Download EATING DISORDERS

Insite
into Nutrition and lifestyle
Summer 2010
Looking after you is knowing what to eat !
Your guide to Eating disorders
Do you know;

Anorexia nervosa and
bulimia nervosa are the
two best-recognised
eating disorders.

Patients with anorexia
nervosa have no
physical complaints

Binge eating appears to
affect an older age
group than anorexia
nervosa and bulimia
nervosa, with many
patients being 40-50
years old.
An IKO (GB) publication in association with Dr Wyndham Boobier 3rd Kyu.
Page 1 – Eating Disorders
You may recall the first nutrition related article was based on the
promotion of optimum health and the second article was related to
consumption of foods around the Christmas period.
One of the things I try to convey when writing such
articles is that I am not a fan of dieting for “body
image” sake. Being “obsessed” with the shape and
size of your body, perhaps resulting from peer
pressure, can lead a number of problems and I
thought it would be a good idea to outline some in this article.
This article is therefore about eating disorders.
Eating Disorders
Eating disorders may be defined as eating related
behaviour which impairs physical health or
psychosocial functioning, or both, and is not secondary
to any general medical disorder. Anorexia nervosa and
bulimia nervosa are the two best-recognised eating
disorders. They share many features and together are a
major source of morbidity amongst younger women in
western societies. Other eating disorders, which do not
meet the diagnostic criteria for anorexia nervosa or
bulimia nervosa, are termed ‘atypical eating disorders’.
Anorexia Nervosa is characterised by three features,
1. The active maintenance of an unduly low weight, and 15% below the expected
weight for the person’s age, sex and height is a widely used figure. A body mass
index (BMI) of below 17.5 is also widely used. Low weight is achieved by a
variety of means, e.g. strict dieting or fasting, excessive exercise and induced
vomiting. In addition, diabetics may under-use or omit insulin.
2. Characteristic attitudes and values concerning body weight and shape. A major
concern is the tendency to judge self-worth
largely, or completely, in terms of body shape
and weight and little else matters. The
concern about weight and shape is
considerably more intense than the average
level of dissatisfaction of shape and weight
experienced by many young women (and
sometimes young men) today.
3. The third feature is amenorrhoea (the absence of at least three consecutive
menstrual cycles). This feature holds little value as diagnostic criteria, and is
seldom used.
Anorexia nervosa is found mainly to women between 10-30 years of age, and to
western countries in which body weight (or thinness) is considered attractive. The
Page 2 – Eating Disorders
disorder is less common among men (<10% of cases are men) and is largely confined
to Caucasians.
Typically, anorexia nervosa starts in adolescence, and as normal dieting which gets
out of control.
As weight falls, the physiological and
psychological features of semi-starvation develop.
The
individual may employ a number of means to control shape and
weight loss at any time. Even if the initial start of weight loss is
the result of a general medical illness, low weight is actively
maintained.
A severe reduction in food intake is the main cause of weight
loss, but the choice of food is also important with “fattening” foods being avoided.
Frequent intense exercising is common, and laxative use, diuretic misuse and selfinduced vomiting are also practised. In addition to the weight loss, the sufferer
perceives their body to be larger than it actually is. As weight is lost, neither feature
improves, in fact both tend to get worse.
Depression, irritability and anxiety are common in
individuals suffering form anorexia nervosa, and in
extreme cases there may be thoughts of suicide. Interests
tend to decline and there may be a marked social
withdrawal.
Symptoms
Often, patients with anorexia nervosa have no physical complaints. However,
investigation often identifies increased sensitivity to cold
and a number of gastrointestinal problems, e.g.
constipation and abdominal pains.
In addition,
restlessness, lack of energy, a low sex drive and poor
sleeping habits are symptoms. The degree of emaciation
is often very striking, growth may be stunted in patients
with pre-pubertal onset, and there may be failure of breast
development. A fine downy hair growth may be present
on the back, arms and side of the face, the skin is often dry and the hands and feet are
cold. Blood pressure and pulse may also be low.
While dieting appears to be a vulnerability factor for anorexia nervosa, many young
women diet but only a few develop the eating disorder, other factors, therefore, play a
role. Examples include a family history of an eating disorder, being bullied,
depression, extreme perfectionism and low self-esteem.
As the intake of food is reduced and weight is lost, there are secondary physical and
psychological changes that perpetuate the disorder. Examples include;


