Medicalizing Food and Eating Behaviors

Young Boy Eating a WatermelonThe agendas people have for food and eating behaviors can make us dizzy. One rallying cry is that food is medicine. Presumably, that makes eating therapeutic. But not if we do it in a problematic way. Then we have an eating disorder. In fact, recent analyses of data from the Global Burden of Disease say “the hidden burden of eating disorders” is spreading globally. So, are we medicalizing food and eating behaviors enough? Or too much?

Bring It On!

For people committed to study and treatment of eating disorders, this is an easy question. Writing in Lancet Psychiatry, Jennifer Thomas and Kendra Becker are very enthusiastic about the need to pay more attention, diagnose more eating disorders, and offer more treatment. Regarding the analysis of global health burden from eating disorders, they say:

“This landmark paper highlights that eating disorders are four times more common than previously thought and associated with double the disability burden. The results show that binge-eating disorder and other specified feeding or eating disorder are especially frequent with increasing age, and also more fully describe the burden of eating disorders in males, shattering the inaccurate but entrenched stereotype that eating disorders affect only thin, young, white women.”

Their beliefs about the need for more fully medicalizing problematic eating behaviors are perfectly clear.

Less Clear: The Diagnoses

Defining and detecting these diagnoses remains more of a challenge. Zoe Jenkins and colleagues describe the problem in another recent paper. They describe the problem of dealing with “nebulous” categories of eating disorders:

“The DSM-51 specifies three main eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder (BED). People with eating disorders who do not meet full criteria for any of the above disorders fall into the nebulous categories ‘other specified feeding or eating disorder’ (OSFED) or ‘unspecified feeding or eating disorder’ (UFED). The OSFED category contains atypical anorexia nervosa, subthreshold bulimia nervosa and BED among others, whereas UFED is designated when full criteria for other eating disorders are not met or insufficient information is known.”

They investigated a proposal to bring more clarity to these classifications, but found that it does not work. The definitions remain fuzzy.

Real and Challenging Problems

The difficulty with providing crisp and clear diagnostic schemes for problematic eating behaviors does not change a simple fact. Many people face significant impairments to their physical and psychological health because of these eating disorders that are difficult to define.

Very much like obesity, eating disorders are heterogeneous and challenging to treat. But skilled clinicians can help people who seek care find their way to better health.

Also like obesity, the question about “medicalizing” food and eating behaviors may be more confusing than helpful. Instead, maybe we should pursue better evidence about what helps and what doesn’t.

Click here and here for two studies of the global burden of eating disorders and here for the commentary by Thomas and Becker. For the paper by Jenkins et al, click here.

Young Boy Eating a Watermelon, painting by Vincenzo Irolli / WikiArt

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April 6, 2023