Eating disorders and obesity are usually seen as very different problems but actually share many similarities. In fact, eating disorders, obesity, and other weight-related disorders may overlap as girls move from one problem, such as unhealthy dieting, to another, such as obesity. This information sheet is designed to help parents, other adult caregivers, and school personnel better understand the links between eating disorders and obesity so they can promote healthy attitudes and behaviors related to weight and eating.
How are eating disorders and obesity related?
Eating disorders and obesity are part of a range of weight-related problems.
These problems include anorexia nervosa, bulimia nervosa, anorexic and bulimic behaviors, unhealthy dieting practices, binge eating disorder, and obesity. Adolescent girls may suffer from more than one disorder or may progress from one problem to another at varying degrees of severity. It is important to understand this range of weightrelated problems in order to avoid causing one disorder, such as bulimia, while trying to prevent another, such as obesity.1
Body dissatisfaction and unhealthy dieting practices are linked to the development of eating disorders, obesity, and other problems.
High numbers of adolescent girls are reporting that they are dissatisfied with their bodies and are trying to lose weight in unhealthy ways, including skipping meals, fasting, and using tobacco. A smaller number of girls are even resorting to more extreme methods such as self-induced vomiting, diet pills, and laxative use.2
These attitudes and behaviors place girls at a greater risk for eating disorders, obesity, poor nutrition, growth impairments, and emotional problems such as depression.3 Research shows, for example, that overweight girls are more concerned about their weight, more dissatisfied with their bodies, and more likely to diet than their normal-weight peers.4
Binge eating is common among people with eating disorders and people who are obese.
People with bulimia binge eat and then purge by vomiting, using laxatives, or other means. Binge eating that is not followed by purging may also be considered an eating disorder and can lead to weight gain. More than one-third of obese individuals in weight-loss treatment programs report difficulties with binge eating.5 This type of eating behavior contributes to feelings of shame, loneliness, poor self-esteem, and depression.6 Conversely, these kinds of feelings can cause binge eating problems.7 A person may binge or overeat for emotional reasons, including stress, depression, and anxiety.8
Depression, anxiety, and other mood disorders are associated with both eating disorders and obesity.
Adolescents who are depressed may be at an increased risk of becoming obese. One recent study found that depressed adolescents were two times more likely to become obese at the one year follow up than teens who did not suffer from depression.9 In addition, many people with eating disorders suffer from clinical depression, anxiety, personality or substance abuse disorders, or in some cases obsessive compulsive disorder.10 Therefore, a mental health professional may need to be involved in treating an adolescent who is obese or suffers from an eating disorder or other weight-related problem.
The environment may contribute to both eating disorders and obesity.
The mass media, family, and peers may be sending children and adolescents mixed messages about food and weight that encourage disordered eating.11 Today's society idealizes thinness and stigmatizes fatness, yet high-calorie foods are widely available and heavily advertised.12 At the same time, levels of physical activity are at record lows as television and computers replace more active leisure activities, travel by automobile has replaced walking, and many communities lack space for walking and recreation.13
Most teens don't suffer from either anorexia or obesity. They are more likely to engage in disordered eating behaviors such as bingeing, purging, and dieting. These behaviors are associated with serious physical and emotional health problems. We've got to get back to three square meals a day, healthy meal planning, nutritious snacks, and regular physical activity.14- Richard Kreipe, MD, Chief, Division of Adolescent Medicine, University of Rochester Medical Center
Eating disorders may lead to
- Stunted growth
- Delayed menstruation
- Damage to vital organs such as the heart and brain
- Nutritional deficiencies, including starvation
- Cardiac arrest
- Emotional problems such as depression and anxiety
Obesity increases the risk for
- High blood pressure
- Cardiovascular disease
- Gallbladder disease
- Respiratory problems
- Emotional problems such as depression and anxiety
Body image is how you see yourself when you look in the mirror or picture yourself in your mind.
Obesity means having an abnormally high proportion of body fat. A person is considered obese if he or she has a body mass index (BMI) of 30 or greater. BMI is calculated by dividing a person's weight in kilograms by height in meters squared. You can also calculate your BMI by going to an online BMI calculator at www.fns.usda.gov/tnrockyrun/diff.htm.
