Is someone you know on a diet? Probably. Because just about everyone is on a diet, or at least watching their weight, or their carbs or their intake of fats and sugars. But when does normal moderation become not so normal? Is it when you start to see the outlines of ribs and bones that weren't there before? The situation doesn't have to become that extreme for someone to be suffering from an eating disorder. Over 5 million people in the United States have an eating disorder, and the majority are female. But the number is probably higher since so many cases go unreported.
We know the main names: anorexia nervosa and bulimia nervosa. But what many people may not know is how dangerous, debilitating and potentially fatal eating disorders can be. Patients with anorexia nervosa have a disturbed body image, an intense fear of gaining weight and pursue being thin at all costs. They are unwilling to maintain a healthy weight. Bulimia is characterized by episodes of compulsive eating, then purging through vomiting, excessive use of laxatives or diuretics fasting, and excessive exercise. With anorexia, bulimia or other eating disorders not otherwise specified, sometimes referred to as EDNOS, extremely disturbed eating behavior becomes a viable method of altering a perceived (and usually distorted) negative body image.
The Health Risks of Eating Disorders
While it is true that eating disorders are usually, but not always, curable medical illnesses, their underlying causes are so varied and complex, they can be extremely challenging to treat. They have been found to recur within families, can result from disturbances in the central nervous system and are often associated with temperamental features like perfectionism, low self-esteem or an extreme need for control. Those with eating disorders often display other psychiatric illnesses like clinical depression, obsessive compulsive disorder, substance abuse or anxiety disorder.
The medical risks of eating disorders are legion.
In the case of anorexia, the disease disrupts virtually all the organ systems. Anorexics are subject to hypotension (low blood pressure), bradycardia (slow heartbeat), and arrhythmias (irregular heartbeat), and individuals with serious degrees of weight loss can develop heart failure. Anorexia also causes osteopenia and osteoporosis, anemia, impaired growth in children and adolescents, and electrolyte problems. Additionally, anorexia has an extremely high mortality rate, with between 6 and 20 percent of patients dying from related causes.
Bulimia sufferers experience kidney problems, severe dehydration, chronically inflamed throat, swollen salivary glands, worn tooth enamel (from all the stomach acid passing through their mouth), gastroesophageal reflux disorder and intestinal distress from laxative abuse.
But whether it's anorexia or bulimia, we're essentially dealing with starvation, which, as anyone would expect, has profound physical and psychological effects on a person. Given that adolescent women are the main sufferers of eating disorders, with 15 to 19-year-olds making up 40 percent of all cases of anorexia in particular, these young victims can face a lifetime of health challenges.
The Media in the Mirror
In addition to the medical, psychiatric and psychosocial causes of eating disorders, some of the most insidious triggers, especially with regard to the problem of body image dissatisfaction, come from the idealized images of beauty we're all subjected to by the media. These images of hyper thin, hyper-toned bodies are not only impossible for most people to achieve and maintain, some of the images aren't even real -- they're airbrushed, Photoshopped and otherwise manipulated.
Driven by the multi-billion dollar cosmetic/exercise/fashion/beauty industries, the body images that are being sold appear to be designed to entice consumers to continue buying their products. But try explaining this to a college age woman, of whom one out of four is using an unhealthy weight loss method, or a 90-pound teenager who thinks she's fat. Or, as more and more research is telling us, to preteenage girls and even children, because the demographics for eating disorders are dropping to those age groups. Physicians are reporting children as young as 6, 7 and 8 years old who exhibit symptoms or full-blown cases of eating disorders.
Of the many tragic sufferers of anorexia was a 15-year-old Olympic hopeful who, at 4 feet 10 inches tall and 97 pounds, was told she was too heavy for the sport. She developed a severe eating disorder, struggled with anorexia and bulimia for six years, and died at 22, weighing 47 pounds.
Perhaps even more tragic is that, unlike other diseases which have support groups to help patients deal constructively with their condition, eating disorders have spawned online communities, what they call Pro-Ana websites, that offer young girls tips on how to diet even more stringently and how to keep their anorexia from their parents and doctors.
Treating eating disorders successfully is a multi-layered process. It requires returning the patient to a healthy weight, addressing the psychological issues and changing the behaviors that lead to disordered eating. Antidepressants, such as fluoxetine (Prozac), are more useful for patients with bulimia than those with anorexia. Unfortunately there may be a slightly increased risk of thought of or attempted suicide in children and adolescents taking antidepressants--the age groups that often are afflicted with these eating disorders. In addition to clinical solutions, it requires patience, insight and commitment, and can often involve the entire family, not only as a support system, but also in identifying the issues that may have caused the disorder. There are several useful support group sites that patients and families may go to: National Association of Anorexia Nervosa and Associated Disorders or the National Eating Disorders Association.
On a more subtle note, it also takes vigilance and insight not to believe that what we're seeing on TV, in magazines and on billboards is a picture of true beauty worth sacrificing health, or life, trying to attain.
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