1 Apr 2004
Eating Disorders - to eat or not to eat?
We all eat, several times each day. Most of us do so without thinking about it: sometimes when we are hungry, sometimes when we are not! We don’t keep any particular watch or control over what we eat, and whilst we may sometimes feel we have overindulged a little, it does not cause us any distress. However, for millions of people in the Uk today, eating is not this simple. Instead, food, eating and their weight are subjects that fill their mind in every free second of their day. Panic and fear surrounds the act of eating, and they feel convinced they are hideously fat and disgusting. These issues around eating can dominate their lives, and for some may even become life threatening.
Section 1 - Defining The Problem
There are three main eating disorders recognized medically. The first of these, and often the most well known, is anorexia nervosa. Sufferers lose weight, and restrict their eating more and more until they become very thin. They cannot see how thin they are and can be fixated on what they see as fat on their bodies. Anorexia is a very dangerous illness because of this: sufferers can get so thin that they become seriously ill.
In contrast, those who suffer from bulimia nervosa are generally at or near normal weight. They share the feelings of repulsion about their own weight, and as a result aim to follow extremely strict diets. However, inevitably their control breaks down, and they then ‘binge’ eating large quantities of the foods that are otherwise ‘forbidden’ to them. During a binge they feel out of control and may eat food that does not belong to them, or even food that is not yet properly cooked or defrosted. After the binge, filled with fear and remorse, they try to ‘purge’ – that is to do something to try to stop themselves from putting on weight because of what they have eaten. Sometimes sufferers make themselves sick, or take large quantities of laxatives. Others may fast for days between binges, or force themselves to adhere to strict exercise regimes. These purging techniques can be dangerous and damage their physical health.
Binge eating disorder is very similar to Bulimia, except that sufferers have not developed this ‘purging’ behaviour. As a result they are generally overweight or obese.
Eating disorders are alarmingly common in today’s society, particularly in young people. Some studies show that as many as ¼ of some groups of teenagers or students may be struggling with disordered eating, and the Eating Disorders Association (EDA) estimate that at least 1.15 million people are suffering in the Uk. However, research shows that a very small percentage of sufferers ever get any treatment, and therefore it is hard to know just how many more people are suffering in silence. In addition to those suffering full-blown eating disorders, many people show signs of disordered eating and underlying insecurities and worries about their appearance. Often this is accepted as ‘normal’.
Studies show that alarming numbers of teenagers regularly use methods such as fasting for periods of time, making themselves sick or abusing laxatives or other drugs in order to control their weight. Many think that these practices are harmless and do not realise the risks they are taking. Eating disorders affect men as well as women, and around 10% of cases getting treatment are in men. Eating disorders also affect all ages. Anorexia now often begins in young teenagers, or even in children under ten. Bulimia and binge eating disorder tend to develop later, but because these illnesses can be so well hidden, it is not unusual to find people in adulthood who have been suffering for many years.
Section 2 - Overview of Causes
Eating disorders are very complex, and there is no one cause that can be blamed. However, here are some factors that can be involved:
“I get so low … I feel so bad, like I can’t move or anything I feel so sad. Then it just hits me. I’m so fat. Just so fat and disgusting. And everywhere I look is fat and I know I have to get rid of it.” Rachel, 32
Depression is often very closely linked with an eating disorder. The desire to lose weight, or feelings of being fat can strike when the sufferer is feeling low and depressed, and the disordered eating offers the only hope they can see of ever getting rid of the dark and bleak way they feel. Sufferers generally accept a lot of responsibility for things that are not be their fault. They blame themselves for the situations they find themselves in, and may try to be as perfect as they can for other people whilst feeling underneath that the ‘real’ them is someone who they must not allow to be seen. This makes their life very lonely and isolated. This, added to fear and anxiety, causes negative and critical thought patterns that make feelings of depression much worse. Once again, losing weight, or controlling eating becomes the only thing that offers any chance of feeling better. The sufferer can react impulsively, in a desperate attempt to do anything that might make them feel better. They feel at the mercy of their emotions, like a ship sailing on the ocean that can suddenly sail into a storm with no real prior warning. They do not understand where their low moods and anxious thoughts come from, and may not even recognise the emotions that underlie the way they feel or the things they do. They feel there is nothing they can do to help themselves when they do feel low, and that the only thing that might help is to lose weight.
