Overview
Eating disorders are compulsions to eat in a way that is injurious to one’s health and are characterized by abnormal obsessions with food and body weight. The eating may be excessive or too restricted often resulting in very serious health problems. Over 50% of people with eating disorders also have severe mental depression which makes diagnosing and treating an eating disorder doubly difficult.
Because problems with body image are far more common among gay men than their straight counterparts, eating disorders like anorexia and bulimia are more common among gay men than straight women and may approach the high levels of eating disorders among young, white women. At the other extreme of eating disorders, obesity is a problem that also affects significant numbers of gay men. Other, less frequently seen disorders can also affect a gay man’s health. Some of these include “disordered eating” which involves an extreme obsession with the consumption of the “right” foods to the point they may actually suffer from malnutrition. Also, some have food phobias about what they absolutely cannot eat to the point that it is considered an eating disorder.
Finally, an eating disorder called Pica, more prevalent in children, involves the habitual ingestion of inedibles like soil or hair. The fetish involving the eating of scat (feces) may actually be a form of this eating disorder. Go to the following site for more information on Pica: wikipedia.org/wiki/Pica.
 Anorexia Nervosa
Anorexia nervosa is a formal psychiatric diagnosis that describes an eating disorder characterized by low body weight and a body image distortion that causes the person to see them self as “fat” regardless of how skinny they may actually be. Dangerously low body weight is maintained by starvation, purging, vomiting, excessive exercise, diet pills, crystal meth or diuretic drugs. Anorexia has one of the highest death rates of any psychiatric condition.
Signs and Diagnosis
Criteria for diagnosing anorexia are from the American Psychiatric Association’s Diagnostic Manual and while some blood tests can be performed, diagnosis of anorexia is based on a combination of behavior, reported beliefs and experiences and physical characteristics of the patient. So just because someone is super thin does not mean they are “anorexic” in a medical sense.
To be diagnosed as having anorexia nervosa a person must display the following:
- Refusal to maintain a minimally normal body weight for their age and height
- Intense fear of gaining any weight or becoming “fat”
- Undue influence of body weight on self-evaluation and drastic change in the way one’s body weight is personally experienced
- Denial of the seriousness of a dangerously low body weight
Causes and Contributory Factors
- Family/genetic factors: Twin studies suggest that genetic factors contribute to anorexia which is shared with a genetic risk for clinical depression.
- Brain chemical factors: Studies indicate that anorexia is linked to disturbance of the serotonin levels. Serotonin is involved in regulation of mood, anxiety and feeding behavior. Serotonin disruptions can be caused by many factors, especially certain party drugs like speed and crystal meth.
- Psychological factors: Feelings of low self worth, fatness and unattractiveness appear to contribute to anorexia as does high levels of obsessive thinking and clinically measurable levels of perfectionism. Clinical depression, anxiety, obsessive-compulsive disorder and drug abuse also contribute to anorexia.
- Social factors: Studies have shown that the cultural expectation and high value placed on thinness in American society and the idea that thin-equals-beautiful is a major contributing factor for some groups, especially young women. However, the same expectations among young gay men must also be seen as a contributing factor to the high rates of anorexia among gay men
Treatment
The first priority of any treatment for anorexia is immediate weight gain which may require hospitalization. In serious cases, involuntary hospital treatment may be necessary under the mental health laws where legislation permits. Most patients are treated as outpatients by means of group and/or individual psychotherapy. Recovering anorexics often harbor hateful dislike for those who they feel are robbing them of their treasured emaciation. Well-meaning friends and family may compliment the apparently recovering person on their healthy look but in the anorexic’s mind they might still be replacing the word “healthy” with “fat” and “ugly”.
For more complete commentary regarding the treatment of anorexia, click here.
Obesity
Everyone’s body stores reserves of energy in fat cells throughout the body and in the liver. Being “overweight” just means that you have more fat than the average person for your age and height. Obesity is a condition where so much fat is stored in the body that it becomes unhealthy and actually increases the risk of developing other life-threatening conditions such as cardiovascular disease, diabetes, certain cancers, sleep apnea, stroke, osteoarthritis and many other serious illnesses. As a medical condition, obesity is usually assessed by the Body Mass Index (BMI) test plus measurement of height and waist circumference and the presence of other risk factors or health conditions and habits such as smoking. Depending on the degree of obesity and the other health factors involved, your physician may treat the condition with dietary changes or sometimes even surgery.
