Obesity- Anorexia Nervosa... Even if it doesn't seem like it at first glance, they are two sides of the same coin. Is it a coincidence that in recent years obesity has developed into a pandemic in our country and, at the same time, there is a continuous increase in the number of people suffering from anorexia? Why is this dipole strengthened?
Can you imagine someone who was obese becoming anorexic and vice versa? How can both coexist in the same person? Make it picture! It may seem like a potentially impossible thing to happen, but for those of us who have been in the Eating Disorders (ED) field for the past 20 years, it is commonplace. Almost 50% of adolescents with anorexia who came to our center for treatment had a history of obesity. Too many times I've heard people tell me that "I'm not getting fat again, I'd rather die anorexic", thus increasing the fear around food. Very often they tell me "it's fine I'm like this, on the other hand I don't understand why from the beginning my parents told me that you should stop eating because it makes you fat and now they're chasing me to eat, what crazy things are these!". The above phrases suggest that the two diseases have much in common as well as many differences.
Until recently, the separation between the two diseases was theoretically clear. Today, however, we are called to see the big picture, i.e. the forest and not just the tree.
Shedding light on the disease
Recently the scientific community has shed light on some unknown aspects of obesity, proving that the following genetic-biological and psychosocial factors are common to anorexia.
(a) Obesity and anorexia are classic examples of how genetic predisposition combined with the environment facilitates the onset of disease. More simply, genes are the bullets while the environment is the trigger that activates either obesity or anorexia. Subsequently, it has been shown that obesity is a predisposing factor for anorexia, as well as that anorexia can trigger obesity.
(b) Genetic similarities were found in the phenotype associated with persistent attempts to control weight and the reinforcement of all those behaviors associated with binge eating episodes.
(c) Excessive calorie restriction disturbs the hormonal and reproductive system as well as the metabolic rate due to malnutrition, with the result that the secretion of the hormone leptin also decreases. This is one of the main reasons for failed attempts to lose weight in people with obesity.
(d) A recent study showed that in anorexia there is an increased neural activation of the reward systems, while correspondingly reduced activation in obesity, consequently leading the sufferers to a large consumption of food precisely to satisfy the need for reward.
(e) Low self-esteem, childhood abuse and neglect, negative body image, negative comments about body shape and weight, hypersensitivity to gender-based criticism act as risk factors for both diseases.
(f) Alexithymia i.e. difficulty recognizing their emotions, feelings of shame and self-blame, anxiety, depression, social withdrawal, social stigma and racism, inevitably lead to low self-esteem since managing food becomes the ultimate goal .
Need for targeted treatment
In closing, I wonder how, as parents and experts, we will deal with obesity in children and teenagers, without encouraging behaviors that lead to anorexia or bulimia. We often see reports in the press about the childhood obesity pandemic in Greece, leading the world, with 44% of school-age boys and 38% of school-age girls being overweight or obese. At the European level, eating disorders affect 1.5-4% of the population suffering from anorexia and 3-6% suffering from the whole spectrum of bulimia. The only way to reverse the epidemic of obesity and eating disorders is to change ourselves, adopting a moderate attitude towards our children's eating behavior. All things in moderation!
Maria Tsiaka
Director of the Hellenic Center for Eating Disorders
PhD candidate, Psychological Medicine, Section of Eating Disorders, King's College, London.
Family Therapist specialized in eating disorders
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