Pathways

In Overcoming Binge Eating, Dr. Christopher Fairburn describes a common pathway for how patients arrive at bulimic behavior:

Typically the person begins dieting and losing weight in the mid-teenage years, despite in many cases not having been overweight in the first place. When the weight loss is extreme, it leads to the development of anorexia nervosa. Eventually, after a varying amount of time, the person’s control over eating starts to break down and he or she begins to binge. Control progressively deteriorates, and the person’s weight gradually returns to near its original level.

Once bingeing begins, it may only be a matter of time before the fear of weight-gain escalates to the point of necessitating the purge.

Sound familiar?

Of course, anorexia is not a required stop in this journey—many people swing from dieting to binge eating without a descent into full-blown anorexia. In either case, one of the easiest points of intervention in this dieting-->anorexia (or not)-->binge eating-->bulimia cycle is the dieting stage. Dr. Fairburn talks about three forms of dieting, including:

1) Trying not to eat for long periods of time 2) Trying to restrict the overall amount eaten 3) Trying to avoid certain types of food

According to him, any of these restrictions can eventually lead to a binge. What I find interesting is how creative we are with our dieting attempts—we may think we’re not dieting because we’re not on a specific plan or because we eat three meals a day, but when you consider the restrictions above, it’s clear how the diet can cleverly masquerade as “I’m too busy to eat” or “I’m just being healthy.” Will dieting always segue into an eating disorder? No. But, for many it will, and it’s important to be aware of this outcome and to be on guard for the plunge into anorexic or binge-eating behavior.