Eating: Everybody's An Expert

The American Psychiatric Association is reconsidering the category of Eating Disorder Not Otherwise Specified, which is diagnosed more often than anorexia or bulimia. Now if only they could do something about judgment.

Eating Disorder Not Otherwise Specified, or Ednos, includes any eating problem that negatively impacts the sufferer's life and isn't anorexia or bulimia: examples include binge eating, picky eating, and restricting food according to the day the way New York Times writer Abby Ellin did. She writes,

To maintain some semblance of control, I divided my eating into Food Days and Nonfood Days: that is, days when I consumed vast amounts, and days when I policed my caloric intake with military precision. The routine kept my weight in check, more or less. Never mind that it was insane.

Ellin says, "no one at my college health center knew what to do with me," and indeed, one of the biggest problems with Ednos is that it's so broad and poorly defined that doctors may not know how to treat it. Insurance policies often don't cover the disorder, so patients must pay out of pocket or convince their doctors to make a more financially advantageous diagnosis. And as Craig Johnson of the Laureate Psychiatric Clinic and Hospital says, "Because there are different presentations that not all clinicians are familiar with, there's a risk that people who have disordered eating who could benefit from clinical attention won't know that they have a problem."

The comments on Ellin's story, via the Times Well Blog, illustrate this risk handily. K in Colorado writes,

Could someone please explain which alternating Food/Non days is a disorder. If it helps one manage food, sounds just fine with me. It ain't gonna kill the patient!!!

And Michael concurs:

[I]f by insanity Abby means she has to endure a little anxiety about managing her food, that she has to think about it and plan it and make difficult choices and stick to a regimen, etc….if that's what she means by insanity, I say there's a better word for it. It's called a program. And any program for managing weight that really works and that keeps working will involve anxiety. [...]

I think it's fascinating that two of the three official eating disorders involve attempts, albeit ill-advised, to avoid obesity.

Maybe I'm missing something–and maybe they've already added a category, but why don't overweight and obesity and morbid obesity classify as eating disorders?

Once we name the attempt to cure the disease the disease, we make recovery more difficult than it already is.

Carrie of ED Bites points out that Ednos has a higher mortality rate than bulimia, and might indeed "kill the patient." But Michael's comment especially is also disturbing for its willingness to pass judgment on another person's eating habits — and to recommend "anxiety" as a cure for obesity. Turns out, Michael's not alone. According to a recent survey, 80% of Americans approve of their own eating habits, but 73% think others need to eat healthier. This should be no surprise to anyone who reads comments on stories about diet at the Times or elsewhere — the Internet is an especially popular forum for people who think they know what others need to do in order to avoid the specter of fat.

Brad Lamm, who helped design the survey, interprets it thus: "We need to help people connect the dots so they see their own poor eating habits and mindless eating, identify the causes, and address them with sustainable solutions." But maybe instead of trying to get people to judge themselves more harshly, we should try to teach them to stop judging others. It's no wonder that people with Ednos might feel they don't really have an eating disorder — there's always an armchair dietitian ready to endorse any eating "program" that staves off obesity. The idea that we should be anxious about what we put in our mouths is all too widespread, as is the idea that anything we do to stay thin is justified, as long as we're not losing our periods or our hair. Ednos sufferers may not experience these classic anorexia symptoms, but they're still in need of treatment — as is a society that thinks their behaviors are a healthy way to live.

Narrowing An Eating Disorder [NYT]
Most Unhappy With Eating Habits Of Others [UPI.com]
Redefining EDNOS [ED Bites]
When An Eating Disorder Has No Name [NYT Well Blog]