The Link Between Obesity and Eating Disorders

A significant number of sufferers of bulimia or binge eating disorder are obese. However, losing weight isn't necessarily the most important strategy. In fact, a psychological approach is often needed in the face of these increasingly frequent serious realities.

Written and verified by the psychologist Valeria Sabater.

Last update: 30 April, 2023

There’s one reality that continually repeats itself. It’s the fact that the treatment of obesity is, as a rule, addressed via medicine and nutrition specialists. However, it’s not common for psychologists or psychiatrists to be consulted. In fact, obesity tends to be associated with genetic factors, diseases, and/or unhealthy eating habits.

Yet, experts in eating disorders (ED) know that obesity can be the prelude to multiple mental health problems. Indeed, it’s increasingly seen in adolescents and young adults. The most common disorders in this population group are bulimia and binge eating disorder.

Although it’s clear that obesity is a public health problem, we should always address it in a multifactorial manner. Therefore, an approach based on improving nutrition or introducing sport into the daily routine isn’t enough. Psychology makes it possible to prevent, understand, and treat the condition more effectively.

The link between obesity and eating disorders

When we mention eating disorders, we have a tendency to visualize a young girl with anorexia nervosa. Indeed, there’s an unconscious bias to associate this whole set of psychological conditions with that single condition and an image of extreme feminine thinness.

However, this type of disorder integrates a wide combination of conditions. Moreover, eating disorders affect a wide spectrum of patients. In fact, they’re one of the most complex clinical realities. Furthermore, they’re the kinds that are shrouded in stigma and social ignorance.

Scientific literature supports a link between obesity and eating disorders. In this relationship, there are multiple variables. The most significant is a family environment focused on concerns about a child’s weight. In this case, the child develops, from early on, the kind of body dissatisfaction that increases over time.

How does the link arise?

We know that childhood or parental obesity increases the risk of bulimia nervosa or binge eating disorder in the child. But, anorexia nervosa doesn’t usually present with this profile. In this case, excessive intake is associated with emotional factors and subsequent purgative behavior. The sufferer experiences discomfort with their own image. In addition, social and family pressure orchestrate the following mechanisms:

• Anxiety and accumulated emotions cause the sufferer to drift into patterns of binge eating. They eat excessively without experiencing physiological hunger. This behavior creates feelings of shame and leads to weight gain.
• In turn, the weight gain encourages them, at some point, to opt for strict diets and purgative behaviors. For instance, vomiting, diuretics, use of laxatives, etc. These actions configure bulimia nervosa.

The University of Sydney (Australia) conducted a study that highlights how, over time, obesity and eating disorders have a great impact on sufferers’ physical and mental health.

The consequences on the sufferer’s health

When a sufferer of obesity exhibits a binge eating disorder or bulimia nervosa, they frequently suffer, at some point, a metabolic syndrome or resistance to insulin. Furthermore, their risk of medical and health complications increases. This can appear, for example, in the form of hypertension, heart problems, diabetes, and dyslipidemia.

Moreover, sufferers’ feelings of discomfort with their own images and poor health intensify their psychological suffering. Almost without realizing it, these patients—mostly young—start to reinforce even less healthy lifestyles. This can lead to social anxiety, not wanting to leave the house, and alcohol or drug abuse.

Risk factors

We know that obesity and eating disorders are related. But, do all obese people suffer from bulimia nervosa or binge eating disorder? The answer is no. As we pointed out earlier, these disorders tend to occur in children who are brought up in family contexts that are oriented toward concern about weight.

As a matter of fact, in many cases, obesity is hereditary. When parents have suffered social criticism for being overweight or obese firsthand, they have a tendency to urge their children to take care of and reduce their weight. Whilst this can be positive (as long as it’s accompanied by healthy lifestyle habits) this isn’t always the case. Not when there’s constant criticism and encouragement of the rejection of the sufferer’s own image.

Furthermore, we can’t ignore the social and cultural aspects. We live in a society oriented to the tyranny of body image and thinness. Thus, although obesity is still a disease, the aesthetic rejection it arouses adds another even more problematic layer.

The therapeutic approach

People can be obese due to pure genetics or associated diseases. Psychological problems, such as depression can also lead to this situation. Therefore, the first thing we must understand is that obesity isn’t always the result of a lack of will or inability to adopt a healthier lifestyle on the part of the sufferer.

In fact, it’s a dimension that’s highly biased by social opinion. It’s even frequently misunderstood by some medical spheres (health fatphobia ). Indeed, obesity is a booming and frequent problem, along with eating disorders. But, what can be done about it? What kind of therapy is appropriate?

Firstly, obesity shouldn’t always be seen as associated with disorders such as bulimia. It must be treated from a multifactorial approach by psychologists, doctors, and nutritionists. Therapeutic programs tend to be of long duration and cognitive behavioral therapy (CBT) is particularly effective.

Before concluding, we must emphasize that, given the recent increases in this clinical reality, every community requires more integrated and specialized therapeutic models in this respect. Moreover, we must be aware that psychological support is always of benefit to the management and treatment of obesity.