The purpose of this paper is to compare the causes and consequences of obesity and eating disorders in the research articles found in the literature. In particular, the biopsychosocial reasons for obesity and eating disorders are explored, and the consequences of obesity or eating disorders from a biopsychosocial perspective are addressed. Whether the result is overeating and obesity or lack of eating and anorexia, the problems of eating disorders appear rooted in the social and psychological despite the biological and physical consequences. A recent intervention for both groups are explored, and an explanation as to how successful it has been and how it might be improved from a biopsychosocial perspective will also be given. Positive and negative aspects regarding the research are also stated.
Eating pathology, emotion regulation, and emotional overeating
A 2013 study carried out by Gianini and colleagues analyzed whether difficulties with emotional regulation made a substantial impact on general eating disorder pathology and emotional overeating. Before the treatment, the subjects filled in the Beck Depression Inventory, the Eating Disorder Examination-Questionnaire, and the Emotional Overeating Questionnaire. The results showed that problems with emotional regulation were due to a specific discrepancy in general eating pathology and emotional overeating, when taking into account negative affect and sex. The authors hypothesized that the specific variance in the pathology of general eating disorders and emotional overeating were difficulties with emotional regulation. The emotions which triggered this were psychological, often with a social basis, however the result, the act of eating and the possible consequence of obesity, is physical. They also endeavored to uncover the particular forms of emotional regulation difficulties which could clearly account for the discrepancy between these outcome variables were taken at the same point in time (Gianini et al., 2003).
The results of the study showed that deficiency in emotional clarity hampered access to strategies for emotional regulation, and this was responsible for the emotional regulation problems connected to emotional overeating. The results also indicated that when obese people who have binge eating disorder suffer negative emotions, they may not have the necessary strategies to manage their emotions; alternatively, the strategies to deal with these emotions may not be efficient or useful (Gianini et al., 2003). Clearly, difficulty with self-regulation of the psychological and social aspects had physical results as these individuals were more likely to overeat.
Limitations to this study included a 28 day retrospective recall of emotional eating, which could have led to inaccuracies regarding the times of emotions, and whether these were prior to, during or after overeating. Also, the temporary precedence of the variables within the tested models was not established due to the fact that all of them were taken at the same point in time (Gianini et al., 2003). Both of these factors could result in a negative impact on the value and strength of the research.
Mortality in eating disorders
In a 2013 study carried out by Suokas et al., the authors worked to accrue more information regarding the outcomes of binge eating disorder and anorexia nervosa by looking at the mortality of adults who were sent to the Helsinki University Central Hospital’s eating disorder clinic between 1995 and 2010. The figures showed that the broad anorexia nervosa mortality risk was at its highest after admission over 12 months before, but decreased after that time. And that the broad BN mortality risk began to increase 24 months from the first admission. The hazard ratio for suicide was raised both in broad bulimia nervosa and anorexia nervosa. The study also indicated that eating disorders are connected to a raised mortality, regardless of whether suitable treatment is accessible. That mortality is high for people suffering from all eating disorders (Suokas et al., 2013). The strength of this study lies in the fact that it was carried out over a period of 15 years providing longitudinal evidence. The biopsychosocial nature of the disease requires attention to each of these three domains in order to reduce the risk, however prevention and treatment continue to focus on the feeding or physical intake of food rather than social or psychological needs.
Stress response and binge eating disorder
In this short paper Gluck notes that stress is reported by obese patients as a major cause of binge eating. From a biopsychosocial perspective, the biological mechanics are still not well understood. The objective of the author is to offer a theoretical summary of the ways in which a primary constituent of the stress response, cortisol, might have a function in binge eating. In the review, the author points to the fact that although the content of the macronutrients seem to be more evident in all the subjects that have a stress response, personal ratings towards binge eating and hunger are different between people who have and do not have an eating pathology.
Compared to the biological factors in disordered eating, human psychological causes have been studied more broadly. The major remaining restriction is that only a small number of studies combine both physiological and behaviorless-induced eating models (Gluck 2006). One limitation in this study relates to a number of the relationships which could be caused by restricted dieting and eating, as opposed to eating pathology differences. Also, in order to generate stress in the laboratory, researchers utilize a number of approaches, thus it is not easy to make a comparison of the different study results. Furthermore, there are no naturalistic approaches. These are all factors that weaken the value and strength of the research (Gluck 2006).