‘People keep telling me how nice I am. But they don’t know what I’m really like. I know I should like myself but I don’t. I hate myself.’ Anna, 17
Low self-esteem is a common problem in young people in the 21st century, but for those with eating disorders it is overwhelming. These are people who very often cannot think of one single thing that is good about themselves and who generally feel it would be better if they did not exist. Self-esteem develops in childhood, when we live in a world that we believe to be entirely predictable and logical. This is important as it helps us feel safe and secure. However, it means that we follow very simple cause-effect rules. Children who face events, relationships or living conditions which are negative therefore can decide that they must be their own fault, because there is no other cause that can they understand. For most children a generally positive and loving environment balances these misunderstandings. However, if childhood is dominated by such messages, self-esteem can suffer. Even if home life is very positive and supportive, if there are messages that are very strong or repetitive, self-esteem can suffer. Low self-esteem can also develop in adulthood. Someone with previously good self-esteem can start to question their value because of traumatic, difficult or abusive situations at home or work. Constant stress can also have this effect, making people begin to question the things about themselves that they always thought were valuable.
“I guess it just makes me feel more pure” Jo, 24
For some there may be obvious trauma in their past which has contributed to the eating disorder. Those who have suffered sexual abuse, in particular, are at heightened risk of developing eating disorders. Other kinds of trauma, particularly those where there is a sense of a loss of control, can also be implicated. It is equally important to remember that not all who suffer have this kind of severe trauma in their lives as it is to remember that it is a possibility, even for someone where you think it unlikely (for example a child who’s family you know well).
- MEDIA EMPHASIS ON THINNESS
“My friends are always reading articles on how to have the perfect celebrity body. They’re not meant for kids our age, but we read them all anyway. If you want to look that good you have to make some sacrifices” Ali, 12
The pressures placed on children and young people regarding their weight and appearance are generally accepted to play some role in the development of these kinds of concerns. Certainly studies show that the impact of these pressures hits our children very young. Children as young as 5 know what dieting is, and are happy to suggest who might want to go on a diet when shown pictures. By the age of 6, many girls already feel that the ideal body shape would be one thinner than their own, and by the time they are teenagers, describe the ideal body shape as one which actually falls into the diagnostic criteria for anorexia. In a world where children and young people are placed under a lot of stress, some decide that they would feel better about themselves if only they were thinner. They look at the lives of the people they admire, and see just someone who is thinner than they feel. Being thin becomes linked with being happy in their minds, and the pursuit of this can become all-consuming. Not everyone who goes on a diet will develop an eating disorder, but severe and strict dieting, linked with another risk factor such as low self-esteem or depression, leaves you at a higher risk of developing an eating disorder. Over 70% of sufferers say that dieting or weight loss was the first step in their illness.
A special note on binge eating:
Binge eating is often triggered by feelings of depression, low self-worth and hopelessness. However, it is also maintained by the vicious cycle that sufferers find themselves in. Typically binge eating develops over a period of time, escalating from what might be called ‘normal’ episodes of overeating, to full-scale bingeing, which can involve consuming incredible quantities of food. It is the sufferer’s reaction to their bingeing: the fear and guilt and self-deprecation that follow that fuels this progression. Often a decision is made following a binge to ‘eat healthily’. However this generally involves very strict, low calorie, and unrealistic diets where foods are categorised strictly into those which are ‘good’ (salads, vegetables etc) or ‘bad’ (chocolate, cakes etc). The sufferer will aim to eat only ‘good’ foods. When this control invariably breaks down, the low calorie diet also fuels the urge to binge. During a binge, the sufferer may experience feelings of satisfaction and pleasure. However, the black thoughts soon return, combined with a sense of shame, fear and anger at themselves for what they have done. These thoughts and feelings can be very intense. If they go on to purge, this method is generally learned at some stage when, after a binge, feelings of desperation are so intense that they feel they have to do something to try to rid themselves of the food they have eaten. Once they find a method that ‘works’, it becomes part of the routine. This actually makes binges worse, as now there is something they can do to get rid of the food once they have eaten it. Binges may even become planned and they may buy food especially for this purpose.
Section 3 - What does the Bible have to say?
As Christians, we have a unique perspective that can help those suffering with eating disorders. We know that it was God who created our food, that it was Him who gave us all we have to eat (Gen 1:29, 9:3). We also know that God understands the way that deep distress can affect our eating. In psalm 102, the writer cries out to God: “My heart is blighted and withered like grass; I forget to eat my food. Because of my loud groaning I am reduced to skin and bones.” (Verses 4-5). Similarly, Psalm 107 talks of people who ‘loathed all food, and drew near the gates of death’ (v18).
The Bible has a lot to say about self-esteem. We know that our true self-esteem should come from who we were created as: children made in the image of God (Gen 1v26) Although we are far from perfect, we know that God looks at his creation and sees it is good (Psalm 8:3-8). Despite our failings, we are still loved by God for who we were made to be. Sometimes this can be hard to believe, particularly when we might feel aware of aspects of our personality that are far from ideal. However, we can be comforted that God made each of us very deliberately the way we were: good and bad (Psalm 139, particularly v13-16). The story of Ehud, in Judges 3 (v12-30) teaches us a very important lesson about this. In his time, being left-handed would have been seen as a real weakness and it is likely that Ehud had always looked at himself as having a particular ‘failing’. However, God had designed him this way deliberately and He did not see it as a weakness at all. In fact, it was a crucial part of His plan.
