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 Health & Beauty | April 2006 
Facts About Eating Disorders
 Sueanne Hagemann - PVNN
| | Thoughts about eating can begin to control a person's mind 24 hours a day, 7 days a week. Your entire life can be centered on this one issue, depriving you of enjoying friends, fun and family. |
Eating Disorders are Widespread and Destructive
• Eating disorders cause immeasurable suffering for individuals and their families
• Eating disorders have reached epidemic levels in America - all segments of society are affected: men and women, young and old, rich and poor, all minorities, all socio-economic levels
• Seven million women
• One million men
AGE AT ONSET OF ILLNESS:
• 86% report onset of illness by the age of 20*
• 10% report onset at 10 years or younger
• 33% report onset between ages of 11-15
• 43% report onset between ages of 16-20
DURATION OF ILLNESS/MORTALITY:
• 77% report duration from one to fifteen years*
• 30% report duration from one to five years
• 31% report duration from six to ten years
• 16% report duration from eleven to fifteen years
• It is estimated that six percent of serious cases die
• Only 50% report being cured * ANAD Ten Year Study
COST OF TREATMENT:
• Treatment for anorexia nervosa and/or bulimia is often extremely expensive and can extend for several years.
• Cost of inpatient treatment can be $30,000 or more a month.
• The cost of outpatient treatment, including therapy and medical monitoring, can extend to $100,000 or more.
Eating disorders are rampant in our society, yet few states in the nation have adequate programs or services to combat anorexia nervosa and bulimia. Only a small number of schools and colleges have programs to educate our youth about the dangers of eating disorders.
Every state in our nation and thousands of schools have extensive programs aimed to prevent alcoholism and drug abuse. The value of such programs, especially education programs, has been proven and accepted into school curricula.
The immense suffering surrounding eating disorders, the high cost of treatment and the longevity of these illnesses make it imperative that vastly expanded education programs be implemented to prevent anorexia nervosa and related disorders.
Since 86 percent of individuals report the onset of their illness by age 20, educations programs should focus on these ages in order to maximize preventive efforts.
ANAD education/early detection/prevention programs provide models for low cost outreach services that benefit hundreds of thousands of our youth. ANAD has urged federal and state governments to undertake and develop education programs for our citizens.
IDENTIFYING AN EATING DISORDER:
Anorexia Nervosa
1. Weight: 15 % below ideal body weight. Refusal to maintain a normal weight or above normal weight for height and age. Not everyone who is of a low weight is anorexic; it is important to recognize that it is the REFUSAL to maintain a normal weight that is the key factor.
It is sometimes difficult in children to identify anorexia because for their height they may be of a normal weight. A possible complication of an eating disorder is stunted growth in children. A pediatrician will need to carefully monitor him/her with a growth chart. Also, young children may not talk about weight but rather may describe physical complaints such as nausea or feeling full.
2. Intense fear of gaining weight or becoming fat, even if underweight. This intense fear is powerful enough to cause individuals to diet to the point of starvation. While the term anorexia means loss of appetite, this is not true of anorexia nervosa. A person with anorexia is hungry but he or she is afraid to eat because of the fear. Often specific foods are avoided especially those that are high in fat and calories. Often individuals will become vegetarians and want to eat healthily when indeed the issue is the fear of gaining weight.
A person with anorexia constantly thinks about food--how many calories, how many fat grams, how much exercise do you need to do if you eat a cookie, etc. How many times do you check the scale?
There is always the attempt to try to control eating because the of fear of gaining weight. Often meals are avoided or eaten very slowly, pondering each bite, fearing that surely it will make them fat.
These thoughts begin to control a person's mind 24 hours a day, 7 days a week. Your entire life can be centered on this one issue, depriving you of enjoying friends, fun and family.
3. Body Image Problems
When a person with anorexia looks into a mirror he/she does not often see an accurate reflection. A person with anorexia sees him/herself as fat, even if he/she is dangerously thin. This is a very frightening experience and feels very real- driving the person to diet.
Sometimes a person with anorexia can accept that he/she is very thin but cannot accept how dangerous the situation really is. It is difficult for him/her to understand that a very low weight and dangerous dieting habits can actually be fatal. The death rate for anorexia is higher than for any other psychiatric illness.
4. Ammenorrhea or Absence of Menstruation
Missing 3 periods is usually the criteria for this definition. This criteria cannot apply to situations where the person is a male, a young female who has not started her periods or a female who is on birth control pills.
Types of Anorexia:
Many individuals with anorexia will severely restrict their calories sometimes taking in only a few hundred calories a day or just water. This is called the RESTRICTING TYPE. Our bodies do not like to starve. Remember, the individual with anorexia has an appetite they just try to control it. It is very difficult when you are starving not to want to eat. What happens to many as a result is that they lose control they eat or eat something they feel they should not have eaten. For these individuals, this might mean something as simple as a cookie, a normal meal or even a binge. With the fear of gaining weight, they may vomit or exercise. This type of anorexia is called the BINGE-EATING/PURGING TYPE one of the most dangerous forms of an eating disorder.
