Eating Disorders

Definition

There is a commonly held view that eating disorders are a lifestyle choice. Eating disorders are actually serious and often fatal illnesses that cause severe disturbances to a person’s eating behaviors. Obsessions with food, body weight, and shape may also signal an eating disorder. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Anorexia

Anorexia nervosa is an eating disorder that makes people lose more weight than is considered healthy for their age and height.

Persons with this disorder may have an intense fear of weight gain, even when they are underweight. They may diet or exercise too much or use other ways to lose weight.

Bulimia

Bulimia is an illness in which a person has regular episodes of eating a very large amount of food (bingeing) and feels a loss of control over eating. The person then uses different ways, such as vomiting or laxatives (purging), to prevent weight gain.

Many people with bulimia also have anorexia nervosa.

Binge-Eating Disorder

Binge eating is an eating disorder in which a person regularly eats unusually large amounts of food. During binge eating, the person also feels a loss of control and is not able to stop eating.

African Americans & Eating Disorders

There is a general belief that eating disorders are a young, white woman’s problem, however, there is increasing evidence that women of color, particularly Black girls and women, also suffer from eating disorders. The organization NEDA cites that exact statistics on eating disorders among women of color are not available. According to their website:

Due to our historically biased view that eating disorders only affect white women, relatively little research has been conducted utilizing participants from racial and ethnic minority groups.

In spite of these factors, reports of eating disorders among women of color are on the rise. Some of this gain may simply reflect an increase in the reporting of these problems rather than actual increases. Three factors affect the rate of reporting among minority women: underreporting of problems by the individual, under and misdiagnosing on the part of the treatment provider, and cultural bias of Diagnostic and Statistical Manual-IV criteria for eating disorders.

Following are a few statistics from prior research:

  • African American girls aged 11-14 consistently scored higher than white girls of the same age on all Eating Disorder Inventory (EDI) scales measuring features commonly associated with eating disorders except for body dissatisfaction and drive for thinness (Striegel-Moore et al, 2000).
  • Black girls may be especially vulnerable to developing eating disorders with binge eating features (Striegel-Moore, 2000).
  • Browne (1993) reports that African-American women feel tremendous pressure as role models, and that as a result, feel they must be perfect in order to counteract negative stereotypes.

A national study of African American and Caribbean Blacks conducted by The National Survey of American Life (NSAL) was the first to examine eating disorders with Blacks included in the sample group, according to a Psychology Today article. Findings from the survey showed binge eating disorder was the most prevalent among Blacks, with an older onset age. According to the author, “This older age of onset may reflect less of a concern for smaller body size and may represent more of a reaction to stress. Lower incomes and stress due to racism may have an effect on the drive to binge as a coping mechanism.”

Cause & Risk Factors

Symptoms

In the U.S., binge eating is the most common eating disorder. More women than men have it. Women are affected as young adults while men are affected in middle age.

Symptoms include:

Exams and Tests

Anorexia

Tests should be done to help find the cause of weight loss, or see what damage the weight loss has caused. Many of these tests will be repeated over time to monitor the person.

These tests may include:

Bulimia

A dental exam may show cavities or gum infections (such as gingivitis). The enamel of the teeth may be worn away or pitted because of too much exposure to the acid in vomit.

A physical exam may also show:

  • Broken blood vessels in the eyes (from the strain of vomiting)
  • Dry mouth
  • Pouch-like look to the cheeks
  • Rashes and pimples
  • Small cuts and calluses across the tops of the finger joints from forcing oneself to vomit

Blood tests may show an electrolyte imbalance (such as hypokalemia) or dehydration.

Treatments & Therapies

Anorexia

The biggest challenge in treating anorexia nervosa is helping the person recognize that they have an illness. Most people with anorexia deny that they have an eating disorder. People often enter treatment only when their condition is serious.

Goals of treatment are to restore normal body weight and eating habits. A weight gain of 1 to 3 pounds per week is considered a safe goal.

Different programs have been designed to treat anorexia. Sometimes the person can gain weight by:

  • Increasing social activity
  • Reducing the amount of physical activity
  • Using schedules for eating

Many patients start with a short hospital stay and follow-up with a day treatment program.

A longer hospital stay may be needed if:

  • The person has lost a lot of weight (being below 70% of their ideal body weight for their age and height). For severe and life-threatening malnutrition, the person may need to be fed through a vein or stomach tube.
  • Weight loss continues, even with treatment
  • Medical complications, such as heart problems, confusion, or low potassium levels develop
  • The person has severe depression or thinks about committing suicide

Care providers who are usually involved in these programs include:

  • Nurse practitioners
  • Physicians
  • Physician assistants
  • Dietitians
  • Mental health care providers

Treatment is often very difficult. Patients and their families must work hard. Many therapies may be tried until the patient overcomes this disorder.

