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An alternative paradigm; The ecological model

Any complete understanding of obesity must take account of the differences both within and between individuals and populations, as well as the moderating physiological adjustments which occur as a result of changes in energy balance. This would mean a more ecological approach to the problem which implies a delicate balance between a wide variety of competing forces. There are three main influences on equilibrium levels of body fat—environmental, biological and behavioural—and these are mediated through fat/energy intake (F/EI) and/or fat/energy expenditure (F/EE), but moderated by physiological adjustments to changes in energy balance.

This model adds the biological, environmental and behavioural influences to an equation whose end point is ‘equilibrium stores’ of body fat. This is a dynamic relationship where fat stores ‘settle’, at least temporarily, until there is some change in components of the equation, after which physiological adjustment occurs, or a new equilibrium, or ‘settling point’, is reached. This paradigm discards the notion of a ‘set point’ for body fat, whereby the body works to achieve and maintain a body fat mass of say 75kg. It also modifies the previous notions of energy balance by specifying the initial aspects of food, exercise, the rate of fat intake and the rate of fat utilisation respectively. Finally, the model incorporates the physiological adjustments which occur with body composition changes and which then bring it back into equilibrium. The components of the model are broken into the mediators (i.e. fat intake and expenditure), influences (environment, biology and behaviour) and the moderators (physiological adjustment).

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That’s the sixty-four-thousand-dollar question. Experts answer it differently, depending on their area of specialty.

The Biological Perspective

Biologists see eating disorders as a foul-up in the body systems that regulate hunger and eating, particularly the hypothalamus. This cluster of nerves in the brain controls many body functions, including intake of water and food.

By releasing hormones, the hypothalamus also regulates the onset of puberty-an important connection to eating disorders. Although we don’t know exactly what “pulls the trigger,” puberty may begin when the body reaches a preprogrammed weight and achieves a certain percentage of body fat. Starving makes both weight and body fat decrease. If the weight-to-fat ratio falls too low, metabolic changes-including the loss of menstruation, a kind of regression from puberty-occur.

Biologists also look for problems in the way the body converts food into neurotransmitters-chemicals that carry signals between cells. The brain “knows” when the body needs certain foods to make the neurotransmitters that are in short supply and tells us what we should eat next. Eating disorders may arise from a malfunction in this feedback system.

Other evidence of the biological basis of eating disorders comes from studies on twins. Identical twins, who grow from a single egg and share an identical genetic blueprint, have a higher incidence of anorexia nervosa than fraternal twins, who grow from separate eggs.

If we can identify the biological breakdown or the genetic glitch that causes an eating disorder, then perhaps medicine can correct the problem and offer hope for treatment.

The Psychological Perspective

Most experts feel biology alone can’t explain eating disorders. The question then becomes, “What factors provoke abnormal eating in one person but not another?”

The answer, they believe, lies in a person’s life experiences and the thoughts and feelings those experiences arouse. A loss or rejection, a death in the family, the act of leaving home, can all start the ball rolling. The anorexic may feel she is somehow not good enough, that she is a disappointment to everyone. She is a “failure” in every capacity except one: her ability to be thin.

In bulimia, some of the same psychological factors are at work. A bulimic also equates thinness with self-worth (although in this case the degree of thinness is less extreme than in anorexia). There are other pressures as well. As biologists suspect, there may be a physical urge to binge. Bingeing also serves as a kind of distraction, allowing a woman to push aside unpleasant feelings and focus instead on intense physical sensations. By overeating, a woman rebels against the limits society tries to impose. She conquers fear by withdrawing into the comfortable, dependable world of bingeing. (Patients occasionally refer to bingeing as their “friend.”) Bingeing has much in common with the abuse of drugs or alcohol. By definition, however, a bulimic feels her behavior is beyond control. Purging thus becomes her way of regaining balance. She tells herself: “I overeat, but it’s okay because I throw it up anyway.” Bulimia lets her control at least one aspect of her life-eating-to make up for lack of control elsewhere.

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After battling a weight problem for most of his life, Mark Maron tuned in to the surprising, binge-fighting power of music and successfully shed 25 pounds.

Mark first got serious about slimming down and staying healthy in 1997. That’s when the then-34-year-old Clifton Park, New York, resident found out that his mother had breast cancer. “I realized that both my mother and I had to start eating smarter— me, to lose weight and avoid getting cancer; her, to possibly save her life,” he explains.

Mark, who weighed 265 pounds at the time, read as much as possible about health, nutrition, and fitness and tried to incorporate all that he learned into his life. For him, that meant eating more vegetables and fruits, trying to steer clear of fatty foods, and working out at the gym at least three times a week.

Sure enough, the extra pounds melted away. But that wasn’t the end of Mark’s weight problem. It seemed that when he had some kind of emotional upset—a crisis at work, a fight with a loved one, or another problem that made him feel bad—he would binge on high-fat foods. “I would feed my emotions by eating things from fast-food drive-thrus and pizza houses, then go straight to bed when I got home,” he recalls. Needless to say, overeating only made Mark feel worse, and he found himself trapped in a vicious cycle.

During a down moment one day, Mark found himself heading for one of his fast-food haunts. Then he remembered a song that he had heard on the radio just a few hours before and decided to make a stop at the nearest music store. “I picked out two CDs. One was by a band called Big Audio Dynamite, and the other was an assortment of 1970s tunes, including my favorite, ‘Born to Be Alive,’” he recalls. “The music was very high energy and upbeat. It really pumped me up.” He got so pumped up that he forgot about stuffing down his sorrows with food and headed for the gym instead.

It’s a habit that has stuck with him ever since. Whenever he senses a slump coming on, Mark cranks up the tunes. Sometimes, he goes to the gym and works out; other times he just stays home and dances. “I danced a lot of my weight off,” he says.

In fact, by fall 1998, those 25 unwanted pounds that Mark had carried around for so long finally disappeared. He maintained his weight at 240 for several months before enrolling in a personal coaching program. Now he’s down to a muscular 230 pounds and

he hopes to lose a little more. “My mom is better now, and we’re both living healthier than we ever have,” he says. “We’re feeling great about it!”

WINNING ACTION

Tune in to fun instead of food. Like Mark, we all hit speed bumps that can send our egos and self-esteem plummeting and trigger a binge. Keep a “fun list” around so that when you get knocked off your feet by something, you can turn to a positive source of consolation, rather than to a pint of ice cream.

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