Eating disorders are diseases in which people have unhealthy relationships with food caused by poor self-image, a fear of weight gain or an inability to stop eating. Such disorders are often coping mechanisms for other personal or psychological problems. There are many eating disorders; 2 common, serious and closely related disorders are anorexia nervosa and bulimia nervosa. While most sufferers from eating disorders are women, men are affected too. About one in every 30 women in Canada will suffer from one or the both of these disorders in her lifetime. Almost 90% of women report that they are unhappy with their bodies, translating into an over $40 billion-a-year diet industry in North America. However, 90% of people who lose weight regain the lost weight within 5 years. Almost 10% of reported eating disorder cases involve males. However, because it is less socially acceptable for men to admit they have such a problem, many cases go unreported, so the actual figure for men is probably higher.
A generally overlooked eating disorder is compulsive overeating. We tend to believe that people who weigh too much can lose weight simply by eating less and exercising more, but the situation is not that simple. Compulsive overeating is much like alcoholism; the person may be in treatment, but the disorder is never cured. Overeating arises from emotional problems. Overeaters eat to fill some void, not out of necessity, and then become depressed about overeating.
Though their weight may be normal, or even low, people with anorexia or bulimia believe that they are fat and ugly. They become obsessed with food. They feel ashamed of eating. They make themselves thin, at great cost to their health. Eating disorders among adolescents are of particular concern. While the most common age of onset is between 14 and 25 years of age, girls are succumbing at much younger ages than ever before to social pressures to be thin. Girls as young as 6 or 7 report fear of becoming fat and think they need to lose weight. In North America, 80% of women report having dieted before the age of 18. Fashion magazines, movies and television programs promote unrealistic ideals of body images that many girls and women feel compelled to live up to. In our weight-obsessed society, not only is thinness considered the most attractive, but overweight is considered a sign of low intelligence, laziness, dishonesty or sloppiness. All of these characteristics have nothing to do with weight, but people who give in to such pressure are vulnerable to beginning an insidious and frustrating cycle of behaviour with harmful consequences. The propensity to develop an eating disorder may be related to several predisposing factors.
It is difficult to establish a "profile" of the typical person at risk of developing an eating disorder. However, there are individual traits that may predispose a person to develop an eating disorder. They include:
Low self-esteem. People who do not feel good about themselves may attempt to change themselves by dieting.
Control issues. People who feel they have no control over their lives may try to assert control over their bodies. Sometimes control of the body's size represents the only control a person has.
Feelings of ineffectiveness or perfectionism. A person who feels he/she is inadequate may believe, falsely, that changing his/her body will help with other aspects of life, such as making decisions, coping with problems or establishing relationships with others.
Fear of maturation. Adolescents who are overwhelmed by the many changes of puberty may try to delay growing up.
Glossary of Eating Disorders
Victims of anorexia nervosa lose weight by starving themselves. Their skin becomes dry and cracked, and may turn slightly yellow. Their hair falls out. Even when an anorexic's weight is down to as low as 37 kg, she may still feel fat and continue to starve herself. The fatality rate for eating disorders is high, as much as 20%, according to some long-term studies.
• refusal to maintain a healthy body weight
• weight at 85% or less than expected for age and height
• intense fear of gaining weight
• distorted body image
• denial of the danger of maintaining low weight
• amenorrhea (cessation of menstruation)
Physical Effects of Eating Disorders
When an eating disorder leads to starvation, the person's heart rate, body temperature and metabolism lower. Women may experience irregular or complete cessation of menstruation. Fine hair grows on the face and back, but hair falls out from the scalp. The skin becomes dry and pasty and the ankles, face and fingers swell. The person experiences fatigue.
Diagnosis and Treatment
Eating disorders must be diagnosed by their specific symptoms, not by the exclusion of "real" illnesses. Eating disorders typically are characterized by body image - a drive for thinness, an excessive fear of becoming fat and destructive attitudes toward food and the physical self. The symptomatology in male sufferers is similar to that in females. Eating disorders are curable if they are identified early, treated by a collaboration of trained health professionals and supplemented by a support network. The goal of therapy should be to develop healthy eating patterns, restore and maintain a healthy weight and establish healthy attitudes toward the body, the self, food and relationships. In order to accomplish such changes, it may be necessary to discover and resolve traumatic or abusive experiences, strengthen coping skills and assist family and friends to help the person as he or she overcomes the eating disorder.
People with bulimia eat abnormally large amounts of food, especially in response to stress. Then they purge themselves of what they have eaten, often making themselves vomit by sticking their fingers down their throats or taking syrup of ipecac. Others use laxatives to force their bowels to move, or they do excessive exercise, or go through periods without eating. They may lose weight for a while by such means. Most, however, soon gain back all of the weight they have lost. Like anorexics, bulimics show signs of starvation such as thin hair and dry skin and may be depressed, anxious, and irritable.
