cause or reveal

Does weight loss cause or reveal the mental illnesses we call eating disorders?

And, by way of correlary - does normalizing weight cure or mask mental illness?

Or is weight change just a result of behaviors?

When I think about it, the above are the questions that divide the eating disorder world and form the fault lines for the positions that divide us.

Your thoughts?


  1. I'm not sure, but they are questions I've wondered at myself. Maybe a case by case?

    I suspect there is more for a case of constant flux in causes and symptoms than stasis as such.

  2. It seems to me that weight loss is definitely the trigger may tip a possible fragile balance of biochemical responses and pathways that seem to cause the ensuing symptoms of this brain disorder. I do believe weight restoration does contribute to the recovery but it seems to require behavioral changes to restore health

  3. My first thought is that most eating disorders do not result in weight loss

  4. question 1 - reveal
    question 2 - neither cures nor masks ED - I believe that an ED does not exist by itself
    weight change is a result of behaviors coupled with the biology of the organism itself
    trick question?

  5. For my daughter, I do think she had thoughts of hating herself and her body before she started losing weight (started after some trauma) but once she lost some weight, things quickly became out of control and spiraled down very rapidly to a very low weight that was repulsive to her. Now that she is better, I see that she does have a tendency to eat less rather than more, particularly when stressed. It's not related to weight and body image now, her weight is stable and good, her body image is excellent, it's more her biology I think. She can want to eat and stay healthy all day long but she has to make a very conscious effort to eat enough, it's the eating not the reason for the eating that helps her stay well, and she and I are both convinced that not eating for any reason at all could lead down the rabbit's hole again. Hope that helps.

  6. I think this all depends if you believe that the mind is separate from the body or that they are all one. Lack of proper nutrition can affect the brain function in a myriad of ways. I believe that some people's brains can misfire when lacking the proper energy intake needed to function normally. Ergo, proper energy intake and rebalancing the system can reverse the effects and restore brain function to normal.

    This answer the "eating disorders do not necessarily result in weight loss" question, in that it may not be the amount of food, but what nutrition the brain actually requires for optimum function.

    I also don't believe that an eating disorder can be "chosen". Therefore, it follows that the genetic markers may be there for an eating disorder in many people but they are triggered in some but the lack of the right nutrients required at the particular time in a person's life, for whatever reason. It may not necessarily be weight loss but a lack of a particular micro-nutrient whatsit that causes the brain to misfire.

    I am now heading for the bottom of the garden with my hard hat on.......

  7. Warning! Having spent far too much of my time in the last two weeks trying to describe my own thoughts on eating disorders to very intelligent people with no medical background or previous publicised interest in the subject I'm coming to the conclusion that the eating disorders world might just be getting so introspective that it's arguing about how many angels can dance on a pinhead when the rest of the world doesn't believe in angels and has run out of pins so my thoughts are at the same time fairly angry and fairly changeable.

    1st Anonymous - I agree, most eating disorders dont result in weight loss - but there is a fair amount of evidence that they usually START with it or with some kind of restriction whether voluntary (like a diet) or involuntary (like a bout of flu). The Minnesota Starvation Study showed what torture starvation does to the brains of even robust individuals so I definitely believe that it can cause mental illness - not in anyone as its known tht most people don't develop a full blown eating disorder after the relatively short periods of restriction involved in dieting or illness - but in the vulnerable. So I suppose it is a case of unmasking that vulnerabilty, but without that trigger it might be left alone and never cause a disturbance of any significance.

  8. Hope this article that appeared in the Wall Street Journal is still accessible in its entirety. I think the discussion will add to what Charlotte and Marcella have written....

  9. I agree that restriction can play a role in many eating disorders (not just AN), but I don't think there's evidence, that in most cases, that leads to weight loss.

  10. True on the weight loss. I could have asked the question referring to restriction with or without weight loss. BN and BED are both associated with restriction but not markedly low weight.

    But I would say that bulimia is associated with initial weight loss and generally with weight suppression (below highest lifetime weight or BMI percentile for age). I'm very interested in a theory out there that it is the level of weight suppression below what is necessary for THAT PERSON that predicts bulimic behavior.

