March is Kidney Month
The goal of Eating Disorder Awareness Month is just as it sounds: to raise awareness about eating disorders. As with all disease, education is the key to recognizing symptoms.
Anorexia & bulimia nervosa are perhaps the most commonly known eating disorders. But others such as binge eating disorder, orthorexia & body dysmorphic disorder exist, as well as a category of eating disorders called EDNOS (eating disorders not otherwise specified).
Anorexia Nervosa
What is it?
A serious, potentially life-threatening eating disorder characterized by self-starvation and excessive weight loss.
What to watch for:
- Dramatic weight loss.
- Preoccupation with weight, food, calories, fat grams, and dieting.
- Refusal to eat certain foods, progressing to restrictions against whole categories of food (e.g. no carbohydrates, etc.).
- Frequent comments about feeling “fat” or overweight despite weight loss.
- Anxiety about gaining weight or being “fat.”
- Denial of hunger.
- Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).
- Consistent excuses to avoid mealtimes or situations involving food.
- Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the need to “burn off” calories taken in.
- Withdrawal from usual friends and activities.
- In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
Health Consequences:
- In anorexia nervosa’s cycle of self-starvation, the body is denied the essential nutrients it needs to function normally. Thus, the body is forced to slow down all of its processes to conserve energy, resulting in serious medical consequences:
- Abnormally slow heart rate and low blood pressure, which mean that the heart muscle is changing. The risk for heart failure rises as the heart rate and blood pressure levels sink lower and lower.
- Reduction of bone density (osteoporosis), which results in dry, brittle bones.
- Muscle loss and weakness.
- Severe dehydration, which can result in kidney failure.
- Fainting, fatigue, and overall weakness.
- Dry hair and skin; hair loss is common.
- Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.
Bulimia Nervosa
What is it?
A serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
What to watch for:
- Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.
- Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
- Excessive, rigid exercise regimen–despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.
- Unusual swelling of the cheeks or jaw area.
- Calluses on the back of the hands and knuckles from self-induced vomiting.
- Discoloration or staining of the teeth.
- Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.
- Withdrawal from usual friends and activities.
- In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
- Continued exercise despite injury; overuse injuries.
Health Consequences:
- The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.
- Some of the health consequences of bulimia nervosa include:
- Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death.
- Electrolyte imbalance is caused by dehydration and loss of potassium, sodium and chloride from the body as a result of purging behaviors.
- Potential for gastric rupture during periods of bingeing.
- Inflammation and possible rupture of the esophagus from frequent vomiting.
- Tooth decay and staining from stomach acids released during frequent vomiting.
- Chronic irregular bowel movements and constipation as a result of laxative abuse.
- Peptic ulcers and pancreatitis.
Binge Eating Disorder (BED)
What is it?
A type of eating disorder not otherwise specified and is characterized by recurrent binge eating without the regular use of compensatory measures to counter the binge eating.
What to watch for:
- Frequent episodes of eating large quantities of food in short periods of time.
- Feeling out of control over eating behavior during the episode.
- Feeling depressed, guilty, or disgusted by the behavior.
- There are also several behavioral indicators of BED including eating when not hungry, eating alone because of embarrassment over quantities consumed, eating until uncomfortably full.
Health Consequences:
- Binge eating disorder often results in many of the same health risks associated with clinical obesity.
- Some of the potential health consequences of binge eating disorder include:
- High blood pressure.
- High cholesterol levels.
- Heart disease as a result of elevated triglyceride levels.
- Type II diabetes mellitus.
- Gallbladder disease.
Eating Disorders Not Otherwise Specified
What is it?
Eating disorders such as anorexia and bulimia include extreme emotions, attitudes, and behaviors surrounding weight and food issues. They are serious disorders and can have life-threatening consequences. The same is true for a category of eating disorders known as eating disorders not otherwise specified or EDNOS. These serious eating disorders can include any combination of signs and symptoms typical of anorexia and bulimia, so it may be helpful to first look at anorexia and bulimia.
What to watch for:
- Menstruation is still occurring despite meeting all other criteria for anorexia nervosa.
- All conditions are present to qualify for anorexia nervosa except the individual’s current weight is in the normal range or above.
- Purging or other compensatory behaviors are not occurring at a frequency less than the strict criteria for bulimia nervosa
- Purging without Binging—sometimes known as purging disorder
- Chewing and spitting out large amounts of food but not swallowing
Dental Complications of Eating Disorders
What is it?
Dietary habits can and do play a role in oral health. Everyone has heard from their dentist that eating too much sugar can lead to cavities, but did you know that high intake of acidic “diet” foods can have an equally devastating effect on your teeth? (In fact, while up to 89% of bulimic patients show signs of the tooth erosion usually associated with regurgitation, some studies have found similar prevalence rates in patients with highly restrictive dietary habits. The harmful habits and nutritional deficiencies that often accompany disordered eating can have severe consequences on one’s dental health. It is often the pain and discomfort associated with dental complications that causes individuals with eating disorders to seek treatment.