reduced stomach emptying gives a feeling of being full,
preoccupation with food magnifies the problems with eating and often results in
social withdrawal, and
Page 3 – Eating Disorders

withdrawal isolates the sufferer from their peers – resulting in a ‘positive
feedback’ which worsens the problem.
While at least 50% of patients with anorexia nervosa recover in terms of their weight
and menstrual function, their concern about body shape and weight often persist to
some extent. In such cases, their eating habits may remain disturbed. Around 25% of
patients develop bulimia nervosa.
Bulimia Nervosa is characterised by three features
1. The presence of “binges” (bulimic episodes), involving the
consumption of large amounts of food. Apart from binging,
very little is eaten.
2. The use of extreme behaviour (similar to patients with anorexia
nervosa) to control body weight and shape, self induced
vomiting and the use of laxatives and diuretics are much more
common.
3. The presence of attitudes and values concerning weight and shape similar to those
found in anorexia nervosa.
People with bulimia nervosa are typically older than those with anorexia nervosa, and
are mostly in their twenties. This disorder is rarely seen in men. In countries in which
anorexia nervosa is found, there has been an increase in the number of patients with
bulimia nervosa.
Clinical features of bulimia nervosa and anorexia nervosa are the very similar, body
shape and weight are major concerns, and sufferers use similar methods of weight
control, however bulimic episodes are present in patients with bulimia nervosa. In
addition, a significant minority of patients have problems with alcohol and drugs.
Symptoms
Irregular or absent menstruation, weakness and lethargy,
abdominal pain and toothache are the most commonly
encountered. On examination, salivary gland enlargement
may be present, and the face may have a rounded
appearance. Calluses may be present on the fingers being
used to stimulate vomiting. Erosion of dental enamel on
the palatal surface of the upper front teeth is also common.
Most who suffer from bulimia nervosa tend to have a history of disturbed eating from
adolescence, and around 33% have previously fulfilled diagnostic criteria for anorexia
nervosa. It’s therefore not surprising that many of the risk factors for anorexia
nervosa have been shown to be risk factors for bulimia nervosa. Parental alcoholism
and parental and childhood obesity are also common. As with anorexia nervosa, the
main target of treatment is the characteristic over-concern about body shape and
weight.
Page 4 – Eating Disorders
Most people with bulimia nervosa are ashamed of the eating habits and hence keep
then secret often for years. When these patients seek help they often complain of
features associated with the disorder rather than the disorder itself, e.g. they present
with gastrointestinal symptoms or substance abuse.
Atypical Eating Disorders
Around 33% of patients who present for treatment of an eating disorder have neither
anorexia nervosa nor bulimia nervosa. These are said to have an ‘atypical eating
disorder’. The one atypical eating disorder to have
been characterised is the ‘binge eating disorder’, in
which the sufferer binges in the absence of extreme
weight control behaviour that characterises bulimia
nervosa, i.e. no self-induced vomiting etc. Many
sufferers are therefore overweight or obese. Though
most patients with binge eating disorder are
concerned about their weight and body shape, these
concerns do not have the same intensity as those
suffering from anorexia nervosa and bulimia nervosa. Outside of the ‘binges’, eating
may be relatively normal, in fact there may be a tendency to overeat rather than under
eat.
Binge eating appears to affect an older age group than anorexia nervosa and bulimia
nervosa, with many patients being 40-50 years old, and male cases are not
uncommon. About 10% of people on weight loss programmes have binge eating
disorder, and the disorder seems to be phasic, with extended periods (several months)
when control of eating is maintained successfully. The aim of the treatment relating
to binge eating disorder is to establish healthy eating habits. Treatment is almost
always on an outpatient, one-to-one basis.
SUMMARY
As students of Kyokushin Karate, you are obviously passionate about health, fitness
and wellbeing. If you feel you need to lose weight for health reasons, go ahead,
health promotion is the perfect reason to lose unwanted weight. Please take care
though with wanting to lose weight because you feel your body shape does not
“conform” to an ideal shape which is often promoted by many magazines and catwalk models. Take another look at the first article (Health Promotion) crash dieting
or food restriction (unless for medical reasons) are not good ideas. Often it’s a case of
changing eating habits in conjunction with appropriate physical activity is all that is
required. If you think you (or someone you know) suffer(s) from an eating disorder
please seek appropriate help and support.
Page 5 – Eating Disorders