Causative Factors
In the simplest possible terms, when average food energy intake exceeds the burning of food energy by the body on average, excess fat begins to build up over time. There may be genetic or family background aspects to the problem for any given person that may affect the amount of food eaten and the basic level of metabolism of food energy, but in the end, obesity is caused by eating more food than is being burned off by the body. This means that even tiny shifts in the body’s energy balance can lead to very large changes in weight over time. For example, an obese 40 year old man who carries 100 extra pounds of fat has only to consume 25 more calories per day for the previous several years than he burns on average. 25 calories a day is equivalent to one apple every three days.
The following factors are thought to contribute to the development of obesity:
- Sedentary, “couch potato” lifestyle
- Diet high in processed sugars and carbohydrates
- Weight cycling caused by repeated attempts to lose weight by dieting
- Underlying conditions like hypothyroidism
- Genetic disorders
- Eating disorders such as binge eating disorder
- Stressful mentality
- Insufficient sleep
- Certain medications
- Smoking cessation
- Gluttony or inability to control food intake
Treatment
If obesity is diagnosed by a medical professional, several courses of action may be recommended. However, all of these involve the reduction of caloric intake and the increase in physical activity in addition to the correction of hormonal or other medical causes of the person’s obesity. The goal of treatment should be to achieve and maintain a healthier weight, not necessarily the ideal weight of a fashion model or porn star. Medications and diets can help but treatment can never be a short term fix but has to be a life-long change in basic habits around eating, exercise and physical activity. Even a moderate weight loss of 5% - 10% and the maintenance of that weight loss can result in significant health benefits by lowering blood pressure and the risks of diabetes and heart disease. Obesity has become the number one contributory factor to deaths from many different health conditions in America today.
The following treatments for obesity may be recommended by your doctor:
- Reduced caloric intake
- Increased exercise and physical activity
- Weight loss maintenance with “talk therapy” and social support and sometimes medications
- Drug therapy as prescribed by physician to increase metabolism (diet pills) or decrease appetite
- Surgery — bariatric (gastric banding), gastric bypass (stomach stapling), etc.
- Treatment for related conditions — diabetes, hyperthyroidism, eating disorders, metabolic or hormonal disorders, depression, anxiety, etc.
For more complete information on obesity, reviews of popular weight loss diets and other related topics, go to the following sites: www.medicinenet.com or wikipedia.org/wiki/Obesity.
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 Bulimia Nervosa
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Bulimia is a psychological condition in which the person engages in binge eating followed by intentional purging. Purging typically takes the form of vomiting, inappropriate use of laxatives, enemas or diuretics, excessive exercise or fasting. Unlike anorexics, bulimics do not purge to make themselves thin and attractive but binge and purge in order to feel in control of themselves and to maintain the same weight. Because of this a bulimic may not appear abnormally thin at all. However, long term bulimia can lead to a long list of possible serious health conditions including malnutrition, high blood pressure, hormonal imbalances, hyperactivity, depression, diabetes, liver failure, kidney infection, heart failure, seizure and many others.
Signs and Diagnosis
The following criteria should be met for a person to be formally diagnosed with bulimia:
- Feels incapable of controlling the urge to consume large amounts of food and to purge afterwards
- Deliberate purging shortly after eating Bingeing and purging for twice a week for three months or more
- Unhealthy focus on body image and desperate desire to remain thin
- Does NOT meet the diagnostic criteria for anorexia nervosa
- Is of normal weight or actually overweight for their age and height
Treatment
There is no known way to prevent the onset of bulimia but once diagnosed the condition can be treated with group and individual psychotherapy. Prolonged bulimia can have very serious consequences. In fact, anorexics who use bulimic techniques to stay thin are twice as likely to die as anorexics who do not.
For a more complete discussion of bulimia and more information on how it differs from anorexia, click on the following link: http://en.wikipedia.org/wiki/Bulimia_nervosa
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