What to watch for:
- Loss of tissue and erosive lesions on the surface of teeth due to the effects of acid. These lesions can appear as early as 6 months from the start of the problem.
- Changes in the color, shape, and length of teeth. Teeth can become brittle, translucent, and weak.
Increased sensitivity to temperature. In extreme cases the pulp can be exposed and cause infection, discoloration, or even pulp death. - Enlargement of the salivary glands, dry mouth, and reddened, dry, cracked lips.
- Tooth decay, which can actually be aggravated by extensive tooth brushing or rinsing following vomiting.
- Unprovoked, spontaneous pain within a particular tooth.
- Changes in the mouth are often times the first physical signs of an eating disorder. If you are experiencing any of these symptoms, talk with your dentist about ways to care for your teeth and mouth. There are methods for improving your oral health while you are seeking help to change harmful eating habits.
Laxative Abuse
What is it?
Laxative abuse occurs when a person attempts to get rid of unwanted calories, lose weight, “feel thin,” or “feel empty” through the repeated, frequent use of laxatives. Often, laxatives are misused following eating binges, when the individual mistakenly believes that the laxatives will work to rush food and calories through the gut and bowels before they can be absorbed. But that doesn’t really happen. Unfortunately, laxative abuse is serious and dangerous – often resulting in a variety of health complications and sometimes causing life-threatening conditions.
What is the laxative myth?
The belief that laxatives are effective for weight control is a myth. In fact, by the time laxatives act on the large intestine, most foods and calories have already been absorbed by the small intestine. Although laxatives artificially stimulate the large intestine to empty, the “weight loss” caused by a laxative-induced bowel movement contains little actual food, fat, or calories. Instead, laxative abuse causes the loss of water, minerals, electrolytes and indigestible fiber and wastes from the colon. This “water weight” returns as soon as the individual drinks any fluids and the body re-hydrates. If the chronic laxative abuser refuses to re-hydrate, she or he risks dehydration, which further taxes the organs and which may ultimately cause death.
Health Consequences
- Disturbance of electrolyte and mineral balances. Sodium, potassium, magnesium, and phosphorus are electrolytes and minerals that are present in very specific amounts necessary for proper functioning of the nerves and muscles, including those of the colon and heart. Upsetting this delicate balance can cause improper functioning of these vital organs.
- Severe dehydration may cause tremors, weakness, blurry vision, fainting, kidney damage, and, in extreme cases, death. Dehydration often requires medical treatment.
- Laxative dependency occurs when the colon stops reacting to usual doses of laxatives so that larger and larger amounts of laxatives may be needed to produce bowel movements.
- Internal organ damage may result, including stretched or “lazy” colon, colon infection, Irritable Bowel Syndrome, and, rarely, liver damage. Chronic laxative abuse may contribute to risk of colon cancer.
Stopping the Laxative Abuse Cycle
Overcoming laxative abuse requires working with a team of health professionals who have expertise in treating eating disorders, including a general physician, a psychiatrist, psychologist, or counselor, and a registered dietician. Support from close friends and family is also helpful. Meeting with others to talk over anxieties, concerns and difficulties can greatly aid in getting through tough times in the recovery process.
Did You Know?
- The rate of development of new cases of eating disorders has been increasing since 1950 (Hudson et al., 2007; Streigel-Moore &Franko, 2003; Wade et al., 2011).
There has been a rise in incidence of anorexia in young women 15-19 in each decade since 1930 (Hoek& van Hoeken, 2003). - The incidence of bulimia in 10-39 year old women TRIPLED between 1988 and 1993 (Hoek& van Hoeken, 2003).
- The prevalence of eating disorders is similar among Non-Hispanic Whites, Hispanics, African-Americans, and Asians in the United States, with the exception that anorexia nervosa is more common among Non-Hispanic Whites (Hudson et al., 2007; Wade et al., 2011).
- It is common for eating disorders to occur with one or more other psychiatric disorders, which can complicate treatment and make recovery more difficult. Among those who suffer from eating disorders:
- Alcohol and other substance abuse disorders are 4 times more common than in the general populations (Harrop&Marlatt, 2010).
- Depression and other mood disorders co-occur quite frequently (Mangweth et al., 2003; McElroy, Kotwal, & Keck, 2006).
- There is a markedly elevated risk for obsessive-compulsive disorder (Altman &Shankman, 2009).
While the term ‘eating disorder’ often conjures up an image of a young, caucasian female who is already thin and need not be watching her weight, this is often far from the reality of the disease. Our society places much emphasis on females to look thin and males to be muscular, however what percentage of our population actually has an outward appearance that fits that ‘ideal’? People of all races, backgrounds, sexual preferences, ages, sexes and sizes suffer from eating disorders of different types. If you know someone who may be struggling with an eating disorder, don’t hesitate to get them help any less than you would someone choking or having a heart attack. Eating disorders do kill people.
All of this information, and more can be found at https://www.nationaleatingdisorders.org
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