VIDEO
Weight, eating and feeling in anorexia
When my doctor weighs me during checkups, she refers to my body mass index instead of my weight. What is the difference?
Body mass index (BMI) is a measurement used by physicians and eating disorders professionals as an indicator of total body fat.
It does not measure body fat directly but has been found to correlate with other direct measures of body fat. It is used in conjunction with a thorough health screening and is often preferred over height/weight tables for determining a healthy weight range in adults. A person’s BMI is calculated using the following formula:
BMI = Weight (in pounds)
(Height in inches)² X 703
While individual variations do occur, the National Institutes of Health provides guidelines for a healthy BMI range. The ranges included apply to adults; the BMI measurement applies differently to children. With children, a BMI percentage for an individual child is compared to BMI measurements for children of the same age and gender. Generally, children with a BMI below the fifth percentile for age and gender are considered underweight. Readers can visit www.cdc.gov and click on “BMI Calculator” to calculate an adult’s or child’s BMI.
Body Mass – Index Guidelines
BMI -Weight Range
Below 18.5 – Underweight
18.5–24.9 – Normal
25.0–29.9 – Overweight
30.0 and Above – Obese
Limitations of BMI
BMI is a calculation based on weight and height and cannot provide any additional detail about body composition (e.g., percentage of body fat). BMI measurements do not distinguish between body fat mass and lean tissue mass, nor do they consider one’s frame size. Therefore, BMI calculations may be over-inflated in an athletic or very fit person due to a higher percentage of muscle mass. Likewise, a BMI calculation may not be as accurate for an elderly person with reduced bone density and muscle mass. Other factors such as ethnicity, pregnancy, adult age, gender, physical activity, and bone structure can produce variations in a BMI measurement.
What is the “set-point theory” of weight regulation?
Set-point is a concept that refers to a body’s natural weight range that is “set” by factors such as heredity, health, age, gender, body frame, and level of physical activity. Similar terms used include “settling point,” “natural weight,” and “regular weight.” These terms describe the weight range at which one’s body is the healthiest and is usually maintained by eating a normal amount of food and engaging in a normal, healthy amount of physical activity. For children and adolescents, set point is part of a normal pattern of genetically predetermined growth and development. Every person has a unique set point- not one number on the scale, but a range of weight that is within the body’s own natural equilibrium. As a helpful illustration, consider a thermostat. When a thermostat is set at a certain temperature, it will regulate heating and cooling systems in order to maintain the set temperature.
Likewise, our bodies have a certain weight “temperature” to which they will naturally gravitate. This temperature is unique to each individual. Some people may tend to gravitate toward the lower range of their set point, others toward the higher end. Fluctuating within this healthy weight range is normal. The human body will tend to resist changes in weight that go beyond set-point range. Thus, practically speaking, if a
person misses a meal during the day, the body responds with sensations of hunger in order to increase the desire to eat.
Likewise, if a person loses weight below their set-point range, the body compensates by reducing its metabolic rate in an attempt to return itself to a normal weight. Experts believe that set-point theory may explain why food binges often follow a period of caloric restriction: The body is attempting to ingest the nutrients and energy that it needs in order to maintain a healthy equilibrium.
Before my son developed anorexia, I thought it was only a problem for girls. What are some other myths about anorexia?
That is a great question because the misconceptions about this illness abound. What follows are some frequently voiced myths and misconceptions about anorexia, followed by facts that refute each myth.
Myth: People choose to have anorexia.
Fact: People do not choose to have anorexia. Anorexia, like other forms of eating disorders, is a serious illness.
Myth: Eating disorders are primarily about food and weight.
Fact: Anorexia and other eating disorders are not solely a problem with food. Behaviors such as food restriction, fasting, and purging are symptoms of underlying issues.
Myth: Individuals with anorexia are just trying to get attention.
Fact: People do not develop anorexia as a way to seek out attention. Although it is maladaptive, anorexia can sometimes serve as a person’s way to cope with something painful in his or her life.
Myth: Anorexia is about vanity. If a person with anorexia says, “I feel fat,” it is just to get compliments.
Fact: People with anorexia experience a real distortion in their body image. This is one of the symptoms of the illness. Often, a person with anorexia will view his or her body very differently than we view it. Described as looking in a “fun-house mirror,” the self-perceptions of people with anorexia are not an accurate reflection of their true body weight and shape.
