Eating Disorders

What is BMI?

Body mass index is a useful guide in assessing the physical risk and physical recovery of adults. The BMI of young people should only be assessed using the correct 'centile' charts as the fact that their bodies are not fully developed needs to be taken in account.

BMI is calculated by taking your weight (in kilos) and dividing it by your height (in metres) squared.

For an adult, a healthy BMI will be in the region of BMI 20 to 25. The risk of developing anorexia rises significantly under BMI 18. At the other end of the scale the complications of obesity will begin at about BMI 27 and become a significant risk at BMI 30.

An eating disorder cannot be diagnosed by BMI alone, there are other factors that need to be considered such as a persons relationship with food, the way that they feel emotionally and their behaviour - it cannot assess a persons mental health e.g those suffering from Bulimia often have a healthy BMI but their health is still at risk and they need help and support.

Below is a BMI calculator which can give you a general idea of your BMI. It is important to remember that BMI is not 100% accurate as it does not assess your overall health or mental health or your body shape and build. It is also not appropriate to be used for athletes as their training means that their muscle definition is different to non athletes.

If you have concerns surrounding food, your weight or body shape it is important to speak to a health professional such as your GP. who can assess your overall health.

 
 

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What is an eating disorder?

Eating disorders are illnesses with a biological basis modified and influenced by emotional and cultural factors. They are illnesses not choices and they affect everybody of all ages. The stigma associated with eating disorders has long kept individuals suffering in silence. In addition, lack of funding for crucial research needed to help sufferes and their loved-ones has created barriers to treatment. Because of insufficient information, the public and professionals fail to recognise the dangerous consequences of eating disorders. While eating disorders are serious, potentially life threatening illnesses, there is help available and recovery is possible.

Food and eating play a very important part in our lives. We all vary in the foods we like, how much we need to eat, and when we like to eat. Food is essential for our health and development. It’s not unusual to experiment with different eating habits, for example you may have decided to become a vegetarian or tried changing your diet to improve your health. However, some eating patterns can be damaging.

Problems with food can begin when it is used to cope with those times when you are bored, anxious, angry, lonely, ashamed or sad. Food becomes a problem when it is used to help you to cope with painful situations or feelings, or to relieve stress perhaps without you even realising it. If this is how you deal with emotions and feelings and you are unhappy about it, then you should try to talk to someone you trust. Try not to bottle things up - this is not helpful to you or other people around you, it won’t make you feel any better and the problem is unlikely to go away.

It is unlikely that an eating disorder will result from a single cause. It is much more likely to be a combination of many factors, events, feelings or pressures which lead to you feeling unable to cope. These can include: low self-esteem, family relationships, problems with friends, the death of someone special, problems at work, college or university, lack of confidence, sexual or emotional abuse. Many people talk about simply feeling ‘too fat’ or ‘not good enough’ but there is always an underlying emotions and feelings.

Often people with eating disorders say that the eating disorder is the only way they feel they can stay in control of their life, but as time goes on it isn’t really you who is in control – it is the eating disorder. Some people also find they are affected by an urge to harm themselves or misuse alcohol or drugs. You may find that you experience feelings of despair and shame. You may have a feeling of failure or lack of control because you cannot overcome these feelings about food on your own.

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Who do eating disorders affect, when and why?

Anyone can develop an eating disorder, regardless of age, sex, cultural or racial background, although the people most likely to be affected tend to be young women, particularly between the ages of 15-25. It is not unusual, however, for an eating disorder to appear in middle age.

Research has shown that your genetic make-up may have a small impact upon whether or not you develop an eating disorder. Even the attitude of other family members towards food can have an impact. A key person - a parent or relative may unwittingly influence other family members through his or her attitude to food. In situations where there are high academic expectations, family issues or social pressures, you may focus on food and eating as a way of coping with these stresses.

Traumatic events can sometimes trigger an eating disorder, such as bereavement, being bullied or abused, an upheaval in the family (such as divorce), long term illness or concerns over sexuality. Someone with a long-term illness or disability - such as diabetes, depression, blindness or deafness - may also experience eating problems.

