Eating Disorders

What are eating disorders?

Eating disorders are mental illnesses that cause serious disturbance in persons everyday diet. It
can manifest as eating extremely small amounts of food or severly overeating. The condition
may just begin as eating too little or too much but obsession with eating and food over takes over
the life of a person leading to severe changes.

These disorders impact approximately 20 million women and 10 million men in the United
States and are found in all populations regardless of age, ethnicity, socioeconomic status,
religion, sex, gender, etc.
Facts about Eating Disorders:
Eating disorders are complicated and nuanced disorders and vary from person to person.
However, there are some overall eating disorder facts that research has been able to clearly
delineate regardless of the individual.
● Eating disorders do not discriminate and are observed in “people of all ages, racial/ethnic
backgrounds, body weights, and genders.”
● Eating disorder onset typically occurs in adolescence or young adulthood but is not
limited to these life stages.
● There is no one distinct cause of eating disorders. Research has found a number of
“genetic, biological, behavioral, psychological, and social factors” that can increase the
risk of eating disorder development.
● Eating disorders can be life-threatening and have the highest mortality rate of any mental
illness.
● While eating disorders do not have a “miracle cure,” there are numerous evidence-based
practices proven to support eating disorder recovery.
Types of Eating Disorders
● Anorexia Nervosa
● Bulimia Nervosa
● Binge eating disorder
● Not otherwise specified (NOS)
Anorexia Nervosa:
An eating disorder characterized by a refusal to maintain a minimally normal body weight and a
distortion in perception of body shape and weight.
• an - without
• orex - mouth
• nervos - of nervous origin
Anorexia nervosa happens when one is obsessed with becoming thin that they reach extreme
measures and this leads to extreme weight loss.

Characteristics of Anorexia Nervosa:

People with anorexia place a high value on controlling their weight and shape, using extreme
efforts that tend to significantly interfere with their lives.
To prevent weight gain or to continue losing weight, people with anorexia usually severely
restrict the amount of food they eat. They may control calorie intake by vomiting after eating or
by misusing laxatives, diet aids, diuretics or enemas. They may also try to lose weight by
exercising excessively. No matter how much weight is lost, the person continues to fear weight
gain.

Anorexia isn't really about food. It's an extremely unhealthy and sometimes life-threatening way
to try to cope with emotional problems. When you have anorexia, you often equate thinness with
self-worth.

Anorexia, like other eating disorders, can take over your life and can be very difficult to
overcome. But with treatment, you can gain a better sense of who you are, return to healthier
eating habits and reverse some of anorexia's serious complications.
Symptoms
The physical signs and symptoms of anorexia nervosa are related to starvation. Anorexia also
includes emotional and behavioral issues involving an unrealistic perception of body weight and
an extremely strong fear of gaining weight or becoming fat.

It may be difficult to notice signs and symptoms because what is considered a low body weight
is different for each person, and some individuals may not appear extremely thin. Also, people
with anorexia often disguise their thinness, eating habits or physical problems.
Physical symptoms

Physical signs and symptoms of anorexia may include:

● Extreme weight loss or not making expected developmental weight gains

● Thin appearance
● Abnormal blood counts
● Fatigue
● Insomnia
● Dizziness or fainting
● Bluish discoloration of the fingers
● Hair that thins, breaks or falls out
● Soft, downy hair covering the body
● Absence of menstruation
● Constipation and abdominal pain
● Dry or yellowish skin
● Intolerance of cold
● Irregular heart rhythms
● Low blood pressure
● Dehydration
● Swelling of arms or legs
● Eroded teeth and calluses on the knuckles from induced vomiting

Some people who have anorexia binge and purge, similar to individuals who have bulimia. But
people with anorexia generally struggle with an abnormally low body weight, while individuals
with bulimia typically are normal to above normal weight.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

● Severely restricting food intake through dieting or fasting

● Exercising excessively
 ● Bingeing and self-induced vomiting to get rid of food, which may include the use of
laxatives, enemas, diet aids or herbal products
Emotional and behavioral signs and symptoms may include:

