Who hasn’t struggled with a few extra pounds here and there, clothes fitting too tight, making it hard to breathe or even move around easily? The truth is that one-third of Americans in 2008 were obese, according to a new study just published by Lancet. All that blubber accumulating around American waistlines is cause for concern, but so is the frenzied and debilitating behavior to shed pounds in order to look young and sexy. Eating disorders in this country, among young and old, are taking a tremendous toll.
What happens to a person with an eating disorder? What can be done about it? We’ll take a look.
What an Eating Disorder Is
According to the National Eating Disorders Association (NEDA), eating disorders such as anorexia, bulimia, and binge eating disorder include extreme emotions, attitudes, and behaviors surrounding and food issues.
There are specific differences between the three disorders. Some individuals may go from one disorder to another, or have two simultaneously.
- Anorexia nervosa – This eating disorder is characterized by self-starvation and excessive weight loss. It is a serious and potentially life-threatening disorder.
- Binge eating disorder – Also referred to as BED, binge eating disorder is a type of eating disorder not otherwise specified, and is characterized by recurrent binge eating without compensatory measures used regularly to counter binge eating. It is the most common form of eating disorder.
- Bulimia nervosa – This is another serious and potentially life-threatening eating disorder. Bulimia nervosa is characterized by cycles of bingeing and use of compensatory measures to counter it such as self-induced vomiting and excessive use of laxatives.
While eating disorders, especially anorexia, are most often associated with women, men are also affected. Recent estimates say that 5 to 15 percent of people with anorexia are male, and the rates are increasing. Male anorexia usually surfaces in the teens, although males in their 60s can also be afflicted. About six percent of males with an eating disorder end in death. Among female adolescents, anorexia affects from 0.5 percent to 1 percent of the population, with an average onset age of 14 to 18. An estimated 0.5 percent to 3.7 percent of females suffer from anorexia nervosa in their lifetimes.
Eating disorders may be the result of a combination of factors. There may be biological underpinnings, with a person genetically vulnerable to developing an eating disorder. If a mother or sister has anorexia, for example, the daughter or sister has a higher risk of developing the eating disorder as well. This suggests a genetic link. Genetic tendencies toward perfectionism, perseverance, and sensitivity are also traits associated with anorexia. There’s also research evidence that serotonin, which is one of the brain chemicals involved in depression, may play a role in anorexia. Psychological factors – having a low self-worth, obsessive-compulsive personality traits, or extreme perfectionism – may also contribute to an eating disorder development. Sociocultural influences also play a part.
Health Risks and Complications
There’s no getting around the fact that anyone with an eating disorder has a problem that requires attention. While an eating disorder may develop over time, and the onset is not clearly recognized or understood, or mistaken for a loss of appetite or increased appetite due to lifestyle or mood changes, the cumulative health effects can be moderate to life-threatening.
Anorexia health risks – Looking at a person suffering from severe anorexia is like looking at a skeleton. Skin appears to hang off the skin like an ill-fitting garment. The hair and nails are brittle and break off easily. The skin is also noticeably dry. Those with anorexia are always cold, have lowered pulse rate. They frequently suffer constipation and occasional bouts of diarrhea. Swollen joints, mild anemia, reduced muscle mass, and loss of menstrual cycle also often accompany anorexia.
There are also long-term health risks associated with anorexia. These include heart problems, osteoporosis, mental health issues and death.
- Heart problems – Several heart problems can develop as a result of anorexia, such as slowing of the heart rate, irregular heart rhythms, lower blood pressure, and heart failure. People with anorexia who use drugs to stimulate urination, vomiting or bowel movements are even more likely to have heart failure than those with anorexia who do not use drugs to induce urination, vomiting or bowel movements.
- Osteoporosis – Lack of calcium puts persons with anorexia at increased risk of osteoporosis, both during the disease and throughout their lifetimes.
- Mental health issues – Anorexia frequently occurs in conjunction with other psychiatric disorders. Clinical depression is seen in a majority of people suffering from anorexia. Other people with anorexia may suffer from anxiety, personality disorders or substance abuse (often in combination, as in co-occurring substance abuse and mental health disorder, along with anorexia). Many individuals with anorexia are at risk for suicide.
- Death – The death rate for women with anorexia is among the highest for a psychiatric disease. About one in 10 women with anorexia will die, either of starvation, cardiac arrest or other complications.
Bulimia health risks – Similarly, those afflicted with bulimia have health risks and complications that may be serious and even life-threatening. Some are the same as for anorexia.
- Heart problems – including irregular heartbeat and heart failure
- Severe tooth decay
- Absence of a period (in females)
- Problems with digestion – including a possible dependence on laxatives in order to have a bowel movement
- Drug and/or alcohol abuse
Binge eating disorder health risks – Some of the complications of binge eating disorder arise from being overweight due to frequent bingeing. On the other hand, others may occur as a result of the yo-yo effect of weight gain, weight loss. Binge eaters generally consume food that is high in fat and low in protein and other nutrients, which could also contribute to complications. Here are some of the complications caused by or associated with binge eating disorder.
