Categories
Depression Eating Disorders

Eating Disorders: The Consequences

Eating disorders are a set of widespread and life threatening conditions.  According to a new study published in Biological Psychiatry based on the largest national sample of U.S. adults of 36,309 people, around “0.8 percent of adults will be affected by anorexia nervosa in their lifetime; 0.28 percent will be affected by bulimia nervosa; and 0.85 percent will be affected by binge eating disorder” (Udo & Grilo, 2018).  Furthermore, eating disorders affect people of every age, sex, gender, race, ethnicity, and socioeconomic group and could have severe consequences on a person’s emotional and physical health (“Risk Factors”, 2018).

Eating disorders affect every organ system in a person’s body, including the brain.  Because of this there are many health consequences associated with having an eating disorder.  By consuming fewer calories, the body starts to break down muscle and tissue for fuel. Due to this, the heart has fewer cells and less fuel to pump blood with and pulse and blood pressure begin to drop and the risk of heart failure increases (“Health Consequences”, 2018).  In the case of orally purging the body of food, the body is losing electrolytes which “can lead to irregular heartbeats and possible heart failure and death” (“Health Consequences”, 2018). Not only does purging cause electrolyte imbalances in the body, it has severe consequences on the gastrointestinal system.  Purging can lead to a deteriorated esophagus and stomach problems such as blocked intestines from undigested food, bacterial infections, constipation, intestinal perforation and in severe cases stomach ruptures (“Health Consequences”, 2018). In addition, purging and malnutrition can cause of pancreatitis or an inflammation of the pancreas (“Health Consequences”, 2018).

Neurologically, due to the restriction of calories in the body, the brain will not receive enough nutrients to function and could lead to a toxic cycle of obsessing about food and difficulties concentrating (“Health Consequences”, 2018).  Furthermore, not eating enough can create difficulties falling or staying asleep, numbness and tingling in the extremities of the body due to damage to the neuronal insulations, seizures and muscle cramps due to electrolyte imbalance, and fainting or dizziness (“Health Consequences”, 2018).  Even more alarming, in the endocrine system sex hormones decrease and can increase bone loss and starvation can cause high cholesterol levels (“Health Consequences”, 2018).

However, the consequences of eating disorders are not merely confined to the physical body.  There are many cognitive and emotional effects associated with restrained eating. People suffering from eating disorders have their cognitive performance and function disrupted by thoughts of food and/or weight (Polivy, 1996).  People with a history of dieting were also found to have more difficulty concentrating than their peers and experience feelings of irritability and negative emotionality and heightened affective responsiveness (Polivy, 1996). Self-harm, suicide attempts and death constitutes as some of the highly associated risks with eating disorders (Keski-Rahkonen & Mustelin, 2016) .  

In fact, according the the National Association of Anorexia Nervosa and Associated Disorders, eating disorders have the highest mortality rate of any mental illness.  One in five people with anorexia die by suicide (“Eating Disorder Statistics”, n.d.). This statistic does not include those that die due to pure self-starvation. The Standard Mortality Ratio, how likely one is to die over the study period compared to same aged peers of the general population, is 5.86 times more likely for people suffering from anorexia nervosa and 1.93 times more likely for people suffering from bulimia nervosa (“Eating Disorder Statistics”, n.d.).  

As eating disorders are complex in nature, the risk factors of eating disorders involves an interaction between a range of biological, psychological and sociocultural factors (“Risk Factors”, 2018). Eating disorders are extremely prevalent and consequential and with more information, education, and funding for research there can be more support for those fighters and survivors of eating disorders.   

References

Eating Disorder Statistics • National Association of Anorexia Nervosa and Associated Disorders.

(n.d.). Retrieved February 10, 2019, from

https://anad.org/education-and-awareness/about-eating-disorders/eating-disorders-statistics/

Health Consequences. (2018, February 22). Retrieved February 10, 2019, from

https://www.nationaleatingdisorders.org/health-consequences

Keski-Rahkonen, A. & Mustelin, L. (2016). Epidemiology of eating disorders in Europe. Current

Opinion in Psychiatry, 29(6), 340–345. doi: 10.1097/YCO.0000000000000278.

