DSM lists two principal “illnesses” under the heading Eating Disorders: anorexia nervosa and bulimia.
Anorexia Nervosa means chronic and pernicious fasting even though food is readily available. “Anorexia” is Greek for lack of appetite. “Nervosa” is Greek for nervous.
Bulimia means recurrent episodes of binge eating followed by self-induced vomiting or other methods of purging. “Bulimia” is Greek for “the hunger of an ox.”
Neither anorexia nor bulimia is an illness in any correct sense of the word. But my concern today is not with either of these issues, but rather with common, everyday overeating.
Many people are unaware that overeating is listed in the DSM, but if you go to the section headed Eating Disorder Not Otherwise Specified you will find the following:
“Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa”(DSM-IV-TR, p 595)
In other words: habitual overeating.
Elsewhere in the text (p 785) the APA offer more detailed criteria for further study, and it is likely that overeating will be included as a free-standing “diagnosis” in DSM 5. And that, of course, will be very good for business.
But regardless of what the APA claim, overeating is not an illness, although, of course, it causes a great many physical illnesses, including diabetes.
The human body is a biological machine, and like all machines, it needs a source of energy. And by energy, I mean movement and heat. Not “psychic” energy or “spiritual” energy or “cosmic” energy or whatever. Just plain old calories and watts. A car gets its energy from gasoline; people get their energy from food.
The human body needs the energy content of food to supply heat and movement. And movement includes not only walking around, but every kind of movement that occurs within the body: the beating of the heart, the movement of the lungs, the pulsing of nerves, etc., etc.. In order for any of these activities to take place, food has to be burned in the same way that the car burns gasoline. Biological burning is slower and cooler than automotive burning, but the process is essentially similar.
If you put more food into your body than you use, the body stores some of the excess as fat. This is an adaptive device that mammals developed millions of years ago, and it gave our ancestors a better chance of surviving food shortages. By overeating in times of plenty, they could – to some extent – live off their own fat through times of famine. Today, of course, at least in North America and Western Europe, the food supply is steady, and so we don’t have periods of famine. But the basic facts of physics and biology are the same: if you eat more than you use, some of the excess will be stored as fat.
We are creatures of habit. We tend to do the same things day after day – sometimes for years. My daily routine requires the expenditure of a certain quantity of energy – say 2000 calories. If I eat less than 2000 calories per day, then I will start to lose weight as my body consumes all my fat reserves. Then my body will start consuming muscle and other tissue in a desperate attempt to stay alive.
If I routinely eat more than 2000 calories, however, my body will store some of the excess as fat. So I go on with my daily routine – doing the same things I do every day, but – and this is critical – getting a little heavier every day. Now basic physics (and common sense) tells us that it takes more energy to move a heavier body than a lighter one. So even though I’m not doing anything extra in the way of exercises, etc., I am burning more calories simply because I’m getting heavier. Until finally equilibrium is reached in which my caloric intake is balanced by my output. The precise point at which this balance is reached, of course, varies from person to person. Some people will reach equilibrium at 200 pounds, others at 400 pounds. But the balance in all cases depends on two factors: habitual energy intake versus habitual energy output. And this is the key to understanding obesity.
Everything else is a side-show. Genetic pre-dispositions and metabolism rates are all interesting facets of the matter, but at the end of the day, if your intake exceeds your output, you will be gaining weight. And if you want to lose weight, you need to eat less and move around more.
So why don’t people just do this? Why is obesity such a problem? And the answer is simple – because it’s difficult. Food is so wonderful and we have such a variety readily available and such convenient methods of preparation, etc.. And moving around doing things is more difficult than sitting on the recliner watching a movie. I’ll discuss this further next post – but for now, back to DSM.
DSM AND OBESITY
As things stand today, overeating is already a “diagnosis” in the DSM. But it’s a concealed diagnosis. Its formal designation is: 307.50 Eating Disorder Not Otherwise Specified (binge eating disorder).
It also meets the APA’s definition of a mental disorder, which can be paraphrased as: any significant problem of human living. Well overeating is certainly a problem, and therefore there should be little difficulty making it a mental illness. But the APA recognizes the need to proceed cautiously in the business of re-defining ordinary human problems as so-called mental illnesses. If their claims seem too ridiculous, they will lose credibility, so there has to be a gradual process – a “softening-up” period so to speak – during which the public is introduced to the notion that what we had thought of as a normal human problem is really a mental illness.
In DSM-III (1987), overeating was not listed specifically. In DSM-IV (1994) it was sneaked in under the ever-elastic NOS category. And by DSM 5, I predict the process will be complete and habitual overeating will be a fully-fledged mental illness.
And this “diagnosis” is the mother-lode of all diagnoses. The psychiatrists are carefully and systematically engineering themselves to center stage in the war on fat. The answer, of course, will be to eat more pills, and the winners will be the pharmaceutical companies and, of course, the psychiatrists themselves.
More on overeating next post.