Defining Anorexia, Part II

This part of "Defining Anorexia" is less about, well, defining anorexia, but about how to use that definition. Obviously, a case definition is important in diagnosing this rotten disease, but it's also important in other ways.

I have Master's of Public Health in epidemiology, and I have sat through an entire two hour lecture on the importance of a case definition in terms of measuring rates of disease. Say you survey people on coughs. You'll find out a lot of information on upper respiratory infections, but it's not very specific. You could have allergies. You could have pneumonia. Big difference there.

People disagree on whether there has been a true increase in the rate of anorexia in the last fifty years. Part of an increase is, no doubt, the increased awareness of the disease, as well as the simple epidemiological fact of you tend to find what you're looking for. Society is, as a whole, more messed up and obsessed about food than ever before. I'm sure you could design a survey to measure that (I'm for hire! I'll send you my resume!), but my mom could easily tell you that. For free.

So. Getting back to the point. Many people with eating disorders, even those admitted to an inpatient hospital unit, don't fit the exact criteria for anorexia nervosa. This is important for two reasons: 1) insurance coverage and 2) how much might this affect our ability to measure the rates of AN. Insurance companies have a hard enough time considering AN an actual illness; they are much more likely to kick a sufferer out prematurely because of some sort of mysterious weight formula they pull out of thin air. I have been discharged from the hospital on the exact day I was over 85% height-for-weight, though I was still 15 pounds under MY usual weight.

There is plenty of research being funded for obesity, heart disease, cancer, asthma, diabetes. While I am not going to debate the worthiness of these causes (except perhaps the first one), there is one thing they all have in common: they're easy to define, you know what to look for, and we know how much is out there. You can't get funding in the Christopher Columbus "let's go find a quicker route to Asia! See ya in a year!" type of way. I've written grant proposals. You'd need a route, funding for the crew, food, antibiotics, weapons to kill harmless indigenous peoples, the whole nine yards.

Therefore, in order to find a cure for anorexia, or at least more effective treatment, we need more research. In order to research anorexia and bulimia, we need to know specifically (specifically) what we want to measure. I think nutritional and neurochemical profiles are the future, as well as brain functioning tests (fMRI, PET scans, the works). That's where the money is at. I'm grateful for people like Cynthia Bulik and Walter Kaye who are truly doing the pioneering, groundbreaking, backbreaking work.

Cheers to them! With ice cream! And a cherry on top!


marcella said...

Excellent posts.
In the end it is my hunch that these scientists will NOT find a single cause for, or indeed a single definition of, anorexia or other eating disorders. I believe that as in autism they will find a spectrum of illness and disorder - which will sadly not make for easier treatments, but hopefully will eliminate some of the positively harmful ones.

CARRIE said...

That is very true, marcella. There will never be an "anorexia" gene, or even a "cancer" gene or "heart disease" gene. There's likely a constellation of genes. It's such a complex interaction of genes and environment.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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