Articles

Eating disorders

By Ms. Mumtaz Khalid Ismail : Project Manger and Chief Nutritionist.

Eating disorders are behavioural maladies brought on by complex factors which may include emotional and personality disorders, family pressures, a possible genetic or biologic susceptibility and a culture in which there is over abundance of food and an obsession with thinness. They are generally categorised as bulimia nervosa, anorexia nervosa and eating disorders not other wise specified. In anorexia nervosa, there is refusal to maintain a body weight normal for age and sex, intense fear of becoming fat even though they are under weight. They also have a distorted self image that result in diminished self confidence, denial of the seriousness of emaciation and starvation and in women, loss of menstrual cycle for at least 3 months.

Late Princess Diana was the most famous self confessed Bulimic patient. Bulimics have a morbid fear of becoming fat. Episodes of binge eating are followed by induced vomiting with or with out the subsequent ingestion of large quantities of laxatives. Initially vomiting is induced by placing a tooth brush or finger in the throat. These patients have minimum of 2 episode of bulimic attack (excessive eating with vomiting) per week for three months. The amount of food ingested can be enormous and they favour high carbohydrate food. Mood swings, bouts of giddiness, weakness, headaches, palpitations, constipation, ulcer, gum disorders and nutrient deficiencies are the common symptoms of this condition. In other eating disorders like compulsive over eating patients are usually obese. They use food as a way of escape and alter mood just like a drug, feel powerless to control eating. Linked to eating disorders are specific personality disorders such as avoidant personality in anorexia, border line personality in bulimia.

People of all races, religious, sexes and economic backgrounds suffer from eating disorders. They affect more in females in their adolescence or young adulthood. This problem arises due to setting of unrealistic standards for body weight and body proportions. Girls who under go early puberty are at higher risk for bulimia and other emotional disorders. These conditions are more in people live in economically developed nations. Glamorized images of under nourished thin models encourage people to aspire towards an unrealistic body shape. People who are physically very active like women in appearance sports, male wrestlers and lightweight rowers are risk of excessive dieting.

A number of factors including cultural factors, family pressures, chemical imbalances, emotional and personality disorders collaborate to produce both anorexia and bulimia although each disorder is determined by different combinations of these influences. Genetics may also play a role.

Common signs and symptoms of these conditions are marked weight loss or gain, fluctuations in weight up to 5kg or more, amenorrhea, chronic sore throats or stomach problems, decay of tooth enamel especially on back of teeth, dizziness or fainting, growth of fine baby like hair in body, chronic fatigue, swollen cheeks, hair loss, blood shot eyes, dehydration, fear of eating foods which contain fat, restricted number of foods in diet, intense fear of weight gain or becoming fat, frequent weighing, compulsive excessive exercise habits, purging behaviour (vomiting, laxatives, diuretics, exercise, enemas), depression and isolation or withdrawal from family and friends. The diagnosis of both anorexia nervosa and bulimia is made on clinical grounds. No specific diagnostic tests exist.

There is no specific treatment for anorexia nervosa or bulimia. Management of these conditions are multi factorial. This includes nutritional therapy, behavioural therapy, interpersonal therapy, family therapy and drug therapy.

Treatment of anorexia nervosa is difficult because people with anorexia believe there is nothing wrong with them treatment involves changing the persons eating habits these feeling may be about their weight, their family problems or their problems with self esteem. Thorough investigation is required with adequate history taking before labelling a person anorexic or bulimic. It is important to note that in order to achieve an ideal body weight, one does not have to eat less or starve but eat correctly.

Dieticians/ Nutritionists must be part of the long term counselling team and should educate the patients and parents on the objective goals of nutritional care the body’s responses to the binge urge cycle and severe dieting and should offer strategies for planning meals. Behavioural therapy concentrates only on changing eating habits. Inter personal therapy deals with the depression or anxiety that might under lie the eating disorders along with social factors that influence eating behaviour. This form of therapy does not deal with weight, food or body image at all. Family therapy is useful for younger patients for whom the family is still a strong influence. Because of the high incidence of depression in patients with bulimia, anti depressant mediation is often recommended if a depressed patient does not respond to psychotherapy with in 4 or 5 months.