April 2016
Eating Problems

What is an eating disorder?

Eating disorders are when people experience severe disturbances in their eating behaviours, habits and related thoughts and emotions (APA). This normally causes an obsession with food and their body weight.

How common is it?
According to the American Psychiatry Association, eating disorders can affect several million people at any given time, mostly females between the ages of 12 and 35. Anorexia most commonly starts in the teenage years among girls. The Royal College of Psychiatrists stated that females are 10 times more likely to suffer from anorexia or bulimia than males. About 4 in every 100 women suffer from bulimia at some time in their lifetime. Males are more commonly to develop a disorder with over exercise to build muscle rather than to lose weight (RCPsy). Not only is there differences in gender but eating disorders are more prevalent depending on occupation too. Eating disorders are more common in occupations which demand a low body weight or low body fat (RCPsy).

The different types of eating disorders
There is a large array of eating styles and habits which can lead to a healthy life. There are some eating problems however that are driven by a fear of becoming fat and can actually damage our health. These are eating disorders which includes eating too little, too much or using harmful methods of getting rid of the consumed food. There are three main types of eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder. People with anorexia nervosa and bulimia nervosa tend to be perfectionists with low self-esteem and are extremely critical of themselves and their bodies (APA). They usually “feel fat” and see themselves as overweight, sometimes even despite life-threatening semi-starvation (or malnutrition). An intense fear of gaining weight and of being fat may become all-pervasive. In early stages of these disorders, people with eating disorders often deny that there is a problem.


Anorexia nervosa is diagnosed when patients weigh at least 15 percent less than the normal healthy weight expected for their height. People with anorexia nervosa don't maintain a normal weight because they refuse to eat enough, often exercise obsessively, and sometimes force themselves to vomit or use laxatives to lose weight (APA).

What are the symptoms?

Behaviours can change including;

  • Constant worrying about weight

  • Calories counting

  • Intensive exercise regime

  • Continuously wanting to lose weight even though you maybe a normal weight for your age and height

  • Address other activities to make you lose weight e.g. smoking, take slimming pills

  • Do not allow yourself to eat but buy or cook food for others

  • Avoid occasions which may include eating

  • Reduced interest in sex

  • Wearing clothes to hide body shape

Symptoms develop as the body goes into starvation, this could include;

  • Osteopenia or osteoporosis (thinning of the bones) through loss of calcium

  • Hair/nails become brittle

  • Menstrual periods cease

  • Skin dries and can take on a yellowish cast

  • Mild anaemia; and muscles, including the heart muscle, waste away

  • Severe constipation

  • A drop in blood pressure, slowed breathing and pulse rates

  • Internal body temperature falls, causing person to feel cold all the time

  • Depression and lethargy


People with bulimia tend to binge eat frequently, eating a lot of food in a short period of time sometimes swallowing food without swallowing. This can be food containing many calories which are high in sugars, carbohydrates and fats. The eating normally ceases when interrupted by another person, falling asleep or when the stomach starts to hurt. Following this, the person feels out of control and starts to fear weight gain and so the person makes them sick or takes a laxative. This cycle is usually repeated at least several times a week or, in serious cases, several times a day (APA). People living with bulimia tend not to be as underweight as those who have anorexia but could be slightly underweight, normal weight or even obese (APA). Bulimia is therefore commonly hidden well and is unknown to even family and friends.

What are the symptoms?

Warning signs of bulimia include;

  • Chronically inflamed and sore throat

  • Salivary glands in the neck and below the jaw become swollen; cheeks and face often become puffy, causing sufferers to develop a “chipmunk” looking face

  • Tooth enamel wears off; teeth begin to decay from exposure to stomach acids

  • Constant vomiting causes gastroesophageal reflux disorder

  • Laxative abuse causes irritation, leading to intestinal problems

  • Diuretics (water pills) cause kidney problems

  • Severe dehydration from purging of fluids


Binge eating disorder
Binge eating is when a person overeats during a discreet period of time. Large quantities of food are consumed and the person feels out of control during their binge. Unlike bulimia, there is no induced vomiting or use of laxatives. Binge eating is chronic and can lead to serious health complications, particularly severe obesity, diabetes, hypertension and cardiovascular diseases (APA).


What are the symptoms?
Symptoms include a lack of control and association with three or more of the following (APA):

  • Eating more rapidly than normal

  • Eating until feeling uncomfortably full

  • Eating large amounts of food when not feeling physically hungry

  • Eating alone because of feeling embarrassed by how much one is eating

  • Feeling disgusted with oneself, depressed or very guilty afterward


Associated factors
In many cases, eating disorders occur together with other psychiatric disorders like anxiety, panic, obsessive compulsive disorder and alcohol and drug abuse problems (APA). There is a relatively high incidence of anorexia in people who suffer from diabetes, Cystic Fibrosis or other illnesses where diet has to be monitored and without adequate treatment, weight is lost (RCPsy). Without treatment of both the emotional and physical symptoms of these disorders, malnutrition, heart problems and other potentially fatal conditions can result (APA).


The causes of eating disorders
Evidence suggests that heredity may play a part in why certain people develop eating disorders, but these disorders also afflict many people who have no prior family history. Other attributes could be not having an “off” switch this is when dieting can be taken to the extreme without the need to restore normal eating patterns. Some people may feel that their weight is the only part of their life which they have control over. Social surroundings can influence our decisions especially in societies where some perceive any expectation of being thin. This is particularly dominant in Western culture. Some cases of anorexia, but not all, are a result of negative body image. The media have been blamed for publishing unrealistic media depictions of women and unhelpful attitudes of body proportion. Low self-esteem can play a role and therefore losing weight can be an attempt of gaining self-worth. People with bulimia are often depressed and a binge eating session can be triggered through coping with feelings of unhappiness. Emotional distress from traumatic life events, sexual abuse, physical illness or large life changing events can result in an eating disorder.


