Social Question

DigitalBlue's avatar

Is it possible to have an eating disorder and not be underweight? Read details, please.

Asked by DigitalBlue (6684 points ) December 4th, 2012

I don’t mean something like binge-eating-disorder. I mean an under-eating disorder.
I know that “anorexia nervosa” has weight requirements for a diagnosis, but are there other eating disorders that don’t?

I have a body image disorder that is very prevalent in people who also have eating disorders, and in the last few weeks I think that I am slowly coming to accept that I may be in that category. The problem is that I am not underweight. In fact, I could stand to lose 30–40 pounds. Realistically, according to actual numbers, not based on my own warped view of myself.

My problem is that I am unable to “diet” or “live healthier” without starving myself. I spent at least a year of my life refusing to consume more than 800 calories a day, while simultaneously running 5 times a week and working out on top of that. I did lose weight, but I have never been underweight in my life. I can’t snap out of that. As soon as I shift any type of focus on my eating habits, I default to starvation, I don’t know how to eat well without starving myself. Sometimes I go days without eating, and I have very negative associations with food and control issues. When I am not starving myself, I gain weight. When I am not starving myself, I also abuse laxatives and diuretics. Is it possible that decades of severe dieting has just trashed the shit out of my metabolism?

Are eating disorders about the physical effects on the body, or about our feelings and habits surrounding food? Can a person who is clinically overweight have an undereating disorder?

Why are overeating disorders not treated the same way as undereating disorders? Why does society scorn the obese or overweight as making dangerous lifestyle “choices,” rather than approaching overeating just the same as dangerous undereating compulsions?

Please note: I’m not asking you for a diagnosis. I’m just looking for general information and discussion on this topic. There are about 100 things that I need to see a therapist for, but I’m not ready to go back to that, so recommending that and bailing on the question isn’t helpful. I’m putting this in social because I’d like the discussion to have some freedom for opinions and anecdotes, but I am not seeking medical advice.

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10 Answers

DancingMind's avatar

I have a difficult relationship to food. My body never really prolaims hunger—or at least, I don’t recognize the feelings that are “hunger! you’re hungry! food!”—and so it’s easy for me to be paranoid about how much or how little I’m eating. If I go without eating I don’t get a cue, I just gradually become weak and fatigued, and so I won’t realize that I’ve been so lethargic until I’ve eaten something and feel the renewed energy.
I have a difficult time knowing how much to eat. A few summers ago, in a fit of self-loathing, I ate between one to two dozen chocolate chip cookies a day. There was mutilated symbolic a reason it was cookies, but I won’t get into that. I had to fight myself to manage to eat so much… and now, after I gained 50 pounds in binging and dropped 40 of them when I stopped eating quite so much, I have an even harder time knowing how much to eat. An even harder time, too, of getting a realistic sense of my size. I obsess over food and don’t really enjoy it. Cookies make me feel sick, but if I go too long without chocolate chips I feel panicked and anxious. Etc… My relationship to food is pretty disgusting, actually. Even though aside from the too-many chocolate chips, and too-many cheerios, I avoid any packagaged food. And even though I present myself with a balanced diet when anyone is present (no one sees me eat the chocolate chips). And even though I love apples, love zucchini, etc… love all the ‘healthy’ food. And even though sugar makes my head feel like it’s humming. I eat pretty badly. I feel like I have to. Eating well would mean treating myself well, and that’s not something I like to do.

So yes. Even though what you describe is different than me… I don’t mean to equate… Yes, I think someone can have an eating disorder and it not be anorexia, or bulemia, or binge-eating (although I did that for a summer), and it not be recognized as an eating disorder.
(Still, does anorexia necessarily mean deathly-skinny? I’m not sure what the definition entails. I know with bulemia, if you don’t vomit soon enough after eating, you can gain weight still, and it can be even harder for an outside observer to diagnose… so I don’t see why not, under the correct conditions, un under-eater can’t also be clinically overweight.)

Your metabolism will shut down if you starve yourself. It’s survival—no energy in, means using what energy you do have as efficiently as possible, or dying that much sooner. But I don’t know how true the ‘forever-shut-down metabolism’ is. Nor the ‘shut-down if no food within 5 hours metabolism.’ On and on.
Given that by quitting smoking you can begin to reverse its effects on your health, or that altering your diet you can begin reverse the progress of diet-onset diabetes… I tend to think that most of what we do to our bodies is reverseable (at least up to the point we break something.) Given that just by excercising you boost your metabolism, I tend to think that metabollic rate must work similarly. Even if you trained your body to a certain level of metabollic activity and lipid storage, it’s then trainable. Probably it’s not easy to change the instilled training, (nor the practiced habits) but I have a hard time believing re-training of the body’s behavior is impossible. There was this bit on NPR a few months ago… I think closer to a year ago… about the epigentics involved in muscular activity. That just by being active, we are actively changing the way our body reads and implements our DNA (it makes different notations in the DNA strand, and begins to build muscle, and increase muscle effeciency, and increase the energy pre-stored in the muscles, all in response to the use. Didn’t matter who—age or previous activity level or anything.) Our bodies are always listening.

DigitalBlue's avatar

@DancingMind I believe that it can be re-trained, as well. But that requires changing habits and the mindset that got you there in the first place, plus its pretty common for metabolism to change as we age. But I don’t disagree that it can be fixed, I just suspect that the damage is something that can also accumulate over years of bad behavior.

I also relate very much to what you said about “eating well would mean treating myself well, and that’s not something I like to do,” that’s something that I am guilty of.