It is important however to recognise that some passages can be very difficult for someone with low self-esteem. Well-meaning sermons can lead these people into a spiral of despair and self-criticism. It is vital to remember this when working with a group where there may be people suffering in this way. Some passages in particular ask us to question our own actions and characters in a potentially critical way (e.g. Romans 12v3, Matthew 5v48, Col 3:7-9; 1Peter 2:1-2 etc). In doing so we strive to become as close as we can to the image of God. However, it is vital that this kind of soul-searching is done on a foundation of knowledge and security in the unconditional love and acceptance of God. We need to know that we are accepted and loved in spite of our imperfections. Focusing on this Biblical drive for perfection without looking at the teachings that show how loved we are causes many Christians to have ongoing problems with their self-esteem. But we are taught as Christians to ‘love your neighbour as yourself (Romans 13:9) and this means that it is essential that we do love ourselves, because otherwise we cannot offer real love and acceptance to others. This does not mean we should become arrogant or proud. We need to accept the way we are before we can learn to treat others the same way.
Section 4 - A Practical Response
As a leader, you may be the first person to find out about an eating problem. Or it may be that someone comes to you for advice and support about a problem that is already known about. Whatever the circumstances, you are in a position to be able to help them with this battle. What you say and do is critical, because if you get it wrong, it may be a long time before any other help is sought.
If you are working with young people, you are working with a group who are statistically at high risk of eating disorders. Be aware therefore that you may well have people in your group who are sufferers. Remember that often people who have lost a lot of weight will disguise it very well, wearing baggy clothes or lots of layers. You might notice some of the other signs first: how they are cold all the time, or how they look very pale and unhealthy. People who are making themselves sick might have sores on their hands, or might disappear to the toilets after eating. When you are working with teenagers, it can be very hard to work out if someone has a problem because so many of them are likely to be dieting, or appear obsessed with their weight and appearance. Look for signs that it is a more serious concern. Severe dieting can be identified by its inflexibility: someone who will not break their diet even for one evening, or who will never ever eat certain foods because they feel they are ‘bad’. You don’t need to be paranoid – but you do need to be aware.
If there are people in your group who you are worried about, then it may be a good idea to think about covering issues such as self-esteem with everyone. These are problems that affect all young people, not just those who have eating disorders. Therefore it can be very valuable to have some sessions looking at self-esteem, or how to deal with feelings of failure. Often these kinds of sessions can reveal problems if they are there, or give people the chance to ask for help if they need it.
The main thing to know is that for a sufferer, an eating disorder is like a battle where it can feel that everyone is against you. Remember that for them the eating disorder feels like the only thing that is keeping them going. It may seem obvious to you that in fact it is destroying them, but this is not how it feels to them. The most valuable thing you can do is to make it very clear that you are on their side. Often this means that it is easier not to mention the issue of food and eating, but instead to focus on how clearly unhappy they are. Encourage them that it is possible for them to recover from their eating disorder. Make sure that they know what this means too – recovery is not about being fat and miserable but about finally being happy with who you are and being able to live without constantly thinking about food, eating and your weight. ABC can provide testimonies from other people who have recovered fully from their own eating disorder, or link someone currently suffering with a friend who has been there and recovered.
If you know someone who is suffering with an eating disorder, it is important that their GP is aware of the problem. This is particularly crucial for younger teenagers, if there has been weight loss, or if they are making themselves sick or abusing tablets such as laxatives, diet pills etc. These things can make someone physically very ill when outwardly they seem fine, and it is really important therefore that they see a doctor. Make sure that the sufferer is receiving some expert support. Eating disorders are serious conditions that need experienced treatment. Praying with someone, and encouraging them is great, and don’t be afraid of doing this, but it cannot replace proper treatment. Get advice and find out how you can help the sufferer best. If this is a problem that you come across frequently then think about getting some training in how to deal with it effectively. Finally, make sure you get some support as well. Eating disorders are truly evil illnesses and you are likely to find that upsetting and stressful at times. You will need someone you can talk to and get support from. Don’t feel guilty about needing this: it will make you much more able to give the sufferer the care they need.
Eating disorders can be terrifying, particularly if you find out about them by mistake. Some of the things people do when they get this desperate are upsetting and really alarming. Often the media portrays people with eating disorders in a very negative way, as people who will always be controlled by this illness. So your first reaction on finding out that someone you know is suffering may be panic. Remember that you don’t have to react straight away. Take some time to think about how you are going to approach the situation and to get some advice and information. Remember that it is possible to recover from eating disorders and that every step forward, no matter how small it may seem to you, is a step along the road to recovery.
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