However, the one trait that is obviously apparent in all sufferers of an Eating Disorder is their low self-esteem. Often they feel as though they are not good enough, that they never do anything right, that they are scrutinised by others because of their appearance, and that their lives would get better if they could just lose weight. Sufferers can feel like they do not deserve to be happy, that they do not deserve good things to happen to them, and that they don't deserve to have anything but what is felt as a miserable existence. They often feel like a burden to others, trivialise their own problems and feel as though other people deserve help more than them.

It is not uncommon for Eating Disorder sufferers to be viewed by others as compassionate, warm, giving, sensitive, and intelligent people. The problem is that each person suffering can not see in themselves the beauty that others do. Their own hate from within distorts their perception of how truly wonderful they really are.

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What are the signs and symptoms of an Eating Disorder?

BE AWARE: A sufferer does NOT need to appear underweight or even "average" to suffer ANY of the following signs and symptoms. Many men and women with Eating Disorders appear NOT to be underweight but it does not mean they suffer less or are in any less danger. Following are the signs and symptoms of the more common Eating Disorders. For other eating-related illnesses please click here.

Anorexia/Bulimia:

  • Dramatic weight loss in a relatively short period of time.
  • Wearing big or baggy clothes or dressing in layers to hide body shape and/or weight loss.
  • Obsession with weight and complaining of weight problems (even if "average" weight or thin).
  • Obsession with calories and fat content of foods.
  • Obsession with continuous exercise.
  • Frequent trips to the bathroom immediately following meals (sometimes accompanied with water running in the bathroom for a long period of time to hide the sound of vomiting).
  • Visible food restriction and self-starvation.
  • Visible binging and/or purging.
  • Use or hiding use of diet pills, laxatives, ipecac syrup (can cause immediate death!) or enemas.
  • Isolation. Fear of eating around and with others.
  • Unusual Food rituals such as shifting the food around on the plate to look eaten; cutting food into tiny pieces; making sure the fork avoids contact with the lips (using teeth to scrap food off the fork or spoon); chewing food and spitting it out, but not swallowing; dropping food into napkin on lap to later throw away.
  • Hiding food in strange places (closets, cabinets, suitcases, under the bed) to avoid eating (Anorexia) or to eat at a later time (Bulimia).
  • Flushing uneaten food down the toilet (can cause sewage problems).
  • Vague or secretive eating patterns.
  • Keeping a "food diary" or lists that consists of food and/or behaviors (ie. purging, restricting, calories consumed, exercise, etc.)
  • Pre-occupied thoughts of food, weight and cooking.
  • Visiting websites that promote unhealthy ways to lose weight.
  • Reading books about weight loss and eating disorders.
  • Self-defeating statements after food consumption.
  • Hair loss.
  • Pale or "grey" appearance to the skin.
  • Dizziness and headaches.
  • Frequent soar throats and/or swollen glands.
  • Low self-esteem, feeling worthless. Often putting themself down and complaining of being "too stupid" or "too fat" and saying they don't matter.
  • Need for acceptance and approval from others.
  • Complaints of often feeling cold.
  • Low blood pressure.
  • Loss of menstrual cycle.
  • Constipation or incontinence.
  • Bruised or calluses knuckles; bloodshot or bleeding in the eyes; light bruising under the eyes and on the cheeks.
  • Perfectionistic personality.
  • Loss of sexual desire or promiscuous relations.
  • Mood swings.
  • Depression.
  • Fatigue.
  • Insomnia and/or poor sleeping habits

Compulsive Overeating/Binge Eating Disorder:

  • Fear of not being able to control eating, and while eating, not being able to stop.
  • Isolation. Fear of eating around and with others.
  • Chronic dieting on a variety of popular diet plans.
  • Holding the belief that life will be better if they can lose weight.
  • Hiding food in strange places (closets, cabinets, suitcases, under the bed) to eat at a later time.
  • Vague or secretive eating patterns.
  • Self-defeating statements after food consumption.
  • Blames failure in social and professional community on weight.
  • Holding the belief that food is their only friend.
  • Frequently out of breath after relatively light activities.
  • Excessive sweating and shortness of breath.
  • High blood pressure and/or cholesterol.
  • Leg and joint pain.
  • Weight gain.
  • Decreased mobility due to weight gain.
  • Loss of sexual desire or promiscuous relations.
  • Mood swings.
  • Depression.
  • Fatigue.
  • Insomnia and/or poor sleeping habits.

