• Eating Disorders: When Food and Weight Take Control

    IMAGE Jane and Elizabeth are adhering to strict, low-calorie diets even though they are both dangerously underweight. Angela and Hank secretly eat huge amounts of food at one sitting and then make themselves vomit and spend hours exercising. Evelyn and Fred eat huge amounts of food and occasionally try dieting, but mostly just feel guilty and depressed. What do these six individuals have in common? They all have some type of eating disorder.

    What Exactly Are Eating Disorders?

    In an effort to stay healthy, many people try to control the amounts of food they eat as well as their body weight and shape. Some people experience short-term alterations in their eating patterns as a reaction to a stressful life situation, or when dieting to improve their appearance and/or health. People with an eating disorder, however, think about food, weight, and body image constantly.
    They usually have medical and psychological issues as well.
    In case of serious medical complications like severe malnutrition, dehydration, or heart irregularities, a hospitalization may be needed.
    There are three primary types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder. They can disrupt school, work, and relationships and cause serious health problems that may require ongoing medical care and even hospitalization. In severe cases, they can cause permanent disability, and even death.

    How Common Are Eating Disorders?

    According to the National Association of Anorexia Nervosa and Associated Disorders, up to 24 million Americans have some kind of eating disorder. Females ages 12-25 account for most cases. However, eating disorders can also occur in males and in people both younger and older. Most patients develop symptoms by age 20. Eating disorders can last from several months to many years.
    Eating disorders occur in people of all racial, ethnic, and socioeconomic backgrounds. The rate of eating disorders is higher in certain occupations, such as dance, gymnastics, and modeling, where there is excessive pressure to maintain a specific weight and appearance.

    What Are the Symptoms of Eating Disorders?

    Anorexia Nervosa

    • Excessive weight loss or lack of normal weight gain, often to the point of starvation
    • Intense fear of gaining weight
    • Distorted body image—for example, seeing oneself as too fat even when underweight
    • Excessive or compulsive exercising
    • Absence of at least three consecutive menstrual periods
    • Obsessive controlling of calories and fat even when underweight
    • Unusual eating habits, such as cutting food into tiny bites
    Some people with anorexia nervosa also binge eat and then make themselves vomit (purge) to keep their weight low.

    Bulimia Nervosa

    • Frequent episodes of binge eating (eating an abnormally large amount of food within two hours or less)
    • Frequent episodes of self-induced vomiting or misusing laxatives or diuretics to prevent weight gain
    • Excessive concern with body weight and shape
    • Feeling out of control while binge eating
    • Attempts to control weight by excessive exercising, misusing diet pills, or fasting
    • Unusual eating habits, such as hoarding food and eating in secret
    People with bulimia nervosa often maintain a fairly normal weight by purging and/or excessive dieting, exercising, or fasting.

    Binge Eating Disorder

    • Frequent episodes of binge eating
    • Little or no use of behaviors to control weight, such as purging, excessive exercising or fasting, although may try dieting
    • Feeling guilty, depressed, or disgusted with oneself because of the binge eating and concern about being overweight
    • Eating large amounts when not hungry
    • Eating rapidly and until uncomfortably full
    Until several years ago, this disorder was called compulsive overeating. Many people with binge eating disorder are overweight.

    What Causes Eating Disorders?

    Combinations of certain factors make some people vulnerable to developing an eating disorder. These factors fall into these broad categories: sociocultural, biological, environmental, family-related, and psychological. The disorder often begins when vulnerable individuals are going through a difficult life change or event.
    "Once an eating disorder develops, the behaviors and feelings keep reinforcing each other and may become ways of coping with other life problems. A self-perpetuating cycle is then created," according to Laura Weisberg, PhD.

    How Are Eating Disorders Treated?

    An individualized treatment plan is developed for people with eating disorders, based on a thorough medical exam and psychological evaluation. Several of the following approaches are usually combined.
    • Health or medical problems treated—First, any medical problems are treated. Then, the psychological issues related to the eating disorder are explored. Nutrition counseling is provided to help reestablish healthy eating and meal planning practices. Medication may also be prescribed. Support groups for people with eating disorders and for their family and friends can also be helpful.
    • Psychotherapy—Several different types of psychotherapy may be used in individual, group, or family sessions. Cognitive behavioral therapy can help to develop healthy ways of thinking and patterns of behavior, especially with food and relationships. Other kinds of psychotherapy focus on underlying psychological issues, such as self-esteem. In some cases, a combination of more than one type of psychotherapy is the most successful approach.
    • Medication—The most widely used medications for eating disorders are antidepressants. They are particularly helpful with bulimia and binge eating disorder because they treat mood-related symptoms and suppress the craving to binge. In cases of anorexia, they may help decrease the obsessions and anxiety related to eating.
    Most people with eating disorders have some success with treatment. However, the extent and speed of response vary with the individual, and relapses are common.
    "Early detection and diagnosis are crucial to treat an eating disorder before it becomes a deeply ingrained cycle. This may prevent serious medical and psychological problems from developing," says Dr. Weisberg.
    So, if you think you may have an eating disorder, make an appointment to talk with your doctor or a mental health professional. If you suspect someone you know may have an eating disorder, encourage her or him to seek professional help.


    National Eating Disorders Organization http://www.nationaleatingdisorders.org

    Overeaters Anonymous https://www.oa.org


    Canadian Mental Health Association http://www.cmha.ca

    National Eating Disorder Information Centre http://www.nedic.ca


    Anorexia nervosa. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated February 20, 2013. Accessed August 12, 2013.

    Anorexia nervosa. National Association of Anorexia Nervosa and Associated Disorders website. Available at: http://www.anad.org/get-information/about-eating-disorders/anorexia-nervosa. Accessed August 12, 2013.

    Binge eating disorder. National Association of Anorexia Nervosa and Associated Disorders website. Available at: http://www.anad.org/get-information/about-eating-disorders/binge-eating-disorder. Accessed August 12, 2013.

    Bulemia nervosa. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed.ebscohost.com/about/about-us. Updated March 28, 2013. Accessed August 12, 2013.

    Bulemia nervosa. National Association of Anorexia Nervosa and Associated Disorders website. Available at: http://www.anad.org/get-information/about-eating-disorders/bulimia-nervosa. Accessed August 12, 2013.

    Shapiro JR, Berkman ND, Brownley KA, Sedway JA, Lohr KN, Bulik CM. Bulimia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007;40:321-36.

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