Medicalising binge eating doesn't address its roots
- Published: 16 January 2010
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Eating disorders are not medical problems, they are psychological and no amount of appetite suppressants and gastric surgery will get to the root of why people binge eat, writes Kelly Blainey.
I am morbidly obese. I also have low self-esteem, depression and binge eating disorder, all of which contribute to my obesity and make any weight-loss attempt I make extremely difficult. According to the Australian government, because of my high Body Mass Index (BMI), I am a perfect candidate for gastric banding surgery. Despite my psychological conditions – or perhaps because of them – this medical procedure, also known as lap-band surgery, is, in their opinion, the most effective way for fatties like me to lose weight.
This sentiment comes from Weighing It Up: Obesity in Australia, the 2009 government report on obesity produced by the House Standing Committee on Health and Aging. The report makes 20 recommendations about how to tackle the problem of obesity in Australia, one of which is the public funding of gastric banding surgery. And our government is not alone: the World Health Organisation also endorses surgery as the “most effective way of reducing weight and maintaining weight loss in severely obese patients.”
But it seems to me like we have missed a step. Surgery may be the most effective way of losing weight, but what ever happened to the question: why are we this fat in the first place? We are rushing to a medical solution without properly investigating the causes. And without knowing the cause, all we can do is treat the symptom –obesity – and hope the problem goes away by itself.
While not everyone who is obese has an eating disorder, a recent US survey found that one third of obese patients presenting to weight-loss clinics had symptoms of binge eating disorder. And I would say that even without a diagnosis, most people who are overweight or obese would in the very least have disordered eating and attitudes to food, coupled with low self esteem and possibly depression.
According to The Butterfly Foundation, an Australian non-profit organisation that supports people with eating disorders, 4% of Australians have binge eating disorder. A further 20% of women aged 18-22 have symptoms of the disorder. If losing weight were simply a case of diet and exercise, the weight-loss industry would not be making nearly $800 million per year in Australia alone. The industry knows that it is not just physical factors that make people fat, but psychological ones that stop them from losing weight and keeping it off.
This means that rather than being a medical problem, obesity is primarily a psychological problem. It’s not as if fat people can’t tell the difference between an apple and a donut. The real issue is why, when we have all this education about what to eat and how much to exercise, are people still choosing to ignore it?
The Weighing It Up report acknowledges this as a problem, saying that the Committee was “particularly concerned about the psychological factors that influence an individual’s ability to control their weight”. The report recognises that the best treatment of obesity would include an allied health approach – not just GPs (or surgeons), but also psychologists, exercise physiologists and dietitians.
Unfortunately, the report makes no concrete recommendations for this allied health approach to treatment. Nor does it, even after recognising the significant psychological factors that contribute to obesity, make any recommendations aimed at addressing these causes. Instead, it jumps straight to a medical solution – surgery.
And then there is the plethora of anti-obesity drugs currently on the market. You can choose from appetite suppressants, anti-depressants that have weight-loss as a side effect and drugs that block the digestion of fat in your digestive system. With all these medical approaches out there, who could blame people my size for wanting to skip the hard work required to uncover the roots of our obesity and change our negative thoughts and eating habits?
Well, I could. I don’t want to be fat forever – but more importantly, I don’t want to be depressed and have an eating disorder for the rest of my life. I am going to keep working on what’s going on deep down, so I can make the slow changes I need to actually lose weight the old fashioned way.
I’m not having a go at people who have the gastric banding surgery – I know it also requires a huge commitment, motivation and change in behaviour. What it doesn’t do, though, is address the thoughts that are underneath that behaviour.
And in the long term, all I can see happening is instead of fat, depressed people, there will be lots of skinny, depressed people, with no awareness of why they feel the way they do.
Skinniness does not equal happiness, but I’m afraid the government thinks it does.
Kelly Blainey is a freelance writer who specialises in health and spirituality. She blogs about binge eating disorder and the politics of fat on her website Bite by Bite.