Reductionism in Eating Disorder Research and Theory
This article gives evidence regarding an alarming and dramatic research trend which favors brain disorder as opposed to biopsychosocial hypothesizes. From 114 trials for people with bulimia nervosa or anorexia nervosa, less than 5% of trials used a biopsychosocial formulation for understanding eating disorders (Harris & Steele 2014). Over the past ten years, the National Health Institute financing trends display a worrying reduction in the studies that incorporate the components of both the mind and brain. The highest financed studies have been on the brain, and the trend is continuing to rise, whereas the biopsychosocial and mind studies began as the worst financed studies and have gone down since 2006. By 2012, financing for biopsychosocially formulated research almost disappeared (Harris & Steele, 2014). Clearly, this is an extremely detrimental aspect that affects research into the biopsychosocial aspects of eating disorders, and in order to improve the biopsychosocial aspects, more funding is required.
Core interventions in the treatment and management of eating disorders
Anorexia nervosa patients should be given psychological treatment, and generally be treated on an outpatient basis. If patients need treatment in a medical facility, they should have psychosocial interventions and a re-feeding procedure which is closely monitored by a physician. Adolescents and children should be helped by family interventions (NICE, 2004). With regard to bulimia nervosa and binge eating disorder, cognitive behavior therapy should be undertaken that has been especially adapted, with attention to whether the patient is an adult or adolescent. The program lasts for four to five months, and involves between 16 and 20 appointments. In addition to this, in the case of eating disorders, all members of the family are advised to take part in the treatment of adolescents and children. Interventions could involve: facilitating communication, behavioral management advice, and sharing information (NICE, 2004). Treatment tends to target social and psychological issues in order to manage the biological consequences of the starvation faced by anorexics.
Sex differences in biopsychosocial correlates of binge eating disorder
In this study, Udo and colleagues investigated sex differences in regard to binge eating disorder and psychosocial and behavioral connections in primary care obese patients. It appeared that obesity-related metabolic problems seemed to be more prevalent amongst men seeking treatment for binge eating disorder in comparison to women in the same situation. A worthwhile opportunity may be possible in a primary care setting, where interventions could be implemented, or referrals could be given by specialists to mitigate obese patients suffering with binge eating disorder. One negative aspect to this study is the fact that there were no obese individuals who did not have binge eating disorder included as participants (Udo et al., 2013). It appears that with regard to binge eating and gender there is a difference and variation in the source of the issue, that being biological in men and emotional or psychosocial in women.
In summary, it has been indicated that when emotional clarity is not at its optimum, access to strategies for emotional regulation and emotional overeating can be impacted. In addition, due to negative emotions, obese people with binge eating disorder may not have the necessary strategies to deal with their emotions, or the strategies may not help. Also, that mortality is elevated for people suffering from all eating disorders, but mitigation of the risk focuses only on the biological component. Furthermore, when compared to the biological factors in eating disorders, human psychological causes have been researched more widely. In addition, there are only a small number of studies which combine physiological and behavior induced eating models. Studies on the brain have been receiving the greatest financial help, whereas biopsychosocial formulated research has almost disappeared. There are a number of core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders, as recommended by the NICE guidelines. There is a woeful lack of a biopsychosocial perspective in many studies due to a policy of reductionism.
- Gianini, L. M., White, M. A., & Masheb, R. M. (2013). Eating pathology, emotion regulation, and emotional overeating in obese adults with binge eating disorder. Eating behaviors, 14(3), 309-313.
- Gluck, M. E. (2006). Stress response and binge eating disorder. Appetite, 46(1), 26-30
- Harris, J., & Steele, A. M. (2014). Have we lost our minds? The siren song of reductionism in eating disorder research and theory. Eating disorders, 22(1), 87-95.
- National Institute for Clinical Excellence (NICE). (2004). Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Clinical guideline, 9.
- Suokas, J. T., Suvisaari, J. M., Gissler, M., Löfman, R., Linna, M. S., Raevuori, A., & Haukka, J. (2013). Mortality in eating disorders: A follow-up study of adult eating disorder patients treated in tertiary care, 1995–2010. Psychiatry research, 210(3), 1101-1106.