Understanding Eating Disorders (by: Andrean Wangsa)

Due to the rise of fad diets, cleanses, and unrealistic beauty standards, it can, unfortunately, be seen that eating disorders have had an exponential growth. Eating disorders are the first ranked mental disorder that has caused death in people, and the factors can be external (environmental, lifestyle, social), or internal (genetics) [1, 15]. Research has shown that eating disorder tendencies might have started from a very young age; About 42% of 1st, 2nd, and 3rd grader female respondents mentioned that they wanted to be thinner [2], 81% of 10-year-old Americans are afraid of weight gain [3]. It is not a shock how 80% of American women are unhappy about their physical appearances [3].

Aside from the physical aspects of eating disorders like wanting to be thinner, they are also caused and triggered by mental symptoms which include a lack of self-control, history of sexual abuse, anger, perfectionism, guilt, etc [1, 4, 5]. 

It is important to understand that food not only aids in physiological needs but also psychological needs. Food gives us a feeling of comfort, fulfillment, and accomplishment; However, it is important to still have a healthy relationship with food instead of looking at it as a threat, or perhaps an escape mechanism.

The stereotypical eating disorder sufferer is usually a skinny, caucasian female; Despite the statistics, eating disorders can hit any race, gender, or age. About 33-40% of binge eaters are male [6-9]. Since eating disorders are mentally correlated, not everyone having it has a skinny physique, binge eaters tend to have a higher BMI, and the severity of anorexia can range from subthreshold to severe [1]. Eating disorder types can also vary, and sufferers can have a complex of more than one disorder.

Most well-known eating disorders include Aneroxia Nervosa and Bulimia Nervosa. Anorexia is the highest suicide rate eating disorder [17-19]; It is where the sufferer sees themselves as being too fat despite their BMI, has a heightened fear of weight gain, and goes through excessive exercise, calorie restriction, or fasting. Bulimic sufferers typically binge eat, but they try to expel the consumed food, typically with the help of purging it out, or laxative abuse [10].

However, some other eating disorders also exist, which include:

– Binge Eating Disorder (BED), where excess food is being eaten. Not to be mistaken for someone who simply likes eating, BED can be due to emotional reasons which cause seeing food for comfort as an escape from reality, or also an excessive appetite [10].

– Pica is a disorder where the patient is in the habit of eating non-caloric items. There are various reported cases, some of which include ice, clay, feces, and paper. There are risks for pica as some things have eaten are dangerous. The cause for pica is unknown, but possible physical triggers include iron deficiency anemia, or malnutrition, whereas mental aspects can include psychological disorders like schizophrenia, autism, etc [10-12, 14].

– Purging disorder is similar to bulimia, however, the patient will purge despite the portion of food entering their body [10].

– Night-Eating Syndrome is when the patient habitually eats an excessive amount of food at night. It is considered as disordered when it happens daily and long term, eating above 25% of their calories after dinner. Patients who have this syndrome also generally have restless leg syndrome, sleep apnea, or other psychiatric conditions [10].

– Female Athlete Triad (Anorexia Athletica) generally happens to female athletes who join endurance sports, there are different characteristics in this disorder; However, some common symptoms include disordered eating, low energy, amenorrhea, and osteoporosis. There is typically an imbalance between caloric intake and energy expenditure, either restricting too many calories or releasing too much energy [10].

– Muscle Dysmorphia is one of the diseases which also have a notable amount of male sufferers, it is when the patient feels like they are not “big” enough in a sense that they need to build muscle, sufferers like to eat excessive protein, and use bodybuilding supplements which are sometimes are unsafe or have unknown effects [10, 13]. 

– Diabulimia happens when a diabetic patient intentionally skips insulin doses to lose weight, which can cause serious damage or even death. With the presence of insulin resistance or absence of insulin, the person cannot use consumed glucose and store energy as fat. It is important for the patient to go to the doctor regularly and consume insulin as advised [10].

– Orthorexia is difficult to physically identify as patients generally look healthy, but orthorexic patients have an obsessive perfectionism over eating a healthy diet, which may lead to further issues relating to obsessive-compulsive disorder (OCD). It is important to note that the purpose of food is not just physiological but also psychological [10].

Treatment of eating disorders includes counseling and medications, which will depend on each respective case and severity. It is also important for the patient to have a good mindset and a healthy relationship with food, meaning that the patient’s environment should support that behavior.

Generally, when someone is going through hardships in life, it is not uncommon to have a friend who instead of providing support, gives judgements, redirects the topic to comparing the weight of the patient to theirs, tells their friend to pray more, or be more grateful. People also tend to underestimate or minimize the problem by saying that the patient is not the only one suffering, or questions the patient’s closeness to their religion. This way of handling is not helpful and should be classified as medieval in the current state of the world.

If you know someone who has an eating disorder, the most proper way to handle it is by listening to their stories without being judgmental or speak to them privately about it. If they are also showing possible eating disorder symptoms, do not diagnose them, instead, recommend them to go to a registered dietitian or psychologist.

Now that it’s clear about how to psychologically handle eating disorder, the Indonesian guidelines of a healthy diet can be seen in the Ministry of Health’s PiringKu picture as seen below:

The picture shows that there should be a major caloric intake from grains and vegetables, then a minor caloric intake from fruits and protein sources which can either be plant or animal-based. Along with 8 glasses of water per day, a minimum of 30 minutes of physical activity, washing hands with soap before eating and praying before eating [16]. 

