The model in the last post described a three step process to explain the cause of an eating disorder: genetic predisposition, environmental trigger and emotional/psychological stimuli. Although the first and third part of the model increase the likelihood greatly of illness, there is no chance an eating disorder will occur without the trigger of starvation.
It remains somewhat controversial to view dieting and undereating as a necessary part of the evolution of an eating disorder. Dieting and losing weight are seen as a beneficial and even health-promoting parts of modern life. The increased concern over obesity and the incessant focus on thinness make dieting a cornerstone of our daily life. Dieting has become the de facto answer to many medical ills.
Yet no one speaks of the medical risks of dieting and chronic starvation. Various diets of 1200 calories per day, half of which often comes from a shake made of processed protein powder, are commonplace. Starving all day in order to wait and eat at night is considered virtuous. The diet industry is a booming business.
This message seeps down to children and adolescents who easily fall into the trap of dieting and soak up the praise that comes with weight loss while nobody seems to worry about the risks associated with a malnourished child.
The immediate risks, including lack of energy, slowed thinking or weakened organ function, do not come to mind when we think about a diet. Instead weight loss is blindly equated with health.
But dieting also triggers ingrained biological adaptations to starvation, the body's protection against times of famine. The adaptations include obsessive thoughts about food and weight, slowed metabolism to conserve energy and the preservation of essential body functions at the expense of less necessary ones. The basic functions include cardiovascular function, maintenance of core temperature and basic organ function but sacrifices muscle mass, higher level brain function and reproductive capability. It's like the body running on a backup generator.
This metabolic shift is the key to the illness model. It is the trigger. If someone rests in starvation metabolism for too long, they run the risk of triggering a longterm, adaptive shift into starvation metabolism, essentially a semi-permanent state to survive famine. In modern life, this mental and physical shift isn't based on actual famine. The food is still all around us. But starving for long enough can trigger the thoughts of an eating disorder if someone is so predisposed. That is the central risk.
When dieting was not pervasive in our culture, this risk was minimal, but recent decades have made dieting almost a rite of passage. All of a sudden, we all are exposed to this risk, we all try to diet and starve at some point, we all test to see if we have a genetic predisposition to an eating disorder. And we all do this without any understanding of the risk we are taking.
Instead when a child or adolescent turns out to have an eating disorder, the general consensus is to throw up our hands in confusion, but the number one risk for developing an eating disorder is that first step to start a diet.
The implications of what this knowledge means for adults and children will be the focus of the next post.