disorderly eating

by Jenny Bryan

'I'd stuff my face one day and then starve the next. It was stupid. Whatever size I was I went through the same pain. I'm pleased with the way I look now and I've finished with dieting. I just eat sensibly, three meals a day. But who knows, tomorrow I might start bingeing again and put on a stone.' Geri Halliwell in a recent TV interview.

image to accompany feature
© Getty

Geri Halliwell, Jane Fonda and Uma Thurman are just three of the high profile names who have recently come clean about their eating disorders. Others continue to deny they have a problem as, week by week, they seem to disappear before our eyes on our TV screens and in our newspapers.

a historical obsession

Eating disorders are undoubtedly on the increase, but Professor Arthur Crisp who has worked in the area for over 40 years explains that they've probably been around as long as men and women have put food in their mouths.

'There are time honoured concerns about food and shape, and they aren't just driven by the fashion industry,' he says. 'But today, food is over-plentiful and reinforced by fast food chains which are ruthlessly commercial in pressing food on us,' he adds.

At least 60,000 people in the UK have been diagnosed with an eating disorder. But over one million more are starving, bingeing or vomiting themselves into a lifetime of poor health and probably an early grave. Genes, parents, fashion icons, school bullying, low self esteem – they've all been blamed for the rising numbers of people who cannot control their eating habits.

'Anorexia has always been present, but bulimia is a much more recent phenomenon which is reaching epidemic proportions. Bulimia erupted in the late 60s and 70s with the social revolutions of the time. People were shaking off the traditional oppressions and that was very liberating. But it spilt over into binge eating, loss of control, obsession with shape and the need to diet,' recalls Professor Crisp.

typical signs of anorexia and bulimia

Anorexia	Bulimia
weight loss excessive exercising moodiness fear of gaining weight and distorted self image obsessive interest in calorie content of food feeling cold periods stop (amenorrhoea)	vomiting after meals eating huge amounts of food in a short period of time feeling out of control, helpless and lonely sore throat, erosion of tooth enamel due to vomiting excessive use of laxatives, diuretics or enemas frequent weight changes dehydration, poor skin condition lethargy

Just when fast food and lack of exercise were resulting in children and young women becoming heavier, so the pressure from the high street and the TV screen to be thin was becoming irresistible. Compare the 22-26% body fat of an average, healthy woman with the 10-15% body fat of many of today's models and actresses.

changing trends

Professor Hubert Lacey, from St George's Hospital, London, explains that, although people with anorexia have traditionally become very thin by intensive dieting, this is changing.

'About 60% now use a pattern of bingeing and vomiting to maintain their low weight and only 40% stick with the more conventional restrictive eating pattern,' he says.

Eating disorders in general are being amalgamated into a broader category of ill health which includes alcohol abuse, self mutilation and other harmful behaviour.

Although the spotlight is on people who weigh in at the extreme ends of the scales, Dr Andrew Hill, chairman of the Association for the Study of Obesity, argues that most of us do still fall within the normal spectrum:

'Shape and weight as a nation haven't fundamentally changed. We are seeing changes at the top end of the distribution curve, so more people are over the level which we call obese. But we are not getting many more people at the extreme of underweight. Instead, we are recognising an increase in eating disorders which can happen at any weight,' he explains.

riding the rollercoaster

Some people seem to ride a rollercoaster of dieting and binging which takes them back and forth between being underweight and obese. Unable to maintain a balanced, healthy way of eating they develop a self-destructive obsession with food – in turn, avoiding and embracing it.

Easy availability of food has meant a shift in eating patterns from an orderly three meals a day, with a relatively finite calorie intake, to almost continual grazing, with an open ended calorie content. With this gradual increase in energy intake, there has been no accompanying rise in energy expenditure – rather the reverse.

'Physical activity is no longer part of people's working days. We work behind desks, use labour saving devices and live in nice heated houses so we don't need to use energy reserves to keep warm,' Dr Hill points out. He's not advocating a return to a Victorian diet and living conditions, just a greater emphasis on balancing the energy books, increasing expenditure as much as decreasing input, and trying to focus more on a body weight that is medically rather than aesthetically desirable:

'Aesthetically ideal body weight is much lower than medically ideal body weight. But the medical ideal is much easier to achieve. The rebound effects of massive weight loss are legendary, yet the health improvement from relatively small weight loss is clear. What matters is feeling in control of your eating and feeling good about yourself.'