Medicalisation of eating and weight-control behaviours: time to take stock?

In recent years, there has been a dramatic proliferation in the number and diversity of conditions recognised as “eating disorders” (ED) in classification schemes for mental health problems, most notably the Diagnostic and Statistical Manual of Mental Disorders. There have also been concerted efforts by influential organisations, such as the United States National Institute of Mental Health, to portray these conditions as “brain-based mental illnesses” for which certain forms of intervention – so-called “evidence-based treatments” - are demanded. Taken together, these developments indicate an increasingly medicalised representation of certain combinations of eating and weight-control behaviours as “disorders” demanding clinical and/or public health attention. This representation predominates not just in academic and public policy literature but also in the popular media. To date, and in contrast to analysis of the medicalisation of other mental health problems, critical analysis of the occurrence and implications of these developments has been sporadic and piecemeal. Hence, the goal of the current contribution was to elucidate, and thereby expose to critical scrutiny, the occurrence and implications of the increasing medicalisation of eating and weight-control behaviours that has occurred in recent times. Additionally, key questions that the author believes might usefully be addressed in future research are suggested. These include “whether and to what extent has medicalisation been beneficial for the increasingly large and diverse subgroup of the population deemed to have or be ‘at risk’ of having an ED” and “what are implications of the increasing medicalisation of eating and weight-control behaviours for different possible approaches to intervention and for public health policy more generally?” Medicalisation, a term originating in the sociology literature in the early 1970s, is the process by which previously nonmedical aspects of appearance or behaviour, such as body characteristics or emotional states, become defined, and treated, as medical problems. For example, what was once described as disruptive behaviour in children and adolescents has come to be known as “attention-deficit/hyperactivity disorder” and what was once described as combat stress among soldiers returning from battle is now called “post-traumatic stress disorder”. In the eating disorders field, medicalisation is apparent in the way in which certain combinations of eating (e.g., “binge eating”) and/or weight-control (e.g., “excessive exercise”) behaviours have increasingly been viewed as “disorders”, “diseases” or “illnesses” demanding clinical and/or public health attention. In this commentary piece, a call is made for greater critical analysis of the occurrence and implications of this process. This includes addressing questions such as whether and to what extent has medicalisation been beneficial for people deemed to have or be at risk of having an eating disorder and what are implications of the increasing medicalisation of eating and weight-control behaviours for different possible approaches to intervention and for public health policy?