The truth about eating disorders

Last week, the Academy for Eating Disorders, a US-based professional association, drew attention to a publication called the ‘Nine truths about eating disorders’ by Dr Cynthia Bulik. It is a bid to spread the message on the subject that doctors say has little research in India with few people reporting it — the earliest reports in India came in 1966, while in the West there are records from the 17th Century.

We asked psychiatrists to take us through the guide, because eating disorders begin with emotional health problems that escalate into a mental health illness that has severe physical consequences. It is not as simple as a desire for slimness.

Truth #1 Many people with eating disorders look healthy, yet may be extremely ill.

It’s not easy for a family member to realise that their loved one has one. Dr Keya Das, a psychiatrist in Bengaluru, asks people to look out for signs that the person “has been reducing quantities of food and is specific about a non-fat diet to the exclusion of health.” They’re preoccupied with weight and weigh themselves often or exercise heavily, even if they appear slim; the person has been progressively losing weight and appears lethargic and irritable when questioned about eating habits; tries to eat alone; uses laxatives or appetite suppressants. She adds that there may be negative comments about self-image or the body.

Truth #2 Families are not to blame, and can be the patients’ and providers’ best allies in treatment.

While family relationships do feed into a person’s self-image, this may not be the only cause. Abuse, stress during adolescence, and other mental health conditions like depression can precipitate it. For treatment though, doctors try and see families too, because, “Families can be a part of the cause and the treatment too. Sometimes family members may be accommodating of certain behaviours,” says Dr Pooja Patnaik Kuppili, a psychiatrist in AIIMS, Jodhpur. For instance, a young woman who may become obsessed with her weight in order to look a particular way if her family is looking for a husband for her.

Truth #3 An eating disorder diagnosis is a health crisis that disrupts personal and family functioning.

Anorexia nervosa (usually starvation to achieve the ‘ideal body’ weight though the person may already be at it) has the highest mortality of all mental illness, says Dr Kuppili. The chance of death is almost 10% in the first 10 years, she adds, with metabolic abnormality and electrolyte disturbances being common. Bulimia nervosa (excessive eating and purging) often comes with an electrolyte imbalance among other problems, while binge-eating, which is most common, is associated with obesity.

The truth about eating disorders

Truth #4: Eating disorders are not choices, but serious biologically influenced illnesses.

Research at the genetic level for eating disorders is still in its infancy, but recent studies do speak of possibilities of increased familial heritability, says Dr Das. “These are based on familial studies, where higher rates of eating disorder are found in the first-degree relatives of those with eating disorders.” Similarly, twin studies have shown that monozygotic (identical) twins are more likely to develop eating disorders compared to dizygotic (fraternal) twins. Women and adolescents are at greater risk.

Truth #5 Eating disorders affect people of all genders, ages, races, ethnicities, body shapes and weights, sexual orientations, and socio-economic statuses.

Most people believe that eating disorders are a Western problem that we in India are importing, along with thigh gaps, bikini bridges and ab cracks. It’s not, says Dr Keya Das, in a 2018 case report titled ‘Anorexia nervosa in rural South India’. A 12-year-old girl from a middle-class family in a district in Tamil Nadu complained of abdomen pain and vomiting and a break in her period. She had been losing weight progressively for over three months and had a BMI of 14.9 (the normal range is 18.5 to 24.9).

Truth #6 Eating disorders carry an increased risk for both suicide and medical complications.

The main cause of death of anorexia is physical body complication, and the second cause is suicide. People with co-morbidities (another condition), such as obsessive compulsive disorder and depression, may also develop this. Anorexia nervosa can also mask some types of cancer, found Dr Kuppili, in last year’s paper ‘Eating Disorders: An Overview of Indian Research’.

Truth #7 Genes and environment play important roles in the development of eating disorders.

Both have a 50% role, says one study. “Conversations surrounding thinness as a virtue would be detrimental to the development of a healthy body image, thereby increasing risk of eating disorders,” says Dr Das. Parenting conversations are important too, and with children role-modelling adults, it helps for mothers and fathers not to harp on their own physical attributes too much.

Truth #8 Genes alone do not predict who will develop eating disorders.

One of the reasons that the girl from rural India cited was “comments from relatives about weight gain and menarche”. In her study, Dr Kuppili found that in Indian adolescents belonging to the Sikh community in the UK, “The symptoms of AN were found to flare up after being teased by peers about weight, which was followed by concerns about weight gain, in the majority of cases.”

Truth #9 Full recovery from an eating disorder is possible. Early detection and intervention are important.

To find out if you have an eating disorder, take the SCOFF test available online.

Sneha suicide prevention helpline: 044-24640060 (8 am to 10 pm); 044-24640050 (24/7)

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Printable version | Sep 18, 2021 12:40:05 PM |

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