Physician Focus: September 2011
By Esther Dechant, M.D. and Beth Mayer, LICSW
As many as 10 million females and one million males in the U.S.
are affected by eating disorders, including Anorexia Nervosa,
Bulimia Nervosa, and Binge Eating Disorder. These conditions are
often hard to detect, carry great shame, and present severe
physical and mental health problems for patients. Many of those
afflicted are young - adolescents, teenagers, and young
adults.
The vast majority of individuals with Anorexia and Bulimia -
some 85-95 percent - are women. Binge Eating Disorder affects about
two percent of all adults - up to four million Americans, affecting
slightly more women than men. Recent studies have discovered an
increasing incidence of these disorders among males. The peak onset
of these conditions occurs during late puberty and in the late
teenage and early adult years.
The topic of eating disorders requires some definitions.
Anorexia Nervosa is characterized by a refusal to maintain a normal
body weight through self-induced starvation. Bulimia Nervosa
consists of episodes of binge eating - consuming large amounts of
food in a short amount of time in a way that feels out of control -
followed by actions to compensate for overeating, such as vomiting,
restricting food, or the use of laxatives. Those suffering from
Anorexia and Bulimia have common traits: they fear gaining weight,
are fixated on losing weight, and are very dissatisfied with their
bodies. Binge Eating Disorder consists of consuming large amounts
of food but without the compensatory actions to purge one's system;
it's often associated with obesity.
Medicine has yet to pinpoint the specific causes of these
illnesses, but we do know that certain factors contribute to them.
Among them are cultural issues, such as the pressure to be thin or
fit a certain body size or image, and stressful psychological
situations, such as traumatic events in childhood, troubled
personal relationships, or major changes in life. Family influence
also plays a role; those with a relative with a disorder, or those
whose parents constantly criticize their appearance, are more
susceptible. Research is also pointing to biology and genetics as
additional causes. Health professionals agree, however, that it is
usually not one trigger that leads to an eating disorder, but
rather a combination of factors.
The mental and physical health issues usually occur in tandem.
Low self-esteem, depression, and anxiety are among the mental
health issues patients face. And the consequences to one's physical
health are serious.
The most serious physical effects of Anorexia, for example,
include cardiac conditions from a weakened heart, which, in severe
cases, can result in sudden death. Another danger is deteriorating
bone health, a particular concern for adolescents because the
teenage years are the most important for developing strong bones.
If a strong skeleton and bone structure do not develop during those
years, a lifelong, debilitating, and potentially irreversible
condition can result.
The danger from Bulimia comes from the purging of what has been
consumed, which changes electrolyte levels in the body and can also
cause cardiac problems. Gastrointestinal issues may also arise from
the constant purging. The effects of Binge eating are similar to
those of obesity - heart conditions, diabetes, high blood pressure,
and high cholesterol.
Treating these ailments can be complex. In most cases, they are
usually treated on an outpatient basis, although hospitalization
may be required. While health providers treat the eating disorder,
they also address all of the other issues that accompany it, such
as depression, anxiety, body image, and self-esteem. These
disorders consume great amounts of time, change the way a person
lives, take up a lot of what we call "psychological space," and
seriously disrupt lives. But there is hope.
The first step to recovery is getting the right treatment.
Psychotherapy is a beneficial tool for individuals struggling with
eating disorders, and can allow the person to understand the root
causes of the eating disorder and how to cope with and manage their
feelings. Nutritional therapy is also critical to the recovery
process and teaches the patient to practice healthy, mindful eating
with the support of a trained professional. While these disorders
can be difficult and affect the whole family as well as the
individual patient, treatment does work and patients do get better.
For more information on eating disorders, visit the Multi-service
Eating Disorders Association at medainc.org or the National Eating Disorders
Association at edap.org. For a video discussion, go to www.physicianfocus.org.
Esther Dechant, M.D. is medical director of the Klarman
Eating Disorders Center at McLean Hospital in Belmont,
Massachusetts, and Beth Mayer, LICSW is chief executive officer of
the Multi-service Eating Disorders Association based in Newton,
Massachusetts. Physician Focus is a public service of the
Massachusetts Medical Society. Readers should use their own
judgment when seeking medical care and consult with their physician
for treatment. Send comments to PhysicianFocus@mms.org
