~ ~ ~ ~

One of the features of the book is a rather exhaustive treatment of current medical research in order to demonstrate claims such as the ones made on this page, as well as to provide useful suggestions as to how we might respond to the fact of epidemic disordered eating in our culture in a more responsible and compassionate way.  What you'll find here, therefore, is the short version which - I hope - is a bit quicker read than an entire book, but certainly not a substitute... 

Of course, if you want to know more about the medical journals and other publications from which this material has been drawn, or if you're interested in concrete ideas for reforming research and health care practices regarding disordered eating, or especially if you're interested in a national pride movement for people with eating disorders, get the book, or give me a call, or e-mail me, or drop by my office, and I'll be happy to talk more about all this stuff.  My main web-page has contact information.  Thanks for your interest.

Not sure exactly what an eating disorder is?  Look here.

~ ~ ~ ~

Falsehood: Eating disorders are rare.

Truth:        Eating disorders affect more people in the United States
                  than any other known health condition. 

It is certainly a common belief that very few people suffer from disordered eating, and it is also a common belief that it's not really possible to find out just how many eating disordered people there are in the United States because the stigma associated with these conditions often makes us reluctant to disclose our disorders to physicians and other health care workers.  Studies recently published in widely respected journals, however, provide ample information for determining how many of us there are.  According to my research, there are 27 million people in the United States with a diagnosable eating disorder; about 3 million anorexics; about 6 million bulimics; about 9 million "eating disorder not otherwise specified" (EDNOS); and about 9 million people with binge eating disorder.

How do we stack up against other health conditions?  Well, within the field of mental health the situation looks something like this:

Most of the information in this table is available online from the National Institute of Mental Health (NIMH).  For additional context consider this: according to the American Cancer Society, between 1990 and 2004 there were 18 million cases of cancer diagnosed; according to the National Institute of Neurological Disorders and Stroke, there are 5.4 million stroke survivors alive today; and according to the American Heart Association, there are 7.1 million heart attack survivors living today. 

Not only are there more people with eating disorders than any other "mental illness," but our prevalence is nearly equal to that of all cancer diagnoses for the last 15 years, all living survivors of strokes, and all living survivors of heart attacks combined.

~ ~ ~ ~

Falsehood: People rarely die from an eating disorder.

Truth:        Eating disorders are the tenth leading cause of death
                  in the United States.

The NIMH asserts that the mortality rate for anorexia is  .56 percent per year.  Since we know that there are 3 million anorexics in the U.S., and we know also that each year .56 percent of these people die, it follows that anorexia kills 16,800 people annually.

According to the National Institutes of Health (NIH), 10 to 15 percent of people who are "obese" are "obese" precisely because they have binge eating disorder. Moreover, in Efforts to Reduce or Prevent obesity, the Centers for Disease Control and Prevention (CDC) asserts that "There were 112,000 more deaths than expected in 2000 among obese individuals (BMI of 30 or higher)." 

Since binge eating disorder is recognized as a contributing cause in about 12.5 percent of all cases of obesity, it is reasonable to conclude that binge eating disorder is a contributing cause in about 12.5 percent of the deaths associated with obesity.  Whence it follows that binge eating disorder kills 14,000 people annually.

There are literally no available statistics on mortality rates associated with bulimia or EDNOS. 
So, we can reliably say that eating disorders cause a minimum of 30,800 deaths annually. 

A searchable database for the leading causes of death is available from the CDC.  In 2003, the 10^th leading cause of death was listed as septicemia at 34,069; suicide was 11^th with 31,484; liver disease was 12^th with 27,503.  The numbers above show that if even 3,300 people die annually from bulimia and EDNOS combined, then eating disorders constitute the 10^th leading cause of death in the United States.

~ ~ ~ ~

Falsehood: Only young people have eating disorders.

Truth:        Eating disorders affect people of all ages,
                  with anorexia being especially prevalent among the elderly.

Although it is widely acknowledged that the average age of onset for an eating disorder is between the ages of 14 and 18, keep in mind (as noted above) that every ten years 5.6 percent of anorexics die.  It follows from this that about 22 percent of anorexics are dead before they reach their mid 50s, the remaining 78 percent survive into their later years.  A recently published study which was based on a review of 10 million U.S. death records found that the median age of death due to anorexia is 69 years. [Hewitt, Coren, and Steel.  "Death from Anorexia Nervosa: Age Span and Sex Differences."  Ageing and Mental Health, 2001; 5, 41-46.]  There are many other studies which confirm this finding; eating disorders affect people of all ages. 

