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For other articles and previous issues click here. November 1, 2004 Dying to
Be Thin Recognizing the signs of an eating disorder can save a life. Are parents, teachers, and healthcare providers turning a blind eye to the signs and symptoms of eating disorders? Young people with anorexia, bulimia, or binge eating disorder may hide these emotional afflictions and their resulting weight loss or gain under fashionably baggy clothing until changes are extreme. They may also become adept at disguising disordered eating behaviors until dramatic changes in appearance draw attention to them. A recent report in the Los Angeles Times suggests that in as many as one-half of all eating disorder cases, early warning signs are overlooked, even by doctors. American Dietetic Association (ADA) national spokesperson Katherine Tallmadge, MA, RD, recalls a client of hers, now in her 20s, who went on a diet at the age of 12 and lost approximately 100 pounds. Since that time, she’s been starving by day and bingeing by night. “Her weight has fluctuated wildly, but it’s mostly down,” says Tallmadge. During the client’s adolescence and young adulthood, no one seems to have noticed that there may be a problem. “When this kid lost 100 pounds going on a diet on her own, people should have been asking what she was doing.” But no one did. Not until she finally sought the help of a registered dietitian more than one decade after her symptoms began did this troubled young woman get the help she needed, which involved not only dietary counseling but also medical attention and psychological counseling. But only a small number of those afflicted with an eating disorder will seek a dietitian’s services, says Tallmadge. “So few people come to see us—this case represents one person out of thousands or even millions of people who have the same problem and aren’t getting help.” Tallmadge’s patient was lucky to get help in time. Many more are dying to be thin. An Escalating Problem The High Cost of Neglect Anorexia nervosa, or self-starvation, is a serious psychological disorder characterized by an extreme fear of gaining weight, a refusal to eat, and the belief, despite evidence to the contrary, that one is greatly overweight. It frequently occurs in individuals with other mental disorders such as clinical depression, anxiety, personality disorder, substance abuse, and obsessive-compulsive disorders (OCDs). It can result in fluid and electrolyte imbalances, organ atrophy, bone density loss that may lead to osteoporosis, reduced muscle mass, lightheadedness, brain atrophy, thyroid dysfunction, mild anemia, swollen joints, irregular heartbeat that can result in cardiac arrest, memory impairment, mental disorientation, liver disease, kidney disease or failure, and deterioration of the muscles, including the heart. Anorexia, which usually begins at puberty and, surprisingly, is the leading cause of death in young women, carries a higher mortality rate—as high as 20%—than that for any other psychological disorder. According to the National Association of Anorexia Nervosa and Associated Disorders, only one-half of all cases of anorexia are cured, 5% to 10% of people with anorexia die within 10 years of the onset of disordered eating behaviors, and 18% to 20% die within 20 years. According to the National Institute of Mental Health (NIMH), approximately one-half of people with anorexia will eventually develop bulimia as well. Bulimia, characterized by excessive eating followed by compensatory behaviors such as purging via compulsive exercising, vomiting, or the use of laxatives, diuretics, or enemas, also tends to appear first during adolescence. It is often more difficult than other disorders to detect because people with bulimia may maintain a more stable body weight than people with anorexia or those suffering from binge eating disorder. As with anorexia, individuals suffering from bulimia may also battle addictions, depression, anxiety, and OCD. Loss of vital minerals can lead to heart failure, and the acid in vomit can erode the outer layer of the teeth and inflame the esophagus. Like anorexia, bulimia is often deadly. According to the NIMH, “Individuals with eating disorders who use drugs to stimulate vomiting, bowel movement, or urination are in the most danger, as this practice increases the risk of heart failure.” Individuals with binge eating disorder, which appears to be more common than anorexia and bulimia, have no control over their food intake and consume large amounts within a short period of time, becoming full to the point of pain. Unlike people with bulimia, those with binge eating disorder do not attempt to counter bingeing behavior with purging, fasting, using laxatives or diuretics, or compulsively exercising. Men make up as much as 40% of those with this disorder, which affects 1% to 4% of the population. The consequences of this out-of-control feasting may include menstrual irregularities, diabetes, osteoarthritis, obesity, hypertension, high cholesterol, coronary disease, depression and anxiety, suicidal ideation, and death. Shattering the Profile Sometimes parents—the people seemingly most likely to observe eating disordered behaviors—choose not to identify the behavior, are unaware of the signs, or, says Sass, think their children will grow out of it. “Sometimes, part of the issue is that they may not want to see them,” says Tallmadge, “so [the problem] may be obvious to everyone but the parents.” Worse still, she explains, sometimes parents are happy that their children are losing weight. “I have one client,” she says, “whose mother encouraged her to smoke to get thin.” One of the obstacles is that when educators and caregivers do look for eating disorders, they look with a narrow focus. To catch all who may be afflicted, they need to shatter stereotypes and break down the notion that there’s a profile for individuals with eating disorders. Although often thought to be problems that affect young white women, anorexia, bulimia, and binge eating disorder occur in the young and old, male and female, the poor and affluent, and individuals of all races and