Polivy, J. (1996). Psychological Consequences of Food Restriction. Journal of the American

Dietetic Association,96(6), 589-592. doi:https://doi.org/10.1016/S0002-8223(96)00161-7

Risk Factors. (2018, August 03). Retrieved February 10, 2019, from

https://www.nationaleatingdisorders.org/risk-factors

Udo, T., & Grilo, C. M. (2018). Prevalence and Correlates of DSM-5–Defined Eating Disorders

in a Nationally Representative Sample of U.S. Adults. Biological Psychiatry,84(5),

345-354. doi:https://doi.org/10.1016/j.biopsych.2018.03.014

 

Categories
Eating Disorders

The Weight of the Issue

“If you develop an eating disorder when you are already thin, to begin with, you go to the hospital. If you develop an eating disorder when you are not thin, to begin with, you are a success story. So when I evaporated, of course, everyone congratulated me on getting healthy.” These resounding words were spoken by poet Blythe Baird, when she was reciting her poem “When the Fat Girl Gets Skinny” at the 2015 National Poetry Slam. Her words shine light on yet another hidden group in the eating disorder community, overshadowed by the stereotypical face of eating disorders that is primarily young, white, skinny, and female. Moreover, referencing the third sentence of Baird’s poem, we as a society contribute to the exacerbation of disordered eating in overweight, obese, or even normal weight individuals by complementing and encouraging the weight loss, before inquiring about its cause.

A study led by Jason M. Nagata from the University of California San Francisco revealed that overweight and obese individuals were twice as likely to engage in disordered eating behaviors (binge eating, meal skipping, fasting, vomiting). However, overweight and obese individuals were also half as likely to be diagnosed with an eating disorder, because of the common misconception that only underweight individuals can be affected by eating disorders. Additionally, a harrowing finding made by Mayo Clinic psychologist Leslie Sim revealed that there was a nine-month delay in the diagnosis of individuals who were once overweight or obese, in comparison to individuals who were underweight or of normal weight.

Overweight and obese females aren’t the ones at risk as their male counterparts are perhaps even more overlooked. After 16-year-old Zachary Haines was classified as obese following a physical examination, he became preoccupied with extreme exercise routines and calorie intake. While Haines’s preoccupations allowed him to lose 100-pounds, they also severely diminished his physical well-being, causing him abdominal pains, irritability, and a lowered pulse rate. Despite these ailments, it would be more than a year before Haines was hospitalized and diagnosed with an eating disorder. According to his mom, Haines’s eating disorder was dismissed by specialists including “a primary-care physician, two endocrinologists, a liver specialist, and nutrition experts” all of whom applauded the weight loss, instead of addressing the glaring health problems and the exact manner in which the 100-pounds were lost.

An important issue that Haines’s story brings to light is that of positive reinforcement and its effect on individuals with eating disorders. In Baird’s poem, there is a line that reads:

Girls at school who never spoke to me before stopped me in the hallway to ask how I did it. I say, “I am sick.” They say, “No, you’re an inspiration.” How could I not fall in love with my illness? With becoming the kind of silhouette people are supposed to fall in love with? Why would I ever want to stop being hungry when anorexia was the most interesting thing about me?

While it may come from a well-meaning place, positive reinforcement can at times be a toxic source of encouragement for individuals with eating disorders. In Baird’s case, the positive reinforcement created the illusion that her anorexia was the key to leading a life of intrigue and popularity. Similarly, in Haines’s case, encouragement from doctors further promoted his behavior and thus exacerbated his health.

We live in a society where skinny equates to pretty. I hear the phrase “Did you lose weight? You look so good!” at least three times a week, from well-meaning friends and family members. It is hard not to resist the temptation to skip a meal here and there and push myself a little harder at the gym, when doing so comes with the promise of beauty and acknowledgment. To be completely honest, I have pushed myself to lose weight by going without food or by pushing a 1-hour workout to a 2 hours and while I did lose weight, I wasn’t happy. Being hungry, being nauseous, being dizzy to the point of fainting did not make me happy. We need to break out of the mindset that skinny equates to pretty. We need to become aware of the fact that a person doesn’t have to be underweight in order to have an eating disorder. So the next time you notice that someone has lost a significant amount of weight, ask them how they lost weight and strive to encourage healthy weight management.

 

References:

 

Button Poetry. (2015, November 3). Blythe Baird – “When the Fat Girl Gets Skinny” (NPS 2015) [Video File]. Retrieved November 14, 2018, from https://www.youtube.com/watch?v=16Tb_bZZDv0

 

“Eating Disorders and Obesity: How are They Related?” (2009, March 6 ). NEDIC. Retrieved  November 14, 2018, from http://nedic.ca/eating-disorders-and-obesity-how-are-they-related.

 

Miller, A. (2014, December). Losing weight, but not healthy. American Psychological Association. Retrieved November 14, 2018, from https://www.apa.org/monitor/2014/12/losing-weight.aspx.

 

Monaco, K. (2018, June 13). Eating Disorders Common in Overweight, Obese Young Adults. MedPage Today. Retrieved November 14, 2018, from https://www.medpagetoday.com/primarycare/eatingdisorders/73467.

 

Muller, R. (2015, March 26). Anorexia Affects More Men Than Previously Thought. Psychology Today. Retrieved November 14, 2018, from https://www.psychologytoday.com/us/blog/talking-about-trauma/201503/anorexia-affects-more-men-previously-thought.

