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Updated 13 October 2015

Obesity and anorexia – two sides of the same coin?

DietDoc investigates the possibility that obesity and eating disorders like anorexia and bulimia nervosa may be two extremes of a linked spectrum of disordered eating.

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I recently had the privileged of hearing Suna Kassier deliver a paper on “Prevention of Obesity and Eating Disorders” at the SASA Roadshow on “Nutrition in NCD Prevention” (NCD = Non-communicable Diseases).

Suna Kassier, a lecturer and Post Graduate Academic Coordinator at the Department of Dietetics and Human Nutrition, at the university of KwaZulu-Natal, has a great deal of experience in this field. She believes that obesity and eating disorders are two ends of a linked spectrum of disordered eating, which makes a lot of sense.

Common factors

Obesity and eating disorders share the following risk factors:

1) Dieting

Both conditions are linked to dieting: overweight and obese individuals try every diet available and use every pill and potion they can purchase to lose weight, while anorexics starve themselves into skeletal ill-health, and bulimics and binge-eaters gorge and purge until their eating patterns are completely disturbed.

2) Media-driven

The urge to achieve slender to skeletal figures (weight-loss regimens, anorexia, purging in bulimia) or bulging muscles (bigorexia) is fuelled by the hype and unrealistic expectations created in the media.

 We cannot all look like models strutting the catwalk, or Mr Universe with a six-pack and muscles that resemble blown up balloons, but the problem is that so many people nowadays want to look like these role models.

3) Distorted body image or dissatisfaction

Both the overweight and the anorexic have distorted body images in both extremes of the weight-spectrum. In a survey conducted a number of years ago, the majority of South Africans suffering from overweight or obesity were “satisfied with their body image” or felt that “being thin was linked to illnesses like Aids, and therefore not desirable”.

Read: Body image - a loaded topic

Dissatisfaction with one’s body image is personified by thin people looking into their mirrors and seeing someone who is fat. Patients suffering from Body Dysmorphic Disorder (BDD) have extreme body image dissatisfaction, which can lead to disastrous behaviour and even suicide.

4) Weight-related teasing

It is an unfortunate phenomenon that human beings, like animals, tend to pick on individuals who deviate from the norm. Fat people are endlessly bullied, insulted, teased and denigrated by their peers. Nowadays even airlines and employers discriminate against passengers and employees who are obese. (Fatness can get you fired!) Conversely very thin people, particularly young men, who are not necessarily suffering from anorexia, are teased and bullied until they turn to body building and supplements to build up their abs and muscles – so that they can fit into our body-shape-obsessed society.

From one extreme to another

Because of the overlap and the many similarities between obesity and eating disorders, it is vital for therapists treating both ends of the weight-spectrum to realise that these disorders are not distinct and are actually mirror images of each other.   

Obesity/anorexia/bulimia/orthorexia/bigorexia/etc are all eating disorders and can even occur simultaneously in one person. Far too often, someone who once was anorexic is “cured” and switches to another condition such as binge eating disorder. Obese people who have shed amazing amounts of fat, can also switch to anorexia or bulimia because they are terrified of gaining weight again.

Read: Meat linked to weight gain

It is important that dieticians, doctors and psychologists treating obese patients and/or people with eating disorders, should keep this relationship in mind and concentrate on identifying factors that can be modified and critical periods when an intervention could save the patient from one or the other condition.

Vital intervention periods

Kassier identified the following periods throughout life which are critical moments when interventions can prevent an individual from developing future obesity or eating disorders:

a) The prenatal period

The prenatal period – as researchers pay attention to the period before and immediately after conception, as well as pregnancy, they have come to realise that if the foetus is over-fed during the intrauterine period, the child will be prone to obesity in later life.

b) Foetal overnutrition

The prime factor driving foetal overnutrition is maternal obesity. In other words, modern populations are caught up in a never-ending vicious cycle where obese mothers overfeed their babies in the womb and then give birth to children who will in turn become obese and/or suffer from disordered eating. The value of ensuring that mothers are not obese or overweight before falling pregnant is becoming more and more evident. Excessive food intake particularly of foods with a low nutrient density and high energy content during pregnancy is just as detrimental to the future of our species as maternal starvation.

Read: Mother's fat harms embryo

c) The adiposity rebound

The phenomenon of the “adiposity rebound” where normal children lose weight to reach their lowest weight by the age of 5 to 6 years and then gradually start to regain weight as they grow older, has been identified as a critical factor in future obesity.

Researchers have determined that if infants experience the adiposity rebound at an earlier age (e.g. 3 years), they will be more inclined to become obese in later life. This pattern of accelerated growth which leads to a very rapid decrease in body weight may be due to infants growing taller at an earlier age due to the high-protein, low-fat diets of modern infants. Mother’s milk, in contrast, is a high-fat, low-protein food, which pinpoints how important breastfeeding is to ensure normal growth in infancy, a normal adiposity rebound and less chance of developing obesity at a later stage.

d) Undernutrition in early life

Millions of infants throughout the world suffer from malnutrition due to poverty and a lack of breastfeeding. Rolland-Cachera and co-workers (2006) suggest that early nutrient deprivation may programme children to develop a thrifty metabolism that will make them vulnerable to obesity in adolescence and adulthood.

These new insights into the many different factors that fuel obesity and eating disorders can be used to shed light on the obesity epidemic in South Africa where so many pregnant women are either over- or undernourished and so many children are not breastfed and are stunted or grow too rapidly at an early age causing them to have an early adiposity rebound. Interventions to address these diet-related problems are urgently required, if we are to win the war against eating disorders of all kinds.

Read more:

Anorexia, bigorexia - same roots?

Eating disorders on the rise

The changing face of eating disorders

References:

- Rolland-Cachera MF et al. (2006). Early adiposity rebound: causes and consequences for obesity in children and adults. International Journal of Obesity (Lond), Supplement 4:S11-17.

- Kassier S (2015). Prevention of Obesity & Eating Disorders. Paper presented at the SASA Nutrition in NCD Prevention Roadshow, Pretoria, on 12 February 2015.


 
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