Bellatrix's avatar

You asked is it possible that years of dieting has trashed your metabolism and I would say absolutely yes. I have the same problem. Started dieting when I was about 17 and when I really, really did not need to and have battled with my weight (and my perception of my weight) from then on. I don’t eat unhealthily (but I don’t get enough exercise) but losing weight is very, very difficult for me to achieve. I am conscious of just focusing on eating ‘healthy’ now and my doctor agrees that’s the most sensible thing to do. Not to focus on losing weight but to focus on feeling healthy! I can keep my weight stable, so I just focus on that.

I definitely think ‘eating disorders’ are about body image and our feelings and emotions and interaction with food and exercise rather than just the physical effects. In fact, I would say they are mostly about psychology than physiology.

As to your questions about society’s attitudes towards overweight issues, I don’t know. It seems to me there is so much scientists still don’t know about the way our bodies work that our obsession with ‘don’t eat fat’ then ‘oh you should eat some fat’ and ‘don’t eat carbs’ then ‘oh you should eat some carbs’ and on and on and on has people jumping from one crazy diet to the next and this will have long term effects on health generally. I really wish I had not started dieting when I didn’t need to and had just focused on eating whole, natural foods and a more paleo diet over the years. That’s pretty much the diet I grew up with plus a lot of walking and it worked for me then.

I also bought a recumbant bike so I can ride it while reading for work. I really want a sort of desk thing I can use while I ride it. That is in the design stages. I remember you posting about a treadmill – the key is to a. get into the habit but b. not become obsessive! I meant to mention too, that I think it’s a better idea to eat small meals more often. That’s supposed to help ramp up your metabolism. Don’t go over three-four hours without food.

Another thing – your sleep is screwed up. There is now a lot of research to show sleep and stress affect your weight and your body’s ability to manage weight. Cortisol for instance plays havoc with weight control. I put on four kilos over the last three months because (as you know) I have been dealing with a huge workload and not sleeping properly. I didn’t change my exercise or eating but my sleep patterns were seriously stuffed up. Now I am sleeping and less stressed, my weight is stabilizing again. So, look at that too. TRY to get some quality sleep and deal with your stress.

Long and short (or fat!), I hear you. I have no answers apart from focus on health by eating whole foods and perhaps look at the paleo way of eating and get some exercise. Don’t focus on your weight but on knowing you are doing what you can to be healthy and I figure weight loss will either happen or you will at least feel well. Any if you ever need to talk – you know where to find me!

Bellatrix's avatar

I added in a paragraph about sleep just in case you missed it! I think that’s particularly pertinent for you.

DigitalBlue's avatar

@Bellatrix I have heard the same about sleep, and I do know that is part of my problem. I really, really, really have to learn how to treat myself better. In so many aspects.
I wrote a much longer reply to your answer in PM, but it was too personal to post.

I have a good friend who raves about the paleo diet, he is nothing short of elated with the results he has achieved since starting it.

Bellatrix's avatar

I got your PM and replied :-)

I am not following the paleo diet consistently. I need to get back to it much more stringently really. I have found I feel much, much better when I eat that way and I still do eat much more paleo than any other way. Grass fed meat, veggies. It just makes sense. Can you grow your own veggies? Even in pots? That’s my plan for over Christmas, to try to get my veggie garden growing and to try to grow more heirloom veggies.

DigitalBlue's avatar

@Bellatrix yeah, I used to have a garden and that fell off the last few years- but I plan to do it again this coming year. I miss having the fresh produce on hand.

burntbonez's avatar

I think this is possible, and I think it is good to get the experience of others in your situation, but I hope you are also talking to a doctor who is an expert in these matters.

Shippy's avatar

I suffered with anorexia all of my adult life. I say that, because although treated I still have those same compulsions. Albeit on a much smaller scale. I also don’t eat a lot and yet I am not thin, nor skinny. I think that is what propelled my anorexia. I was never thin enough without starving myself. As my natural body weight is to be regular size or athletic at times, or pleasantly plump at other times. (If I just eat whatever I want).

I oddly never found my healing to be associated with food at all. To me, anorexia was about other issues, all but food. I simply used food as the external control factor. Food was a tactile sense, there is something also very sensual about food. It has a lot of other meanings to it, apart from hunger. I used food as my gauge. This is where I could exert power. But really my eating disorder came from completely different sources. The fear of rejection, the fear of not matching up, wanting acceptance, feeling in control plus some self denial and self hatred thrown in.

When I began therapy many years ago, for my eating disorder, that was simply just one of the issues I was dealing with. I was also dealing with drug addiction, alcoholism, sexual abuse, rape, neglect to name a few. I never once had a weigh in, I never once discussed food.

What I did discuss was me, how I related to the world, my self image, my self concept. How I was never rescued, how I never had good parenting and thus was unable to parent myself. How I absorbed media images of people, their lives, their body’s and how lacking I felt. I began to see a correlation between rejection of sensual pleasure, meaning , feeling the sun on my face, sand beneath my soles, allowing love into my life. Knowing that I am lovable. Knowing I am OK as I am. This journey took years, maybe even twenty. Because it was so deep.

But more than that, because I could be right off track on your question, someone once asked me, “If you were a car, would you refuel yourself?” The answer is yes. I wouldnt treat a car the same way as I had treat my body all those years. I would oil it, refuel it. So caring and wanting to change I made healthier food choices. Then began the healing, the accepting of my body. I still battle at times, but I have come strides, miles, When I am anxious or when I feel I am losing control over life, I revert back to food and my power stuggle with it, but it is no where near where it was. I don’t want to hurt myself anymore. People did that to me, all my life, why wouold I do such a thing to myself now. It is a daily program of recovery for me, at best a weekly. But at least I understand the source.

Simone_De_Beauvoir's avatar

Yes, of course. It depends on what you eat. Obesity occurs in underfed populations a lot.

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