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What are the physical dangers associated with Eating Disorders?

There are many men and women suffering with all types of Eating Disorders that do not appear in any specific weight range. Those with Anorexia can be slightly overweight... while those with Compulsive Eating can be slightly underweight. Variations for all who suffer can be anywhere from extremely underweight to extremely overweight to anywhere in between. The outward appearance of anyone with an Eating Disorder does NOT dictate the amount of physical danger they are in, nor does is determine the emotional conflict they feel inside. They need not display even close to all of the below symptoms to be in danger.

ALL Eating Disorders are dangerous. It is important to understand that even though a person may be suffering specifically with Anorexia, Bulimia or Compulsive Overeating, it is not uncommon for them to exhibit behaviors from each of the three. It is also not uncommon for one Eating Disorder to be swapped for another (i.e. a person who is suffering with Anorexia switches to Bulimia; a persons suffering with Compulsive Overeating switches to Anorexia). This is why it is important to be aware of the dangers below, all of which are risks no matter what Eating Disorder you suffer with.

Do not fall into the trap of thinking "I only do this a few times a month so I can't be at risk" or "I don't do this all the time, I just go through healthy and non-healthy cycles" - that does not mean that you are not in danger, nor does it mean you do not suffer from an eating disorder.

Dangers associated with and diseases triggered or caused by Eating Disorder behaviors are:

Malnutrition: caused by undereating or overeating. The word malnutrition indicates deficiency for energy, protein and micronutrients (e.g. Vitamin A, Iodine and Iron) either singularly or in combination. It can cause severe health risks including (but not limited to) respiratory infections, kidney failure, blindness, heart attack and death.

Dehydration: caused by the depletion or lack of intake of fluids in the body, or by restriction of carbohydrates and fat. Restriction or starvation, vomiting and laxative abuse are the primary causes in sufferers of Eating Disorders. Symptoms include dizziness, weakness, or darkening of urine. It can lead to kidney failure, heart failure, seizures, brain damage and death.

Electrolyte Imbalances: electrolytes are essential to the production of the body's "natural electicity" that ensures healthy teeth, joints and bones, nerve and muscle impulses, kidneys and heart, blood sugar levels and the delivery of oxygen to the cells.

Hyponatremia (related to "water-loading"): as stated above, electrolytes are essential for proper body functioning. Drinking too much water (more than eight, eight-ounce glasses in less than twelve hours), can cause Hyponatremia (not enough sodium in the blood), especially in someone already malnourished or dehydrated. Hyponatremia can cause fluid in the lungs, the brain to swell, nauseousness, vomiting, confusion and even death.

Lanugo: (soft downy hair on face, back and arms). This is caused due to a protective mechanism built-in to the body to help keep a person warm during periods of starvation and malnutrition, and the hormonal imbalances that result.

Oedema: swelling of the soft tissues as a result of excess water accumulation. It is most common in the legs and feet of Compulsive Overeaters and in the abdominal area of Anorexics and Bulimics (can be caused by laxative and diuretic use).

Muscle Atrophy: wasting away of muscle and decrease in muscle mass due to the body feeding off of itself.

Impaired Neuromuscular Function: due to vitamin and mineral deficiencies (specifically potassium), and malnutrition.

Paralysis: transient (or temporary) paralysis which is extreme weakness of muscles or not being able to move at all can be caused by low levels of potassium, and/or the degeneration of nerve cells in the spinal cord or in the brain which have been deprived of essential nutrients. Left untreated, periods of paralysis may happen more frequently and more severely, leading to permanent muscle weakness, and even result in death.

Tearing of oesophagus: caused by self-induced vomiting

Mallory-Weiss tear: associated with vomiting, a tear of the gastroesophageal junction

Gastric Rupture: spontaneous stomach erosion, perforation or rupture.

