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 Diet & Nutrition

August 2009

Eating Disorders
Dr E Suneetha
Eating disorders are characterised by gross disturbances in eating behaviour. Individuals with eating disorders are filled with intense negative feelings about their body weight or shape and adopt unhealthy practices such as extreme reduction of food intake or extreme overeating.

"I had bulimia for a number of years. And that's like a secret disease. You inflict it upon yourself because your self-esteem is at a low ebb, and you don't think you're worthy or valuable. You fill your stomach up four or five times a day - some do it more - and it gives you a feeling of comfort. It's like having a pair of arms around you, but it's temporarily, temporary. Then you're disgusted at the bloatedness of your stomach, and then you bring it all up again. And it's a repetitive pattern, which is very destructive to yourself."
- Diana, Princess of Wales
"

Eating disorders are a relatively recent 'syndrome'. Common eating disorders observed include anorexia nervosa and bulimia nervosa. In addition, there is a third category called Eating Disorders Not Otherwise Specified (EDNOS), which consists of binge eating disorder and other severe conditions that are akin to anorexia nervosa and bulimia nervosa but do not match the official definitions of these illnesses. Eating disorders are puzzling and complex in many ways because they are a self-imposed disease. Despite scientific research to understand them, the biological, behavioral and social underpinnings of these illnesses remain elusive. Eating disorders in most cases threaten the person's happiness, health and life in a subtle and pervasive way, and may even be potentially lethal in few cases. People with eating disorders are normally young and bright. They do not complain about their eating habits and they either hide them or defend them, or both, sometimes in the face of advanced emaciation. It is hard to understand why bright and skilled people condemn themselves to the misery of obsession with food and why they sacrifice their life in the pursuit of thinness.

Anorexia Nervosa
'Anorexia,' in etymological terms, means 'lack of appetite'. However, people with anorexia in contrast feel hungry but try to suppress the hunger and avoid eating. Individuals suffering from it are so focused on fighting hunger that it is hard for them to acknowledge that they have it; that's where the term 'nervosa' comes in. Anorexia can be traced back to early middle ages, where in Middle Europe, female saints like Catherine of Siena (14th Century) suffered and died because of it.

Anorexia nervosa is characterised in individuals by a refusal to maintain body weight over a minimal level considered normal for age and height, a distorted body image, an intense fear of fatness or weight gain while being underweight, and amenorrhoea (the absence of at least three consecutive menstrual cycles). They imagine that they are overweight - while in reality they are grossly underweight. In their imagination, they either restrict food or exercise excessively to lose weight severely. He or she may be obsessed with their weight and hence may frequently weigh themselves, reduce the portion size drastically or avoid certain foods like carbohydrates and fats completely.

Bulimia Nervosa
Bulimia nervosa is characterised by binge eating and purging. This typically involves consumption of calorie dense food, usually eaten inconspicuously or secretly. By relieving abdominal discomfort through vomiting, the individual can continue to binge. In case of anorexia, the complications are more or less the result of starvation, whereas in bulimia, complications occur because of eating and purging. Unlike anorexics, bulimics do realise that they have a problem and are more likely to seek help. Most persons suffering from bulimia nervosa are at or near normal weight and so it is difficult to identify them. But like people with anorexia, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape. Bulimic people usually try to hide their disorder until they feel that they are out of control, or when they realise that the disorder is negatively affecting their personal and social life. Bulimia was revealed as princess Diana's "secret disease" in Andrew Morton's book, Diana: Her True Story. Diana's openness about her problem has helped many to come openly about their problem and thus save many lives. Many things can be learnt from her public confessions.

  1. Pressures in life can be trigger points for bulimia.
  2. The eating habit may be a silent cry for help, seeking others' attention.
  3. Eating disorders often can be a reflection of their hatedness towards themselves.
  4. People try to get psychological comfort for their problems through eating disorders.
  5. Guilt of overeating often causes the person to try to get rid of the extra calories through vomiting, using laxatives or water pills, or excessive exercise.

Impact on health
Individuals with eating disorders consume a diet too low in energy and nutrients, and hence are at a higher risk for medical complications such as electrolyte imbalances and cardiac arrhythmias. In addition, the major concern is that the victims are mostly adolescents who are still in their growing phase. Lack of adequate nutrition, most notably calcium, vitamin D and iron during peak growth periods may prevent normal peak bone mass from being achieved and frequent amenorrhoea. Many studies indicate that individuals with eating disorders also suffer from mood alterations like anxiety, fatigue or anger.

Handling eating disorders
Many celebrities are under constant pressure to look perfect to meet the expectations of the public and enter into the trap of dieting. They are often pressed for time in reducing their weights. Such periods have been suggested as important risk or trigger factors for the development of eating disorders. It is not necessarily dieting per se, but the interplay of complex factors like the pressure to lose weight or body fat, overstress on calorie count, availability of expert guidance, personality of the celebrity and others.

It is difficult to convince individuals that they are in need of help, since they believe that weight loss helps in better aesthetic appeal. They need to be educated about weight control, sound nutrition, and 'natural' growth and development. The focus on leanness must be de-emphasised. They also need to understand their nutritional requirements and maintain regular eating patterns with balanced meals. Weight goals must be realistic and should not be drastic. Dieticians should be knowledgeable about the symptoms of eating disorders and must be able to recognise when their clients are becoming more obsessive with weights. Once the eating disorder is diagnosed, the goal is to modify the behavioural, cognitive and affective components of the individual's eating disorder and to develop a rational approach for achieving self-management of healthy diet and optimal weight.

Fa(c)t
  • 1.25 % was the prevalence of eating disorders In India (Mammen et al., 2007)
  • 91% of women surveyed on a college campus had attempted to control their weight through dieting, 22% dieted "often" or "always" (Kurth et al., 1995).
  • 81% of 10-year-olds are afraid of being fat (in America). 51% of 9 and 10-year-old girls feel better about themselves if they are on a diet. (Mellin et al., 1991).
  • 35% of "normal dieters" progress to pathological dieting (Shisslak & Crago, 1995).
  • 63 Kg is what an average American woman (5'4" tall) weighs. The average American model is 5'11" tall and weighs only 53 Kg. Most fashion models are thinner than 98% of (American) women.
  • 7 million girls and women struggle with eating disorders while 1 million boys and men struggle with it in the US. Women and adolescents are more prone to eating disorders.
 

    
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