● Preoccupation with food, which sometimes includes cooking elaborate meals for others
but not eating them
● Frequently skipping meals or refusing to eat
● Denial of hunger or making excuses for not eating
● Eating only a few certain "safe" foods, usually those low in fat and calories
● Adopting rigid meal or eating rituals, such as spitting food out after chewing
● Not wanting to eat in public
● Lying about how much food has been eaten
● Fear of gaining weight that may include repeated weighing or measuring the body
● Frequent checking in the mirror for perceived flaws
● Complaining about being fat or having parts of the body that are fat
● Covering up in layers of clothing
● Flat mood (lack of emotion)
● Social withdrawal
● Irritability
● Insomnia
● Reduced interest in sex
Causes
The exact cause of anorexia is unknown. As with many diseases, it's probably a combination of
biological, psychological and environmental factors.

● Biological. Although it's not yet clear which genes are involved, there may be genetic
changes that make some people at higher risk of developing anorexia. Some people may
have a genetic tendency toward perfectionism, sensitivity and perseverance — all traits
associated with anorexia.
● Psychological. Some people with anorexia may have obsessive-compulsive personality
traits that make it easier to stick to strict diets and forgo food despite being hungry. They
may have an extreme drive for perfectionism, which causes them to think they're never
thin enough. And they may have high levels of anxiety and engage in restrictive eating to
reduce it.
● Environmental. Modern Western culture emphasizes thinness. Success and worth are
often equated with being thin. Peer pressure may help fuel the desire to be thin,
particularly among young girls.
Risk factors
Anorexia is more common in girls and women. However, boys and men have increasingly
developed eating disorders, possibly related to growing social pressures.

Anorexia is also more common among teenagers. Still, people of any age can develop this eating
disorder, though it's rare in those over 40. Teens may be more at risk because of all the changes
their bodies go through during puberty. They may also face increased peer pressure and be more
sensitive to criticism or even casual comments about weight or body shape.

Certain factors increase the risk of anorexia, including:

● Genetics. Changes in specific genes may put certain people at higher risk of anorexia.
Those with a first-degree relative — a parent, sibling or child — who had the disorder
have a much higher risk of anorexia.
● Dieting and starvation. Dieting is a risk factor for developing an eating disorder. There
is strong evidence that many of the symptoms of anorexia are actually symptoms of
starvation. Starvation affects the brain and influences mood changes, rigidity in thinking,
anxiety and reduction in appetite. Starvation and weight loss may change the way the
brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors
and make it difficult to return to normal eating habits.
● Transitions. Whether it's a new school, home or job; a relationship breakup; or the death
or illness of a loved one, change can bring emotional stress and increase the risk of
anorexia.
Complications
Anorexia can have numerous complications. At its most severe, it can be fatal. Death may occur
suddenly — even when someone is not severely underweight. This may result from abnormal
heart rhythms (arrhythmias) or an imbalance of electrolytes — minerals such as sodium,
potassium and calcium that maintain the balance of fluids in your body.

Other complications of anorexia include:

● Anemia
● Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure
● Bone loss (osteoporosis), increasing the risk of fractures
● Loss of muscle
● In females, absence of a period
● In males, decreased testosterone
● Gastrointestinal problems, such as constipation, bloating or nausea
● Electrolyte abnormalities, such as low blood potassium, sodium and chloride
● Kidney problems
If a person with anorexia becomes severely malnourished, every organ in the body can be
damaged, including the brain, heart and kidneys. This damage may not be fully reversible, even
when the anorexia is under control.

In addition to the host of physical complications, people with anorexia also commonly have
other mental health disorders as well. They may include:

● Depression, anxiety and other mood disorders

● Personality disorders
● Obsessive-compulsive disorders
● Alcohol and substance misuse
● Self-injury, suicidal thoughts or suicide attempts
Prevention
There's no guaranteed way to prevent anorexia nervosa. Primary care physicians (pediatricians,
family physicians and internists) may be in a good position to identify early indicators of
anorexia and prevent the development of full-blown illness. For instance, they can ask questions
about eating habits and satisfaction with appearance during routine medical appointments.