Overweight refers to an excess of body weight compared to set standards. The excess weight may come from muscle, bone, fat, and/or body water. A person can be overweight without being obese (for example, athletes who have a lot of muscle). However, many people who are overweight are considered obese due to excess fat on their bodies. A person may be considered overweight if he or she has a BMI of 25-29.9.
Anorexia nervosa is self-starvation. People with this disorder eat very little even though they are thin. They have an intense and overpowering fear of body fat and weight gain.
Bulimia nervosa is characterized by cycles of binge eating and purging, either by vomiting or taking laxatives or diuretics (water pills). People with bulimia have a fear of body fat even though their size and weight may be normal.
Binge eating disorder means eating large amounts of food in a short period of time, usually alone, without being able to stop when full. The overeating and bingeing are often accompanied by feeling out of control and followed by feelings of depression, guilt, or disgust.
Disordered eating refers to troublesome eating behaviors, such as restrictive dieting, bingeing, or purging, which occur less frequently or are less severe than those required to meet the full criteria for the diagnosis of an eating disorder.
1 Neumark-Sztainer, D. Obesity and Eating Disorder Prevention: An Integrated Approach. Adolescent Medicine, Feb;14(1):159-73 (Review), 2003.
2 Neumark-Sztainer, D., Story, M., Hannan, P.J., et al. Weight-Related Concerns and Behaviors Among Overweight and Non-Overweight Adolescents: Implications for Preventing Weight-Related Disorders. Archives of Pediatrics and Adolescent Medicine, Feb;156(2):171-8, 2002.
3 Neumark-Sztainer, D. Obesity and Eating Disorder Prevention: An Integrated Approach. 2003.
4 Burrows, A., Cooper, M. Possible Risk Factors in the Development of Eating Disorders in Overweight Pre-Adolescent Girls. International Journal of Obesity and Related Metabolic Disorders, Sept;26(9):1268-1273, 2002; Davison, K.K., Markey, C.N., Birch, L.L. Etiology of Body Dissatisfaction and Weight Concerns Among 5-year-old Girls. Appetite, Oct;35(2):143-151, 2000; Vander Wal, J.S., Thelen, M.H. Eating and Body Image Concerns Among Obese and Average-Weight Children. Addictive Behavior, Sep-Oct;25(5):775-778, 2000.
5 Yanovski, S.Z. Binge Eating in Obese Persons. In Fairburn, C.G., Brownell, K.D. (eds), Eating Disorders and Obesity, 2nd ed. New York: Guilford Press, 403-407, 2002.
6 Waller, G. The Psychology of Binge Eating. In Fairburn, C.G., Brownell, K.D. (eds) Eating Disorders and Obesity, 2nd ed. New York: Guilford Press, 98-102, 2002.
7 Fairburn, C., Overcoming Binge Eating. New York: The Guilford Press, 1995, pp. 80-99.
8 Goodman, E, Whitaker, R. A Prospective Study of the Role of Depression in the Development and Persistence of Adolescent Obesity. Pediatrics. 2002 Sep;110(3):497-504. Lumeng JC, Gannon K, Cabral HJ, Frank DA, Zuckerman B. Association between clinically meaningful behavior problems and overweight in children. Pediatrics. 2003 Nov;112(5):1138-45.
9 Goodman, E., Whitaker, R.C. A Prospective Study of the Role of Depression in the Development and Persistence of Adolescent Obesity. Pediatrics. Sep;110(3):497-504, 2002.
10 National Mental Health Association. Teen Eating Disorders. 1997.
11 Irving, L.M., Neumark-Sztainer, D. Integrating the Prevention of Eating Disorders and Obesity: Feasible or Futile.Preventive Medicine, 34:299-309, 2002. Stice, E. Sociocultural Influences on Body Image and Eating Disturbance. In Fairburn, C.G., Brownell, K.D. (eds) Eating Disorders and Obesity, 2nd ed. New York: Guilford Press, 103-107, 2002.
12 Battle, E.K., Brownell, K.D. Confronting a Rising Tide of Eating Disorders and Obesity: Treatment vs. Prevention and Policy. Addictive Behavior, 21:755-65 (Review), 1996.
13 French, S.A, Story, M., Jeffery, R. Environmental Influences on Eating and Physical Activity. Annual Review of Public Health, 22:309-35 (Review), 2001.
14 Kreipe, R. Personal communication. November 9, 2003.
Adapted from Eating Disorders and Obesity Companion Piece
U.S. Department of Health and Human Services Office on Women's Health.