Mental by Steve Ellen

Author:Steve Ellen [Dr Steve Ellen, Catherine Deveny]
Language: eng
Format: epub
Publisher: Schwartz Publishing Pty. Ltd
Published: 0101-01-01T00:00:00+00:00

11

EATING DISORDERS

Eating is threaded through all aspects of our daily life – our social interactions, our celebrations, our culture, our identities and our emotions. It’s so ubiquitous that we rarely consider its complexity. At its simplest, we need to eat in order to live, but there is much more to eating than nutrition. We begin life being fed, then we learn to eat independently, and once we’re older we learn to feed others. Nearly every relationship involves eating. Food is a pillar of every economy. Every culture has rituals and practices related to eating. Every emotion has an impact on eating. Our eating practices and our weight are key aspects of how we define and view ourselves and others. Furthermore, like it or not, they impact on how others view us and relate to us.

Feeding and eating behaviours can be used as a communication. They can express positive attitudes like nurturing, love and belonging. They can also express anger and punishment – feeding prisoners gruel; no dessert for misbehaving teenagers. We can eat to relieve uncomfortable emotions, and we can eat to reward ourselves. Nearly every medical and psychiatric disorder has some impact on eating and weight – and vice versa.

With food meeting so many complex needs, it’s no wonder eating disorders are some of the most mysterious of all mental health problems.

The key eating disorders are anorexia nervosa, binge-eating disorder and bulimia nervosa. Obesity, while described as a major community health problem, is not considered to be a mental disorder.

Assessment

It’s rare to find a person who at some stage hasn’t stressed about their eating or weight. Unfortunately, most of the stress has nothing to do with health – it’s usually about looks and acceptance. And most of the obsession with weight is built around an illusion that we’ll be happier at a different weight.

Weight ranges recommended by health bodies are only guides. What is a healthy weight for you depends on your body type, your genetics and various other factors. Also, weight is just one of the many risk factors that affect your health – things like smoking, sedentary lifestyles, exercise levels, drinking, pollution, risk of road trauma and travel habits. There is a growing belief that worrying about weight does more harm than good. The medical evidence around weight, especially obesity, is not iron-clad.

In clinical practice, when assessing eating disorders the key things investigated are eating patterns, weight and body image. These form the crux of the three eating disorders.

Assessing eating patterns is pretty straightforward. We ask about the types of food, eating behaviours, feelings while eating, calorie counting, and any purging behaviours such as vomiting or laxative abuse. Past diets are important, as is information about weight concerns and efforts to lose weight.

Assessing weight is largely based on measurements such as the Body Mass Index (BMI), fat measurements and waist circumference. None of these are ideal, but they are the best we’ve got.

BMI is by far the most common measure. The formula is:

BMI = kg/m2

where kg is a person’s weight in kilograms and m2 is their height in metres squared.

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