If you notice that a family member or friend has low self-esteem, severe dieting habits and
dissatisfaction with appearance, consider talking to him or her about these issues. Although you
may not be able to prevent an eating disorder from developing, you can talk about healthier
behavior or treatment options.

Key goals in nutritional therapy for anorexia nervosa:

● Weight restoration and body-weight maintenance
 ● A development of neutrality toward food through re-developing intuitive understandings
of hunger, fullness, and satiety.
● Regulation of phosphate levels in of food through an individualized program.
Recovering from Anorexia:
● Start by eating very small amounts of food and increase intake very gradually over time.
● Make sure nutritional experts correct any biochemical imbalances before beginning the
weight gain process (supplements, vitamins etc).
● Get into a routine when it comes to food- eat regularly at particular times throughout the
day (three balanced meals per day).
● Set a target weight so there is a goal to work towards. A gain rate of 0.5-1kg per week
(but no more) is widely recommended by experts. This can be achieved by eating 3,500-
7000 extra calories per week.
Treatment:
Hospitalization is indicated for
● Severe malnutrition (body weight less than 75% of ideal),
● Suicidal ideation
● Electrolyte disturbances
● Dehydration
● Abnormal vital signs (e.g., bradycardia, hypothermia)
● Failure of outpatient treatment
Vitamin and mineral supplementation may be necessary. An inpatient or outpatient structured
eating program may help restore healthy eating habits.
Psychotherapy is a mainstay of treatment for certain eating disorders.Because drug therapy is,
for the most part, ineffective for anorexia nervosa, psychotherapy is often the treatment of
choice.
Family-based therapy appears to be more effective in anorexic adolescents (but not adults) than
other therapeutic modalities.In adults, psychotherapy has been found to reduce anorexic
behaviors in up to 60% of patients.
Nutritional Considerations:
● Refeeding: Particularly in persons who are significantly underweight, electrolytes should
be carefully monitored and refeeding introduced gradually and progressively
● Hypokalemia has been reported in 14% of patients with bulimia nervosa, and
hyponatremia may be brought on by the use of diuretics, vomiting, and/or excessive
water intake.
● On restrictive vegetarian or vegan diets can be adequate.
● Patients who follow vegetarian diets should not be pushed to alter that preference.
● Many healthy people choose to avoid meat or avoid all animal-derived products, and
these choices bring many health benefits.
● People suffering from eating disorders also often report feeling disgusted by meat.
However, vegetarianism does not cause eating disorders.
 ● Vitamin/mineral deficiency. More than half of patients with anorexia nervosa failed to
meet the recommended dietary allowance (RDA) for vitamin D, calcium, folate, vitamin
B12, zinc, magnesium, and copper when assessed by diet history.
● Deficiencies are also commonly found for several vitamins, including thiamine, B2,
niacin, B6, folate, C, E, and K.
● There have been case reports of patients with anorexia nervosa who were diagnosed with
pellagra due to niacin deficiency and scurvy due to vitamin C deficiency.
● There are also case studies of patients with bulimia nervosa presenting with folate
deficiency and coagulation abnormalities due to vitamin K deficiency. Replacement of
these and other nutrients is an important part of nutrition therapy.
● Zinc in particular has been found to enhance the rate of recovery in anorexics by
increasing weight gain and improving anxiety and depression.
● Bone health. Low intakes of calcium, vitamin D, and vitamin K can reduce bone mineral
density and put eating disorder patients at very high risk for osteoporosis.
● Weight gain itself reduces bone turnover in patients with anorexia nervosa.
● In one study, treating bone disease in anorexic patients with calcium and vitamin D
supplements was as effective as etidronate for reversing osteoporosis.

