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MIND&BODY
| TUESDAY, JANUARY 31, 2017 | THE STRAITS TIMES |
B9
HelpAtYourFingertips
Not hungry, but can’t stop gobbling
Those with binge-eating disorder
cannot control their food intake
Abigail Ng
Before you dismiss your friends as
being greedy, you should find out if
there is an underlying reason they
are eating so much, to the extent of
feeling queasy or even unwell.
Dr Victor Kwok, head of the
department of psychiatry at Sengkang Health, recalled that in
secondary school, he had an obese
classmate who could not stop eating when they were at a buffet.
Despite being advised to stop, the
classmate kept on eating and eventually felt very uncomfortable
because he had eaten too much.
Dr Kwok said: “This was puzzling
to me then.”
His classmate may have been suffering from binge-eating disorder.
Although there is no official data in
Singapore, it is estimated that the
disorder is three times more common than anorexia and bulimia
combined.
People with the disorder have
episodes of binge-eating, where
they would gobble large quantities
of food in a short span of time.
Some characteristics of the
disorder include:
• Uncontrollable intake of food.
• Eating more rapidly than usual.
• Eating alone due to
embarrassment.
• Eating until one feels
uncomfortably full.
This differs from overeating,
which may happen at all-you-caneat buffets, said Dr Kwok. At such
buffets, most people try to eat more
and even skip an earlier meal in
order to eat their money’s worth.
What sets overeating apart from
binge-eating disorder is that there
is no loss of control over the
amount of food eaten.
At buffets, we pick and choose
the items we want to eat, even if we
eat to the point of slight discomfort.
At the end of the day, we might
even feel a sense of achievement.
But people with the disorder
would feel disgusted and guilty
after eating large amounts of food.
In fact, they would eat a lot even
though they do not feel hungry.
People with binge-eating disorder may also be suffering from depression and anxiety disorder due to dissatisfaction with their body. PHOTO: ISTOCKPHOTO
These binge-eating episodes
would result in weight gain, increasing the person’s risk of developing
chronic diseases like Type 2 diabetes, high blood pressure and high
cholesterol. Dr Kwok said that 40 to
50 per cent of people with the
disorder could be overweight.
He cited the case of an undergraduate who piled on the kilos
after uncontrollably stuffing himself with fried chicken and burgers
at night. At meal-times, he also ate
more than usual and did not bother
to exercise regularly.
As a result, his weight ballooned
to more than 100kg and he was so
embarrassed that he did not want
to leave his house.
If he woke up late, he would skip
classes as he was afraid the other
students would stare at him when
TREATABLE
You can say you are
concerned about his
loss of control during
eating and that it
could be a symptom
of a medical problem
that can be treated.
’’
DR VICTOR KWOK, head of the department
of psychiatry at Sengkang Health, on how
to approach someone with the disorder.
he walked into the classroom, said
Dr Kwok. The boy’s parents
thought he was just greedy and
scolded him, telling him that he had
lost his good looks. This lowered his
self-esteem even more.
Dr Kwok said people with bingeeating disorder may also be suffering from depression and anxiety
disorder. This could be due to
dissatisfaction with their body or
anxiety that people would comment about their weight.
Binge-eating and anxiety disorders share common factors like
family discord or stress.
For those who are worried that a
family member may have bingeeating disorder, Dr Kwok suggested
approaching him in a private setting without being judgmental.
“You can say you are concerned
about his loss of control during
meals and that it could be a symptom of a medical problem that can
be treated,” Dr Kwok said, adding
that such people may be reluctant
to talk about their bingeing episodes due to shame or disgust.
People with the disorder can seek
help from these healthcare professionals:
• Psychiatrists with training
in eating disorders.
• Psychologists, who can offer
cognitive behavioural therapy to
help patients cope with triggers.
• Dietitians, who can give advice
on a balanced food intake.
• Physiotherapists, who can
suggest exercises for patients
to maintain a healthy weight.
[email protected]
DocTalk
AskTheExperts
Add a second drug to
better control diabetes
Excessive caffeine
intake can cause
rapid heart rate
Dr Abel Soh
Mr Tan, 46, who was overweight,
had been feeling tired for the
past month. His vision occasionally
became blurry and he had lost 3kg.
He started urinating more
often and was drinking more
fluids. This went on for three
weeks before he sought help
from a doctor.
A blood test at the clinic
showed that his blood sugar level
was much higher than normal,
confirming that he had diabetes
mellitus. This is a condition
where the body is unable to
properly use and store sugar,
resulting in blood sugar levels
rising higher than normal.
In Type 1 diabetes, the body
fails to produce insulin. It occurs
mainly in children and adolescents.
Type 2 diabetes, which
comprises 90 per cent of all
diabetic cases, occurs because the
body does not produce enough
insulin and is unable to use
it properly, or what is
described as insulin resistance.
This type of diabetes usually
occurs in people over 40
who are overweight and
have a family history
of the chronic ailment.
Prompt treatment of diabetes
is very important because,
over time, high blood sugar can
lead to a host of complications
such as heart attack, stroke,
blindness and kidney failure.