Patients may drop out of programs if they have unrealistic hopes of being “cured” with therapy alone.

Different kinds of talk therapy are used to treat people with anorexia:

  • Cognitive behavioral therapy (a type of talk therapy), group therapy, and family therapy have all been successful.
  • Goal of therapy is to change patients’ thoughts or behavior to encourage them to eat in a healthier way. This kind of therapy is more useful for treating younger patients who have not had anorexia for a long time.
  • If the patient is young, therapy may involve the whole family. The family is seen as a part of the solution, instead of the cause of the eating disorder.
  • Support groups may also be a part of treatment. In support groups, patients and families meet and share what they have been through.

Medicines such as antidepressants, antipsychotics, and mood stabilizers may help some anorexic patients when given as part of a complete treatment program. These medicines can help treat depression or anxiety. Although medicines may help, none has been proven to decrease the desire to lose weight.

Bulimia

People with bulimia rarely have to go to the hospital, unless they:

  • Have anorexia
  • Have major depression
  • Need drugs to help them stop purging

Most often, a stepped approach is used to treat bulimia. Treatment depends on how severe the bulimia is, and the person’s response to treatments:

  • Support groups may be helpful for mild bulimia without other health problems.
  • Counseling, such as talk therapy and nutritional therapy are the first treatments for bulimia that does not respond to support groups.
  • Antidepressants known as selective serotonin-reuptake inhibitors (SSRIs) are often used for bulimia. A combination of talk therapy and SSRIs is very effective if talk therapy does not work alone.

People may drop out of programs if they have unrealistic hopes of being “cured” by therapy alone. Before a program begins, you should know that:

  • You will probably need to try many different therapies to overcome this difficult disorder.
  • It is common for bulimia to return (relapse), and this is no cause for despair.
  • The process is painful, and you and your family will need to work hard.

Binge-Eating Disorder

The overall goals of treatment are to help you:

  • Lessen and then be able to stop the binging incidents.
  • Get to and stay at a healthy weight.
  • Get treated for any emotional problems, including overcoming feelings and managing situations that trigger binge eating.

Eating disorders such as binge eating are often treated with psychological and nutrition counseling.

Psychological counseling is also called talk therapy. It involves talking with a mental health provider, or therapist, who understands the problems of persons who binge eat. The therapist helps you recognize the feelings and thoughts that cause you to binge eat. Then the therapist teaches you how to change these into helpful thoughts and healthy actions.

Nutrition counseling is also important for recovery. It helps you develop structured meal plans and healthy eating and weight management goals.

The health care provider may prescribe antidepressants if you are anxious or depressed. Medicines to help with weight loss may also be prescribed.

Outlook (Prognosis)

Anorexia

Anorexia nervosa is a serious condition that can be life-threatening. Treatment programs can help people with the condition return to a normal weight. But it is common for the disease to return.

Women who develop this eating disorder at an early age have a better chance of recovering completely. Most people with anorexia will continue to prefer a lower body weight and be very focused on food and calories.

Weight management may be hard. Long-term treatment may be needed to stay at a healthy weight.

Bulimia

Bulimia is a long-term illness. Many people will still have some symptoms, even with treatment.

People with fewer medical complications of bulimia and those willing and able to take part in therapy have a better chance of recovery.

Binge-Eating Disorder

Binge eating is a treatable disorder. Long-term talk therapy seems to help the most.

Complications may include:

  • Bone weakening
  • Decrease in white blood cells, which leads to increased risk of infection
  • Low potassium levels in the blood, which may cause dangerous heart rhythms
  • Severe lack of water and fluids in the body (dehydration)
  • Lack of protein, vitamins, minerals, and other important nutrients in the body (malnutrition)
  • Seizures due to fluid or sodium loss from repeated diarrhea or vomiting
  • Thyroid gland problems
  • Tooth decay

Bulimia

Bulimia can be dangerous. It may lead to serious health problems over time. For example, vomiting over and over puts stomach acid in the esophagus (the tube that moves food from the mouth to the stomach). This can lead to permanent damage of this area.

Possible health problems include:

Binge-Eating Disorder

With binge eating, a person often eats unhealthy foods that are high in sugar and fat and low in nutrients and protein. This can lead to health problems such as high cholesterol, type 2 diabetes, or gallbladder disease.

Other possible health problems may include:

  • Heart disease
  • High blood pressure
  • Joint pain
  • Menstrual problems

When to Contact a Medical Professional

Call your health care provider if you or a loved one has symptoms or shows a pattern of disordered eating.