Bulimia Nervosa
1. Binge Eating
All of us will overeat now and then- this is pretty normal behavior. For instance at Thanksgiving, we all sit down at the dinner table and probably overindulge. Binge eating in bulimia has certain characteristics that make it much different..
A binge is characterized by:
• A larger amount of food than most people would eat during the same time period(may consist of thousands calories)
• Consumed within a short period of time (typically 2 hours or less)
• A feeling that one CANNOT STOP or CONTROL one's eating
• Accompanied by physical or emotional distress
2. Purging
Following a binge, an individual may feel consumed with fear, guilt or shame and the need to try to undo his/her behavior. Purging is a way to compensate for binging. Purge behaviors come in many forms: vomiting, taking laxatives, water pills, starving or excessive exercise.
It is important to recognize that purging rarely works well for weight loss. Laxatives and diuretics make you lose water not weight. Even vomiting seems to be ineffective- it has been reported that 50-75% of the calories have already been absorbed.
3. Binging and Purging occurs more than 2 x a week for at least 3 months
4.Body Image : Self evaluation and self esteem is overly influenced by weight and shape
Many people in our culture are concerned with how they look, what they weigh or how to change the body parts they don't like. In bulimia, there is an intense connection between self respect and the way the body looks. We can be great in a lot of things, but if our thighs are too big, well then, we are just not good enough.
What about weight in bulimia nervosa?
Weight can be normal, underweight or overweight. Unlike anorexics who can be often identified by their low weight, it is more difficult to identify bulimics. Weight can also dramatically shift and large swings might be an indicator that someone in developing an eating disorder.
Eating Disorder Not Otherwise Specified (NOS)
Just because one does not meet these exact definitions does not mean that the person does not have an eating disorder. As a matter of fact, most people will not meet the full criteria. Individuals may begin as anorexic but then not be able to hold the low weight ( 15% below) and may go onto develop bulimia. Actually up to 50% of patients with anorexia develop bulimic symptoms. Some patients with bulimia develop anorexic symptoms.
Binge Eating Disorder (BED)
This was often referred to as COMPULSIVE OVEREATING, typically characterized by:
• A larger amount of food is eaten than would normally be eaten under the circumstances (usually at least over 2500 calories) within at least a 2 hr period of time
• Accompanied by feelings of physical discomfort and emotional distress.
• This occurs at least 2 times per week for 6 months. There is no purging associated with BED.
EATING DISORDER WARNING SIGNS:
ANOREXIA NERVOSA
• Deliberate self-starvation with weight loss
• Intense, persistent fear of gaining weight
• Refusal to eat or highly restrictive eating
• Continuous dieting
• Excessive facial/body hair because of inadequate protein in the diet
• Compulsive exercise
• Abnormal weight loss
• Sensitive to cold
• Absent or irregular menstruation
• Hair loss
BULIMIA NERVOSA
• Preoccupation with food
• Binge eating, usually in secret
• Vomiting after bingeing
• Abuse of laxatives, diuretics, diet pills
• Denial of hunger or drugs to induce vomiting
• Compulsive exercise
• Swollen salivary glands
• Broken blood vessels in the eyes
PHYSICAL REPERCUSSIONS FROM ONE OR BOTH DISEASES
• Malnutrition
• Dehydration
• Ruptured stomach
• Serious heart, kidney, and liver damage
• Tooth/gum erosion
• Tears of the esophagus
PSYCHOLOGICAL REPERCUSSIONS FROM BOTH DISEASES
• Depression
• Low self-esteem
• Shame and guilt
• Impaired family and social relationships
• Mood swings
• Perfectionism
• 'All or nothing' thinking
WHO IS AT RISK OF DEVELOPING AN EATING DISORDER:
Everyone! In every race, culture, age group, and sex there are people with eating disorders. Yet, in this section ANAD identifies the groups who are at a greater risk.
Females: Because of the increased number of media images portraying 'thin and perfect' models, many girls struggle with body image issues that potentially result in eating disorders.
Youth: Early adolescence to early adulthood with 11 and 17 identified as times for increased vulnerability. Perhaps they represent time of change. The 11 year old may be experiencing changes in her body hormonally as she becomes ready to get her periods. Often there is increase in fat in 'all the wrong places' creating anxiety. Perhaps it is even more difficult when the school, in a well meaning attempt to have children be healthy, measure body fat. Of course, there is always the issues of boys and what culture tells about having an attractive body.
