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Defining Eating Disorders

August 7, 2009

Over at Living Rhetorically in the Real World, we’re talking about definitions, so I thought I’d bring the conversation over here. Check out the post there to discuss how you define yourself in terms of fitness (me, I’m calling myself a runner and an athlete these days).

My question here at Living Healthy is this: what is the definition of an eating disorder? This month’s poll is about the physical and mental affects of gaining or losing a few pounds, so I’d like to add that to this question. If, for example, you have the physical symptoms but not the mental symptoms of an eating disorder, does it constitute as an eating disorder?

These questions were sparked after reading the New York Times article about dieting monkeys living longer than the ones that are not on a restricted-calorie diet. I have qualms about this study right from the start. Even if animals live longer on this diet, known as calorie restriction or CR [edited to say: CR is a very specific lifestyle diet which you can read more about here and here], do they have the same quality of life as animals that eat a normal amount of food? The research shows that some monkeys have died in ways unrelated to age- but are the deaths related to the fact that they were on a CR diet or because they would have died in the situation anyway? The reasons for these deaths include anesthesia, gastric bloat, and endometriosis. All of these causes of death could have been directly linked to a poor immune system. A weakened immune system could definitely have been the result of going on a CR diet.

I know that some readers here have tried calorie restriction so I would really love your input as I do not know very much about it. I don’t wish to step on any toes, but the way I see it, calorie restriction seems to have a dangerously close relationship with an eating disorder. CR can create the exact same physical issues as anorexia, but some medical professionals promote it as a lifestyle, and the diet has many followers. If you’re restricting calories (as low as 1,000 calories a day or fewer), and you’re doing it on a calorie restriction diet so it has nothing to do with your body image etc, does that mean that it is not an eating disorder because the mental symptoms are not there? If it’s called “calorie restriction” rather than “anorexia”, does that make it a safe practice?

At our trusty Dictionary.com, an eating disorder is defined as “any of various disorders, as anorexia nervosa or bulimia, characterized by severe disturbances in eating habits”. The next entry describes an eating disorder as a psychological disorder “that involves insufficient or excessive food intake”. Those kinds of definitions still make me wonder about calorie restriction.

What do you think? Am I muddling up my definitions? Are you a CR follower and can you enlighten me? Share your input in the comments.

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26 comments

  1. Hmmm I feel strongly about the questions you pose, but am not sure I may adequately express my thoughts. I guess my biggest issue comes from the definition you cite of an “eating disorder.” I believe 99% of the population would fit the 2nd description at one moment in time or another. Most of us over-eat at Thanksgiving, when we’re eating our favorite foods, or when we forget to allow enough time for our brain to signal its full. Eating in excess seems to be a general “given” on occasion and may even be considered a part of “normal” eating (see Eve’s, a nutritionist’s, post here: http://nutritionbyeve.wordpress.com/2009/08/04/normal-eating/ ). When it comes to eating insufficiently, I’m sure most of us, also, have consciously limited our food intake (not necessarily by c.r.) to compensate for overindulging on occasion. What’s missing from the definition I think, is “frequency.” If these behaviors of excess or insufficiency are more frequent than not, that may signal a problem. Not sure if I’m making sense.
    When it comes to calorie “restriction” — if you read my blog, you know I count my calories. I definitely do not “restrict” myself to any level of insufficiency –I often eat more than the govt’s recommended daily intake (which is a whole other issue for another day) — but I do set loose “caps” for myself depending on my activity level.
    I feel like with our cultural emphasis on social eating, the out of control portion sizes and abominable calorie counts of most foods at restaurants, addictive food additives and combinations — there are a lot of things working against healthy eating. Sometimes I feel like it’s a matter of de-conditioning and re-training myself to be a healthy eater — that’s where being a highly conscious and aware eater really come into play and that’s why I practice calorie restriction (I’d prefer to call it conscious eating with calorie boundaries and flexibility lol). I’ve rambled…Sorry!


  2. I WONT GO ON FOREVER as I could but link this article which has been in my head about CR since I read it YEARS ago:

    http://nymag.com/news/features/23169/

    interesting
    interesting
    NOT FOR ME
    interesting


  3. You know, I’ve read about animal studies such as the one you are referring too, and I’d never thought about their “quality of life”, which is actually a very excellent point. I do know that when they say “calorie restricted” most studies don’t give a calorie range in “human terms”, in other words they never say about how many calories the rats are getting, and how that compares to humans. They usually just don’t let the rats eat “ad lib” or , whatever they want. I don’t like that about the studies, but I am also now interested in their quality of life, as that is a great point. I like discussing research :)


  4. Hi! I love your blog and, as usual, great post and some great questions.

    I just wanted to add that anorexia is not always a function of body image; it sometimes occurs when a person is literally “too nervous” to eat. These people know they are too skinny but can’t bring themselves to eat enough to put on weight.