Some people may acquire blood
vessel disease, which may call
for the amputation of a limb. It
can also lead to impotence in men.
Many diabetes patients are able
to keep their blood sugar levels
in check by making lifestyle
changes, such as exercising more
and moderating the amount of
carbohydrates and fat in their diet.
Such measures can help
an overweight diabetic person
lose weight which, in turn,
keeps his blood sugar levels
from spiralling out of control.
Taking tablet medication
can also be useful.
Usually, the first-line
medication for Type 2 diabetes
is metformin. This drug helps
to lower the body’s resistance
to insulin.
A patient would be put on
metformin when he is diagnosed
with Type 2 diabetes, together
with advice to exercise and
make dietary changes.
In some cases, however,
metformin alone is not enough
to bring down one’s blood sugar
to an ideal level. For these
people, a second-line
medication should be added.
Currently, there are many
options for second-line
medications, including the newer
sodium-glucose transporter-2
(SGLT-2) inhibitors.
SGLT-2 inhibitors, such as
dapagliflozin, lower a person’s
blood sugar level by suppressing
the amount of sugar absorbed
in the kidneys. Sugar is then
passed out in the urine.
The medication has additional
benefits of inducing weight loss –
an average of 2kg to 4kg – and a
slight reduction of blood pressure.
In Mr Tan’s case, he was found
to have an HbA1c of 11.8 per cent.
HbA1c measures the patient’s
blood sugar control over the past
two or three months. A higher
HbA1c level indicates higher
prevalent blood sugar level.
To reduce his risk of developing
Q I am a 67-year-old woman.
Why does my heart palpitate
sometimes to 128 beats per minute
for an hour on some occasions? Is
there a problem with my health?
I have been taking medication
for high blood pressure for
almost 11 years now.
Last year, I cut the dosage
by half as my blood pressure
readings had gone down to less
than 100/60. It has since stabilised.
complications, Mr Tan should
ideally achieve and maintain a
HbA1c target of less than 7 per cent.
An effective way to lower his
high HbA1c level is to start
him on a combination drug
regimen, such as dapagliflozin
and an extended-release
metformin formulation.
An extended-release tablet
means that he has to take it only
once a day. Such drugs can help
patients adhere to their medication
better. Side effects are also
decreased, compared with taking
immediate-release metformin.
Meanwhile, a combination
medication therapy has the
advantage of lowering one’s blood
sugar via two different pathways
that complement each other.
Dapagliflozin helps to expel
sugar from the body through
the urine, while metformin lowers
the body’s insulin resistance.
The extended-release
formulation of these two drugs
can lead to a blood sugar drop
of up to 2 per cent in patients.
Side effects, such as nausea or
diarrhoea, are potentially reduced.
In addition, both drugs are
highly unlikely to cause blood sugar
levels to fall to overly low levels.
In general, anyone who
has diabetes should be seen
by a doctor at least once every
three or four months to have
his condition monitored.
Eye and foot examinations,
as well as urine tests for protein
leakage, should be conducted
yearly.
This way, any diabetes-related
problems can be caught and
treated before they take a turn
for the worse.
[email protected]
• Dr Abel Soh is a consultant
endocrinologist at Abel Soh Diabetes,
Thyroid and Endocrine Clinic,
Mount Elizabeth Medical Centre.
A Your concerns are valid and
they are not unusual. There are numerous causes of fast heart rate,
many of which are not serious.
Fast heart rates can be associated with either high or low
blood pressure. For instance, in
hyperthyroidism (excessive production of thyroid hormones by
the body), excessive thyroid
hormones will cause a fast heart
rate and elevated blood pressures.
As your blood pressure is well
controlled with a lower dose of
medication, it is unlikely that the
fast heart rate is related to a
reduction in medication.
On the other hand, medications
such as cough syrups and medications for runny nose (frequently,
the over-the-counter ones) can
cause palpitations as well.
Apart from hyperthyroidism,
the other common causes of fast
heart rate include anaemia, conditions causing low oxygen supply
such as asthma, chronic obstructive airway disease and heartrelated conditions such as coronary artery disease, cardiomyopathies or diseases affecting the
heart muscle and arrhythmias.
A prolonged period of palpitations is uncomfortable. It can be
particularly worrisome if you
have other symptoms such as
chest pain, shortness of breath,
cold sweat or dizziness.
Your doctor would need to ask
you questions to find out more
about your health before he can
give you advice.
• Was the fast heart rate detected
with a blood pressure device
or an exercise monitor?
• How frequently do you
experience the palpitations?
• Do you have other associated
symptoms such as chest pain
or shortness of breath?
• How is your health in general?
Fast heart rates are commonly
related to our lifestyle habits.
Anxiety, insufficient sleep, excessive caffeine and alcohol intake
can precipitate rapid heart rates.
Avoiding caffeinated products
and alcohol, and maintaining a
healthy lifestyle will frequently
improve the symptoms.
You should seek medical attention if the palpitations are associated with these symptoms.
If the symptoms last more than
an hour, like you mentioned, you
should have them evaluated by a
medical professional.
Assistant Professor
Calvin Chin
Consultant, department
of cardiology, National Heart
Centre Singapore
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