  11. People with BN do attempt to suppress weight, but that suppression is associated with weight gain. (Hertzog et al, 2010) Most people with bulimia gain weight over time and most fall in the normal weight range.

  12. Yes, weight suppression does generally lead to weight gain over time, and raising the optimal weight range for that person, I believe. "Normal" for someone who weight cycles is generally higher and higher - often making it "weight suppression" to stay at what is classified as "normal weight range" (a term I'd love the world to lose!). The theory about weight suppression isn't about suppressing below "normal" it is from that person's highest historical weight range.

    All the more reason for us to decry dieting and throw out the idea of keeping people at population-derived weight norms.

  13. Right, I understand what weight suppression is and why it's bad. But your post asked for thoughts about weight loss and normalization.

    In general there aren't large changes in body weight in BN and BED during recovery, but when weight suppression and the binge eating it prompts cease, it's not unusual for some weight loss to occur. My point is that weight doesn't say much at all about mental or physical health in BN or BED overall and, in some cases at least, a little weight loss might be the result of improved mental health and less binge eating. Looking at weight doesn't tell us much about most eating disorders.

  14. RIGHT!
    I'd reframe as "does the nutritional mismatch between person and intake cause, or reveal ED?" Because activity changes can trigger some EDs too.

    My money is that for some people, this situation "reveals" disease - the classic pull the trigger model. This implies that it's rather accidental. They INTENDED to diet, but not to "get ED". In other cases, disordered eating may arise more or less deliberately - again, not seeking to "get ED", but knowing or intuiting that "eating like this makes me feel better" (at least in the short term).

    Nutritional restoration doesn't MASK anything, it TREATS the most dangerous symptoms of EDs.

  15. One of the key challenges with weight restoration for some sufferers is that as Laura asks, and is indeed correct in posting, anxiety or the predisposing factors are still there.

    One of the challenges with moving through the stages of Maudsley (when I was involved in it) is that Stage 3 is often seen as the least important by the therapist, the family and the sufferer. I now believe it is the most important.

    With older Ed sufferers, often individual therapy is suggested and I think this could also be a problem where the predisposing patterns of the illness are not dealt with as a family. It is almost as though we forget that if people could do it alone they would, so why cut them loose and think they can deal with underlying anxiety and depression on their own?

    Just my thoughts....

  16. Laura, I spend a lot of time thinking about this, as you do. But I do think that the question needs to be more focused in order to get at useful information. I have often wished that the term "eating disorder" could be erased from the discussion because it is so general, somewhat like the term "neurosis" or "metabolic disorder", and that when we discuss etiology we are best served by being specific. So the question is: does weight loss cause or reveal the mental illness we call anorexia nervosa? For, as one of your readers pointed out, weight loss is not a feature of all eating disorders. Does normalizing weight cure or mask anorexia nervosa, is, I think, the question we are trying to get at.

    I think that even within those who have AN, there are some for whom weight restoration seems to normalize brain functioning and with it psychosocial health, yet for others it is only a first step in healing. I am not sure whether this reflects severity of illness, duration of illness, the patient's developmental stage when the illness first presented, or some yet undefined subcategory of the brain disorder we currently call anorexia nervosa

  17. "that Stage 3 is often seen as the least important by the therapist, the family and the sufferer. I now believe it is the most important."


  18. How about equally important?

    Family MUST stay focused and steady ALL THE WAY THROUGH: we must not leave it to the clinicians or the patient. We need to make sure Stage 3 is JUST as urgent and JUST as important. I see too many families allow themselves to take a rest, give in to social pressures to be "normal," and forget their job is to get the patient all the way through, and onward, and relapse prevention in place!

  19. I don't think it's entirely nutrition mismatches. Food THOUGHT suppression is associated with binge eating. There's worthwhile research on this. Cognitive aspects are important, in addition to weight suppression.

  20. Anonymous, I agree. I believe this mechanism is likely to be part of all eating disorders - we really need to understand this better!!!


Post a Comment

Popular Posts