Spotting Eating Disorders

by Page Love MS, RD, LD; NutriSport Consulting; USHSTA Advisory Board

Already at epidemic proportions, the disordered eating phenomenon is commonplace in toady’s fast-paced society. Young women and men alike have been affected by an onslaught of storytelling in the media as well as the cultural visual acceptance and display of ultra thin body types in both print and on television. The terms “anorexia” and “bulimia” are no longer foreign words. Health classes at the grade school level warn children of the drastic side effects of these diseases. But, yet the statistics keep growing. More and more people are getting caught in the race for thinness- power-happiness. Although concrete statistics are not available because so many who are stricken live in a world of secrets and denial, it is estimated that more than one million Americans struggle with eating disorders and that an additional 5 – 20% will die as a result from medical complications.

Even yet again recently as we hear of an elite gymnast of Olympic caliber dieting of the disease (recent media coverage on NBC – Night Line), we wonder how many others are being affected. And what about the cause? Experts are not sure of the origin of these diseases, however a number of risk factors seem to ring out as more and more cases are identified. The following are a list of common characteristics and behaviors of people with eating disorders:

-obsessed with diets and exercise because of an intense fear of becoming fat or gaining weight regardless of how thin they already are

-practice of rigid and ritualistic diet behaviors that center around food and exercise and that take up the majority of their time, energy, and mind

-a body weight 15% below normal or expected ideal

-menstrual irregularities or amenorrhea (periods stopping) in females

-practice of purposeful purging either through making oneself vomit, excessive exercise, or fasting for long periods of time

-use of laxative, diuretics, or diet pills regularly

-cravings for and bingeing on sweet, starchy, and fatty foods especially eaten in private

-fear of establishing intimate relationships

-feeling of low self esteem

Diagnosis of eating disorders has recently taken a new turn in that the diagnostic criteria have recently been expanded and updated as well as put in a category of their own. As well, a new criteria, “binge eating disorder,” has been established under “Eating Disorder Not Otherwise Specified.” Refer to new DSM IV (Diagnostic and Statistical Manual, Fourth Edition, American Psychiatric Association, 1994) descriptions below:

“The essential features of Anorexia Nervosa are that the individual refuses to maintain a minimally normal body weight, is intensely afraid of gaining weight, and exhibits a significant disturbance in the perception of shape or size of his or her body. In addition, postmenarcheal females with this disorder are amenorrheic.”

Other features:

– diagnostic criteria include that the individual must weigh 85 percent of what is considered normal for that persons age or height or a body mass index of 17.5 or below

– weight loss is usually accomplished through total reduction in food intake (average calorie intakes between 300 – 700 calories/day), and low protein and low carbohydrate intakes

– individuals tend to feel “globally overweight”, thus the distorted body image

– subtypes: restricting – a person affected with this is not regularly engaged in binge-eating or purging behavior; binge-eating/purging type – this person regularly engages in binge-eating or purging behavior(self-induced vomiting or misuse of laxatives, diuretics, or enemas)

Physical symptoms of anorexia may include: constipation, abdominal pain, cold intolerance, lethargy, emaciation, hypotension, dryness of skin and dullness of hair, brittle nails, anemia, edema, dental problems, osteoporosis, pituitary hormone abnormalities and altered thyroid function

“The essential features of Bulimia Nervosa are binge eating and inappropriate compensatory methods (i.e. purging) to prevent weight gain. To qualify for the diagnosis, the binge eating and inappropriate compensatory behaviors must occur on the average, at least twice a week for three months.

Other features:

– a binge is described as “eating in a discrete period of time an amount of food that is definitely larger than most individuals would eat under similar circumstances” (less than two hours)

– a feeling of “lack of control and frenzied state when eating

– intense shame involved with eating problems and will often secretly binge

– usually normal weight or slightly overweight

– subtypes: purging – person regularly engages in self-induced vomiting, or misuse of laxatives, diuretics, or enemas; nonpurging-person has used other inappropriate compensatory behaviors such as fasting, or excessive exercise, but is not regularly engaged in the above purging behaviors

Physical symptoms specific to bulimia may include:

– permanent loss of dental enamel and ragged appearance of teeth and increased frequency of cavities; salivary and parotid glands may become enlarged; calluses and scars on hands, dependence on laxatives to stimulate bowel movements; fluid and electrolyte abnormalities; possible consequences of purging behaviors may be esophageal tears, gastric ruptures, and cardiac arrhythmias.

Common factors of both anorexia and bulimia diagnoses:

– most prevalent in industrialized societies

– 90 percent of cases are female

– usually begins during adolescence (between the ages of 13 and18)

– people with disorder and their immediate biological relatives are usually at risk for other mood disorders i.e. Depression

– persons involved in binge eating/purging behavior may be prone to Borderline Personality Disorder and Obsessive Compulsive Disorder

The “Binge Eating Disorder” is characterized by binge eating behavior in the absence of inappropriate purging behavior and are associated with the following: eating much more rapidly than normal; eating until feeling uncomfortably full; eating large amounts of food when not feeling physically hungry; eating alone because of being embarrassed by how much one is eating; and, feeling disgusted with oneself, depressed, or feeling very guilty after overeating.

How are disordered eating problems treated? The first step is identification of the problem. The second step is seeking help for the problem. Utilize your support system including family, friends, and outlying resources like school counselors and church pastors. The most appropriate treatment for disordered eating is one that combines medical, psychological, and nutrition counseling along with participation in self-help groups for both the person involved and their family. The team approach consisting of a therapist, registered dietitian, psychiatrist or psychologist, medical doctor, and possibly a dentist are the key components. Treatment is a long slow moving process that involves intensive therapy to deal with the underlying issues that often lead to disordered eating such as depression; adjustment reactions to adolescence, divorce, sexual abuse; and addictive behaviors going along with drug and alcohol abuse. Nutritional therapy is must and is often the core to the affected person regaining the physical health that is necessary to deal with the mental rebuilding process that must take place. The following area list of helpful behavioral eating hints for those people who may be caught in a disordered eating illness:

– regular meal schedules including smaller feedings and planned snacks avoiding skipping of meals if possible

– slow reintroduction of “unsafe” foods in realistic portions with an emphasis on rebuilding high quality protein and complex carbohydrate content of food intake

– defocus away from regular weigh ins, calorie counting, or fat gram counting; focus on variety of foods that make up a well balanced food intake

– promotion of weight stabilization and caloric intake to promote restoration of normal tissue levels

– reduction in caffeine content of diet and increase in natural fiber intake slowly

– vitamin/mineral supplementation when nutrient deficiencies present

-food journaling focusing on identification of hunger signals and moods and emotions associated with eating

-eating behavior goals set on regular basis to encourage the normal socialization of eating behavior

Where should you go for help? A number of non profit organizations are available to provide general information about disordered eating as well as referral information for those individuals who may need assistance. Refer to the following list:

– American Anorexia and Bulimia Association — 201-836-1800

– Anorexia Nervosa and Associated Disorders — 312-831-3438

– Anorexia Nervosa and Related Eating Disorders, Inc. — 503-344-1144

– Eating Disorders Awareness and Prevention — 206-382-3587

– Anorexia Bulimia Care, Inc. — 617-492-7670

– Bulimia Anorexia Self-Help, Inc. — 314-567-4080

– Center for the Study of Anorexia and Bulimia — 212-595-3449

– National Anorexic Aid Society– 614-436-1112

– Overeaters Anonymous, World Service Office — 505-891-2664

– American Dietetic Association National Referral System — 1-800-877-1655 (can refer you to a dietitian in your area with a specialty in eating disorders counseling)