Gastrointestinal Bleeding: bleeding into the digestive tract.

Oesophageal Reflux: partially digested items in the stomach, mixed with acid and enzymes, regurgitates back into the esophagus. This can lead to damage to the esophagus, larynx and lungs and increases the chances of developing cancer of the esophagus and voice box. Reflux can sometimes become severe enough that food cannot be kept down at all and medical attention should be sought immediately.

Barrett's Oesophagus: associated with Cancer of the oesophagus and caused by Oesophageal Reflux, this is a change in the cells within the esophagus.

Cancer: of the throat and voice box (Larynx) due to acid reflux disorders.

Insomnia: having problems falling and/or staying asleep.

Chronic Fatigue Syndrome: continuous and crippling fatigue related to a weakened immune system.

Hyperactivity: manic boughts of not being able to sit still.

Swelling: in the face and cheeks (following self-induced vomiting).

Callused or bruised fingers: this is caused by repeated use of the fingers to induce vomiting.

Dry skin and hair, brittle hair and nails, hair loss: caused by vitamin and mineral deficiencies, malnutrition and dehydration.

Low blood pressure, Hypotension (more common in those with Anorexia and Bulimia): caused by lowered body temperature, malnutrition and dehydration. Can cause heart arrythmias, shock or myocardial infarction.

Orthostatic Hypotension: sudden drop in blood pressure when sitting up or standing. Symptoms include dizziness, blurred vision, passing out, heart pounding and headaches.

High blood pressure, Hypertension (more common in those with Compulsive Overeating and Binge Eating Disorder): elevated blood pressure exceeding 140 over 90 can cause blood vessle changes in the back of the eye creating vision impairement, abnormal thickening of the heart muscle, kidney failure and brain damage.

Low Platelet Count or Thrombocytopenia: caused by low levels of Vitamin B12 and Folic Acid, and/or by excessive alcohol use. It may also be an indication of a suppressed immune system or immune dysfunction.

Low Blood Sugar/Hypoglycemia: can indicate problems with the liver or kidneys and can lead to neurological and mental deterioration.

Elevated Blood Sugar/Hyperglycemia: can lead to diabetes, liver and kidney shut down, circulatory and immune system problems.

Diabetes: high blood sugar as a result of low production of insulin. This can be caused by hormonal imbalances, hyperglycemia, or chronic pancreatitis.

Ketoacidosis: high levels of acids that build up in the blood (known as ketones) caused by the body burning fat (instead of sugar and carbohydrates) to get energy. It can be a result of starvation, excessive purging, dehydration, hyperglycemia and/or alcohol abuse (it can also be a result of uncontrolled or untreated diabetes). It can lead to coma and death.

Iron Deficiency, Anemia: this makes the oxygen transporting units within the blood useless and can lead to fatigue, shortness of breath, increased infections, and heart palpitations.

Kidney infection and failure: your kidneys "clean" the poisons from your body, regulate acid concentration and maintain water balance. Vitamin deficiencies, dehydration, infection and low blood pressure increase the risks of kidney infection thus making permanent kidney damage and kidney failure more likely.

Osteoporosis: thinning of the bones with reduction in bone mass due to depletion of calcium and bone protein, predisposing to fractures.

Osteopenia: below normal bone mass indicating a calcium and/or Vitamin D deficiency and leading to Osteoporosis. Hormone imbalance/deficiencies associated with the loss of the menstrual cycle can also increase your risks of Osteoporosis and Osteopenia.

Arthritis (degenerative): can be caused by hormonal imbalances and vitamin deficiencies as well as increased stress on the joints in individuals who suffer from Compulsive Overeating.

TMJ "Syndrome" and Related TMJ Problems: degenerative arthritis within the tempero-mandibular joint in the jaw (where the lower jaw hinges to the skull) creating pain in the joint area, headaches, and problems chewing and opening/closing the mouth. Vitamin deficiencies and teeth grinding (often related to stress) can both be causes.

Amenorrhea: loss of menstrual cycle due to lack of secreting the hormone Oestrogen by the ovaries. Loss of the menstrual cycle can also lead to Osteopenia and Osteoporosis.