• binge- eating followed by purging; repeated binge-and-purge episodes
• feeling out of control while eating
• dieting frequently, even though weight may be healthy
• believing that self-worth is only possible for the thin
• obsession with weight and body shape and a distorted perception of own weight, size
• engaging in self-destructive behaviour, such as alcohol or drug abuse, credit card abuse, stealing money or food, smoking to suppress appetite
• swollen parotid glands under the jaw, caused by frequent vomiting
• frequent, unusual dental problems, caused by stomach acids in the mouth during vomiting
Anorexia Athletica (Compulsive Exercising)
Anorexia athletica is not recognized as a diagnosis in the same manner that anorexia nervosa and bulimia nervosa are. However, it falls under the category of eating disorder because, like the other disorders, it involves obsession with food and weight. The person with anorexia athletica exercises compulsively to control weight in an attempt to boost self-esteem and gain a sense of control and power.
• exercising more than is necessary for good health and being fanatical about weight and diet
• taking time away from activities and relationships to exercise
• focusing on challenge at the expense of enjoying physical activity and always pushing to the next challenge, yet never being satisfied with athletic achievements
• defining self-worth in terms of performance
• asserting that the compulsive behaviour is healthy because one is athletic
Eating too much is not generally recognized as an eating disorder, but, as with other eating disorders, it involves an unhealthy relationship with food and emotional problems associated with eating. It does not involve purging.
• recurring episodes of binge eating and consequent feelings of having no control
• feelings of guilt and shame associated with overeating
• weight gain; during a binge may eat more quickly than normal and until over-full; eating large amounts despite not being hungry; "grazing" rather than eating meals; eating alone in secret.
Binge Eating Disorder (BED)
People with BED binge eat but do not use other behaviours regularly to maintain their weight (eg, vomiting, fasting, overusing laxatives). A person with BED often has a natural weight that is higher than that of the "average" person, let alone our society's cultural ideal. The person diets, becomes hungry, then binges in response to that hunger. A binge eating person may also eat for emotional reasons, such as feeling shame or embarrassment, needing comfort, attempting to avoid uncomfortable situations and feeling emotionally numb. Diet programs do not help BED and may even make the situation worse.
• eating large quantities and eating frequently, often until feeling uncomfortably full, then feeling guilty or ashamed
• feeling out of control and unable to stop eating
• eating quickly or secretly
• having a history of diet failures
• being obese (approximately one-fifth of obese people engage in binge eating)
Night-eating syndrome is not formally acknowledged as an eating disorder, but it is similar to eating disorders in that it involves obsessive eating. Biological and emotional factors may play a role in the syndrome.
• little or no appetite for breakfast
• eating more after dinner than for dinner, with more than half of the daily food intake being consumed after dinner. Eating is not bingeing but continuous throughout the evening hours.
• pattern persisting at least two months
• difficulty sleeping
• eating produces feelings of guilt, anxiety or shame
Pica is a craving for non-food substances, including dirt, clay, chalk, paint chips, cornstarch, baking soda, coffee grounds, cigarette ashes, rust and plastic. It usually occurs in pregnant women, people with diets deficient in minerals contained in the matter consumed or people with psychiatric disturbances. Pica can be harmless unless the substances consumed are toxic.
Nocturnal Sleep-Related Eating Disorder
Nocturnal sleep-related eating disorder is considered a sleep disorder, not an eating disorder. Episodes occur somewhere between wakefulness and sleep. The person may binge or consume strange combinations of food or non-food. When awake, the person has little or no recollection of the episodes.
Bingeing and Purging
A person who binges and purges is in medical danger; effects of bingeing and purging include:
Electrolyte Imbalances . Purging causes the loss of protein and electrolytes such as potassium, sodium and chloride that nerves and muscles require for proper functioning. Hypokalemia (low potassium levels) can occur quickly and is characterized by fatigue, muscle weakness and spasms, irritability and depression. In severe cases, it can cause irregular heartbeats, convulsions and even death due to heart or kidney failure.
Gastrointestinal Problems . Bloating, fullness, abdominal distress and constipation are frequent complaints of bulimics. Repeated vomiting can inflame the esophagus and even tear the esophageal lining. Laxative abuse causes stomach discomfort, cramping and constipation, weakening the body because it does not have the opportunity to absorb fat, protein and calcium through the intestinal walls.
Nutritional Deficiencies . Purging and vomiting prevent appropriate absorption of protein, carbohydrates, fats and lipids.
Edema . Using laxatives has a minimal effect on caloric absorption; weight loss induced by using laxatives or diuretics is the result of fluid loss. Once dehydration occurs, there is often rebound fluid retention for 48 to 72 hours, leading to edema (swelling), which makes the person feel bloated and fat, perpetuating the binge-purge cycle.
Ipecac Use . Ipecac contains emetine, a muscle poison that accumulates in the body and may cause death. Using syrup of ipecac to induce vomiting for weight loss is dangerous.