictures of well-known figures who have had plastic surgery. The message that gets transmitted is that you are not good enough. It is up to you, according to the popular culture, to shape and mold yourself into an unrealistic body which is what the actresses and models generally represent.

Most experts believe that these images are toxic to the well-being of the typical individual. However, they cannot be blamed as the sole source of eating disorders. Everybody in the culture is exposed to these images, but only some people, a minority I might mention, develop an eating disorder. It would probably help the well-being of most people in our society if more realistic images of bodies were shown.

MEMBER QUESTION: I had WLS in May of 2003. I went from 333 pounds to 208. In June of 2004 I had a serious back injury and have been out of work since then. In December of 2004 I had a quadruple heart bypass. With all the pain, inactivity and boredom I have turned to my old friend food for comfort. I now weigh 226 pounds. I am terrified I am going to gain back all the weight I lost. I am also afraid that I have stretched my pouch. I am afraid to admit to anyone that I have become a failure.

BROWNELL: If you look at the overall picture, you are still 100 pounds down, which is a tremendous accomplishment. Never forget this, because it can help give you strength. With that said, you might be catching some early warning signs of serious problems. You are doing exactly the right thing to seek out expert help.

My suggestion would be to have a discussion with the surgeon to find out the extent to which the pouch can be stretched, but more importantly, it may be helpful to see a therapist who can work with you to find more constructive ways of coping with the very real stressors you are experiencing. Given all that you've gone through, most people would be seeking out a "friend," that would help them cope with the difficult circumstances -- your friend happens to be food. A therapist may be able to help you find a friend or a better way of coping, which would allow you to alleviate some of the stress and feel comforted, while not jeopardizing the progress you've made with your weight. Good luck!

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