Soujanya is a pretty young girl and has just entered the third year of college. In the past two years, she has gone from being an overweight adolescent to an extremely thin, starved-looking girl. Her parents are alarmed. What has happened to their daughter?
Soujanya suffers from an eating disorder. An eating disorder can range across extremes of the spectrum. It may involve extreme reduction or extreme consumption of food. The majority of people suffering from eating disorders are girls and young women. In urban and rural India, the rising wave of obesity is causing intense concern to health care providers. In this scenario, eating disorders may not get enough attention. However, girls suffering from these disorders are at high risk for major health issues and even fatalities.
Types of eating disorders
The commonest eating disorders are anorexia nervosa , bulimia nervosa and binge-eating disorder .
Eating disorders are treatable and require both nutritional and psychological counselling. It requires the cooperation of the family and behaviour modification for the family as a whole.
Anorexia nervosa
Soujanya is a classic case of anorexia nervosa. Starting out overweight, she developed an unhealthy obsession with her weight because of some nasty remarks made by college mates. Girls suffering from this disorder relentlessly pursue weight loss to the point of emaciation. They develop a terrible body image and perceive themselves as being ‘fat' even when they are painfully thin. Food becomes their enemy and they develop an intense fear of gaining weight. As their weight drops below a certain limit, they may stop having their periods.
Girls with anorexia lose weight by extreme reduction of food intake and excessive exercising. Classically, a girl with this disorder will cut an idli into miniscule pieces and then feel ‘full' after eating two of those pieces. Some girls will lose weight by self-induced vomiting or misusing laxatives. Typically, these girls will weigh themselves repeatedly. Many people with anorexia also have psychiatric and physical illnesses, including depression, anxiety and obsessive behaviour.
If not treated aggressively, this disorder may lead to major health problems. It is important to be completely sympathetic with the sufferer and not try to shame her more. The family has to pitch in totally and provide her psychological support. Mealtimes should not become pitched battles. Instead, supervised meals in a pleasant atmosphere will go a long way in helping her out of this problem. Psychiatric counselling from a sympathetic professional is an essential part of the treatment.
Bulimia nervosa
Princess Diana made bulimia nervosa a household word when it was revealed that she was bulimic. Bulimia is essentially binge-eating followed by a type of behaviour that compensates for the binge, such as purging (e.g. vomiting or excessive use of laxatives). The repeated induced vomiting can lead to a chronically inflamed and sore throat, worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acids. Bulimics tend not to be excessively thin and may actually have a normal weight but are obsessed with their weight and body image. Similar to anorexia, people with bulimia often suffer from depression and anxiety.
Intense psychological support along with behavioural therapy will help girls and women suffering from bulimia. A physician may also prescribe an antidepressant if depression is a major part of the problem.
Binge-eating disorder
Girls and women with this disorder are plagued with guilt and self-loathing because they are unable to control the amount they eat. They have recurrent binge-eating episodes where they continue to eat well after they are full. The typical binge may consist of eating an entire box of sweets or a whole brick of ice-cream after having completed a large meal. Some binges may last a whole day, leaving the person feeling physically and emotionally sick. As a result, people with binge-eating disorder often are overweight or obese.
People with binge-eating disorder need psychological support and positive motivation. Instead of shaming them, a proactive program of exercise and supervised eating will help them break bad food habits. The family should cooperate by drastically modifying eating patterns in the house. Temptations like sweets, chips, aerated drinks and other junk food should be banned from the house.
The author is an obstetrician and gynaecologist practising in Chennai and has written the book 'Passport to a Healthy Pregnancy'.
www.passport2health.in