It is important to always remember that eating disorders can affect anyone despite their age, gender, appearance, or race, and be cautious in word choices when talking to patients as conventional words may be triggering to them.  

“Your body is your home, a garden, not a battlefield – it can heal and grow if given the time and nourishment. Love the journey, it involves patience and care, flowers too will bloom, in time.” – Muskan Karmani

For more details, visit the websites provided below in the “Further Reading” tab:

1. http://hukor.kemkes.go.id/uploads/produk_hukum/PMK%20No.%2041%20ttg%20Pedoman%20Gizi%20Seimbang.pdf
2. https://kesmas.kemkes.go.id/assets/uploads/contents/others/LEAFLET-ISI-PIRINGKU-ilovepdf-compressed_1011.pdf
3. http://www.p2ptm.kemkes.go.id/infographic-p2ptm/obesitas/page/14/isi-piringku-sekali-makan

 

References:

1. Wardlaw, Gordon,M: Contemporary Nutrition: A Functional Approach(2nd edition). McGraw Hill (2012)
2. Collins, M.E. (1991). Body figure perceptions and preferences among pre-adolescent children. International Journal of Eating Disorders, 199-208.
3. Mellin, L., McNutt, S., Hu, Y., Schreiber, G.B., Crawford, P., & Obarzanek, E. (1991). A longitudinal study of the dietary practices of black and white girls 9 and 10 years old at enrollment: The NHLBI growth and health study. Journal of Adolescent Health, 23-37.
4. Truglia, E., Mannucci, E., Lassi, S., Rotella, C. M., Faravelli, C., & Ricca, V. (2006). Aggressiveness, anger and eating disorders: a review. Psychopathology, 39(2), 55–68. https://doi.org/10.1159/000090594
5. Lloyd, S., Yiend, J., Schmidt, U., & Tchanturia, K. (2014). Perfectionism in anorexia nervosa: Novel performance based evidence. PLoS ONE, 9(10). https://doi.org/10.1371/journal.pone.0111697
6. National Institute of Diabetes and Digestive and Kidney Diseases. Binge eating disorder [Internet]. Available from: http://win.niddk.nih.gov/publications/binge.htm.
7. Sadock BJ, Sadock VA. Kaplan & Sadock’s synopsis of psychiatry. Behavioral Sciences/Clinical Psychiatry. 11thed. New York: Lippincott Williams & Wilkins; 2015. p.519- 22.
8. Brownley KA, Berkman ND, Peat CM, Lohr KN, Cullen KE, Bann CM, et al. Binge-eating disorder in adults: A systematic review and meta-analysis. Ann Intern Med. 2016;165(6):409-20. doi: 10.7326/M15-2455.
9. The National Institute of Mental Health. Eating disorders: Facts about eating disorders and the search for solutions [Internet]. Available from: www.nimh.nih.gov/ health/publications/eating-disorders-new-trifold/index.shtml.
10. Wardlaw, Gordon,M: Contemporary Nutrition: A Functional Approach (5th edition). McGraw Hill (2018)
11. RG at: https://www.nationaleatingdisorders.org/learn/by-eating-disorder/other/pica
12. Khan and Tisman: Pica in iron deficiency: a case series. Journal of Medical Case Reports 2010 4:86.
13. Taqui, A. M., Shaikh, M., Gowani, S. A., Shahid, F., Khan, A., Tayyeb, S. M., Satti, M., Vaqar, T., Shahid, S., Shamsi, A., Ganatra, H. A., & Naqvi, H. A. (2008). Body Dysmorphic Disorder: Gender differences and prevalence in a Pakistani medical student population. BMC Psychiatry, 8, 1–10. https://doi.org/10.1186/1471-244X-8-20
14. Advani, S., Kochhar, G., Chachra, S., & Dhawan, P. (2014). Eating everything except food (PICA): A rare case report and review. Journal of International Society of Preventive & Community Dentistry, 4(1), 1–4. https://doi.org/10.4103/2231-0762.127851
15. Galmiche, M., Déchelotte, P., Lambert, G., & Tavolacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. The American Journal of Clinical Nutrition, 109(5), 1402–1413. https://doi.org/10.1093/ajcn/nqy342
16. Doni, M. (2017). Download Pedoman Gizi Seimbang, Kementerian Kesehatan – linisehat.com. Retrieved 7 March 2021, from https://linisehat.com/download-pedoman-gizi-seimbang-kementerian-kesehatan/
17. Holm-Denoma, J. M., Witte, T. K., Gordon, K. H., et al. (2008). Death by suicide among individuals with anorexia as arbiters between competing explanations of the anorexia-suicide link. Journal of Affective Disorders, 107(1-3), 231-236.
18. Keel, P. K., Dorer, D. J., Eddy, K. T., Franko, D., Charatan, D., & Herzog, D. B. (2003). Predictors of mortality in eating disorders. Archives of General Psychiatry, 60(2), 179-183.
19. Rudd, M. D., Berman, A. L., Joiner, T. E. Jr., et al. (2006). Warning signs for suicide: Theory, research, and clinical application. Suicide and Life-Threatening Behavior, 36(3), 255-262.