Health news of the week : Eating Disorder
What is an Eating Disorder?
Eating disorders are mental illnesses that cause serious disturbances in a person’s everyday diet. It can manifest as eating extremely small amounts of food or severely overeating. The condition may begin as just eating too little or too much but obsession with eating and food over takes over the life of a person leading to severe changes.
In addition to abnormal eating patterns are distress and concern about body weight or shape. These disorders frequently coexist with other mental illnesses such as depression, substance abuse, or anxiety disorders.
Eating disorders when manifested at a young age can cause severe impairment in growth, development, fertility and overall mental and social wellbeing. In addition, they also raise the risk of an early death. People with anorexia nervosa are 18 times more likely to die early compared with people of similar age in the general population.
Who gets eating disorders?
Eating disorders can affect both men and women and are slightly more common among women. Often these disorders begin during adolescence or young adulthood but may also develop during childhood or later in life.
Types of eating disorders
Anorexia nervosa – This is characterized by an intense fear of being obese and a continued pursuit of becoming thin.
Bulimia nervosa – an emotional disorder characterized by a distorted body image and an obsessive desire to lose weight, in which bouts of extreme overeating are followed by fasting or self-induced vomiting or purging.
Binge-eating disorder – Binge eating disorder (BED) is a severe, life-threatening, and treatable eating disorder characterized by recurrent episodes of eating large quantities of food (often very quickly and to the point of discomfort); a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterwards; and not regularly using unhealthy compensatory measures (e.g. purging) to counter the binge eating.
Eating disorders not otherwise specified (EDNOS) – this includes eating disorders that do not meet the criteria for anorexia or bulimia nervosa. Binge eating could be a type of EDNOS. EDNOS is the most common diagnosis among people who seek treatment.
Symptoms of eating disorders
Anorexia nervosa:
There is a loss of at least 15 percent of body weight resulting from refusal to eat adequately despite feeling hungry. There is an unnatural fear of becoming fat. There is a distortion of self-perception. Thin anorexics may feel they are fat. There may be a tendency to exercise obsessively. Anorexic women may go months without getting their periods, suffer weight loss and may suffer from infertility. A significant proportion of people with anorexia will also develop bulimia.
Bulimia nervosa:
These patients first eat too much (binging) and then purge or vomit it all out. Eating binges involve consumption of large amounts of calorie-rich foods. The person feels totally out of control and self-disgust during these periods. After such binges they attempt to purse out the food to compensate for binges and to avoid weight gain. This could be by self-induced vomiting or misuse of laxatives. A person with bulimia is usually close to their normal body weight and are less recognisable than a person with anorexia.
Binge eating disorder:
This is characterized by frequent episodes of binge eating. Individuals feel loss of control during these binge episodes. The binge eating can lead to serious health consequences such as obesity, diabetes, hypertension (high blood pressure) and heart disease.
Treatment for eating disorders
Eating disorders can be effectively treated. The earlier they are detected, the easier it is to treat them. Recovery can take months or years, but the majority of people recover. Once diagnosed, treatment is a multidisciplinary approach.
The health care providers involved include psychiatrists, psychologists, physicians, dieticians or nutritional advisers, social workers, occupational therapists and nurses.
Treatment includes diet education and advice, psychological interventions and treatment of concurrent mental ailments like depression and anxiety disorders.
Medications
These are usually prescribed to treat co-existing psychiatric ailments.
Nutritional counselling and diet plans:
These help patients to gain weight and learn healthy eating plans and patterns.
Recommendations for anorexia nervosa:
Place of treatment (on an outpatient basis or in the hospital) is determined based on physical aspects of the disease.
Patient is explained that healing may take many months if not years
Forced treatment of anorexia nervosa should only take place when all other measures have been exhausted.
With children and adolescents still living with their family, other members of the family need to be involved. Atempts should be made to restore normal weight
In the hospital set up a weight gain of between 500 g and a maximum of 1000 g per week should be aimed at. In the outpatient setting, the goal should be a gain of 200 to 500 g per week. Patients should be weighed at the same time regularly in the morning wearing light clothing
Guidance regarding adequate nutrition should be given
Recommendations for bulimia nervosa:
Psychotherapy is the treatment of choice for bulimia nervosa.
For children, adolescents, and young adults, Cognitive behavioral therapy (CBT) is regarded as the treatment of choice
Usual course lasts at least 25 sessions at a frequency of at least 1 session per week.
Management of physical symptoms is important
Patients with co-morbidities like borderline symptoms need psychiatric support as well
With children and adolescents still living with their family, other members of the family need to be involved. Administration of selective serotonin reuptake inhibitors (SSRIs) is the drug therapy of choice
Recommendations for binge eating disorder:
Usually patients may be overweight or obese and may need therapy.
Those with existing psychological complaints and disorders like depression, social phobia etc. need therapy
Relapse prevention is an important measure as well.
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