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Companion Guide for A Season in Hell

QUESTION 11: ISN'T OBESITY AN "EATING DISORDER?"

Many people, professionals included, assume that people become and remain significantly overweight (obese) because they are unable to control how much they eat. Thus, they take in many more calories than they expend. This commonly help belief assumes that obesity is the prototypical "eating disorder" because obese persons "compulsively overeat" in response not only to hunger but also to anxiety and stress. According to this model, obese persons have passive, dependent personalities which render them unable to cope with life's challenges the impulsive abuse of food as an emotional anesthetic.

Recent reviews of the research literature addressing obesity indicate that this theory is a pernicious oversimplification which feeds the "weightism" discussed earlier. As Dr. Judith Rodin of Yale University has written, "obesity is determined by a great number of factors other than food intake alone. A complex interaction among genetic, physiological, and behavioral variables affects both the development and maintenance of the obese condition . . . We do know, however, that obese people are not simply people who cannot control their eating, and that restricting food intake may not, by itself, be the most effective form of treatment."

This topic is too complex to do it justice in this guide. Students or other skeptical viewers of A Season in Hell should be encouraged to do their own research. There are very few "facts" free from controversy in this area, but the following suggest that most instances of obesity are not "eating disorders":

(1) Approximately 1 in 5 obese people meet criteria for bulimia which are less rigorous than those listed earlier in this guide. Thus, although the rate of bulimia is probably higher among obese people than the general population, obese people are not, as some people believe, "bulimics who don't purge."

(2) Obese people in the general population are no more neurotic or emotionally disturbed than normal-weight people. The psychological disturbances of obese people who present for treatment are usually a function of the discrimination which they have endured.

(3) Comparisons of obese and normal-weight children with respect to their ability to delay gratification have produced inconsistent results. Similar inconsistency is found in studies comparing obese and normal-weight adults on their belief in an ability to control their own lives.

(4) In our culture many obese people are chronic dieters who have experienced marked and rapid fluctuations in weight. It will be recalled that the attitude of restraint which accompanies chronic dieting increases the probability of binge-eating by promoting dichotomous thinking (on my diet vs. out of control).

(5) Studies of amounts eaten in real-life settings by obese and normal-weight people are inconclusive: Some find that obese people eat more, whereas other studies find no differences. Laboratory studies are also inconsistent, although they tend more often to find no difference. There is no good evidence that obese persons eat more rapidly or voraciously.

(6) Obese people tend to eat more when food tastes better. Research does support the casual observation that many obese people have a strong preference for sweet-tasting, fat-dense foods. Although this preference is attributable in part to their status as dieters, there is a good chance that genetics and early learning experiences play an important role. Thus, food preferences and food availability may contribute to obesity.

(7) Research strongly supports the proposition that, as predicted by the set-point theory, body weight in general and obesity in particular has a genetic component. The nature of the processes affected by the genetic risk for obesity is unknown. It might be a tendency to low basal metabolism, which results in a more efficient mechanism for storing fat.

(8) The genetic component might also be the demonstrated tendency of obese people to become easily aroused and hyperesponsive in the presence of external stimuli such as good-tasting, good-smelling food. Heightened responsivity is an important area of future research because it could lead to conditioned increases in insulin production in response to food. This conditioning would increase hunger, the perceived pleasantness of sweet taste, and food intake. The food-arousal-insulin connection might then generalize to make other arousing events (e.g., stress) cues for hunger. If genetically vulnerable children grow up in family where food is plentiful, visible, accessible, and charged with emotional importance, the result may well be obesity.