 

Categories
Eating Disorders

No Such Thing As “Too Old”

Eating disorders have long been affiliated with populations ranging from the preteen-early 30’s age range. However, as with many physiological or psychological ailments, eating disorders don’t just vanish once an individual reaches a certain age. While numerous individuals recover from their eating disorder, many go on to live with them for the rest of their lives. Many individuals may even develop an eating disorder well into their 60’s!

Dr. Holly Grishkat is a site director for Philadelphia’s The Renfrew Center for Eating Disorders, where she also overlooks a “Thirty-Something and Beyond” program, for adults struggling with eating disorders. In an article for Today’s Geriatric Medicine, Dr. Grishkat mentions that many individuals who partake in the “Thirty-Something and Beyond” program have struggled with eating disorders for decades. “After 30 years, the eating disorder has become almost a personality characteristic for these women, as many of them define themselves by the eating disorder,” she says. The program also consists of individuals who have relapsed as well as those whose eating disorders developed at a later age.

While some symptoms and triggers may be similar between young and older populations affected by eating disorders, a Psychology Today article states that the two populations are affected by very different stressors. For instance, younger individuals are often affected by media standards, self-esteem issues, peer relations, or stressful experiences. Older adults, on the other hand, are affected by “the death of a spouse, parent or close friend or divorce, empty-nest, retirement and menopause” states Dr. Martina M. Cartwright.  

However, geriatric eating disorders may not always be caused by the listed stressors. In a 2016 study, Francesco Landi et al. examines the anorexia of aging, which, as the name suggests, is the emergence of an anorexia-like state in older adults, due to the loss of appetite.

Landi attributes the loss of appetite to numerous factors some of which include: the deterioration of taste buds and olfactory receptors, hormonal changes, medical conditions and the resulting effects of medicine on food intake; difficulty chewing, mobility (diminished ability to cook or obtain food); and social isolation.

As with younger individuals, anorexia has drastic effects on the elderly, with some negative side effects being: malnutrition, poor bone health, weakness/ “frailty,” diminished mobility and physical capabilities, and death.

So how do we battle the anorexia of aging? Landi recommends increasing the quality and aesthetic of food as well as the ease of access (easier to consume/obtain). Additional suggestions include improvement of social interactions and medical treatment.

The seeming lack of focus on the struggles of older populations with eating disorders demonstrates the prevailing misconception that eating disorders only affect the young. The harrowing idea of an eating disorder shadowing an individual for decades or the severity of anorexia in the elderly calls for an increased awareness on this topic.

References:

Cartwright, M. M. (2013, October 4). Does Grandma Have an Eating Disorder? Psychology Today. Retrieved September 20, 2018, from https://www.psychologytoday.com/us/blog/food-thought/201310/does-grandma-have-eating-disorder

Landi, F., Calvani, R., Tosato, M., Martone, A. M., Ortolani, E., Savera, G., … Marzetti, E. (2016). Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments. Nutrients, 8(2), 69. http://doi.org/10.3390/nu8020069

Schaeffer, J. (n.d.) Elder Eating Disorders: Surprising New Challenge. Today’s Geriatric Medicine. Retrieved September 20, 2018, from http://www.todaysgeriatricmedicine.com/news/exclusive_0409_03.shtml.

Categories
Eating Disorders

Elephant in the Room: There Are More Than Three

You are sitting in a room filled with people. Your next door neighbor Kevin, best friend Melissa, and your cousins from down South even decided to stop by. Everyone is playing a friendly game of Taboo until your mother calls everyone in for dinner in the next room over. You are the last one to go in because you do not want anyone to know. You are afraid that everyone, even Melissa, will never look at you the same way again.

Because you do not eat at all. Not because you cannot, but because you will not. And if you do, you might eat more than you can control. Not because you want to, but because you cannot stop once it is happening. You are inherently afraid of the elephant always lurking behind you. Why introduce it into the room now, at the dinner table, when everyone is enjoying their meals? Sometimes the elephant unexpectedly introduces itself, mostly because your frame has become thin enough for the elephant to extend itself. Or maybe, your frame has stayed the same, and the elephant has stayed alongside to accompany you.

Telling friends and family about a constant struggle with food is not an easy topic of discussion, but many people realize that a support system exists for their distressed relationship with eating; however, several other people are still left behind tumbling in the dust, stranded away from guidance or intervention. As a society, I think time has come for the elephant in the room to be identified.

Anorexia nervosa, bulimia nervosa, and binge eating disorder are the three elephants in the room that have been discussed and addressed extensively, but there exists a bigger elephant in the room than you might think. While all three are serious disorders, many others on the wide spectrum of eating disorders are not being given the attention they deserve. The media covers mainly anorexia, followed by bulimia and then binge eating disorder; however, according to the 2008-2012 Mental Health Surveillance Study conducted by the Center for Behavioral Health Statistics and Quality, anorexia is less common than bulimia and binge eating disorder in individuals aged 18 and over, occurring in less than 0.1% of the adult population.

