You are a counselor for those suffering from eating disorders. Today, you have two different group sessions: one consisting of clients with obesity issues, and one dealing with anorexia issues. So that the clients feel more comfortable, you would like to first start the session by explaining some of the physiological factors that cause people to eat or not eat. Then, you will open the floor for questions from the group.
Hello, my name is Coy Stoker. Today we will be talking about both obesity and anorexia nervosa. As we will see, obesity and anorexia are, figuratively speaking, different sides of the same coin. Furthermore, at the end of this session, we will all have a better understanding of one of the common factors in both obesity and anorexia, which is dieting. Joe Lewis (n.d.), the multi-billionaire, once said, “I went on a diet, swore off drinking and heavy eating, and in 14 days I lost two weeks” (p.1). This session will specifically cover the interplay between hunger and satiety, and genetics and the environment; and their collective influence on those who suffer from eating disorders.
First, I think it would be beneficial if I set up a framework of sorts from which the rest of the session can work within. Metabolism, in the human body, works in three stages: the cephalic phase, the absorptive phase, and the fasting phase (Pinel, 2007). As we progress through this session everything that is discussed should be seen in the context of these three phases. The first phase of metabolism is the cephalic phase. This section of human metabolism happens right before we eat and ends when our bodies start to actually absorb nutrients from the food we have eaten. Second is the absorptive phase, and much like its name the absorptive phase entails the absorption of energy and nutrients from the food we have eaten. Lastly is the fasting phase, which of course is the phase where we are not eating, and the body is using its stores of energy to meets its energy demands. It is in the context of these three stages for which the rest of our discussion will unfold.
Now that we have set up a foundation to work from let’s get started. A common misconception about hunger is that we eat when our stores of energy are depleted and that we stop eating when we have enough energy. The scientific term for this belief is the set-point theory. This theory has dominated the science of metabolism for the last half-century. However, as of late new discoveries have shown that this theory is lacking at best. It certainly does not explain the abundance of eating disorders in the United States. If we only ate when we needed food, then obesity would not be a problem; likewise, if we only ate when our bodies were depleted of energy then anorexia would not be such a problem. No, the truth is that a settling-point theory is more consistent with the evidence. The settling-point theory explains that metabolism in our body’s works more dynamically than statically; that our bodies adjust to our eating habits. Let’s go back to the first stage of metabolism. According to the set-point theory during the cephalic phase, we become hungry because energy is depleted from our bodies; however, this is far from the truth. In actuality, our bodies voluntarily rid the bloodstream of energy (glucose) in order to prepare for the forthcoming feast. In that case, we do not become hungry because we have insufficient energy but rather because our bodies know that we are about to eat. According to this evidence, hunger is more of a psychological matter, than a nutritional matter. Also, we do not stop eating because our stomach is full. In fact, we stop eating because of a complex interaction between hormones, such as serotonin and peptides, in the gastrointestinal tract. According to this evidence, the way to control eating is not through simply eating less for a short period of time, like dieting, but to change the way that we think about eating. Our bodies store 85% of our energy in the form of lipids or fats. Settling-point theory dictates that if we want to lose weight then we should lower our caloric intake as well as increase our activity level indefinitely. Furthermore, if we want to increase our weight, the settling-point theory says that we should increase our caloric intake as well as moderate our activity level. Simply increasing or decreasing our caloric intake is only a short-term solution to a long-term problem. The solution lies in understanding that our bodies work more like a river than a lake. We are not a body of water, figuratively speaking, that can be filled up or evaporate but always returns to the same level. On the other hand, we are more like a river, which can be raised or lowered depending on the amount of water (i.e. food) coming into it and the amount of water exiting it. Figuratively speaking, if we wanted to raise the water level of a river we would need to increase the amount of water going into the river and decrease the amount of water exiting the river. Conversely, if we wanted to lower the river we would need to simultaneously restrict the amount of water going into the river while at the same time allowing more of the water to exit the river. In this way, the river will settle in a new position, either higher or lower than before.
Now that we have a more clear understanding of how metabolism and hunger work in the human body let’s take some questions:
Lindsey asked: “My parents were both obese, is that why I am”?
Yes and no. According to several studies conducted on identical twins, obesity has both a genetic and an environmental component (Pinel, 2007). Sometimes obesity has more to do with eating patterns than genetics. The way that we were raised can affect the amount of food we eat and even how many times a day that we eat.
Robert asked: “My girlfriend and I eat together all of the time, so we eat the same food and amounts of food, but she never gains weight as I do. Why is that?”
Let’s go back to the analogy of the river. There are two components to the river. The first component has to do with the amount of water going into the river the second has to do with the amount of water coming out of the river. Now from what you are saying you both have the same amount of water coming into the river, but do you both have the same amount of water coming out of the river? Other factors can affect energy output though, such as non-exercise activity thermogenesis (NEAT). NEAT includes fidgeting and the maintenance of posture and muscle tone (Pinel, 2007). This can figuratively affect the amount of water flowing out of the river.
Nancy asked: “My mom says that I became anorexic because I’ve been reading too many Cosmo magazines and want to look like those girls. Maybe I did, but I really just don’t crave food. What do you think it is?”
Well, anorexia does have a psychological component; however, anorexia is more of a cyclical problem. The pattern is started by you, more often than not, by the belief that oneself is overweight, whether that is true or not. This leads to dieting which in turn lead to eating less and less food. Now because you are eating less, fatty meals begin to make you sick because you are not used to it. Then you begin to associate the sick stomachs with the big, high-fat meals. After a while, those types of meals can even make you throw up. At that point, figuratively speaking, there is very little going into your river even though the same amount is coming out. So to answer your question, social pressures do start you on the path of anorexia, but there is a whole lot more that goes into it.
Tyra asked: “I don’t eat because every time I do, I just feel sick! Do you know why this is?”
As stated in the above question, you become sick because you have begun to associate food with sickness. You are eating less now; therefore, when you eat big meals you become sick. As the process progresses you begin to associate food with sickness.
In conclusion, human metabolism is better understood in the context of a river rather than a lake. According to this belief, in order to change the level of the river both the intake and expenditure of water need to change. It is also important to realize that both obesity and anorexia is a product of the complex interaction of genetics and our environment, rather than one or the other.
Lewis, J.E. (n.d.). Retrieved June 18, 2008, from Quoteland Web site: http://www.quoteland.com/author.asp?AUTHOR_ID=2137
Pinel, J. P. J. (2007). Basics of biopsychology. Boston, MA: Allyn and Bacon.