Medical update: the heavy toll of dieting and eating disorders

Weight-preoccupation is widespread in modern Western society, affecting people of all ages, classes, occupations and ethnic backgrounds. Our society’s idealization of thinness is producing an alarming increase in eating disorders and, in extreme cases, dangerous illnesses such as anorexia nervosa. Efforts to acquire the “ideal” body are leading more and more young people, especially women, to diet at the cost of health. Popular feminine images of the 90s put unrealistic demands on today’s women, pressuring them to be “thin, lean yet large-breasted.” Believing that self-control should allow them to achieve the skinny look — despite today’s biological tendency to be larger and heavier — many feel guilty for being even slightly overweight. Many young women are malnourished, consuming less than the recommended daily intakes of key nutrients. (Some select “lite” foods for the wrong reason — not as part of healthy eating — but because they don’t like themselves the “way they are.”) Health problems arising from nutrient shortages include fatigue, inability to work or learn properly, disturbed or halted menstruation, anemia (from lack of iron) and low bone density.

As one specialist puts it, “today’s images equate thinness with power and success, exacerbating the unhealthy preoccupation with dieting.” Going further, one nutritionist suggests that “as weight concerns are almost universal, we should no longer consider them pathological but an adaptive response to living in a thinness-obsessed society.” Yet most people can never achieve the idealized svelte shape — no matter how rigorously they diet — because of the body’s tendency to maintain a “set-point” and put back lost weight as soon as the diet ends. The yo-yo dieting cycle, which often starts in the teen years, may lead to later obesity. According to some experts, “dieting is a way in which people may try to express control, and those with low self-esteem may hope to gain approval through being thin, precariously relying on body size for proof of worthiness rather than on more substantial and enduring qualities.”

Eating disorders fall on a continuum with persistent dieters at one end, those with anorexia nervosa or bulimia nervosa at the other. Anorexia nervosa involves the pursuit of thinness to the point of starvation. Bulimia nervosa also involves extreme dieting, but with frequent bingeing followed by vomiting and purging sessions, perhaps also abuse of laxatives and diuretics (water-loss pills). With a rising incidence, over 300,000 Canadians already suffer from these eating disorders, which can coexist, overlap or occur separately, sometimes causing devastating health problems, even death. Girls and women make up about 95 per cent of those with severe eating disorders, males 5 per cent. Studies find a high rate of depression and other psychiatric disturbances among adults with serious eating problems. Besides those diagnosed with full-blown anorexia nervosa or bulimia, countless others — not strictly anorexic or bulimic — share some characteristics of these disorders.

Anorexia nervosa (AN), which is the relentless pursuit of thinness, affects about one per cent of young females aged 14-25 (and some males), of whom 15 per cent are in danger of dying from the disorder. Symptoms may start with a narrowing of food choices, preference for low-calorie diet foods, withdrawal from social occasions and physical signs such as hair loss or feeling perpetually cold. The disorder may result from poor family dynamics, overly strict upbringing, neglect or abuse, which produce an extremely low sense of self-worth. Families of those with AN are typically “enmeshed” or overprotective, emphasizing appearance and scholastic grades, valuing achievements solely in terms of the family and discouraging independence, so that the child grows up with a deficient sense of self. Recent research reveals that 65 per cent of those with anorexia and other severe eating disorders have experienced some form of abuse, perhaps engendering feelings of revulsion that may translate into an extreme need to “punish the body.” The hallmarks of anorexia nervosa include: body weight 15 per cent or more below normal (“desirable”) weight; misperception of feelings (such as anger, sadness) and a distorted body image. In female anorexics, menstrual periods cease, breasts diminish, osteoporosis (bone loss) sets in, and the body may become covered with fine hair (lanugo). By the time anorexics come to medical attention there are usually clear signs of starvation and disorders such as pancreatitis, anemia, cold intolerance and heart irregularities.

Bulimia nervosa, once regarded as a subset of anorexia, is now considered an eating disorder in its own right, especially prevalent among high school and college students. It afflicts an estimated 2-4 per cent of Canadian females aged 12 to 25 (and some adolescent males). Unable to stick with restricted diets, bulimics engage in cycles of bingeing and self-inflicted vomiting and purging — with excessive use of laxatives and diuretics. Many take laxatives in vast quantities, on the false premise that they reduce calorie absorption, when in fact they only cause dehydration. The purging doesn’t rid the body of unwanted calories, as laxatives work on the large intestine after the calories have been absorbed (in the small intestine). Self-imposed vomiting, which may take hours per session, gets rid of only a few calories and is extremely hard on the digestive system, throat and heart. Alerting signs of bulimia may be a chipmunk-like face — with swollen cheeks (from enlarged parotid or salivary glands) — and teeth eroded by the acidity of frequent vomiting. Many bulimics seek medical advice because of constipation, fatigue, rectal bleeding and Russel’s sign — callused hands, rubbed by being stuck down the throat to induce vomiting. Other complications of bulimia include stomach bleeds, kidney disorders, electrolyte imbalance — possibly producing serious, sometimes fatal, heartbeat irregularities. Associated factors include a family history of alcoholism and depression.

For more information, see Health News, August 1985, or contact the National Eating Disorders Information Centre: (416) 340-4156.

COPYRIGHT 1994 Strategic Inc. Communications Ltd.

COPYRIGHT 2004 Gale Group

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