Eating Disorders Awareness Week – It's time to pay attention
By Richard L. Levine, M.D. – Penn State Children's Hospital

We live in a culture preoccupied with being thin. In vulnerable young women these pressures can interact with other biological, psychological and social factors and lead to an eating disorder. These factors combined are often the reasons why eating disorders have become increasingly common in our society. Over the past three decades, eating disorder cases have increased two to five times.

Eating disorders are serious medical conditions that can affect every organ of the body. Anorexia nervosa and bulimia nervosa can have significant, sometimes irreversible medical complications. The prognosis is favorable with early recognition and aggressive treatment.

The majority of patients are typically Caucasian adolescents and young adult women. However, the number of men and women from other ethnic and demographic backgrounds with eating disorders, are increasing.

The etiology of eating disorders   bio biological, psychological and cultural factors

Eating disorders have been found to run in families. A biological vulnerability for the development of eating disorders is presently being researched. Current studies are looking for genetic markers for these disorders. A possible biological connection is neuroendocrine dysfunction, particularly the dysregulation of the neurotransmitter serotonin.

Psychological problems also play a large role in the development of eating disorders. Individual issues such as depression, poor self-esteem and poor body image, as well as complicated family issues, such as parental discord, rigid parenting style, and even abuse, can sometimes lead to symptoms of eating disorders.

Cultural influences play an ever-growing role in the development of eating disorders. Being thin is arguably the primary attribute perpetuated by the media. Many pictorials and advertisements are computer enhanced to increase the physical attractiveness of the models. Thus, young women are repeatedly comparing themselves to unrealistic, often unattainable ideal body images featured in magazines, movies and on television. Female models increasingly reflect a taller, thinner body type. Yet the average model is approximately 23% underweight and many fashion models reportedly have eating disorders.  For a young woman already vulnerable due to biological and psychological factors, the repetition of the Òthin is beautifulÓ stereotype can lead to the development of eating disorders.

Anorexia and Bulimia

Anorexia nervosa is a refusal to maintain a normal weight for an individual's height. Patients with anorexia nervosa are preoccupied with the issues of food and weight, with an intense fear of gaining weight and a distorted body image.

Patients with anorexia nervosa have an abnormal metabolism with reduced energy expenditures. Their bodies slow their metabolism to cope with a perceived starvation state. Fat mass and lean body mass is reduced. The patients experience what is called auto-cannibalism   so so named because the body literally eats itself, converting proteins from muscle, and other tissues into glucose to provide energy for the body.

Patients with anorexia nervosa demonstrate low blood pressure and a very slow heart rate. They may also have EKG abnormalities, along with shrinkage of heart size and abnormal heart function.

Hormonal complications of anorexia nervosa include the risk of growth retardation, permanent short stature and amenorrhea—a loss of menstrual cycles. The chronic hormonal imbalance can create significant risk of osteoporosis, even in adolescent years.

Currently, the mortality rate among patients with anorexia nervosa is at approximately 4%. Causes of death include suicide, electrolyte disturbances and arrhythmia.

Bulimia nervosa is the diagnosis of recurrent episodes of binge eating followed by recurrent, inappropriate compensatory behavior to prevent weight gain. Bulimics will self-induce vomiting, abuse laxatives, and exercise excessive in an effort to stay unnaturally and dangerously thin.

There is a significant risk of heart damage from abuse of emetine (Ipecac), sometimes used to induce vomiting. This medication can lead to significant skeletal and cardiac muscle damage.

Because of the purging behavior associated with the disease, bulimics often show significant electrolyte abnormalities and gastrointestinal complications.  With vomiting, this can include ulcers and acid reflux, and with laxative abuse, chronic constipation.

The goals of treatment for patients with eating disorders include medical stabilization, nutritional rehabilitation, control of abnormal eating behavior, psychological treatment and prevention of relapse. The American Psychiatric Association emphasizes a multidisciplinary team to help patients overcome this difficult illness: a physician, psychiatrist, psychologist and dietician.

There are inpatient and outpatient treatment models for all eating disorders, as well as new intensive outpatient and partial hospitalization models. Psychological treatment would include individual, group and family therapy. 

Studies have also shown that medications can also assist in the treatment of eating disorders. The antidepressant fluoxetine (Prozac), has been effectively in treating bulimia nervosa and in helping patients control bingeing and purging behavior, especially when used in conjunction with psychotherapy. This medication has also been shown to help prevent relapse in patients with anorexia nervosa. 

For patients who are clinically malnourished, however the most important medicine is proper nutrition. 

Prognosis

The prognosis of patients with eating disorders is favorable, especially in adolescents. Studies indicate a 71-86% satisfactory outcome with long-term follow-up in teens with anorexia nervosa. Adults have a more guarded prognosis with higher relapse rates. There are concerns with a patient crossing over from symptoms of anorexia nervosa to the bingeing and purging of bulimia nervosa. 

Patients with bulimia nervosa have also demonstrated a favorable prognosis, but relapse is common.  In any case, early detection of the problem and intervention is vital to saving lives. For more information, there are a numerous resources available.

Websites

Something Fishy Website www.something-fishy.com/ed.htm

Gurze Books www.bulimia.com

National Organizations
American Anorexia and Bulimia Association
212-575-6200

Eating Disorders Awareness and Prevention
1-800-931-2237