You've read the headlines. You know the statistics. Obesity is epidemic in our culture. American children are the fattest on earth, and the Chinese are now not far behind. Explanations for this have primarily centered around the notion that our nation's longstanding economic success (and now China's emerging success) has resulted in a shift in our culture from frugality and hard work to overindulgence and sloth. In addition, this overindulgence and sloth has been coupled with the consumption of cheap, high fat foods that are addictive and have poor nutritional value. There is no doubt that these behavioral factors and food choices contribute significantly to this epidemic of obesity. However, these sociocultural and economic factors alone cannot explain this phenomenon.
The truth is that obesity often results from an eating disorder in the individual. Despite protestations to the contrary by some, it is virtually impossible to become morbidly obese without overconsumption. A person with compulsive overeating, or binge eating disorder, typically presents as preoccupied by food and frequently engages (sometimes secretly) in episodes of uncontrolled eating, or bingeing, during which she or he may feel frenzied or out of control. At these times, the person consumes food past the point of being comfortably full. These compulsive overeaters will even typically eat when they are not hungry. They often have feelings of guilt and shame after binge eating and they often binge eat alone.
In addition to binge eating, compulsive overeaters can also engage in 'grazing' behavior, during which they return to pick at food throughout the day. This results in a large overall number of calories consumed, even if the quantities eaten at any one time may be small.
Recent taxonomy has sought to distinguish between the diagnoses of compulsive overeating disorder and binge eating disorder. When a compulsive eater overeats primarily through bingeing, he or she is said to have a binge eating disorder. Where there is continuous overeating and grazing, but no bingeing, then the person is said to have a compulsive overeating disorder.
One patient who struggled with a binge eating disorder recently described her obsession with food and the excessive amounts of time and thought she devoted to food. Often, she would secretly plan or fantasize about eating alone where she would prepare what she described as a "feast." For her, eating was an opportunity to indulge in her deepest pleasure, to be a "baby queen" where every desire could be indulged without limit. She remarked, "I can go home and spend hours and hours preparing the most elaborate meal. It is grand. And then I spend several more hours eating it. I almost start to panic when I see that it is going to end. I just don't want it to end. I always want to feel that there is going to be more for me, like I'm never going to run out."
Of course, there may be genetic factors which contribute to a person's predisposition towards obesity. However, the above description reveals important psychological factors that can often contribute to these eating disorders. They include significant feelings of deprivation, significant feelings of envy and entitlement and the significant use of denial.
The significant feelings of deprivation emanate from early life. The child's enormous feelings of emptiness and longing, resulting from some emotional deprivation or trauma, become converted into an enormous appetite, needing to be filled up. There is often little consciousness of the true nature of the relationship between the person's compulsive overeating and any emotional struggle.
Significant feelings of envy and entitlement also emanate from this feeling of deprivation. The person longs for comfort and satisfaction and comes to feel that she or he deserves to indulge in order to feel good, to satisfy him or herself, to be rewarded. After all, should she not have what she wants? Why should he have to say no, or not have the desert he loves, or stop eating if it makes him feel good? Why should she have to be without? Entitlement may seem to be in contradiction to the low self-esteem often observed in the obese compulsive overeater, but it, in fact, consistent with it and results from unmet primary needs.
The significant use of denial is reflected in the failure often to acknowledge the amount of the overconsumption or the impact of it. In the moments of overindulgence, the person denies that she or he is taking more than they should. "I don't really eat that much", one 350lbs patient would frequently exclaim. Additionally, there is a denial of the limits and the boundaries of the consumption and of the body. There is also a denial of the absence of control that the person is exercising over their food.
Sometimes, of course, obesity and compulsive overeating are the sequelae of childhood abuse or neglect. In particular, emotional neglect and childhood sexual abuse have often been linked to these difficulties. Not everyone who is obese and compulsively overeats has been sexually abused, or not everyone who has been sexually abused will be obese and compulsively overeat. However, for those with the two co-exist, the obesity and overeating serve as an ineffective attempt to manage the emotional dysregulation caused by the abuse. Food is used to nurture, soothe and calm the chronic anxious feelings that ensue from childhood abuse or neglect. The obesity can sometimes serve as an unconscious attempt to create a sense of being held or a physical barrier between self and others; a soft envelope or a protective wall of fat, if you will.
There are many who treat obesity and compulsive overeating like an addiction, utilizing a medical model of disease. They see the compulsive overeater as being driven merely by her or his disturbed brain chemistry. This disturbed brain chemistry results in a dysregulation of the person's consumption. While there may be real clinical evidence of a biochemical component to the compulsivity seen in eating disorders, to ignore the psychological underpinnings of this illness is to suggest that the person is merely the victim of their bad chemistry, with little or no responsibility for or capacity to make choices about their behavior. "I'm an addict, I can't stop myself" one patient would often repeat, in explaining why she could not be responsible for having eaten nearly two dozen Krispy Kreme doughnuts.
Dieting is often unsuccessful for the compulsive overeater as feelings of deprivation are often activated by the restriction inherent in dieting. This then eventually fuels greater need for gratification, often leading to a binge episode. Appropriate treatment for obesity and compulsive overeating should include both attention to the biochemical components driving the compulsive behaviors, as well as attention to the psychological factors which contribute to the person's denial and feelings of deprivation, envy and entitlement.