Questions & Answers

Q : WHAT IS THE DIFFERENCE BETWEEN AN EATING DISORDER AND DISORDERED EATING?
A: An eating disorder is a medical diagnosis with set criteria (i.e. anorexia is defined by weighing less than 85 percent of normal body weight and losing menstrual periods for three consecutive months). Disordered eating covers a range of behaviors from dieting, bingeing, and purging to extreme portion control and chewing and spitting out food. These behaviors can be part of eating disorders but alone are not sufficient to create a diagnosable eating disorder.
Q: WHAT IS BINGEING AND BINGE EATING DISORDER?
A: Technically, a binge is “eating within about two hours, an amount of food that is definitely larger than most people would eat. For some people that’s 2,000 calories in a sitting. For others, as many as 10,000.
The kind of food doesn’t matter. The big factor is the feeling – “out of control” to stop and maybe even “out of body.” Binge eating disorder occurs when individuals binge regularly. It is a lifestyle wrought with shame that involves a constellation of behaviors such as eating in secret, foregoing social situations to stay at home, and compulsive eating to deal with uncomfortable emotions.
Q: WHAT IS THE DIFFERENCE BETWEEN HEALTHY EXERCISE AND COMPULSIVE EXERCISE?
A: Both frequency and motivation help make this distinction. Compulsive exercise involves working out every day, even when sick, injured, or exhausted. An individual who obsessively strives for the “high” to cover up stress or emotional issues might also be in trouble. Exercise is, indeed, healthy when done in moderation. But when overdone or performed compulsively, the “high” of exercise and the weight loss are self-reinforcing. The addiction to the exercise can be a gateway to the addiction of the eating disorder.
Q: WHY IS IT IMPORTANT TO EXAMINE EATING DISORDERS THROUGH STAGES OF LIFE: MARRIAGE, PREGNANCY, PARENTING, MID AND LATE LIFE?
A: Transitions are stressful. And eating disorders are attempts to cope with overwhelming stress. At the same tine, eating disorders ebb and flow over time based on how much stress a woman is feeling at any particular time in her life. Understanding the context of the eating disorder—the why now?—could do so much to help with healing. And how we treat a 19 year-old with anorexia should be very different from how we treat at 90-year-old with the same symptoms.
Q: WHAT ABOUT THE MEN? DO MEN GET EATING DISORDERS?
A: Of course they do. Men make up about 10 percent of anorexia and bulimia cases. More shocking, 2.8 million U.S. men (2 percent of the total population) have binge eating disorder, which usually leads to obesity.

But since most eating disorders happen to women, in Lying in Weight, I framed the question differently. What about the men who partner with women who have eating disorders? Who marries a woman weighing 85 or 385 pounds, or a woman who vomits after dinner every night? If we think of it that way, the emphasis shifts toward relationships and how the eating disorder plays out in couples.

Q: HOW DOES AN EATING DISORDER AFFECT PREGNANCY?
A: Not very well. Studies of pregnant women with eating disorders show that dieting, bingeing and purging all cause medical complications. Also, anorexia, bulimia and binge eating disorders are each linked to infertility. But, ironically, if you flip the question and ask, “What might pregnancy do to an eating disorder?” the answer is that pregnancy can be an oasis from the eating disorder. Studies show the majority of women with eating problems either cut down or stop their bad behaviors when pregnant. One reason is that what a woman cannot do for herself, she can do for her baby.
Q: IF A MOTHER HAS AN EATING DISORDER, WILL HER CHILD GET ONE TOO?
A: Studies show eating disorders run in families. But before making any assumptions, we have to ask: “Exactly what is being passed down and around?” The answer is a combination of bad genes, habits, and attitudes. So a child might inherit a predisposition. An anxious temperament. This kind of child grows up in a world obsessed with childhood fat and comes of age in a household where mom is overfocused on her body. That’s an eating disorder waiting to happen. Psychologist Cindy Bulik, when she was president of the Association for Eating Disorders, put it this way: “Genes load the gun. Environment pulls the trigger.”
Q: WHERE DO WE GO FROM HERE? HOW DO WOMEN IMPROVE THEIR RELATIONSHIPS WITH FOOD AND AVOID THE SOCIETAL PRESSURE TO BE SIZE 2?
A: There is no cure for eating disorders, no magic bullets, and no one-size-fits-all treatment. Every woman is unique and so is her problem with food and body image. Therefore, she has to find her unique approach to healing. Right now there is a mix of traditional psychotherapy and medication to treat eating problems. I also found some new alternatives and adjuncts, from the internet to biofeedback to yoga. But the commonality among all women who were on their way toward recovery was discovery. Discovering themselves through poetry, writing, painting, public speaking, fundraising, and even advocacy. Personally, I found my voice in writing Lying in Weight. I learned that I am indeed not alone in feeling that I carry a remnant of my anorexia and that there is strength and healing in sharing our stories with our own voices.