Eating Disorders

Eating disorders are conditions in which a person's eating behaviors and food habits are so unbalanced that they cause physical and emotional problems.

Fear of Fat

Actress Tracy Gold appeared for six seasons in the television series Growing Pains. She had been diagnosed with anorexia at age 12, but went through psychotherapy and seemed fine for the next few years. At age 19, when she weighed 133 pounds, Tracy decided that she had to go on a diet of 500 calories per day to get down to 113 pounds. She did not stop at her target weight, however, but continued to lose weight. Her weight went down to 100 pounds, and then down to 90 pounds, and then down to 80 pounds. In January 1992, Tracy's fear that she was fat—when in fact she weighed only 80 pounds—forced her to leave the Growing Pains set to enter the hospital. Tracy's anorexia had returned.

What Are Eating Disorders?

The term "eating disorder" describes a wide range of eating and weight problems. At one end of the spectrum are anorexia nervosa (an-o-REK-see-a ner-VO-sa) and bulimia (bu-LEEM-e-a) nervosa. Anorexia involves starving oneself to reduce body weight below a healthy minimum level. Bulimia involves binge eating followed by vomiting or other forms of purging and emptying the stomach. At the other end of the spectrum is excessive or binge eating without purging afterward to the point of severe ("morbid") obesity. Between the extremes are the much more common anorexic, bulimic, and binging behaviors that include body image distortions, "yo-yo" dieting (body weight going up and down like a yo-yo), too much or too little exercising, and feelings of anxiety and shame about food and body size.

The various eating disorders have distinct causes, origins, and symptoms, but the behaviors can be similar, and the less serious conditions sometimes may lead to more extreme ones.

In the United States today, pop culture figures discuss their current diets in all media. Bookstores carry racks of books recommending quick weight loss programs, strategies, and fad diets. Magazines and television carry advertisements for weight-loss drugs, diet foods, fat-burning supplements, remedies, and programs. In all, preoccupation with body size and weight loss have become public health issues, and eating disorders are having a profound impact on the physical and psychological health of people and society.

Anorexia Nervosa

Actresses and supermodels are admired as glamorous and superthin, but according to the American Anorexia/Bulimia Association, more than 1,000 women and girls die of anorexia each year. More than 90 percent of people with anorexia are girls, but it can affect boys too, especially boys who are active in sports that involve body image.

The primary characteristic of people with anorexia is a refusal to eat enough food to maintain a healthy minimum body weight. Starvation and weight loss may become severe enough to require hospitalization, but there are earlier warning signs too, which may include:

• a distorted body image, seeing themselves as fat in the mirror even when they are dangerously thin
• avoiding meals with others
• moving food around on a plate to hide a refusal to eat
• exercising too much or too frequently
• being a perfectionist
• feeling in control only when refusing to eat.

Medical complications

Anorexia is a very serious disorder. When the body is not nourished properly, it responds to starvation by slowing down its metabolic processes. Complications may include anemia and other dietary deficiencies, drops in blood pressure and breathing rate, bone loss, loss of menstrual periods, loss of muscle mass and strength, dry skin, brittle hair and nails, constipation, and joint swelling. When people with anorexia lose the body fat they need to maintain a stable body temperature, they begin to feel cold all the time, and their skin may become covered with a baby-soft hair called lanugo (la-NOO-go). If starvation continues without treatment, anorexia may lead to heart failure and sometimes even to death.

Bulimia Nervosa

Bulimia is often called "binge and purge," and the term "bulimia" comes from Greek words that mean "ox-like hunger." People with bulimia eat huge quantities of food during binges, and then follow the binge with a purge to rid the body of the food they have eaten. Purging often involves self-induced vomiting, but people also use emetics (substances that cause vomiting), enemas, laxatives, and diuretics ^* .

Sometimes, bulimia results in visible weight fluctuations—the way anorexia and binge eating disorder do—but often it does not, and many people with bulimia are able to keep their eating disorder a secret for many years. The actress Jane Fonda reported that she had had bulimia for more than 20 years, at times binging and purging more than 20 times per day.

Bulimic behaviors may include:

• eating binges that continue to the point of abdominal pain
• frequent trips to the bathroom to vomit after eating
• trying to keep the vomiting a secret
• hiding laxatives, diuretics, and emetics
• exercising too much or too frequently
• abusing alcohol or street drugs
• acting impulsively ^* or recklessly
• frequently feeling out of control about the amount of food eaten.

Medical complications

People with bulimia may experience the same side effects of starvation that people with anorexia do. Purging behavior causes other serious health problems, including dehydration, fatigue, skin rashes, broken blood vessels in the eyes or face, and sometimes seizures. Constant vomiting damages the digestive system, especially the stomach, the esophagus ^* , and the mouth. Sometimes, a dentist will recognize the signs of bulimia even before a primary care doctor does because of the gum disease and tooth damage that can result from bulimia.

Binge Eating Disorder

Binge eating disorder resembles bulimia nervosa, but without bulimia's purging and exercising behaviors. People with binge eating disorder frequently eat abnormally large amounts of food. They may call themselves "fast food addicts" or "compulsive overeaters." Binge eating is linked to depression, although researchers do not yet understand how the cause-and-effect linkage works. Characteristics of binge eating behavior may include:

• frequently feeling disgust or guilt after eating
• eating more rapidly than usual
• eating when not physically hungry
• eating to the point of abdominal pain
• eating alone out of shame
• frequently feeling out of control about the amount of food eaten.

Medical complications

Binge eating often results in yo-yo dieting and in obesity, which in turn can lead to other health problems, including diabetes, heart disease, high blood pressure, and gallbladder disease. Experts estimate that approximately 15 percent of mildly obese people in weight loss programs have binge eating disorder, and that the percentage is much higher for people with severe ("morbid") obesity.

How Are Eating Disorders Treated?

Anorexia nervosa, if left untreated, may lead to severe malnutrition and medical emergencies that require hospitalization. Most people with eating disorders, however, can be treated by their family doctor and by a team of health care providers using a cross-disciplinary approach.

The doctor who diagnoses an eating disorder may prescribe medication for anxiety or depression, and probably will refer patients and their families to a nutritionist or dietician, to a counselor or family therapist, and to a support group. Long-term psychotherapy may be required for eating disorders that have continued for a long period of time before diagnosis. Because relapses may occur, as happened with Tracy Gold, ongoing support from family and friends remains an important part of treatment.