Kudos to the eating disorders work group on DSM-V

for deciding not to make obesity a disease in the next edition of the Diagnostic and Statistical Manual of Mental Disorders.

This decision has significant ramifications for how docs treat and to some extent see obese patients. I'm a big proponent of changing the dialogue around obesity from a discussion of weight to a discussion of health. The two are not synonymous. I'm also hoping this will stop bariatric surgeons from marketing their surgeries as eating-disorder treatments, for instance.

The group also recommended changing criteria for anorexia and bulimia:
• Now patients must weight 85% of ideal body weight or less for a diagnosis of anorexia; in future, if the changes go through, the criterion will be "restriction of energy intake [leading to] markedly low weight." This rightly shifts the emphasis from the rigid weight characteristic to a pattern of eating and relationship with food. Now insurance companies will have a harder time cutting people off from treatment once they hit 86% of ideal body weight.
• Loss of menstrual period is no longer one of the criteria for anorexia. Some women never lose their period, no matter how thin they get; others keep menstruating even at very low weights.
• Bulimia will be diagnosable with purging episodes of once a week; right now, the criterion is two episodes a week.
• Binge eating is likely to become a diagnosable eating disorder.