The incidence of eating disorders, particularly in Western societies, has seen dramatic increases in recent years. Although most associated with late-stage adolescence and early adulthood, eating disorders can affect anyone at any age. The condition is so common that you probably know someone who is suffering from an eating disorder, even though you may not be aware this person is battling this health issue. Maybe you are battling it yourself. As a nutritionist, you will likely encounter people in your practice who suffer from disordered eating.
In this article, I discuss ten things that you should know about the three most common eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder), from basic information on the topic to tools you can use to help prevent the disease to warning signs that the disease may present. Use this information as an entry point into this very complex problem.
1. Three Main Types of Eating Disorders Exist
Three main types of eating disorders exist: anorexia nervosa, bulimia nervosa, and binge eating disorder:
Anorexia nervosa: This disorder is identified with very restrictive dieting, an excessive fear of gaining weight, and, eventually, a skeletal-looking frame due to the body’s starving. It has the highest mortality rate of any eating disorder category.
Bulimia nervosa: In bulimia, sufferers engage in binge eating episodes during which they feel a lack of control over their behavior, followed by a feeling of guilt that leads them to purge the food they just ate. To be diagnosed with bulimia nervosa, such episodes have to occur twice a week for at least three months.
Binge eating: Binge eating disorder is defined as recurrent episodes of eating in a two-hour period of what most people would eat in an entire day and lacking a sense of control over the eating during the episode.
2. Disordered Eating Is Different from Eating Disorders
Disordered eating differs from eating disorders. In disordered eating, there is some disturbance in eating behavior. For example, a person with disordered eating typically feels some level of dissatisfaction with his or her body size and shape and may exhibit behaviors such as an insistence on eating alone, chewing food but spitting it out to avoid swallowing or employing other seemingly abnormal methods of eating.
An eating disorder is a group of conditions where an individual is intensely preoccupied with his or her body weight and engages in abnormal eating behaviors (involving either insufficient or excessing intake) to a degree that threatens the person’s health and, possibly, his or her life.
Generally, disordered eating is a precursor to an eating disorder. If left untreated, disordered eating can, and many times does, lead to more serious and potentially life-threatening health issues.
If you’re like most people, you’ve had days when you just can’t get your clothes to fit the way you want and feel stressed about it. Or maybe you’ve been skipping breakfast and lunch for the past few weeks because you’re just not that hungry. Don’t jump to the conclusion that you have disordered eating. Take a deep breath, relax, and determine whether your habit is something you can easily stop or resolve. If not, you may want to talk to someone about the behaviors that have you worried.
3. The Rate of Eating Disorders Is Increasing
In recent years, the number of individuals diagnosed with an eating disorder has increased. In the United States alone, 5 million people suffer from anorexia nervosa and bulimia nervosa, with women ages 18 to 30 years old making up the largest group of sufferers.
Although the increase could be due to a change in the language or diagnostic definitions, that’s a hard sell. A change in the definition of the disease may include people in that category when before they wouldn’t be, but the number of people falsely defined would be small enough to have little influence on the overall number swell.
4. Men Suffer from Eating Disorders, Too
Eating disorders are typically reported among women. In fact, the lifetime prevalence of anorexia nervosa is ten times greater in women than in men. Furthermore, more women than men report or are diagnosed with binge eating disorders. However, the perception that men rarely get these diseases is incorrect.
Although men reportedly are ten times less likely to have a certain eating disorder than women, those numbers may not tell the whole story. Consider the following:
- Men are more apt to conceal their eating problems, thus leaving eating disorders in men largely undiagnosed or underdiagnosed.
- Some say that up to one in five males suggest that they have some type of dissatisfaction with their body size and shape.
- If you compare the cases of eating disorders in homosexual men to the number of cases involving women, the rates are more comparable than the rates between heterosexual men and women.
Hundreds of thousands of men worldwide suffer from an eating disorder. As a health professional, you must be aware that the same pressures that lead women to develop eating disorders can, and do, affect men. Bottom line: Although women still suffer from eating disorders at a higher rate than men, that tenfold gap is probably closer than the reported cases indicate.