- Gall bladder disease ane other problems with digestion
- Heart disease
- High blood cholesterol
- High blood pressure
- Joint pain
- Muscle pain
- Suicidal thoughts
- Type 2 diabetes
Treatment for bulimia may require several types of treatment. Research shows, however, that perhaps the most effective way of overcoming this eating disorder is the combination of psychotherapy with antidepressants. Treatment generally involves using a team approach, with the individual and his or her family, primary care doctor or other medical provider, and mental health providers and dieticians experienced in treating eating disorders.
Psychotherapy, also called talk therapy or psychosocial therapy, is a general term. Simply put, it involves a patient talking with a psychotherapist or mental health provider about his or her condition and related issues. But there is a specific type of psychotherapy, called cognitive behavioral therapy (or CBT), that may benefit persons with bulimia. CBT is based on the theory that a person’s thoughts, not other people or situations, determine behavior. CBT helps patients to identify negative or unhealthy beliefs and behaviors and replace them with healthy and more positive beliefs and behaviors.
Family-based therapy may be an effective treatment for children and adolescents suffering from an eating disorder. Since the individual with the eating disorder may no longer be capable of making the right decisions regarding nutrition and health needs, the family is brought into treatment. Family therapy gets the family involved in making sure that the child or adolescent suffering with an eating disorder follows healthy-eating patterns and helps the child restore weight safely and effectively.
Interpersonal therapy, which focuses on a person’s current relationship with other people, may be beneficial for those suffering from binge eating disorder.
Dialectical behavior therapy, which helps patients learn behavioral skills to better tolerate stress, regulate emotions, and improve interpersonal relationships, may also benefit patients with binge eating disorder.
Medications may be used to help reduce some of eating disorder symptoms. At present, there is only one medication approved by the Food and Drug Administration (FDA) to treat bulimia. This is fluoxetine (brand name, Prozac), a type of selective serotonin reuptake inhibitor (SSRI). But doctors may prescribe other antidepressants or medications, particularly if there is accompanying mental disorder such as anxiety or depression. There is no medication specifically designed to treat binge eating disorder, although several have been found useful in reducing symptoms of binge eating disorder. These include SSRIs and tricyclic antidepressants (TCAs), which may affect certain brain chemicals associated with food. Topiramate, an anticonvulsant (brand name Topamax), has also been found to reduce episodes of binge eating, although it can also cause serious side effects, such as trouble thinking and a numb, burning, or tingling sensation.
Safe weight restoration and education on nutrition — An obvious goal of treatment for any eating disorder, whether it’s anorexia, bulimia, or binge eating disorder, involves the safe restoration of a healthy weight. But nutrition education is also important so that the person suffering from the eating disorder is well informed and confident of his or her ability to safely maintain a healthy weight. Underweight persons who suffer from bulimia need to have a healthy weight restored. Those with binge eating disorder may benefit from medically-supervised weight loss programs, but only after the binge eating disorder has been treated.
Hospitalization may be required for severe cases of anorexia or bulimia combined with other serious health complications. But anorexia and bulimia can usually be treated without hospitalization. There are also specialized eating disorder clinics and facilities offering intensive inpatient treatment, as well as treatment programs for eating disorders on a day treatment basis, not requiring full hospitalization. Those with co-occurring substance abuse and mental health disorder who also suffer from an eating disorder may be best helped at a residential treatment facility that specializes in simultaneous treatment of all of these conditions.
Relapse prevention is a challenge that necessitates ongoing education and use of coping strategies. Just because a person has successfully overcome an eating disorder and regained a healthy weight doesn’t mean that future stresses or challenges may not precipitate a return to the former unhealthy behavior – and result in a relapse. Just as in substance abuse, relapse is a particular danger, especially in early recovery. Experts caution that periods of bingeing and purging, for example, may continue to go on for years following treatment. During high stress situations, a person may return to the familiar and comforting – eating to excess and then purging – rather than continue with the healthy eating patterns. Additional counseling may be necessary to jumpstart the return to use of coping strategies to deal with the cravings and urges, create healthy relationships and manage stress.
After overcoming an eating disorder through treatment, that’s not all there is to being fully capable of living a healthy and productive life. As already mentioned, unexpected challenges, major and minor stresses, difficulty in relationships and other issues can cause a strain on a person in recovery from an eating disorder. The best help an individual in recovery can get is often through participation in a support group with people who know what it’s like to be in recoery from anorexia, bulimia, or binge eating disorder. They’ve been there themselves and can offer not only encouragement but also share strategies on how they’ve been able to cope.
Is There Hope?
While in the midst of an eating disorder, it may be difficult for the person suffering from it to be able to see any hope for the future. The patterns of unhealthy eating have become so entrenched, and accompanying anxiety, depression, or other mental health and/or associated physical conditions so severe that outside professional help is the only solution. It may require family intervention to get the individual into treatment.
But any effective long-term recovery depends on the motivation and determination of the individual. A person has to want to be healthy, has to learn and practice healthier ways of living, learn and practice effective coping measures, and begin to develop healthy relationships.
The bottom line is that whether a person is young and wants to be sexy or is any age and has developed an unhealthy eating disorder, there is help and there is hope. Eating disorders don’t have to take the awful toll that, without help, they almost inevitably do. Stop the downward spiral caused by eating disorders. Get help now, whether you are the person with the eating disorder or your loved one or friend is the one who suffers from it. The only way to live to see tomorrow – and be healthy and happy doing so – is to address the eating disorder today.