As a budding eating disorders therapist, I am always excited to see that other mental health providers offer treatment for disordered eating and body image concerns. Recently, I have noticed that some mental health clinicians will advertise that they treat obesity or eating disorders and obesity, somehow insinuating that like an eating disorder diagnosis, obesity is a pathological or maladaptive condition surrounding food and weight and must be treated. This can lead to a common misconception that obesity, in itself, is an eating disorder, and something that should be changed.
Obesity Describes Weight – Not an Eating Disorder
I’ll get straight to the point and tell you that the DSM-5 does not recognize obesity as an eating disorder diagnosis. In the DSM-5, an eating disorder is considered “a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.” I understand that this might appear confusing. You may be wondering, doesn’t obesity include a persistent disturbance of eating behaviors that significantly impairs one’s physical health or psychosocial functioning?
I want to emphasize that this is not necessarily the case. According to the Centers for Disease Control and Prevention, obesity is a label for a range of weight that is greater than what is typically considered to be healthy for a given height (based on body mass index parameters), and which can increase the likelihood of particular health conditions. Stated more simply, the term obesity describes a certain weight that could possibly make someone susceptible to health concerns, but does not always do so. Also, nowhere in this definition does it say that the person engages in disordered eating behaviors.
However, what society often does is assume that someone who is obese or overweight must have a problem with food. In fact, by considering obesity an eating disorder, you are assuming that just because someone exceeds a medically-determined “healthy” weight, they have to have a disturbed and impairing relationship with food, one that is pathological and must be addressed. Such a misconception of obesity can be extremely misleading and stigmatizing, and can prevent individuals who are obese from receiving appropriate treatment, if they do in fact want and need help.
Things to Keep in Mind
To be more sensitive to the reality of obesity and eating disorders, please keep in mind the following:
Obesity is not an eating disorder, but can result from eating disorders. That being said, you may automatically presume that someone who is obese with an eating disorder has to be struggling with binge-eating disorder. This is not a fair assumption. An individual with obesity can struggle with a combination of restricting, purging, laxative and diuretic abuse, binging, overexercising, and other disordered behaviors. Engaging in any or all of these behaviors can affect the individual’s weight, which can lead them to fall into the “obese” category.
Obesity could lead to an eating disorder, but may not. Someone who is overweight or obese from a variety of other factors may feel pressure to lose weight. Subsequently, they may engage in various weight-manipulating behaviors. Depending on the frequency, intensity, duration, and functional impact of such behaviors, this individual may or may not develop an eating disorder.
You can be obese without having an eating disorder. Obesity is the result of multifaceted genetic, environmental, and behavioral factors. Someone with obesity can exhibit overeating and not engage in regular physical activity. However, they may not necessarily meet the symptom criteria for an eating disorder. Also, regardless of the person’s relationship with food, many other factors may play into their obesity. For instance, obesity can be related to other medical conditions, such as diabetes, polycystic ovarian syndrome, hormonal imbalance, or gastroparesis. Moreover, certain medications can contribute to weight gain that may result in obesity.
When someone falls in the “obese” range, this does not necessarily mean they are unhealthy and struggling with various medical conditions. Being classified as obese can be just a reflection of the person’s height and weight. This could even be misleading as someone’s weight includes both muscle and fat, and therefore someone with a high BMI could actually be “healthy” but heavier because they have more muscle. That being said, obesity does not necessarily signify unhealthiness, but is a description of the person’s body type. Automatically assuming that obesity is pathological, dysfunctional, and something that must be treated ends up shaming and alienating the individual solely because they are heavier.
Thus, obesity may or may not be an effect or precursor of an eating disorder, but in itself is not an eating disorder. Obesity is not necessarily something that is pathological and harmful to the individual but may solely reflect the person’s weight and height. This distinction is incredibly important for medical and mental health professionals, so that they do not automatically stigmatize and view obesity as something that is undesirable that must be treated, just because of the person’s weight or appearance. Instead, we need to consider the individual’s own presenting concerns (which may not include obesity) and be cautious about stigmatizing obesity as something that is negative and undesirable.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (Fifth Edition). Washington, DC: American Psychiatric Association.
CDC. (2018, November 19). Disability and Obesity | CDC. Retrieved January 12, 2019, from https://www.cdc.gov/ncbddd/disabilityandhealth/obesity.html
Bahar Moheban, M.A. is a clinical psychology doctoral candidate and registered psychological assistant in Torrance under the supervision of Dr. Nazanin Moali. She provides individual therapy and facilitates Virtual Body Image Groups for adults and adolescents with eating disorders, body dissatisfaction, and comorbid disorders. If you are experiencing body image distress or any other psychological turmoil related to a chronic illness, contact Bahar for a counseling appointment.