An article published by Smink and Hoeken (2012) in the peer-reviewed medical journal known as Current Psychiatric Reports revealed that when younger women aged 15-19 years are included in the data and statistical analysis, the “lifetime prevalence of anorexia increases to 0.9 percent of women in the population…” and “…0.3 percent of men exhibit the disorder at some point in their lives.” Smink and Hoeken (2012) also suggested that the prevalence rates of anorexia, bulimia, and binge eating disorder are 1.2%, 1.6%, and 5.7%, respectively, in the population aged 15 and older.

Unlike many eating disorders studies, this study also included a comprehensive meta-analysis of 125 other studies to collect the epidemiological data of all eating disorders, and found that eating disorder not otherwise specified (EDNOS), which has most recently been termed other specified eating or feeding disorder (OSFED), had the highest population prevalence and is associated with psychological and physiological risks comparable to specified eating disorders, such as anorexia, bulimia, and binge eating disorder. While this group of researchers’ goal was to reduce the size of the EDNOS/OSFED category, what about the rest? You may not have even known they existed.

“Sweetheart, eat your peas, Al. They are not going to eat themselves.” This theoretical exchange between a mother and her “picky” child Al is not enough to represent avoidant/restrictive food intake disorder (ARFID), when a person is conflicted by food or foods, resulting in inadequate nutrition (“Avoidant/Restrictive Food Intake Disorder,” 2013). What Al’s mother does not know is that he is choosing not to eat the peas because he fears eating green-colored foods in the shape of spheres. Two doors down from Al’s house, Jane takes her plate of dinner to her room to “eat,” but what her family does not know is that she goes to the backyard and empties her plate into the trash can, pretending she ate everything. The truth? She is afraid of eating any food as a result of her growing fear of vomiting or choking.

“Teacher, Tim is chewing on his pencil again.” This theoretical situation in which a young student alerts her teacher about her classmate’s “weird” habit of eating the wood of pencils may be an understatement of pica, an eating disorder usually defined by a persistent ingestion of non-nutritive substances (e.g. rocks, wood, or even glass) “for at least one month at an age for which this behavior is developmentally inappropriate” (“Pica,” 2013). Consuming these substances over the course of a long period of time can potentially cause unwarranted physiological consequences (e.g. digestive issues), and especially in individuals who have autism spectrum disorder or schizophrenia where pica can manifest itself more seriously.

“Just a midnight snack, that’s all.” Meanwhile, Charlie consistently does not feel hungry until the very peak of the night around 4 A.M., which may be the result of night eating syndrome (NES) disorder characterized by a “delayed circadian pattern of food intake” (“Other Specified Eating or Feeding Disorders,” 2013). Charlie may be consuming a lot of food during unusual times of the evening or night, which is typically uncontrollable and causes individuals to become physically and mentally distressed by both the disturbed sleep cycle episodes of late-night feeding.

Before reading this article, you may have known about only three of the six, seven, or eight plus eating disorders that have been officially recognized on the spectrum of eating disorders. When people think eating disorders they usually assume a discussion of anorexia or bulimia, and sometimes acknowledge binge eating. By introducing EDNOS/OFSED, ARFID, pica, and NES into the playing field we can begin to understand that eating disorders can affect anyone and in a multitude of ways, and not necessarily the ways in which we have been taught in school and the media to accept.

With the elephant in the room that there are more than three, we need to create a society that is open to discussion about and accepting of these many other disordered relationships with eating. The elephant that was once invisible is now ready to be painted with perspective about these once hidden, invisible eating disorders.

References:

American Psychiatric Association. (2013). Feeding and Eating Disorders. Avoidant/Restrictive Intake Disorder. http://dx.doi.org/10.1176/appi.books.9780890425596.dsm10

American Psychiatric Association. (2013). Feeding and Eating Disorders. Other Specified Eating or Feeding Disorders. http://dx.doi.org/10.1176/appi.books.9780890425596.dsm10

American Psychiatric Association. (2013). Feeding and Eating Disorders. Pica. http://dx.doi.org/10.1176/appi.books.9780890425596.dsm10

Karg, R.S., Jonaki, B., Batts, K.R., Forman-Hoffman, V.L., Liao D., Hirsch E., Pemberton, M.R., Colpe, L.J., & Hedden S.L. (2014). Past Year Mental Disorders Among Adults in the United States: Results from the 2008–2012 Mental Health Surveillance Study. CBHSQ Data Review.

Smink, F. R. E., van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of Eating Disorders: Incidence, Prevalence and Mortality Rates. Current Psychiatry Reports, 14(4), 406–414.