Emotional and physical health are closely linked where eating disorders are concerned. For people experiencing anorexia, the first step is to regain weight to a healthy level. You will need to know what is your healthy weight? How much food you need to reach the healthy weight? How you will ensure you will not become fat? How will you control and manage your eating patterns. For bulimia and binge eating, it is important to interrupt the cycle and prevent the binge occurring in the first place.


Restoring a person to normal weight or temporarily ending binge/purge cycle does not however address the emotional problems that may be the cause (APA). It is important to understand the thoughts, emotions and behaviours which trigger the eating problem. Psychotherapy can help with this, in particular Cognitive Behavioural Therapy (CBT) and interpersonal therapy (IPT). The Royal College of Psychiatrists suggests that CBT and IPT are effective forms of therapy for bulimia, which individuals receiving weekly sessions over approximately 20 weeks.


Some medications have also been effective in the treatment of eating disorders (APA). The most helpful treatments for you will probably depend on your particular symptoms, your age and situation. Doctors sometimes prescribe medication to help reduce the anxiety you experience while tackling the illness and, in particular, to reduce the 'ruminations' that sufferers describe. Most experience has been with the drug Olanzapine, as this is safest in young people and in people who are at a low weight. It may be more effective than diazepam and similar drugs and is less likely to be habit-forming (RCPsy). For bulimia, high doses of antidepressants such as Fluoxetine (Prozac) can reduce the urge to binge eat even if you are not depressed. This can reduce your symptoms in 2-3 weeks, and provide a “kick start” to psychotherapy. Unfortunately, without the other forms of help, the benefits wear off after a while.


Anorexia – how effective is the treatment

  • More than half of sufferers make a recovery, although they will on average, be ill for 6-7 years.

  • Full recovery can happen even after 20 years of severe anorexia.

  • Past studies of the most severely-ill people admitted to hospital have suggested that 1 in 5 of these may die. With up-to-date care, the death rate is much lower, if the person stays in touch with medical care.

  • As long as the heart and other organs have not been damaged, most of the complications of starvation seem to improve slowly once a person is eating enough


Bulimia – how effective is the treatment

  • About half of sufferers recover, cutting their bingeing and purging by at least half. This is not a complete cure, but will let you get back some control of your life, with less interference from the eating problem.

  • The outcome is worse if you also have problems with drugs, alcohol or harming yourself.

  • CBT and IPT work just as effectively over a year, although CBT seems to start to work a bit sooner.

  • There is some evidence that a combination of medication and psychotherapy is more effective than either treatment on its own.

  • Recovery usually takes place slowly over a few months or many years.


Nutrition and exercise
Due to the physical problems it is important to include general medical care within the treatment plan such as nutrition management and counselling. A dietician may meet with you to discuss healthy eating - how much you eat and how to make sure you get all the nutrients you need to stay healthy. You may also be referred a suitably qualified exercise physiologist to advise you on the quantity, type and intensity of exercise which will be good for you. This can help to rebuild physical well-being and a healthy view of eating. With the appropriate medical care, eating habits can improve and the person can return to better emotional and psychological health (APA).


Assessing if I have a problem
There is a questionnaire which is used by doctors to determine if an individual has an eating problem. It is called the SCOFF questionnaire (RCPsy).

  • Sick. Do you make yourself sick because you are uncomfortably full?

  • Control. Do you worry that you have lost control over how much you have eaten?

  • One stone. Have you lost more than 6 kgs (one stone) in three months?

  • Fat. Do you think you are fat, when others think you are thin?

  • Food. Does food dominant your life?

If you answer “yes” to two or more of these questions, you may have an eating disorder.

Looking after yourself

  • Maintain structured mealtimes

  • Learn of healthy ways of eating and take steps towards a balanced diet

  • Keep a daily diary of the food you eat, when you eat it and capture your thoughts and feelings. This will determine if there is a connection between your emotions and how you eat.

  • Be honest and open about what you are and are not eating. Avoid being secrecy.

  • Remind yourself that you do not always need to be a perfectionist

  • Remind yourself that in the medium term, losing weight will make you feel anxious and depressed

  • Make a list of what the eating disorder has given you and a list of what you have list through it

  • Learn to love your body and be kind to it

  • Know what is a reasonable weight for you and understand why

  • Do not weigh yourself more than once a week

  • Join a self-help group and seek groups that can help

  • Avoid websites or social media that encourage weight loss and diminish self esteem

  • Do not self-analyse or be critical on your image. Nobody is perfect.

  • Maintain healthy relationships with friends and family. They love you for who you are.

Bulimia can sometimes be tackled using a self-help manual with some guidance from a therapist. Anorexia requires more organised help from a clinic or therapist


‘WPA Public Education Initiative’

Dr. Avdesh Sharma, International Lead, WPA; Consultant Psychiatrist, India
Dr. Sujatha Sharma, Consultant Psychologist, India
Stefanie Radford, Senior Project Manager, United Kingdom
Rajeev Verma, Administrator, India
Pragya Mehra, Media Specialist, India
Jatin Kumar, Media Editor, India

Supported by Unrestricted Educational Grant by SUN Pharma SUN LOGO

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