The month of February recognizes Eating Disorder Awareness, shedding light on the signs, symptoms, and prevention of eating disorders.
There are many misconceptions about eating disorders, such as that disordered eating is a lifestyle choice. Eating disorders, however, are serious illnesses associated with severe disturbances in an individual’s eating behaviors and related thoughts and emotions, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD). People with eating disorders often become so preoccupied with food and their body weight that their daily life is significantly impacted.
Eating disorders affect people of all genders, ages, races, religions, ethnicities, sexual orientations, body shapes and weights. An estimated 9% (28.8 million) of the U.S. population will have an eating disorder in their lifetime, according to ANAD. Twenty-two percent of children and adolescents show disordered eating nationwide, according to The National Eating Disorders Association (NEDA). Despite stereotypes that eating disorders more commonly occur in women, nearly one in three people struggling with an eating disorder is male, according to NEDA.
“Eating disorders impact everything from quality of life, mental health, physical health and can even cause death. Eating disorders have the highest mortality rate of any mental disorder,” said Dr. Maria Rago, Clinical psychologist and ANAD president. “Malnutrition can cause dehydration and electrolyte imbalance, which affects every system in the human body from the heart to the kidneys to the GI system to the brain.”
Types of eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder (BED), body dysmorphic disorder (BDD), avoidant/restrictive food intake disorder (ARFID), pica, rumination disorder, and other specified feeding or eating disorder (OSFED), each with its own distinct symptoms and potential health impacts.
Health impacts
Emotional and behavioral symptoms of eating disorders include an individual exhibiting a preoccupation with weight loss, food, calories, and dieting, refusing to eat certain foods (often eliminating whole food groups), making excessive excuses to avoid meals or situations involving food, and extreme concern with body size and shape, according to NEDA. Physical symptoms include noticeable fluctuations in weight (both up and down), stomach cramps, dizziness upon standing, sleep problems, fainting, and more.
Eating disorders can quickly become life-threating when untreated, leading to medical complications impacting organ systems throughout the body, according to NEDA. The earlier a person seeks treatment, the greater the likelihood they recover physically and emotionally. For this reason, it is important that a patient’s primary care doctor acknowledges and recognizes the signs, symptoms, and health impacts of eating disorders.
“There are many myths that abound around eating disorders, and many people have difficulty being diagnosed because of them,” said Dr. Rago. “If a patient is not underweight, a physician may not understand that they can be at risk for medical complications of an eating disorder. Starvation at any weight can cause dehydration and electrolyte imbalance. Higher weight patients may not be recognized as having an eating disorder. Physicians should diagnose eating disorders not only on weight but also on behaviors, including an overweight BMI in a person eating very low calories or extremely high exercise levels.”
Common health consequences of eating disorders include cardiovascular issues, such as reduced resting metabolic rate, a result of the body’s attempts to conserve energy after long periods of nutrient restriction; gastrointestinal system impacts such as slowed digestion, leading to nausea and vomiting, blood sugar fluctuations, bacterial infections, and stomach pain; and neurological and endocrine issues such as lowered thyroid and sex hormones, according to NEDA.
“Seventy percent of people with eating disorder also suffer from other mental disorders, especially mood disorders, anxiety, PTSD, and obsessive-compulsive disorder. Being compassionate and non-judgmental in clinical settings means a lot to people with eating disorders,” said Dr. Rago. “Psychiatrists, cardiologists, nephrologists and GI doctors are all very important components of caring for people with eating disorders.”
Prevention of eating disorders
Shame, stigma, socioeconomic inequality, and societal misconceptions about the illness may impede the identification and treatment of individuals with eating disorders. Prevention for eating disorders includes planned attempts to change factors that may promote the development of associated behaviors in certain individuals.
Eating disorder prevention includes reducing an individual’s risk factors, such as working with a care team to reframe thoughts away from body dissatisfaction and basing one’s self-esteem on weight and shape, as well as strengthening ‘protective or resilience factors,’ such as self-compassion and appreciation for the body’s functionality. Prevention also includes identifying individuals at risk of disordered eating, according to ANAD, such as children with a parent with an eating disorder, children who have been abused, etc.
“Young people especially have always been very vulnerable to eating disorders, likely because they are trying to find a way to be accepted by their peers,” said Dr. Rago. “They are also developing their identities which can be a confusing time. During the Covid-19 pandemic, we saw a rise in adolescent eating disorder cases, as young people were isolated and could not attend their normal activities.”
“ANAD’s wish is for people with eating disorders to get compassionate help across the weight spectrum,” said Dr. Rago. “We also continue to encourage physicians to help patients find short-term and long-term goals to contribute to their patient’s eating disorder recovery.”