Myth: Anorexia is a rich, young, white girls’ problem.
Fact: Research has shown that this is not true. A person with anorexia may be from any racial, ethnic, or economic background. Anorexia does not discriminate. It affects young and old, female and male.
Myth: People with anorexia do not engage in binge eating.
Fact: People with anorexia may sometimes engage in binge eating. Binge episodes are often followed by an attempt to purge what has been consumed through the use of laxatives, vomiting, or excessive exercise.
Myth: A person cannot have anorexia if they eat three meals a day.
Fact: Fasting is not the only means of food restriction. It may be that a person limits the types of food eaten or the amount of food eaten. For example, a person may eat a normal amount of food for several days and then follow this with severe calorie restriction. A related misconception is that people with anorexia do not eat junk food, only healthy food. This is not necessarily the case. In fact, people with anorexia may eat sugary foods in order to maintain their physical energy Myth: You cannot die from anorexia if you exercise to keep your heart and body strong.
Fact: People with anorexia may believe this myth in an attempt to convince themselves that their illness is not serious. Some believe that taking vitamin supplements will protect their bodies from the effects of malnutrition or that they will not face health risks if they avoid certain well-publicized eating disorder behaviors. Yet the medical complications of starvation and malnutrition are real.
Myth: If my loved one would just eat, she would be fine.
Fact: To be sure, returning to a normal weight is an important part of recovery from anorexia nervosa. However, just telling your loved one to eat more will not make anorexia go away. It is important that your loved one seek help for their eating disorder.
Myth: Someone is to blame for this eating disorder.
Fact: There are many different reasons why someone develops anorexia, and multiple risk factors have been identified. While trauma and other stressors can be a contributing factor, we now know that anorexia has a complex etiology. Fortunately, we are learning more and more about various biological, psychological, and sociological factors that contribute to the development of eating disorders.The more we know, the more we are able to provide effective treatment.
Myth: If I tell someone about my eating disorder, they will just try to make me fat.
Fact: Getting help is not about getting fat; it is about becoming healthy and getting your life back. It is common to feel nervous about beginning the recovery process, but do not let it keep you from getting help. Your doctor or therapist is not trying to take away your sense of control; they are trying to help empower you toward healing.
Myth: Anorexia is all about control.
Fact: There is some truth to this statement, but it is important to clear up any misconceptions surrounding the idea of control and eating disorders. A person with anorexia may feel that he or she has been unable to effect change in certain aspects of life or may feel unable to control the unfolding of certain life events. He or she may instead attempt to control food intake as a way of having mastery over one area of life. For some patients, anorexia serves as a complex distraction from other painful, seemingly unmanageable feelings or events. A person with an eating disorder does not know of another way to cope, but most would change this if they could. Part of the recovery process is acquiring other, healthier ways of coping with life’s challenges.
Myth: Anorexia is just a “phase.”
Fact: Anorexia is never normal behavior. It is an eating disorder that needs serious attention.
Myth: You can never recover from anorexia.
Fact: You can recover. Recovery can take time, but with the help of treatment, it is possible. It is important to seek help as soon as you suspect an eating disorder.
Myth: There is nothing I can do to make my loved one recover.
Fact: It is true that you cannot make your loved one recover. However, there are things that you can do to support your loved one’s recovery.
Lynn shares:
Another myth might be that “all people with anorexia eat very little, if any, food.” The diagnosis of anorexia in my case was missed because it appeared that I ate normally and seemed to function and perform well. As a distance runner, I even ate more than most people my age, consuming at least 2500 to 3000 calories per day. Even so, my exercise level was so extreme that I continually lost weight. Most people thought I was a big eater, but I was constantly ravenous because I wasn’t meeting my calorie needs, even with what might have looked like a lot of food. I was still deliberately restricting food intake so that I always remained in a negative calorie balance. I later learned how such intensive training and nutritional deprivation can be very dangerous.
People do not choose to have anorexia. Anorexia, like other forms of eating disorders, is a serious illness.
It is important that your loved one seek help for their eating disorder.
Terms:
Metabolic rate – The rate of energy production in the body.
Etiology – The cause or origin of a disease, condition, or illness.