    So much of eating disorders seems to revolve around anxiety and control issues. I would perhaps add to the definition that an eating disorder occurs when eating habits exert control over a person to a point where the detriments to physical, emotional, and mental health outweigh any (if any) positive gains.


  5. I think that Calorie Restriction versus Disordered Eating and Eating Disorders are two different things depending on one’s motivation. CR may be practised by someone such as a diabetic based on doctor’s orders. It can be healthy.
    DE/ED on the other hand is not about food and calories at all. The food/eating is only a symptom of deeper psychological issues.
    Just my opinion.


  6. I wonder how this translates to humans. We know that extreme calorie restriction is extremely unhealthy and can result in long term health problems, and even death.

    I guess I’m pretty basic in my views: Healthy eating, Healthy weight, Healthy lifestyle mindset.

    I am going to read some of the links you and the other commenters posted so I can learn more. Thanks for a great post.


  7. I’ve done CRON (calorie restriction/optimal nutrition) for few years now, and I think earlier commenters really hit the nail on the head when they distinguish calories restriction from an ED based on physical and emotional impact.

    For those who practice CR, CR is only half the equation. The ON part is equally, if not more, important. Those who practice CR make an effort to eat highly nutritive food, precisely because they have a deep respect for their bodies and they only want to put the best quality fuel in them. In fact, for a legitimate CR follower, they often adhere to CRON principles because it makes them feel good physically and emotionally.

    When I first began CRON, it was really eye opening to see how much or how little nutritional value some foods have. For me, it has made eating a more interesting, pleasurable experience as I’m constantly seeking out new and interesting veggies/meats/fruits etc to try.


  8. I think labels are just that– labels. My mom works in special ed, and it’s the same thing with children who have special needs. It doesn’t matter what you call them; as long as they get the help they need, that’s what’s important. If one is suffering, it doesn’t matter if he/she doesn’t fit a certain definition.


  9. […] Healthy in the Real World’s blog posting on “Defining Eating Disorders,” (8/7/09) here — How would you define an “eating disorder”?  Do you think calorie restriction […]


  10. I don’t think CR is really an ED, though it may kind of look like it. I have a cousin very into it, but I haven’t really examined it well. This is a man who can hike up and down Grand Canyon 2x in one day. I get cranky and cold if I’m not eating enough, though that tends to be when I’m camping, and I’m unlikely to be having optimal nutrition or anywhere close. It makes philosophical sense that eating just enough to get all the nutrients would be healthier, I just think it would take all the pleasure out of food, and make living too difficult and rigid to be worth it. OTOH, maybe it does skirt the ED, because it’s a person using their mind to override their bodies desire for food.


  11. Annabel- I strongly encourage rambling! Thanks for the link defining “normal” eating. That is just amazingly well put.

    MizFit- That’s the same article I found when I first heard about CR ages ago! It’s such an interesting one. Makes me want to do my own nutrition challenge on it. I always find things that are interesting to just be so tempting to learn more about and try out.

    Gina- there are so many thing to consider when looking at studies like this one. The quality vs. quantity is one I’ve been curious about for a long time now.

    Tudor- thanks for the extended definition! I would agree with you.

    Mia- so are the physical problems that arise from an ED not the same as the ones that arise from CR, do you think?

    Diane- there’s so much to ponder!

    Rachel- Aha! Thank you; that is something that I COMPLETELY forgot about when writing this post… a fundamental difference between CR and ED would likely be the nutrition factor. People with an ED usually have very poor nutrition whereas people adhering to a CR diet tend to take the time to make sure every single calorie counts and offers them the most nutrients possible.

    Chocolate-Covered Katie- but depending on what we call ourselves, does that make a difference? I wonder…

    Julie- interesting idea! You’re right; there does remain a struggle between the mind and body.


  12. I look at disorders as behaviors that interfere with the ability to behave in a normal healthy manner. If you wonder if you have one, you probably do :-) The curve needs to be generous, however, with the extremes under scrutiny. I eat warrior style, so I fast for what many consider long periods each day. I don’t find it a problem because I’m adapted to it. I may not eat a lunch, but I will go to the restaurant with others and have the social time, etc. I don’t mind watching others eat at times I don’t. If they have a problem with me not eating, I think they have the disorder.


