Family doctor

Overview:

• The most common eating disorders are bulimia and anorexia
• Anorexia is characterised by extreme weight loss and intentional starvation
• Bulimia involves binge eating followed by purging with vomiting or laxatives
• 90 percent of people with eating disorders are young women or adolescents
• The condition is aggravated by low self esteem and a fear of getting fat
• People with eating disorders usually think they are bigger than they really are
• Treatment may involve a combination of drug therapy and counselling
• About of half of sufferers will continue to experience eating disorders
• Hospital care may be necessary for cases of severe starvation.

What is it?

Eating disorders are a common and serious problem that mainly affect women.

The main disorders are anorexia nervosa and bulimia nervosa.

Anorexia is characterised by extreme weight loss from starvation and bulimia involves overeating followed by vomiting or use of laxatives to stop food from being absorbed.

About 90 percent of people with eating disorders are adolescent and young women. About one percent of adolescent girls become anorexic and two to three percent will experience bulimia.

Women are believed to be more vulnerable to the disorders because of their quest to obtain a so-called ideal thin figure. Both conditions also do occur in men however.

Eating disorders can be fatal. One in 10 cases of anorexia leads to cardiac arrest, death from starvation, suicide or other serious medical problems.

Many people who suffer from eating disorders suffer from low self-esteem and a fear of weight gain. The disorders may manifest as a way of dealing with stress and emotional problems.

It's believed they may develop eating disorders to take control of one area of the their life when they have little control over other events.

Women with eating disorders may have strange eating habits or rituals, and are often weighing themselves.

Eating disorders can run in families. It's believed daughters of mothers who are worried about their child's weight are more at risk, and so are girls who have fathers or brothers who criticise their weight.

The full reasons why some people develop the condition is not known - it may be a combination of the brain's own chemical balance with environmental factors playing a role.

Often sufferers come from happy well-to-do homes with no apparent reason for the conditions to develop.

What are the symptoms?

The signs of both bulimia and anorexia involve a distorted body image. People who suffer from either disorder will believe they are fatter than they really are. This is particularly true of bulimics. One study found they are likely to believe they are more overweight than anorexics of the same size.

Symptms of anorexia nervosa involve the following signs:

• Intentional starvation and extreme weight loss from strict dieting.
• Girls and women with the disorder will look painfully thin to others, but they are likely to believe themselves to be overweight.
• The problem normally begins at puberty.
• Girls with anorexia are often perfectionists, well behaved, good students and good at sports.
• Anorexia should be considered in vegetarians who have stopped eating meat to avoid fat. Vegetarian diets in conjunction with excessive weight loss may be an indication of anorexia.
• Women with anorexia may stop regular menstruation, have orthopaedic problems, and dry skin covered with fine hair.
• Their stomachs can become bloated after eating.
• Severe anorexia can lead to confusion and problems concentrating.
• Other complications include depression, blotchy skin, constipation, no menstruation, and severe malnutrition.

Symptoms of bulimia involve the following signs:

• Binge eating of large amounts of food, followed by making themselves vomit, taking laxatives, diet pills, enemas or excessive exercise.
• Women with bulimia may eat a lot of junk food to sooth emotional stresses and anxiety, but then feel guilty about what they've eaten and want to get rid of it.
• Women with bulimia may be underweight, but not as thin as anorexics, and can hide their problem from others for years.
• The problem may begin at puberty.
• Sufferers are impulsive and may also abuse drugs and alcohol.
• They may have burst blood vessels in the eyes from continued vomiting, dental cavities from excessive acid and gum disease.
• Regular menstruation may stop.
• Other complications include sore throat, dehydration, and constipation

Some people with eating disorders do not acknowledge they have a problem and may refuse treatment.

A support person is recommended to accompany the sufferer to a medical consultation to diagnose the problem. They may be able to offer additional information when the patient is down-playing symptoms.

A diagnosis of anorexia is made when the patient refuses to maintain a normal body weight, has a distorted body image, denies starvation or being underweight, and has not had a period for three months.

Men can also get anorexia and it can occur in male athletes, but these cases are rare.

A diagnosis of bulimia is made when there are at least two bulimic events per week for two months.

Blood tests are likely to be ordered to rule out other causes. There may be tests for kidney, liver, and thyroid function. An ECG to check the heart's condition may also be ordered.

What can be done to help?

Treatment involves drug therapy and counselling.

Treatment of bulimia involves breaking the cycle of over eating and vomiting. Patients normally realise their behaviour is wrong, and counselling and family therapy can help to change their behaviour. However, about half of sufferers will continue to experience problems. The antidepressant, Prozac, has been used with good effect in bulimia.

The treatment of anorexia involves counselling and psychotherapy to encourage the patient to gain weight and address any psychological problems they may experience. Again, about half of sufferers will continue to have an eating disorder and psychological problems.

Antidepressants may also help to treat depression in anorexics.

Sometimes hospital care and an intravenous feeding is necessary for severe cases of starvation.

What can be done to prevent it?

A reduction in eating disorders may occur when society and families begin minimising the importance of looks and body weight.

Young women should be encouraged to develop healthy eating habits and maintain a normal body weight.

Where to go for help?

Your doctor will be able to help.

Eating Disorders Association of New Zealand is a registered charity committed to forging links between those who suffer from anorexia or bulimia. Ph 09 8189561