Julie Watts, Clinical Psychologist

Eating disorders are becoming increasingly prevalent in our society. There are number of different disorders which can significantly impact on people’s lives. These include Anorexia Nervosa, Bulimia, Binge Eating, and Obesity. The reasons for the development of such problems are complex and include societal factors, such as idealised and unrealistic body images, equating thinness with success, and desirability, and the promotion of fad diets. Other contributing factors can include family beliefs and behaviours towards food, personality factors, perfectionistic and rigid beliefs, stressful events, and family difficulties.

More severe disorders such as anorexia, where there is at least a 15% below normal body weight, restricted eating or excessive exercise, morbid fear of fatness, and body image distortion, will usually require a multidisciplinary team approach and frequently inpatient treatment to stabilise people’s weight. Treatment will often involve family therapy, as sufferers are most frequently 10-19 years.

Bulimia is diagnosed when people at least 3 times a week for 3 months uncontrollably binge, i.e. consume large quantities of food in short periods of time, engage in compensatory weight loss behaviours such as vomiting, laxative use, periods of starvation, use of appetite suppressants or excessive exercise. They have a morbid fear of fatness and usually try to attain a weight below optimal levels. This disorder is often untreated as sufferers may not be drastically underweight and may even be normal weight or slightly overweight. Bingeing is almost always done in secret and rarely admitted to others. Purging through vomiting or laxatives has major medical risks. Over-exercising as a way to control weight can also lead to other problems such as injuries. These behaviours are usually very compulsive and often lead to significant restrictions in people’s lives as the focus becomes on maintaining weight, food restrictions or exercise routines.

Many other people will not meet the criteria for a diagnosis of these eating disorders but may exhibit behaviours that still cause difficulty and impairment. There are effective psychological treatments for eating disorders and early intervention before these problems lead to impairments in daily functioning is crucial.

Obesity is now a major health issue and the leading cause of premature death and illness in Australia, with 2/3 of adults being overweight or obese. Whilst the principle of weight control is a simple equation of balancing energy in (calories consumed) and energy expenditure (exercise), for many people it is not so easy. There are many reasons people may find this difficult including poor food choices, underestimating consumption, emotional eating, a more sedentary lifestyle, psychological factors, genetic predisposition and motivational issues.

Long term follow up studies of obesity treatment indicate that 90-95% of those who lose weight will regain the weight within several years. Unfortunately the body is designed to “defend” against weight loss. Therefore weight loss leads to metabolic changes that aim to return the body to the usual weight. The more restrictive the diet is the quicker the weight regain. The other difficulty is that restricted eating itself results in a number of changes including increased preoccupation with food, irritability, mood changes, and decreased concentration. It can set up a risk of binge eating, which increases feelings of guilt, hopelessness, lack of control, decreased self-esteem and the cycle continues.

There are effective and proven psychological treatments which can assist people to understand the factors that contribute to their weight difficulties and develop strategies for managing these differently. This includes shifting the focus from body weight and image onto improvement in health and wellness. The other crucial area that needs to be addressed is the distinction between strategies required to lose weight and the usually overlooked area of weight maintenance.