~ ~ ~ ~

Falsehood: There is a lot of research currently being done on eating disorders.

Truth:        There is less money available for research on eating disorders
                  than there is for any other known health condition.

Research into causes and treatments for eating disorders is conducted by several universities and government institutions, but the overwhelming majority of this research is funded and conducted by the NIMH.  The most recent year for which reliable figures are available is 2003 during which the NIMH spent 1.5 percent of its annual research budget on eating disorders research - this 1.5 percent equals a total of about $20.1 million.  That sounds like a lot of money, but  is actually less than the total amount spent for research on any other condition handled by the NIMH.  When you take prevalence into account, 1.5 percent of the NIMH budget turns out to be very little money indeed.  Here's why - we know how many people are afflicted with each of the different conditions researched by the NIMH, and we know how much money is spent on researching these conditions - so it's a simple task to find out how much money is spent by the NIMH
per case for each of the conditions that they research;

total research funds divided by prevalence equals per case funds. 

As with the prevalence and mortality statistics mentioned above, the calculations for this data are painstakingly enumerated in Radical Recovery.  The result is an accurate picture of the priorities at the NIMH, and here's what that picture looks like:

~ ~ ~ ~

Falsehood: Treatment for eating disorders is quite successful.

Truth:        There is no accepted standard treatment for any eating disorder,
                  relapse rates are very high, and most people do not recover.

Although there are literally dozens of different approaches to treating disordered eating, there is no accepted standard model of treatment for any eating disorder.  Some of the treatment options currently available are of a more conventional nature such as outpatient and inpatient routines at mental health facilities, but even these approaches include a tremendous variety.  Many of the less conventional approaches border on the bizarre and fearsome and include such things as "eye movement and desensitization reprocessing" (EMDR), gastric by-pass surgery, ear stapling, court ordered tube-feeding, and American Indian "sweat lodges."  All of these "treatments" cost a lot of money, very few of them are covered by any medical insurance plan, and none of them has been demonstrated to be effective in restoring people with disordered eating to a healthy way of life.

The most widely recognized, longest operating, and best treatment facilities are able to achieve only minimal success; indicating that at least 90 percent of all overweight people who lose weight gain their weight back within 2 years, people who have gastric bypass surgery spend twice as much time in the hospital during the three years that follow their surgery than during the three years prior to surgery (with most rehospitalizations being procedure related), about 75 percent of all bulimics relapse within 3 years of any form of treatment, and most anorexics manage less than a 10 percent increase in body weight - a truly underwhelming figure when you consider that anorexics are, by definition, at least 15 percent below "normal" body weight to begin with. 

There is no accredited graduate program of study at any university in the United States where one can acquire a specialty in the treatment of eating disorders.  Eating disorders treatment  providers are not regulated by any central organizing body, no specialized license is required (nor is there one available) to offer treatment on an outpatient basis, and treatment providers are not required to report new diagnoses or their treatment outcomes to the CDC or any other public health facility.

~ ~ ~ ~

Falsehood:  Having an eating disorder is nothing to be proud of,
                   it's embarrassing and shameful.

Truth:         Our culture's attitude about disordered eating is flawed;
                   there is something useful, appropriate, and good
                   about the way that we eating disordered people understand
                   the world around us.

Disordered eating behaviors arise from a way of thinking about the world that is unique, fitting, and can be highly beneficial.  Researchers have identified many elements of our culture that promote and glorify unhealthy eating habits.  From pervasive media emphasis on dieting and thinness to the common association of happiness and status with one's ability to consume, from portrayals of anorexics as sexy and cute to images of normal weight and overweight people as disgusting and ugly, we are enculturated into a society that goes out of its way to trigger disordered eating in a great many ways.  What's really questionable and in need of change is a cultural framework that induces disordered eating in as much of its population as possible, and then characterizes the condition it has induced as shameful and unworthy of research or reliable treatment options.  The shame and stigma associated with disordered eating are imposed on us from a defective set of cultural attitudes.

We eating disordered people respond to a destructive lunatic culture in a way that is predictable and expected - we become ill.  Based on our enormous prevalence, normal eaters would be wise to take notice of us.  It appears that there's something dangerous in our culture that is producing an epidemic of disordered eating, and it is we eating disordered people who are living proof of this danger and the need to move society in a more healthy direction.  To be a living indicator of a better direction for our culture - is this not something to be proud of?

