Are you “really” fat?
For most of us, we can tell when we are overweight and could lose a few pounds. We also know when we’re at a healthier weight. For people with anorexia nervosa, their perceptive of weight doesn’t match their physical size. These individuals are often thin, but feel like they are fat. This can result in problems with eating food. What causes anorexia nervosa? How is it treated? Can it be prevented?
Anorexia nervosa, or anorexia, is an eating disorder that is classified by an inaccurate perception of weight and strong fear of gaining weight despite not being overweight. People with anorexia try to control their weight and shape by restricting the amount of food they eat and/or exercising excessively. Besides these options, they might purposely vomit after eating or misuse laxatives, diet aids, diuretics or enemas as means to restrict their weight. A person with anorexia fears weight gain no matter how much weight they’ve lost. The key thing to understand is that anorexia isn’t about the food, but about maintaining control so they can deal with emotional issues. Typically, these individuals equate being thin with self-worth. Many people hide their thinness, eating habits or physical problems from others. Anorexia can take over your life and be life-threatening if it gets significantly out of hand. This is because anorexia is basically starvation. The cause is unknown, but people who are at higher risk for developing it include those who have a tendency to be a perfectionist, increased emotional sensitivity and high levels of perseverance. People with obsessive-compulsive disorder (OCD) and high levels of anxiety are also like to develop anorexia. These individuals are better able to follow strict diets, go without food even if they’re hungry and feel that their never thin enough. Anorexia is often associated with other mental health disorders, such as depression, mood disorders, personality disorders, alcohol/substance misuse and self-injury/suicidal thoughts/suicide attempts. Also, if you have a family history of anorexia, are dieting or experiencing any sort of emotional stress, you are more likely to develop it. Anorexia has become more prevalent than ever before because of the importance our cultural places on being thin and associating this with success and self-worth. While this makes it common among girls and women, it’s becoming more commonplace in boys and men.
Symptoms of anorexia fall into two categories, physical and emotional/behavioral. Physical symptoms include extreme weight loss (for children, not making expected developmental weight gains), thin appearance, abnormal blood counts, fatigue, insomnia, dizziness/fainting, bluish discoloration of the fingers, hair that thins/breaks/falls out, soft/downy hair covering the body, constipation, abdominal pain, dry/yellowish skin, intolerance of cold, irregular heart rhythms, low blood pressure, dehydration, swelling of arms/legs, eroded teeth and calluses on the knuckles (from induced vomiting). Emotional or behavioral symptoms include severely restricting food intake through dieting or fasting, exercising excessively, bingeing and self-induced vomiting to get rid of food, use of laxatives/enemas/diet aids/herbal products, preoccupation with food, cooking elaborate meals for others but not eating them, frequently skipping meals or refusing to eat, denial of hunger, makes excuses for not eating, eating only a few certain “safe” foods (low in fat and calories), adopting rigid meal or eating rituals (ex. spitting food out after chewing), not wanting to eat in public, lying about how much food has been eaten, fear of gaining weight, repeated weighing/measuring the body, frequent checking in the mirror for perceived flaws, complaining about being fat or having parts of the body that are fat, covering up in layers of clothing, flat mood (lack of emotion), social withdrawal, irritability and reduced interest in sex. Anorexia can result in a variety of complications, such as anemia, heart problems (ex. mitral valve prolapse, abnormal heart rhythms or heart failure), osteoporosis, loss of muscle, absence of a period (women), decreased testosterone (men), gastrointestinal problems (ex. constipation, bloating or nausea), electrolyte abnormalities (ex. low blood potassium, sodium and chloride), kidney problems and death. It’s vital to note that if anorexia causes severe malnourishment, every organ in the person’s body can be affected and the damage that is done might not be able to be reversed, even if the person’s anorexia becomes under control at some point in the future. Also, it’s essential to note that some people with anorexia binge on food and purge the same way that a person with bulimia does, but are still underweight; whereas, people with bulimia tend to have normal or above normal weight.
One of the key things to understand is that most people with anorexia don’t want treatment at first because they don’t think they need it or don’t see their condition as an illness, but as a lifestyle preference. In severe cases, an individual can end up hospitalized in order to restore their body to a better level of functioning before starting outpatient therapy. Once the person is ready to accept the help being offered, the goal is to get them back to and remain at a healthy weight. This involves multiple different healthcare personnel. Your primary care doctor is able to deliver any medical care, oversee your calorie needs and monitor weight gain. A mental health specialist, like a psychologist, can help you to devise strategies to follow the nutritional guidelines that are set by the team. A dietitian can assist in developing the specific plan that you need to follow in order to meet the caloric needs specified by your primary doctor. Another big element is the support from your family and friends. There aren’t any medications that are specifically designed to treat anorexia. However, your doctor might prescribe medications to help you deal with any other mental health disorders that you have. It’s important that you talk to your doctor about taking vitamins and minerals in order to replenish what your body needs but might not being receiving from your food intake (remember that just because something is natural doesn’t mean that it’s the best thing for you and some supplements can increase weight loss). In order to be successful with changing your dietary habits, it’s key to stick to the plan, not isolate yourself from your supports and resist looking in the mirror/weighing yourself frequently. If you have anxiety, it can be helpful to try things, like yoga, meditation or massages to help prevent a relapse.
There isn’t a specific thing that you can do to prevent yourself from getting anorexia. If you notice that you or a loved one is having low self-esteem, odd dieting habits and aren’t happy with their appearance, you should speak to a doctor. The key is to catch the disease early enough that it can be prevent from advancing. Primary care doctors should be able to identify early indications if a person is at risk by asking the appropriate questions about eating habits and satisfaction with appearance.
Anorexia is a complex, complicated and serious disease. The good news is that it can be treated and managed. If you have any questions or concerns about anorexia, please speak with your doctor. If you would like more information, please visit the National Eating Disorders Association’s anorexia nervosa page at https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia