Disordered Physiology and Disordered Eating

Since January, when the American Academy of Pediatrics released a guideline for treating the disordered physiology of children and youth with obesity, we’ve been inundated with popular psychology influencers concerned about the impact on young persons with disordered eating. Their arguments are quite passionate. “Obesity guidelines for kids terrify me,” says one person with a book to sell. Another says “I don’t think there should be any form of treatment for obesity.”

But these emotional appeals serve only to further confuse complicated questions about a range of complex disorders that sometimes overlap and interact. Just as obesity is not simply a single distinct clinical condition, the umbrella terminology of eating disorders covers a wide range of problems that may overlap with a clinical diagnosis of obesity. So sweeping generalizations suggesting that care for one of these conditions must come first or last or not at all are really not helping.

Overlapping Diagnosis and Care

Bingeing is one symptom of disordered eating behavior that commonly overlaps with obesity. And now clinicians and patients are telling us that treating obesity in patients who also suffer with symptoms of bingeing can be helpful with those symptoms. In some patients, it may be that the disordered physiology of obesity may also play a role in driving abnormal patterns of eating behavior, such as bingeing. Aaron Kelly, who is Co-Director of the Center for Pediatric Obesity Medicine at the University of Minnesota, explains:

“What we’re starting to see with newer anti-obesity medications is that their mechanisms of action may address fundamental aspects of both metabolism/energy regulation and pathways that promote abnormal eating patterns. There may be more overlap than previously thought. We are just beginning to scratch the surface of understanding the complex interplay of obesity pathophysiology and disordered eating tendencies.“

Anecdotal reports suggest that some patients with bingeing behaviors find significant benefits. Kristen Ireland tells the Wall Street Journal that she has found liraglutide to be very helpful with her symptoms of bingeing. “I feel free now,” she says. This has come from taking the medication for years now, with occasional interruptions caused by problems with her insurance carrier. Those interruptions caused the return of distressing symptoms:

“I’d be back to eating quarts of ice cream every night, and then I’d purge in the morning,”

We Need More Than Anecdotal Evidence

One thing is clear from all of this. We need more than emotional appeals to fear about disordered eating. We also need more than anecdotal evidence about how advanced medicines for the disordered physiology of obesity might help with some disordered eating behaviors. The scientific literature has some pilot studies and hypotheses. But this is not good enough.

Disordered eating deserves serious attention and careful study. If these medicines can help, we need solid evidence to support their safe use and potential benefits.

Click here and here for further reporting on this. For relevant scientific literature, click here, here, and here.

Figure A (Geometrical Patterns), painting by Morton Schamberg / WikiArt

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June 23, 2023