Our culture is permeated with numerous psychological carcinogens - triggers for disordered and unhealthy eating habits.  We eating disordered are the evidence that this is so.  As such, we should be thanked - as the miner is grateful to the canary who tests the quality of the air to insure safety.  Our behavior is damaging and unhealthy, but the disposition and psychological constitution from which it arises is vitally important - we are part of the conscience of our culture.

Eating disorders reflect a defect of some kind, this much is certain.  The assumption that the defect is within those of us who suffer has been proven a mistake as it has not resulted in any medical improvements for us; useful research is not being conducted, treatment options are unreliable, and our very existence (prevalence) is unacknowledged. 

We postulate, therefore, (and there's a lot of discussion about this in the book) that the defect from which epidemic disordered eating emerges is not within us but without - our cultural environment is defective and must be reoriented in order to prevent more people from losing their lives to these conditions.

~ ~ ~ ~

Falsehood: This situation is too big for me to be able to do anything about it.

Truth:        There is plenty you can do to make a difference, beginning with
                  speaking up and talking openly about eating disorders.

Radical Recovery contains extended explanations for why we eating disordered are systematically excluded from the benefits of adequate research and treatment, even to the point of remaining uncounted by the nation's major research institutions.  To be sure, some people recover from prolonged and severe disordered eating, but this is not the norm - and our healthcare system is perfectly okay with this, as evidenced by the lack of effort to fund or conduct appropriate research or develop reliable standard methods of treatment.  Of course, being marginalized or excluded from the basic necessities of life (such as adequate healthcare) solely because one is part of a specific group of people (the eating disordered) fits perfectly the accepted understanding of oppression.  That we eating disordered constitute an oppressed group is not difficult to demonstrate on paper, but getting the authorities in eating disorders orthodoxy to take this seriously is more difficult.  What can we do to change the fact that minimal research and occasional recovery are acceptable to these authorities and "experts?"  Well, we can begin by speaking up.

Like it or not, our own silence serves to reinforce the status quo.  If we don't complain - VERY LOUDLY - no one will have reason to change things for us.  Perhaps you find it unfair that this burden to bring about change should fall on those of us who suffer or have suffered from disordered eating rather than on more appropriate healthcare agencies?  Well, like it or not, the people in the best position to bring about change and act on our behalf - the eating disorders authorities and experts - have refused to do so.  They appear satisfied with vague and useless estimates concerning prevalence and mortality, and they seldom utter a complaint about ineffective treatments and pitiful recovery statistics.  So, it is up to us.

Recovery is a radical enterprise, if for no other reason than that it requires that we call into question our deeply rooted cultural beliefs that (a) extreme thinness is extremely attractive, and (b) over-consumption is a reliable indicator of affluence and (by implication) quality of personal character. 

The dominant view within eating disorders orthodoxy (indeed the only view at present) is that disordered eating behaviors indicate some kind of inner psychological defect.  This view has failed us in practical terms, and it has laid the groundwork for our being stigmatized and made ashamed of who we are inside merely because our behaviors are unhealthy.  We are not defective, our culture is defective.  And we can bring this fact into the public awareness by speaking up, protesting, "coming out," and learning to interact in a positive way with a world that greatly needs to be changed. 

Make no mistake about it - these remarks are not an endorsement of unhealthy behavior, this is advocacy for the cause of recovery.  If anyone endorses unhealthy behavior, it is our experts and authorities whose contentment with our current prevalence and mortality is demonstrated by their conspicuous complacency.

~ ~ ~ ~

So that's what the book is about; bringing this national failure out into the open, explaining why we eating disordered people need to be out in the open in order to solve these problems, providing practical suggestions about how to address these problems on a large scale, how to talk to others about eating disorders, and how to engage in direct action (protests) if need be.  We should do whatever it takes, we're worth it, too many of us have died because of systematic negligence and destructive cultural attitudes.

What would you like to see on this page?

Thanks very much for reading this,
I look forward to hearing your thoughts about any of this material.

Chris Kraatz, Ph.D.
Proud Bulimic, Anorexic, Binge Eater.

More information about
Radical Recovery:
A Manifesto of Eating Disorder Pride
from the publisher's web-site
(includes table of contents and ordering information)

Chris Kraatz's web-site