The onset of eating disorders can occur at any age, however and the age of onset does appear to be getting younger.
Eating disorders can occur at any time and certainly reports of adult onset and individuals at 70 years of age have been reported.
Males: Increasing we are becoming more aware of eating disorders in males. For adults, the approximate ratio of men to women is 1:10. About 20-30% of younger anorexics are male. We probably are not identifying the disorder because of the stereotyping that this is a female illness. There are probably as many bulimic men than there are anorexic women.
Minorities: Once considered an illness of affluent white females, the picture has dramatically changed. In the US, eating disorders appear to be as common among Hispanic as well as Caucasian women. Recent focus of African American women indicates that it is more common than expected. Black women are prone more to bulimia nervosa and abuse of laxatives. There appears to be an overall increase in other countries.
Athletes: Women participating in certain sports such as gymnastics and distance running are especially vulnerable. Men involved in wrestling are often at risk as they attempt to make weight.
Genetics: Evidence is pointing to the fact that there is a strong genetic component to the illness. There also seems to be some sort of relationship between eating disorders and substance abuse, affective disorders (depression and bipolar) and anxiety disorders.
WHAT CAUSES EATING DISORDERS?:
A Biopsychosocial Approach
There are so many avenues to developing an eating disorder. There is no one single cause but rather a complex interaction between the biological issues such as genetics, metabolism etc. - psychological issues such as control, coping skills, personality factors, family issues and social issues such as a culture that promotes thinness and media that transmits this message.
Dieting
Why do some people diet and nothing happens? Why do others develop eating disorders?
In adolescents who develop eating disorders, those that were labeled as 'severe dieters' had an 18 times greater chance of developing an eating disorder; with moderate dieting, 5 times greater, non-dieters 1:500 chance of developing an eating disorder.
Why is dieting at certain ages more dangerous?
Whatever the reasons, dieting to lose weight may make us vulnerable to develop an eating disorder. See below for other possible explanations.
Genetics
Genes load the gun - Environment pulls the trigger!
We are far from knowing specific genes that cause eating disorders. There are a number of genes that work with environmental triggers and possible dieting and loss of weight may influence the development of anorexia by turning on a gene that may influence an eating disorder.
There are many cases of transgenerational eating disorder and twin studies which make this connection. There is probably a 5-6 greater chance of developing an eating disorder if an immediate relative has an eating disorder.
Depression and Anxiety
Looking at depression and anxiety disorders as psychiatric illnesses which are biological in nature, we see that they commonly co-exist in the eating disorder patient and their families.
Excessive Exercise
Referred to as an exercise induced anorexia, this concept is being explored.
Thought: Did you know that rats who were put on a restrictive diet spent increasing amounts of time running on their activity wheel? They lost a great deal of weight. If the researchers let them continue to do this, the animal would have died.
Psychological Factors:
No one factor causes an eating disorder. The list below is long and incomplete. Everyone is unique but sometimes there are patterns:
For anorexia:
• fear of growing up
• inability to separate from the family
• need to please or be liked
• perfectionism
• need to control
• need for attention
• lack of self esteem
• high family expectations
• parental dieting
• family discord
• temperment - often described as the 'perfect child'
• teasing about weight and body shape
For bulimia:
• difficult regulating mood
• more impulsive - sometimes will be involved with shoplifting, substance abuse, etc.
• sexual abuse
• family dysfunction
Social-cultural causes
• the sexual revolution
• emphasis on thinness as the ideal for beauty
• availability and indulgence of food
• role of the media
• obesity and reaction to the larger body size
Thought: If we took an average 5'2'' woman, age 22 and normal weight of 125 lbs and expected her to fit in the Barbie image - she would have to be 7'2'' tall?
Self-Evaluation Quiz
• Are you constantly thinking about your weight and food?
• Are you dieting strictly and/or have you lost a lot of weight?
• Are you more than 10% below your healthy weight?
• Are people concerned about your weight?
• Is your energy level down?
• Do you constantly feel cold?
• Are your periods abnormal or have your periods stopped?
• Are you overeating and feeling out of control?
• Are you vomiting, using laxatives or water pills, herbal agents, or trying to fast as a way to control your weight?
• Are you over exercising or do others consider your excercise excessive ?
• Does your weight drastically fluctuate?
• Do any of the above interfere with your enjoyment of life, relationships, or everyday functioning?
Note: This quiz is not intended to diagnose an eating disorder . It is simply designed to indicate that a person may be thinking too much about food, weight, etc or engaging in potentially eating disordered behaviors.
If you answered yes to more than 5 of these questions, we would encourage you to get a professional evaluation. Please contact anad20@aol.com for a list of professionals and support groups in your area. For Help in Vallarta call Sueanne Hagemann 322 223-8001
Information National Eating Disorder Research Project |
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