This post was written by Rosalind Kaplan, MD, FACP. Dr. Kaplan has been in clinical practice for more than 26 years. She enjoys practicing General Internal Medicine because of the variety of issues she is able to address. She is especially interested in the interaction of physical and psychological health, including the effects of stress on wellness, and in the medical monitoring of patients with eating disorders.
It’s estimated that up to ten million people in the United States suffer from eating disorders, and the statistics are not getting better. Most people think that there are two kinds of eating disorders: Anorexia Nervosa, in which the patient restricts calories and starves themselves and Bulimia Nervosa, in which the patient binge eats and then purges what they’ve eaten, usually by making themselves vomit.
Actually, there are a number of types of eating disorders in addition to Anorexia and Bulimia, such as Binge Eating Disorder: an uncontrollable need to eat large amounts of food in one sitting, and even eating disorders that occur during sleep, when the patient is unaware of their actions. Some people may even have more than one type, or a mixture of eating disorder symptoms.
There are also many fallacies that surround abnormal eating behavior, including: people engage in starvation or purging food in a quest for thinness alone; eating disorders affect only young, affluent, white females; and the most dangerous fallacy is that an eating disorder patient can stop their abnormal eating behavior voluntarily, if only they tried.
In reality, patients with eating disorders may be male or female (males make up at least a tenth of all sufferers, but may be less likely to present with symptoms because of stigma or lack of awareness of their disease). Eating disorders cut across all ethnic and socioeconomic groups. Patients with eating problems may be underweight, normal weight, or overweight, depending on their eating symptoms.
We don’t really know what causes an eating disorder, but there is likely a genetic component to these illnesses, as often multiple members of a family are affected and studies of twins separated at birth and raised in different environments show that if one has an eating disorder, the other is much more likely to also have one than we might expect. There are also many environmental triggers to abnormal eating behaviors, including exposure to unrealistic body ideals in the media and often well-intentioned but misguided comments about weight or body image by parents, coaches and, unfortunately, sometimes health professionals.
Warning signs of eating disorders include restriction of amounts or types of food, dramatic weight changes (losses or gains), compulsive exercising, and retreating to the bathroom immediately after meals.
Aside from the psychological pain inflicted by an eating disorder, there are numerous potential medical consequences. Patients who become extremely underweight can have serious metabolic, gastrointestinal and cardiac problems. Women and girls may stop menstruating and develop osteoporosis. Patients who vomit or use laxative to purge food may have dangerous electrolyte and fluid imbalances, as well heart, stomach and kidney problems. Those who binge-eat often become obese and may develop high cholesterol, diabetes, and heart disease.
Those with eating disorders need multiple kinds of help: medical care, nutritional and psychological counseling. Some may require medications for the eating disorder itself, accompanying depression or anxiety, or medical complications.
The most important factor in recovering from an eating disorder is early intervention. The sooner someone seeks help, the more likely they are to have a complete remission. If you believe you have an eating disorder, asking for help can be difficult, but there are many resources. You might start with your doctor, or contact the National Eating Disorders Association or the American Anorexia Bulimia Association to find help near you.
If you are concerned that someone else in your life has an eating disorder, don’t just stand by. Contact a parent, spouse, sibling or teacher who can intervene. If you feel you must intervene yourself, be aware that you may be met with denial and/or anger. If this happens, you may still offer resources and support. These disorders cause distress to the patient, including shame, fear, physical symptoms, and often have accompanying depression and anxiety. The best case is that the sufferer becomes ready to seek help on his or her own.