The Medical Minute: Eating disorder awareness

By Martha Peaslee Levine and Richard L. Levine

Are you aware of the many forms an eating disorder can take? In our program at the Penn State Milton S. Hershey Medical Center, an emaciated 10-year-old cried over a ham sandwich which she was certain contained 4,000 calories. A woman in her 40s, who after gastric bypass surgery swung from obesity to emaciation, still struggles with her relationship to food. A young man tried to get healthy through diet and exercise, but got so caught up in the process that his weight plummeted and his mood crashed.

Eating disorders can affect men and women. We see them in the young and old. They are present in all ethnic groups, in all socio-economic classes, at all stages of education. Why are they so prevalent? On some level, they have always been present. In our clinic, work with an Amish population demonstrates that even those isolated from media images and societal pressures can struggle with eating disorders. Yet the barrage of media images, the enticements of advertisements and the digital manipulation of photographs all push an ideal that is not attainable. We are not going to look like the models in the magazines. But you know what? Typically even the models don’t look like they do in the magazines. Digital image manipulation is viewed as an art form. Unfortunately, the reader is not always aware of the level of artistic license brought to the images.

Media and its pressures on young people, particularly women, is one factor involved in disordered eating, but there is a genetic variable. Certain individuals are more at risk to develop an eating disorder, especially if others in their family have struggled with eating issues. Temperament can be involved. Individuals can be perfectionists, but also feel that they are never good enough. Some whose lives are chaotic feel they only can control their emotions through food. Others whose lives are rigidly structured by someone else feel they have no control and restrict their diets because that is the only thing they can change.

Eating disorders include:

-- Anorexia Nervosa, defined by severely low weight, intense fear of weight gain, disturbed perception of body shape and weight and loss of monthly periods;
-- Bulimia Nervosa, defined by regular and recurrent episodes of binge eating with compensatory behavior to prevent weight gain;
-- Binge-eating disorder, understood as persistent and frequent episodes of binge eating that are not accompanied by compensatory behaviors.

Eating disordered behaviors are used to help individuals deal with uncomfortable 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 toward self-harm when restricting or bingeing does not dull the emotional pain. Among emotional disorders, eating disorders have the highest association with death, either by suicide or medical complications.

These disorders can lead to many medical consequences. A few of the most deadly risks of anorexia are severe muscle wasting, wasting of bones with possible stress fractures and potentially fatal heart arrhythmias. 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. Binge eating disorder can be associated with obesity. Obesity is a challenging health problem that puts individuals at increased risk for type 2 diabetes, hypertension, dyslipidemia, coronary artery disease and stroke.

So what should people be aware of related to disordered eating?

-- Know the different forms that eating disorders can take. Even individuals who do not fit society’s mold of an eating disorder can still need and receive treatment.
-- Understand the potentially deadly complications of these eating disorders and take the risks seriously. There is often an off-hand comment in our society, “I wish I could have anorexia for just a little bit.” No one should tempt these illnesses into their lives. Once they are there, it is a challenge to get rid of them.
-- Recognize that treatment is possible. A team will be needed to provide all the necessary tools, nutritional help, medical management, therapy, psychiatric medications, and new coping skills to deal with tough feelings and manage stress.
-- Realize that media literacy is necessary. We need to challenge what we see in the magazines, on TV and on the Internet. So much of it is false -- don’t get caught up in believing that it is real.
-- Remember that each of us must value ourselves and others as unique individuals. Don’t try to match those impossible images in the magazines. There is so much more depth and richness to each and every one of us. Treasure your uniqueness and talents!

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

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