  13. What an interesting question. I think that in today’s society, in which we don’t have to worry about hunting and gathering and surviving, we have a lot of extra time to spend thinking about and obsessing over things we would otherwise not obsess over. Clearly eating disorders are diseases of well developed countries. I think that many people do have some form of an eating disorder, though we call it “disordered eating” now to distinguish it from the more severe cases of anorexia or bulimia. I don’t think you’re muddling your definitions. I think it definitely depends on the reason someone is follow a CR diet. Many food bloggers try out these diet fads and even though they may have a healthy body, the obsession with food and trying to be “healthier” and whatnot – well, it’s not healthy mentally. I’m talking myself in circles as I usually do in these comments, so I’ll stop. But I really liked this post and reading the responses :)


  14. Hi Sagan

    Good topic and a tough one to address indeed.

    I know eating disorders are a serious thing, but according to the strict medical definition, I believe the latest stats for teens were something around 5%.

    In terms of calorie restriction, although that can be tied to an eating disorder, it for me personally is a whole other ball game, simply because it seems it is becoming more popular today as more and more animal studies are proving the longevity involved.

    The way I approach this is that regardless of what any study says, overeating is just logically bad for the body. Just think of it like over-driving your car. We all know that (generally speaking) cars that drive less, last longer.

    But would I ever physically count calories and restrict myself, I have to say no. It may turn into an obsession and can make life a little difficult to say the least. My approach to this is if we eat a natural, non-processed plant based diet – we are getting two benefits in one. The calorie numbers automatically decreases sharply and one never has to count or deprive oneself.

    My two cents on the topic :)


  15. I’m a little confused here. Aren’t all diets considered a calorie restriction diet? We all know that losing weight requires a calorie defecit. The difference between an eating disorder such as anorexia and dieters is that typically people with EDs go on very low calorie diets and starve their metabolism to a grinding halt.


  16. This topic is so complex and sensitive Sagan, it’s hard to draw a clear line between eating choice and eating dissorder. Let’s see, in the worst times of my struggles, I was consuming 500 cal a day… that’s not enought for even your brain to function properly. Now I’m up to about 1000, and i feel much better about it. I’ve read the study about the monkeys. I also read a study they did on people, comparing different types of diet styles (Mediterranean, CR, Low-Carb, Vegan, etc) and it turns out the people on Low-Carb styles were at a healthier weight and much better overal well-being after the 5yr-long study. Mediterranean came out second… CR dead last. So, while I don’t think CR automatically equates to ED psycologically, it does seem to have the same harmful effects on your physical being. ED is hard to understand, it’s hard to see where it came from, it’s hard to pin-point a cause and treat it. I think it stems from psycological issues much more commonly than from the desire to be thin. That is one of the biggest missconceptions about ED. People that want to be thin may behave like ED, or yo-yo diet, etc, but ED is chronic and ever-lasting. I won’t rant about it, but I hate when people say “I had an ED when I was 15″… no, you didn’t have ED, you were 15 and wanted to be thin and dieted immaturely for a bit… ED doesn’t come and go, it stays and you have to manage it your whole life.
    Hahaha I’ve transgressed from the point! excellent post Sagan, it got me thinking (and monologuing!)
    Good luck in your race!!!


  17. Dr. J- interesting take on it, I think you’ve definitely got something going here. If we’re that focused on food, we probably don’t have the healthiest relationship with it.

    Maggie- you summed it up so well! My weight is within the healthy range but there’s definitely been times when, even though my body wasn’t changing at all, my mind was going nuts. My body wasn’t exhibiting signs of disordered eating but it was DEFINITELY there in terms of the mental aspect.

    Evita- natural and non-processed… that’s music to my ears.

    Tony- true! But I’m talking about the diet that is called Calorie Restriction (or CR). With CR, the people who follow the diet spend their entire life eating a super low amount of calories; sometimes even less than 1,000 a day. It’s a lifestyle diet so they do it forever. It’s very little food so the participants all have a very low amount of body fat.

    Marta- thank you SO MUCH for your thoughts on this! You’ve raised such an excellent point which I hadn’t really thought about before.


  18. I remember when I first started down the path of my ED, someone told me, “It isn’t about food and getting skinny, you know, it’s about your control issues.” Control issues?! I thought they were blowing smoke. But you know what, looking back on it, they were right. I think getting incredibly thin and showing so much discipline with not eating really was a way for me to control one area of my life (because all the other areas seemed out of control to me).

    But it’s definitely a fine line to walk…I’ve seen many people delve into EDs who have started off a restrictive “diet.” I know restricting calories works, but if someone is not emotionally stable in their life, I’d be worried about where it could lead to.


  19. Sagan,

    Interesting question. I found Medline’s page on eating disorders helpful.

    http://www.nlm.nih.gov/medlineplus/eatingdisorders.html

    Calorie restricting for perceived health doesn’t sound like anorexia to me, but I could see someone with anorexia using the calorie restricting concept as an excuse or rationale. Very interesting issue to look at.

    Leigh Ann Otte
    Managing Editor
    My Family Doctor magazine


  20. Thank you for clarifying that this is a specific diet. I was following the same thought path as Tony. :) I practice ‘calorie restriction’, but it’s 2,000-2,300 calories, which is, I think, different than what they’re talking about in the article. I hope. :)

    I’ve been stumbling across more and more blogs lately whose writers are following extremely low calorie diets. It’s very disconcerting.


  21. I am vehemently against CR. That is just…against nature. We’re not supposed to subsist on such ridiculously low intakes, and it takes a toll on our mental state, too. Sometimes, such limitation, though not starting from a full-fledged eating disorder, can CAUSE eating disorders.


  22. Thanks for giving a description of what CR is. Well, I can say without question that CR is absolutely terrible for a person lol.


  23. Hmmmm…even if I could live longer on the CR diet, I’d never do it because I don’t like feeling hungry all the time. I think I’d enjoy life more (even if it was shorter if I could eat enough to feel full. I doubt you can achieve that on 1,000 calories. To me, it seems like the CR diet would just make you constantly cranky, and I would not want to live longer in that kind of state.


  24. Holly- control freak, right here. And when my eating was somewhat disordered, that’s definitely what it was about.

    Leigh Ann- thanks for the link!

    Cammy- it is, isn’t it? I really wonder about how easy it is to function energetically with such low amounts of calories…

    Burpexcuzme- you’re absolutely right. And that’s a scary thought.

    Tony- it’s rather concerning!

    RickiRae- I get cranky when I don’t get enough to eat, too. And eating is, well, enjoyable. Being hungry all the time really wouldn’t be.


  25. oh sagan! I was excitedly gathering my thoughts through your post and following comments by everyone.

    Eating disorders are clearly defined in the DSM-IV … This is the diagnostic statistical manual for psychological (mental) disoders. This is the only criteria that is capable for diagnosis of eating disorders and requires many criteria- frequency of habits, length of habits, cofounding habits, etc. For example, the term anorexia means “loss of appetite”. However, the definition of the eating disorder “Anorexia Nervosa” ( the nervosa is commonly dropped , causing confusion in definitions) is required to meet the criteria set in the DSM…. “persons restricting eating to maintaint a body weight less than 85% of appropriate body weight WITH an intense fear of gaining weight, denial of seriousness of low body weight….”

    Calorie restriction is just that, eating a certain amount of calories or rather limiting your intake. Calorie restrition with all of those other factors I listed in the quote above would classify as an eating disorder. There is a fine line and it could easily lead to irrational thoughts, leading to diagnosis of an ED .

    Binge eating is different, bulimia nervosa is different- there are other eating disorders that aren’t manifested with calorie restriction.

    My personal thoughts as a graduate student in Nutrition who has suffered and recovered from an eating disorder- I needed to be on a calorie restricted diet post eating disorder to help reduce the amount of binges that were leading to purges that were caused by larger issues. I also needed to work through those issues- but the calorie restriction was under the intent of sticking a regime that kept food as fuel- no emotional attachments- no abusing food to deal with something. That CR led me to binge-free days which allowed me to be capable of dealing with the mental aspect of the ED. After that, I could resume eating intuitively- however I felt was best to fuel my needs. I think calorie restriction long term could lead to malnutrition quite easily. Although, I think people need to pay attention to the bottom line that they don’t need that extra slice of cake, and they don’t need to eat a cheeseburger for lunch everyday.. etc.

    oh okay novel over.


  26. Excellent post, thank you!! Finding that line (dieting VS eating disorder) is so hard from what I’ve read in the comments here and on other posts. Having never had an eating disorder, I don’t have good enough insight to know what it must be like.

    Having said that, I am currently doing calorie restriction, along with specific food dieting and a wholatta exercising to lose 35lbs put on in the last 3 years (possibly as a reaction to quitting smoking).

    I’m only a few weeks into eating 1200 cal per day. So far, I haven’t seen a problem. I exercise 2 hrs a day, so I’m burning alota calories. I’m scheduled to do this til Oct, then, after having lost the weight, build modified habits to maintain what was a healthy weight 4 yrs ago.

    I feel we do need to be careful to set time limits & boundaries whenever we do any restrictive activity, also blogging helps, as we can track what we’re doing. That could help red-flag excessive behavior so it doesn’t become an ED.

    While I am amazed at how many calories I can burn without losing weight, taken as a short-term experiment, I think calorie restriction can be ok, if you’re healthy at the start. It is what is making a difference in my weight loss struggle…

    Great blog, by the way…



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