5. Binge Eating Is Commonly Diagnosed among Adults
Binge eating disorder is the most common eating disorder. Approximately 3 percent of the U.S. population has been diagnosed with this disorder, and similar numbers are reported globally. Surprisingly, this disease is seen most often in 46- to 55-year-olds. Binge eating disorder is also the most common eating disorder among college-age adults (18- to 25-year-olds).
Binge eating, like all other eating disorders, is prone to underreporting, particularly among subgroups. So whatever number is given to you regarding how many people have these diseases, add a couple hundred, a couple thousand, or perhaps even tens of thousands to those total numbers, depending on the disorder and what subgroup you are researching.
6. You Can Be Overweight or Obese and Have Bulimia
You cannot be anorexic and be obese or overweight. In fact, one of the criteria for being diagnosed with anorexia is that you are consistently below normal body weight. With bulimia, the situation is a bit different. Overweight individuals can indulge in bingeing and purging cycles.
As I explain earlier in “Disordered Eating Is Different from Eating Disorders,” bulimia is characterized by regular episodes of binge eating followed by episodes of purging. Because these episodes can occur relatively sporadically (a diagnosis requires them to occur an average of twice a week for at least three months), you can see how an individual could be overweight or obese and still meet the criteria for bulimia.
7. One Symptom Does Not an Eating Disorder Make
To be diagnosed with an eating disorder, a number of symptoms must be present. For example, to be diagnosed with anorexia nervosa, several of the following criteria must be met:
- You must be consistently below normal body weight
- You must refuse to gain weight to healthy levels
- You must have an intense fear of being fat or gaining weight
- You must have some sort of body image distortion issue
- For women, three consecutive menstrual cycles must be missed (called amenorrhea).
Now, if you are a thin person who was always underweight as a child and even into adulthood, and you do not exhibit any of the other symptoms, you do not have anorexia nervosa. Even if you start to worry about gaining weight, you are still not anorexic. To be properly diagnosed with an eating disorder, you must demonstrate a certain number of the diagnostic criteria.
Chances are you don’t have anything to worry about. However, if you become overly concerned about your weight, continue to lose weight, or begin to display behaviors associated with disordered eating (refer to the earlier section “Disordered Eating Is Different from Eating Disorders”), have a chat with your physician. These conditions may indicate a situation that, if left untreated, could develop into anorexia.
8. Anorexia Nervosa Is the Most Deadly Eating Disorder
Eating disorders are mental illnesses, and, of all mental illnesses, they have the highest death rate. Of all the different types of eating disorders, anorexia nervosa is by far the deadliest. Keeping your body below normal weight and the different methods with which this is accomplished — like intense exercise, vomiting, laxatives, outright starvation, and so on — is traumatic for the body. Many people with anorexia die of heart and other major organ failures due to the lack of body fat and the damage done by the complete lack of nourishment.
Excessive dieting can be considered an eating disorder. Consider these alarming statistics: 95 percent of all dieters regain their lost weight within a few years, and nearly one-third of regular dieters progress to pathological dieting. Further, of the pathological dieters, almost one-fourth develop some type of eating disorder.
9. Mental Health Treatment Is a Large Component of the Cure
Fifty percent of those diagnosed with eating disorders are also diagnosed with depression. To treat eating disorders, the recommended approach usually involves treating both the eating disorder and the underlying depression. This combination consists of individual psychotherapy, medication, information dissemination, family therapy, and, sometimes, hospitalization. The mental health component is probably the most important part of treatment for many sufferers.
One thing that makes treating eating disorders so difficult is that a person needs to eat food to survive, yet food is one of the root causes of the health issue the person is suffering from…quite the distressing situation.
10. You Need to Be on the Lookout for Warning Signs
Although many people associate eating disorders with teenage girls, they can affect anyone at any time. No one is impervious to the pressure to look a certain way. A few years back, for example, it was reported that up to
80 percent of 10-year-olds — 10-year-olds! — reported being afraid to “get fat.” And, as I mention in the earlier section “Binge Eating Is Commonly Diagnosed among Adults,” binge eating disorder mainly affects middle-aged adults.
Because these diseases know no age or gender boundaries, anyone can be affected at any point. Therefore, you need to be aware of your own feelings and behaviors regarding eating and be on the lookout for those closest to you.