The Medical Minute: Eating disorder awareness

By Martha Peaslee Levine
and Richard Levine

"Be comfortable in your genes" is the theme of National Eating Disorders Association (NEDA) as it focuses on the need for individuals, especially women, to accept their genetically determined body and not try to force themselves into molds (or jeans) that don't fit. Actually the key message for this year’s National Eating Disorders Awareness Week (Feb. 24 to March 1) is "Be comfortable in your genes. Wear jeans that fit the true you."

So how do genes and jeans relate to eating disorders? Research has clearly demonstrated a genetic link in developing eating disorders. Estimates from studies have suggested that 56 percent of the risk for developing anorexia nervosa is determined by genetics. This means that certain individuals are at a higher risk for developing eating disorders, but clearly other factors besides genetics are involved. Peers, society and families all can contribute to the development of eating disorders.

This is how "jeans" relate. Consider sexualized ads that push young women into size zero jeans, comments by classmates in which girls compare their latest diets (in an effort to get into those jeans), and family comments which often equate success with external measures (can you fit into your designated role-or jeans-in the family and in society?). These pressures don't only affect women, but also affect men. All these messages work to feed a woman's lowered self-esteem. She ends up refusing to feed herself or binges to fill the empty sense of disappointment and then purges to push the guilt away.

Anorexia nervosa is an illness defined by intense fear of gaining weight, a distorted view of body size and shape, and losing weight to a point often way below levels that are considered minimally normal. This low weight can be obtained and maintained through restricting food or through mechanisms that encourage weight loss, over-exercise, purging behaviors, etc. Individuals with bulimia nervosa often can be normal or even slightly over their ideal weight, but this disorder is characterized by repeated episodes of extreme over-eating (bingeing) and then compensatory behaviors (purging). In addition, individuals can suffer from eating disorders, without meeting all the above criteria, and still threaten their lives and health.

Eating disorders lead to significant medical complications. Among emotional disorders, they have the highest association with death. The disorders themselves can lead to life-threatening medical consequences. In addition eating disordered behaviors are used to deal with significant disturbing emotions, such as depression, anxiety and the emotional fallout of past traumas including physical, sexual and emotional abuse. Any of these intense emotions can push an individual towards self-harm when restricting or bingeing does not dull the emotional pain.

Anorexia results in severe muscle wasting, wasting of bones with possible stress fractures and potentially fatal heart arrhythmias, as a few of the most deadly risks. With bulimia, significant issues arise for the body as the assault of overloading it with food and then purging the food takes its toll. Individuals have died from arrhythmias as the body's electrolytes fluctuate. Individuals also have ruptured their stomach or esophagus from the extreme amount of food or the pressure of repeated vomiting. Individuals have suffered strokes, arrhythmias and death related to taking medicines designed to increase metabolism or rid the body of excess calories after binges. The impulsiveness of bulimia also can lead to other increased risks. Families of individuals suffering from bulimia often have a high risk of alcohol and drug abuse.

It actually could be helpful if the risk of death frightened individuals away from eating disorders. Actually, young girls often describe being more afraid of becoming fat than they are of cancer, nuclear war or losing their parents. The risk of death feels too unreal, and the distressing feelings, which eating disorders help numb, are much more real. So what do individuals who are struggling with eating disorders, their friends, the families, and really all of society need to remember?

1. Be aware of how you define yourself and others. Do you focus on external beauty rather beautiful internal qualities, such as honesty and compassion? Jeans versus genuine -- which is more important?
    
2. What are your dreams? If your body isn't healthy it can't take you where you want to go.
    
3. Don't believe negative thoughts that others tell you or that you tell yourself. People often criticize themselves the most harshly. If you're calling yourself lazy, fat, ugly, stupid, ask yourself, "Would I say this to my best friend?" Treat yourself as nicely as you would treat others.
    
4. Respect your uniqueness.
5. Challenge the media's messages. A certain pair of jeans or size or shape will not bring excitement and happiness into your life.
6. If you find yourself unhappy, work to understand the inner feelings rather than looking to the outer for the answer. A few pounds less will not automatically make you happier.
7. Don't make your body speak for you. Use your voice to express your thoughts and fears, instead of trying to express your hurt with eating disorder symptoms.
8. Taking up less space, doesn't mean that life will hurt less. Life has bumps and it takes emotional padding to help soften the blows.
    
9. No one is perfect, and that's OK. You might be able to accept this intellectually, but you need to accept it emotionally, too.
10. Control is an illusion. Individuals with eating disorders believe that by controlling their weight, their calories, their types of food, they can control life, keep it safe, comfortable, constant. Life is not controllable. The only thing constant in life is change. Change can be scary or exciting-- both feelings are closely related. A half-empty, half-full type of view. The challenge is realizing that overly full or completely empty won’t control life or the challenging feelings that come with it.

For information about the National Eating Disorders Association, visit their Web site.

Martha Peaslee Levine is assistant professor of pediatrics and psychiatry, and director, Partial Hospital and Intensive Outpatient Eating Disorders Programs at Penn State Hershey Medical Center.

Richard Levine is professor of pediatrics and psychiatry and chief, Division of Adolescent Medicine and Eating Disorders at Penn State Hershey Medical Center.