Food is a necessity. It provides nutritional support for the body, it’s satisfying and delicious, it brings people together. But what about when food becomes more than just a good meal or a nutritious snack? What about when the calories consumed consume your life or when what you eat becomes how you define yourself? What happens when eating habits become eating disorders?
Eating disorders are not as simple as what someone does or doesn’t eat. With a multitude of causes, eating disorders are a complex illness that must be examined on an individual basis to fully understand who it affects, why it affects them and what can be done to help.
Eating disorders are illnesses. They are serious medical and mental health issues that affect all populations across many demographics, geographical locations and social statuses. Eating disorders are not a choice; individuals suffer from a serious illness that when left untreated can cause serious health consequences.
Eating disorders “are related to abnormal behaviour and thinking that develops due to a change in the way the brain functions,” explains Dr. Laird Birmingham, medical director at the Woodstone Residence for the Treatment of Eating Disorders. “They are not a choice, they are not a benefit and they are beyond the control of the individual who suffers from them,” adds Birmingham, who is also a Professor of Psychiatry at the University of British Columbia.
Causes of Eating Disorders
The cause of an eating disorder is a combination of factors. Disorders often develop as an attempt to cope with other problems. A preoccupation with food or exercise is used in place of healthier coping techniques that may help to mask emotions or gain control. The need for such food or weight management can occur as a result of family genetics, personality variables, societal pressures, a history of abuse, hard home life or dysfunctional eating habits. Individuals may develop the disorder due to psychological issues such as low self-esteem, depression and anxiety. Seeking perfection and thriving off competition are individual traits that often push a person to focus on food as a way of achieving their goals.
There is never a single cause – eating disorders are individual to the person struggling with the illness.
The media portrayal of aesthetic ideals only adds fuel to the fire but as Dr. Julia Raudzus, medical director for the Provincial Adult Tertiary Eating Disorder Program at St. Paul’s Hospital in Vancouver, notes, is not the foremost factor when it comes to developing a disorder. “It is important to remember that as a society we are all exposed to those images and we all do not develop eating disorders. We cannot just blame the media as being the one source. It goes beyond saying that if the media was different then we wouldn’t have eating disorders.” There is much more to the problem than the simplistic view of an obsession with food or the influence of the media.
Types of Eating-Disorders
Anorexia Nervosa
One of the most common types of eating disorders is anorexia nervosa. It is characterized by a refusal to maintain normal body weight due to extreme dieting or exercise. Sufferers have a distorted body image, seeing themselves as overweight when they are actually underweight, and an intense fear of becoming obese that often results in a feeling of being fat.
The most obvious signs of anorexia nervosa are dramatic weight loss and an obsession with foods or dieting. Those who suffer try to hide behind loose clothing, avoid meal times and deny that their thinness might be a problem.
Individuals affected by anorexia can develop serious medical issues as a result of the disease including dehydration, cold intolerance, cardiac arrhythmias and osteoporosis among other complications often related to malnutrition.
Bulimia Nervosa is Characterized by cycles of binge eating followed by purging, either through self-induced vomiting or misuse of laxatives or by over-exercising
Bulimia Nervosa
Next to anorexia, bulimia nervosa is among the most well-known eating disorders. Characterized by cycles of binge eating followed by purging, individuals with bulimia often feel out of control as they engage in excessive food intake and attempt to compensate by purging, either through self-induced vomiting or misuse of laxatives or by over-exercising.
Those with bulimia will often leave quickly after a meal and spend a long time away from others after eating. Other signs of someone suffering may include excessive use of gum or mouthwash or scarred knuckles from repeatedly inducing vomiting along with hiding their appearance or complaining about being fat.
Bulimia can lead to gastroesophageal reflux disease, kidney problems and abnormal heart rhythms.
Binge Eating
Binge eating is often the result of pressure to lose weight that causes stress that is in turn relieved by binging on large quantities of food. This becomes a vicious cycle when the stress of binge eating causes additional episodes of binging. Binge eaters do not develop a preoccupation with exercise, purging or fasting, often resulting in overweight or obese individuals.
Binge eaters often hoard food or hide large quantities in strange places and seem to be constantly dieting without losing any weight. Binge eating is almost as common in men as it is in women and often affects older people more than teens.
Because binge eating often leads to obesity, the health consequences can be quite serious and often goes hand-in-hand with depression.
Other Eating Disorders
While most may be familiar with both anorexia nervosa and bulimia, eating disorders have grown to include several other illnesses that have serious side effects if left unnoticed or untreated.
Anorexia athletica has become synonymous with excessive and obsessive exercise, often in conjunction with calorie reduction. Over exercise refers to exercising to the point of exhaustion and can transform into a serious disorder as it creates physical, psychological and social problems.
Night Eating Syndrome is a condition that continues to gain recognition among medical professionals. It is characterized by a delayed timing of food intake, most often in the second half of the day, resulting in negative health consequences due to obesity and sleep disruption.
The most common diagnosis for eating disorder patients tends to be Eating Disorder Not Otherwise Specified, or EDNOS, as most individuals show signs of many disorders without actually filling the complete criteria for any one disorder. EDNOS can come with the same consequences as anorexia nervosa or bulimia and is just as serious; the difference can be seen as individuals demonstrate a variety of behaviours, most of which could change over time.
Dr. Laird Birmingham, medical director at the Woodstone Residence for the Treatment of Eating Disorders.
Youth and Adolescents
Eating disorders affect everyone. Unfortunately, this often include youth and adolescents who struggle daily with the pressures to be thin, popular, accepted or recognized.
While eating disorders may not be entirely preventable, they can at least be treated early on. “The first step is to increase resiliency of our youth,” says Birmingham. “This means increase their self esteem, improve their support system, help them develop a belief system and help them to interpret the media and other messages with which they are bombarded.”
Children need to develop a healthy relationship with food, where it is never seen as a reward or punishment. Healthy eating needs to start at home where there is a focus on good health and not weight management. Exercise should be encouraged for fun. Just as with anyone, especially those suffering from eating disorders, an emphasis on unique achievements or individuality as opposed to physical appearance, shapes or sizes will help individuals realize their worth.
As a parent, concerned friend or school teacher, being aware of the warning signs of eating illnesses may allow intervention to occur before serious problems develop, especially because there is no one test to determine if a child or youth has an eating disorder and denial can make it hard to see the signs.
Treatment
Eating disorders are surrounded with shame and secrecy, a sad fact that needs to change before all those who suffer will be able to receive the support they desperately need.
According to the National Association of Anorexia Nervosa and Associated Disorders, only ten percent of people with eating disorders receive treatment. And without treatment, the effects of an eating disorder can be fatal with eating disorders having the highest mortality rate of any mental illness. Studies show that 20 per cent of those suffering from anorexia will prematurely die from complications relating to the disorder.
So what can be done to help those who suffer? Because eating disorders are a complicated disease and a single cause cannot be pinpointed, treatment methods must vary between patients. Raudzus stresses the importance of individualized assistance.
“It’s looking at matching a patient to a type of treatment that is most appropriate for where they are within the illness. If somebody is not ready to make any change and they aren’t needing acute medical care and you put them in an inpatient program and just expect them to get better, without matching them to the kind of service that they need, you can end up doing more damage to the patient.”
Treatment needs to begin with assessing the trigger; understanding why someone may struggle with their body image or eating habits will begin to uncover what can be done to help alleviate the pain. Just as the cause of an eating disorder is specific to the sufferer, so will be the treatment.
Treatment may include a variety of options including counselling, medical supervision and nutritional education. New patterns of thought must be established to help those think and approach food in a healthy way. Generally, the earlier the intervention, the shorter the treatment and potentially, the greater success in dealing with the damages.
As a society, the public’s portrayal of perfection, success and health needs to be altered. Instead of focusing on looks or image, obesity campaigns that shame those who are overweight should focus on being healthy and not being skinny. Commenting or talking about weight and appearance, even in the form of a compliment, can have a negative impact as looks are emphasized over other individualized qualities.
The Male Population
While eating disorders are generally thought to be a problem particular to the female population, studies are showing that more men are also experiencing the ill-effects of eating disorders. These statistics show a steady rise among male patients suffering from eating disorders but the statistics are often skewed as more men are simply coming to terms with their conditions and seeking out treatment. While few men come forward to find the help they need, men do suffer from serious eating illnesses and need the same support as females.
It’s not a surprise to many within the medical communities that men are also affected considering the pressures that are put on the male population. Action figures are muscular, athletes are heroes and supermodels seem to get all the attention. On top of the aesthetic aspects of the illness, men are feeling the pressure to be the best man they can be – a ‘real’ man who is strong, successful and often superior to their counterparts. When one or any of these factors is threatened and combined with the socio, psychological or genetic stimulants, men are just as susceptible to succumb to the illness as women.
While the pressure to succeed is felt across all populations, males are often expected be the ones in charge and in control of their lives. This control, when not handled well emotionally or professionally, may manifest itself in the form of an eating disorder where diet and exercise provides the control and opportunity to succeed that may have been missing for many males.
Men then face their own set of problems when it comes to diagnosing and curing eating disorders. In the past, men have been less likely to seek treatment for eating disorders because the illness is so often viewed as a female problem. Many treatments are geared towards the female population leaving a lack of options for men seeking therapy groups and treatment centres. Programs are often designed for women and do turn down men based solely on their sex.
While the underlying causes of disorders are the same for men and women, the current treatment options are not, yet slight modifications would provide men the same opportunities to receive assistance. Services specifically designed to help men in their food management fight are few and far between, putting them at a disadvantage when it comes to seeking out treatment and actually finding help.
Dr. Julia Raudzus, medical director for the Provincial Adult Tertiary Eating Disorder Program at St. Paul’s Hospital in Vancouver
Conclusion
Eating disorders are a serious illness that need to be treated as such. Without the proper support, guidance or medical help, those suffering may continue to do so in silence as they constantly put their health at risk. Increasing the understanding of the diseases, eliminating the stigma and recognizing the importance of finding help will force those affected to fight their problems without food and it’s unfortunate consequences.
If you or someone you know seems to be suffering from an eating disorder, do not hesitate to get help. For more information, contact your local health care professional or the Canadian Mental Health Association (www.cmha.ca) to find out more about support in your area.
