‘Eating disorders and obesity’ – two sides of the same coin

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‘Eating disorders and obesity’ – ‘two sides of the same coin’

Interestingly, some leading workers in the field have suggested that ‘eating disorders and obesity’ are merely ‘two sides of the same coin.’ Here, they specifically mention the eating disorders of anorexia and bulimia. As is the case for the DSM-V classification, eating disorders, including binge eating, are regarded by most people as separate psychiatric maladies best treated by psychological therapy; while obesity is thought of as a separate condition that is best treated by a medical approach.

Most people believe that obesity should be treated by physicians using a physical approach such as special diets, weight control and even surgery. Nonetheless, all these conditions including obesity have similar behavioural features and risk factors such as low self-esteem, childhood neglect and abuse, excessive influence of media, problems with body image and even common genes that predict possible eating disorders and obesity.

Most importantly, eating disorders have a high death rate. Indeed, according to some researchers, anorexia nervosa has the highest mortality rate of all mental diseases.

Hence, we shall begin our discussion with obesity, which is by far, the largest problem (if you will pardon the pun). It also seems tidier to discuss the other conditions, which are classified as psychiatric disorders, later on in this chapter.


The main characteristic of obesity is an excess of body fat. As mentioned in Chapter 5, there is a pandemic of obesity that affects numerous countries worldwide. The problem seems to have originated in the United States and spread to the other developed countries in Europe. In fact, when I first visited the USA in the early 1980’s, I was appalled by the number of obese people I saw across all of the various states. More surprisingly, the problem has also infested poor and less-developed countries, particularly in urban regions.

The main cause of the problem is the advent of subsidised farming as well as the influence of international food companies, including the numerous fast-food chains, which are present throughout the world.  The latter have provided cheap, highly processed foods which contain fats, oils and starches.  Other factors have aggravated these reasons such as the greater reliance on machines instead of physical labour, and the use of economical mechanical transport. As a result, there has been a spread of sedentary lifestyles, which has been exacerbated by television addiction. There is also evidence that  genetic make-up also contributes to the development of obesity.

As far as Polynesian islanders are concerned, obesity is associated with beauty

There are also social factors at play. The highest rate of obesity occurs among Polynesian islanders, where obesity is associated with beauty.  Here, obesity rates are almost 80%. The lowest obesity rates are in Asia, with a considerable drop to a mere 0.5%.

Most people do not associate obesity with malnutrition, because they believe that malnourishment occurs due to scarcity of food. However, researchers have noticed that in certain African countries obesity co-exists with malnourishment. In Africa, mothers are overweight, while their children are underfed.  An example of malnutrition in countries without food shortages is obesity itself which is often associated with diabetes and other diseases linked with overeating.

In summary, although the actual cause of obesity is still not known, it seems that as a population, obesity appears when a relatively small increase in calorie intake is combined with a simultaneous reduction in physical activity. However, as far as the individual is concerned, the causes seem to be a complicated mixture of genetic, individual, environmental and societal elements.

Unfortunately, the measurement of obesity is a rather hazy area, since there is no clear-cut distinction between what is normal and what is not. The most common current measure of obesity is the BMI (Body Mass Index), which relates body height (in metres) to mass (in kilograms). However, BMI seems to give a reasonably accurate measure of obesity. Using the BMI, 3 categories have been established: underweight, normal and obese. A BMI of 30 or greater is regarded as an indication of obesity. Interestingly, the high level of obesity in the USA, of over 35%, now seems to be leveling off.

As mentioned, obesity is often associated with ill-health and particularly diabetes. Certain forms of cancer are also related to obesity. The high costs involved in the treatment of obesity and the diseases associated with it has led The Obesity Society in the US to declare obesity as a disease;  an idea applauded by the American Medical Association. Nonetheless, as we have seen, obesity does not currently qualify as a mental disorder.  Nevertheless it seems that it certainly qualifies as an illness.