The body is not just impacted by eating disorders – biology drives them

This blog post relates to my new paper on the role of biology in eating disorders, published in Trends In Molecular Medicine on 9th March 2024. You can read and download it for free here.

Last year I was approached to write an article for a special edition of the journal, "Trends in Molecular Medicine" on the subject of eating disorders. It is always heartening to me when researchers and editors embrace the expertise that comes from having lived/living experience of the conditions being studied, and it's also very flattering when someone considers your own expertise to have value.

I have to admit, though, that I was a little bit daunted. I accepted, but quickly starting thinking thoughts along the lines of, "what can my own experience say about the molecular basis of eating disorders? What do I know about medicine?" Whilst I believe that there is so much that can be learnt from observing and interpreting the phenomenological aspects of living with a particular diagnosis, my day to day symptoms are more about trying to cope with the difficulties that arise in the moment than focussing on the cellular and genetic basis of those symptoms. Untangling the causes of the myriad symptoms I experience is difficult when I swept up in their downstream effects.

My ambivalence wasn't helped by the article type I was being invited to write being called "This Scientific Life" - I didn't realise I had one. I would consider my life more artistic and creative, if in its own way experimental. I wasn't sure what was so scientific about me having a feel around for something useful to say about the biology of my condition.

But the more I thought, the more I realised that there is so much to say, because there are so many questions to ask. So often we feel like the only valid component of undertaking research and the creation of knowledge is the part where we provide answers. If we are to "say something" about a condition or phenomenon, it has to be something that has been proved by data - a theory. The value of hypothesis seems to be somewhat overlooked, and maybe this is because we are in part uncomfortable with pointing towards what we don't know (which in the case of eating disorders, is a lot).

This might be especially the case when the evidence based we have for understanding eating disorders is so intractably linked to our current ways of treating them. The discomfort in asking questions about what we don't know might bring about a sense of invalidating the knowledge upon which current practice is built, undermining clinical confidence. I don't think this needs to be the case - it can be both true that we know something and yet have so much more to know.

In my paper, I raise a lot of questions about how we currently think about eating disorders, primarily as psychological conditions with physiological consequences. We need to move beyond the idea that biological impacts are always secondary to the supposed "true" or "underlying" essence of an eating disorder which is the real bit that needs treating. I argue that "both/and" rather than "either/or" thinking is essential if we are to help people like myself who have lived experiences that indicate an inseparability of biology and psychology.

You can read more about all this in the paper, and I would love to hear your thoughts. Sometimes I feel like I am out on a limb with my perspectives within the field of eating disorders, so hearing other people's views is invaluable for sense-checking my own thinking.

I realised through writing this paper just how integral asking questions and hypothesising is to the process of creating knowledge, and that rushing over this in our quest to help people or prove pet theories only stifles original thinking and innovation. It is entirely scientific to ask questions, have humility, and to remember there is so much that we do not know. Perhaps those living with the conditions we study have some of the most vital questions of all.