ethnic backgrounds. Among all these groups, there may be individuals unconsciously or deliberately concealing a serious disorder, but since they seem to be outside the profile, they slip through the cracks. According to Gayle E. Brooks, PhD, vice president of clinical services, The Renfrew Center, who spoke at a congressional briefing last December, “Since women of color and poor women do not fit the affluent white girl profile, doctors and therapists often fail to assess them properly for eating disorders. Research has found that it takes longer for nonwhite women to be correctly diagnosed with anorexia, and their symptoms are more severe at the time of diagnosis.” Boys and men are often overlooked. Many men, for example, may not eat all day and then binge all night long, a behavior Tallmadge sees frequently in men, even those in their 40s and 50s. Another stumbling block to diagnosis, says Dawn Jackson, RD, LD, Northwestern Memorial Wellness Institute, ADA national spokesperson, is that “some of the signs and symptoms can look just like those of a typical teen going through the typical teenage years.” Therefore, she says, “it’s often very difficult to catch at the beginning stages for both parents and healthcare providers.” “I’ve seen more and more eating disorders among older people,” says Tallmadge. “I’m shocked at the number of women in their late 20s and 30s with eating disorders.” One of her clients was a 40-year-old woman suffering from anorexia. In some cases, these older patients have battled their weight for years. “All of a sudden, they go on a diet, then the diet never stops, and they become petrified of gaining the weight back,” Tallmadge says. It can happen at any age, she adds. “They latch onto a diet and think that it’s working for them, and they can’t stop because they have a horrible fear of weight gain.” By the time they seek help, she says, what they’re manifesting is fear—fear of weight gain, bingeing, overeating, and losing control. “We all harbor little fears like that,” she explains, “but their fears are beyond the norm. They’re excessive to the point where they starve.” The following is merely a sampling of the many telltale signs and behaviors to which educators, caregivers, and healthcare professionals should be alert. Abnormal Eating Habits Parents of young people with binge eating disorder or bulimia may notice that their children eat nonstop all afternoon. People with anorexia may complain of feeling bloated because, says Tallmadge, they psychologically associate bloating with certain foods. Individuals with eating disorders have food fears, she says, and will come up with a roster of excuses not to eat. “They’ll have certain foods they won’t touch—for example, pasta—and they’ll make up reasons such as ‘It’ll give me a stomachache, it makes me sick, I’m allergic to it,’” she notes. “I had an anorexic patient who told me she felt like passing out after she drank juice because she was afraid of the high calories.” What’s typically on a person’s plate may provide clues to undiagnosed eating disorders. If salads, high-fiber foods, and diet sodas are the staples, consider the possibility of anorexia. “[People with anorexia] get really good at understanding the concepts of weight loss,” says Tallmadge. “We teach people that to lose weight they should eat more fruits and vegetables, but [those with anorexia] take it to the extreme. They stuff themselves with fruit and vegetables, which have few calories, so that they don’t eat anything else.” Additionally, those with eating disorders who typically deny hunger will often eat alone and exhibit ritualistic eating patterns, such as pushing food around on a plate to deflect attention from the failure to eat, eating one food at a time, not allowing certain foods to touch on the plate, or insisting on eating from a certain bowl or plate. Compulsive Exercise Mood and Mentation Changes Physical Signs and Symptoms Individuals who put their fingers down their throat
to induce vomiting may display scrapes on the back of their knuckles,
caused by their teeth. • cessation of menstruation • paleness • dizziness or fainting • hair loss or dry and brittle hair • skin yellowing • dry skin or brittle nails • lethargy • weight fluctuations • swollen glands in neck • development of downy skin hair called lanugo • persistent sore throat • sores on the mouth • bloodshot eyes Language Behaviors • smoking; • abuse of drugs, alcohol, or diet supplements; • leaving a room right after eating; • frequent use of the bathroom after eating and remaining there for long periods; • frequent toothbrushing or excessive use of mouthwash or breath mints to reduce bad breath associated with vomiting; • excessive use of laxatives, diuretics, diet pills, ipecac, or enemas; • excessive spending; • promiscuous behavior or avoidance of intimacy; • hiding foods; • making frequent trips to convenience stores in one day; • wearing baggy clothing (This may be a fashion statement, but it may also be an attempt to hide weight loss or gain. Wearing tight, form-fitting clothing may also be an indication.); • preoccupation with weight and consecutively trying different diets; and • making meals or baking for others but not indulging in the foods made. Young children may be less adept at hiding the signs or behaviors, but there may be hints. Parents can be alert to children hiding food in their rooms—in their closets and drawers and under their beds. Educating parents, caregivers, and healthcare professionals and alerting them to these and other clues that may suggest that an individual is experiencing or is at risk for an eating disorder may help prevent years of psychological damage and physical deterioration and is likely to save lives. — Kate Jackson is a staff writer at For The Record.
Alliance for Eating Disorders Awareness American Dietetic Association Anorexia Nervosa and Related Eating Eating Disorders Coalition National Association of Anorexia Nervosa and Associated
Disorders National Eating Disorders Association National Institute of Mental Health Overeaters Anonymous The Renfrew Center Foundation |
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