Binge Eating Disorder:

Binge-eating disorder is a serious eating disorder in which you frequently consume unusually
large amounts of food and feel unable to stop eating.

Almost everyone overeats on occasion, such as having seconds or thirds of a holiday meal. But
for some people, excessive overeating that feels out of control and becomes a regular occurrence
crosses the line to binge-eating disorder.

When you have binge-eating disorder, you may be embarrassed about overeating and vow to
stop. But you feel such a compulsion that you can't resist the urges and continue binge eating. If
you have binge-eating disorder, treatment can help.

Symptoms
Most people with binge-eating disorder are overweight or obese, but you may be at a normal
weight. Behavioral and emotional signs and symptoms of binge-eating disorder include:
● Eating unusually large amounts of food in a specific amount of time, such as over a two-
hour period
● Feeling that your eating behavior is out of control
● Eating even when you're full or not hungry
● Eating rapidly during binge episodes
● Eating until you're uncomfortably full
● Frequently eating alone or in secret
● Feeling depressed, disgusted, ashamed, guilty or upset about your eating
● Frequently dieting, possibly without weight loss
Unlike a person with bulimia, after a binge, you don't regularly compensate for extra calories
eaten by vomiting, using laxatives or exercising excessively. You may try to diet or eat normal
meals. But restricting your diet may simply lead to more binge eating.

The severity of binge-eating disorder is determined by how often episodes of bingeing occur
during a week.

Causes
The causes of binge-eating disorder are unknown. But genetics, biological factors, long-term
dieting and psychological issues increase your risk.

Risk factors
Binge-eating disorder is more common in women than in men. Although people of any age can
have binge-eating disorder, it often begins in the late teens or early 20s.

Factors that can increase your risk of developing binge-eating disorder include:

● Family history. You're much more likely to have an eating disorder if your parents or
siblings have (or had) an eating disorder. This may indicate that inherited genes increase
the risk of developing an eating disorder.
● Dieting. Many people with binge-eating disorder have a history of dieting. Dieting or
restricting calories during the day may trigger an urge to binge eat, especially if you have
symptoms of depression.
● Psychological issues. Many people who have binge-eating disorder feel negatively about
themselves and their skills and accomplishments. Triggers for bingeing can include
stress, poor body self-image and the availability of preferred binge foods.
Complications
You may develop psychological and physical problems related to binge eating.

Complications that may be caused by binge-eating disorder include:

 ● Poor quality of life
● Problems functioning at work, with your personal life or in social situations
● Social isolation
● Obesity
● Medical conditions related to obesity, such as joint problems, heart disease, type 2
diabetes, gastroesophageal reflux disease (GERD) and some sleep-related breathing
disorders
Psychiatric disorders that are often linked with binge-eating disorder include:

● Depression
● Bipolar disorder
● Anxiety
● Substance use disorders
Prevention
Although there's no sure way to prevent binge-eating disorder, if you have symptoms of binge
eating, seek professional help. Your medical care provider can advise you on where to get help.

If you think a friend or loved one has a binge-eating problem, steer her or him toward healthier
behavior and professional treatment before the situation worsens. If you have a child:

● Foster and reinforce a healthy body image, regardless of body shape or size
● Discuss any concerns with your child's primary care provider, who may be in a good
position to identify early indicators of an eating disorder and help prevent its
development.

Key goals in nutritional therapy for binge eating disorder

● Re-establishment of blood-sugar levels through portion re-distribution

● Improving on food-related behaviors and a development of neutrality toward food
through re-developing intuitive understandings of hunger, fullness, and satiety.

Nutritional Considerations
● Weight-loss treatments for patients with binge eating disorder.
● Studies of the effects of both dietary and behavioral approaches to weight loss show that
weight-loss treatments reduce binge eating frequency.
● Although it was once suspected that attempts at weight loss preceded binge episodes, the
structured meal plans provided for weight loss may give binge eaters a feeling of greater
control over food intake.
● Spontaneous remission of binge eating has also been reported.