Easily bruising skin: vitamin deficiencies that decrease the body's ability to heal itself, low blood pressure, low platelets count and/or extreme weight loss will all lead to easily bruised skin that can take a long time to heal.

Dental problems, decalcification of teeth, erosion of tooth enamel, severe decay, gum disease: will be caused by stomach acids and enzymes (from vomiting) and lead to Vitamin D and Calcium defiencies as well as a hormonal imbalance. Can also be due to the lack of exercise the teeth can get from the process of eating certain foods. Dental problems can sometimes indicate problems with the heart.

Liver failure: the liver aids in removing waste from cells, and aids in digestion. You cannot live without your liver. Fasting and taking acetaminophen (a drug found in over-the-counter pain killers) increases your risks of liver damage and failure. Loss of menstruation and dehydration (putting women at risk of having too much iron in their system), and chronic heart failure can lead to liver damage or failure.

Bad circulation, slowed or irregular heartbeat, arrhythmias, angina, heart attack: there are many factors associated with having an Eating Disorder that can lead to heart problems or a heart attack. Sudden cardiac arrest can cause permanent damage to the heart, or instant death. Electrolyte imbalances (especially potassium deficiency), dehydration, malnutrition, low blood pressure, extreme orthostatic hypotension, abnormally slow heart rate and hormonal imbalances all cause serious problems with the heart. High blood pressure, accumulation of fat deposits around the heart muscle, high cholesterol, decreased exercise due to lack of mobility, diabetes and hormonal imbalances can all lead to serious problems with the heart.

Infertility: the inability to have children caused by loss of the menstrual cycle and hormonal imbalances. Malnutrition and vitamin deficiencies can also make it impossible to succeed with a full-term pregnancy and can increase the chances significantly of a baby born with birth defects.

Problems during pregnancy: including potential for high risk pregnancies, miscarraige, still born babies and death or chronic illness from minor to severe in children born all due to malnutrition, dehydration, vitamin and hormone deficiencies.

Depression: mood swings and depression will all be caused by physiological factors such as electrolyte imbalances, hormone and vitamin deficiencies, malnutrition and dehydration. Living with the Eating Disorder behaviors themselves will cause depression.
Depression can also lead the sufferer back into the cycle of the Eating Disorder (or may have initially been the problem before the onset of the ED). Stress within families, jobs and relationships can all be causes. There are also a percentage of people born with a pre-disposition to depression, based on family history. Depression can also lead to suicide.

Temperature sensitivity: caused by loss of the healthy insulating layer of fat and lowered blood pressure.

Cramps, bloating, constipation, diaorrhea, incontinence: increased or decreased bowel activity.

Peptic ulcers: aggravated or made more severe by increased stomach acids, cigarette smoking, high consumption of caffeine or alcohol.

Pancreatitis: this is when the digestive enzymes attack the pancreas. It can be caused by repeated stomach trauma (such as with vomiting), alcohol consumption or the excessive use of laxatives or diet pills.

Digestive difficulties: a deficiency in digestive enzymes will lead to the bodies inability to properly digest food and absorb nutrients. This can lead to malabsorption problems, malnutrition and electrolyte imbalances. Diseases that may be triggered by a history of an Eating Disorder include: Celiac Disease (gluten sensitivity), and Crohn's Disease.

Weakness and fatigue: caused by poor eating habits, electrolyte imbalances, vitamin and mineral deficiencies, depression, malnutrition and heart problems.

Seizures: the increased risk of seizures in Anorexic and Bulimic individuals may be caused by dehydration, hyperglycemia or ketoacidosis. It is also possible that lesions on the brain caused by long-term malnutrition and lack of oxygen-carrying cells to the brain may play a role. Some types of antidepressants can increase the risk of seizures and usually carry a warning against prescribing them to people with Eating Disorders, unless the benefits significantly outweigh the risks.

Death caused by any of the following or any combination of the following: heart attack or heart failure; lung collapse; internal bleeding; stroke; kidney failure; liver failure; pancreatitis; gastric rupture; perforated ulcer; depression and suicide.

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