Dubai: Are you one of those who often denies yourself certain foods, follows rigid eating rules or are obsessed with your weight? Or are you at the other end of the spectrum where you frequently resort to bingeing and secretive eating? Either way, you could be in trouble as you could well be suffering from an eating disorder.
Few are aware about the dangers of eating disorders. But as Dr. Victoria Mountford, Clinical Psychologist and Eating Disorder Service Lead at Dubai-based SAGE Clinics, warned, “Eating disorders are serious mental health disorders where the individual has concerns about their weight, body shape or size. They affect both physical and psychological wellbeing, and can cause significant anxiety, distress and low mood. Eating disorders affect the individual and their families. They also affect all parts of the individual’s life i.e., at home, school, work and in their relationships. They can occur in anyone, irrespective of age, gender or ethnicity.”
The tricky part, however, is that eating disorders go unnoticed for long periods of time.
Dr. Teizeem Dhanji, another Eating Disorders Specialist and Consultant Child & Adolescent Psychiatrist at SAGE, explained: “Eating disorders may go unnoticed for a significant amount of time due to the feelings associated with having such a disorder such as shame or guilt. Often, individuals find it difficult to ask for help or to recognise that there is a problem. Loved ones may notice changes in behaviour or appearance.”
She identified the common most symptoms as under:
• Restriction of food, rigid rules or preoccupation around eating and weight
• Secretive eating or bingeing episodes
• Behaviours such as vomiting, excessive exercise, or taking tablets to lose weight
• Mood changes: anxiety, low mood, irritability
• Social isolation
• Fluctuations in weight or significant weight loss
• Physical symptoms such as dizziness, headaches, feeling cold or losing menstrual period
Dr. Ajay Kumar, Specialist Psychiatrist with Prime Medical Centre, Dubai, said, “Prevalence of eating disorders has been higher since the pandemic. Research shows high percentages of disordered eating attitudes in adolescents too.”
Most common eating disorders
Among the most common are Anorexia Nervosa and Bulimia Nervosa. While Anorexia is characterised by an abnormally low body weight, an intense fear of gaining weight and a distorted perception of weight, Bulimia is a serious, potentially life-threatening eating disorder. People with bulimia may secretly binge — eating large amounts of food with a loss of control over the eating — and try and get rid of the extra calories in an unhealthy way.
The doctors said if Anorexia Nervosa is not treated on time, several body systems can be affected, with increasing involvement as BMI falls. “Important signs and symptoms are secondary to starvation. In addition to their chronic psychopathology and physical health problems, they have significant impairment in social functioning and employment, and impose a higher burden on care givers. Anorexia Nervosa has the highest mortality rate of any major psychiatric disorder, with a four-to-five-fold increase in mortality. One in five deaths in from suicide; the others reflect the many adverse health consequences of the disorder, notably cardiac events and sepsis,” explained Dr Kumar.
According to the doctors, Bulimia Nervosa can impact physical health too, mostly due to repeated vomiting or use of laxatives or other drugs. More serious physical health problems can occur but are very rare. The outcome of bulimia nervosa is better than anorexia nervosa.
SAGE Clinics highlighted two separate case studies to drive home the manifestations of eating disorders. The first is a 15-year-old girl who came the clinic during the pandemic. She would routinely miss school and would be constantly worried about gaining weight. She began to cut out carbohydrates and fats from her diet and exercised secretly. She had developed anorexia nervosa, a type of eating disorder and by the time she presented for treatment, had lost 10kg. Her periods had stopped and she was malnourished. She described herself as sad and often irritable. Her grades had slipped at school and parents noted that she had isolated herself.
In a second case, a 45-year-old man suffered from binge eating disorder. He always liked his food, however, whenever he felt upset or stressed, he would secretly order large quantities of sweet foods, fries, pasta and binge on these. He would often binge on the way home from work. Afterwards, he would feel disgusted with himself, guilty and worried about his weight and health. He avoided contact with his wife and found himself getting angry at his children. Physically he noticed he was often out of breath and his knees and back began to hurt
The SAGE Clinic doctors said the first case was treated with family-based interventions.
“Based on the Maudsley Model of Family Therapy for Anorexia Nervosa (FT-AN), we work with the young person and their family to help overcome the eating disorder, using a combination of family therapy and specialist eating disorder knowledge,” said Dr Mountford.
In the second case, Dr Dhanji said the patient was treated with Cognitive Behaviour Therapy for Eating Disorders (CBT-ED). “This is suitable for all types of eating disorders. It involves developing a personalised treatment plan, which addresses the unhelpful thinking patterns, emotions and behaviours which may have developed.”
The two doctors said Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) is also employed. The focus here is on addressing anorexia and exploring maintaining factors such as difficulties in managing emotions and relationships, unhelpful thinking styles and aspects of identity.
Reluctance to change
Dr Kumar said most patients with Anorexia Nervosa are reluctant to change their behaviour, let alone see a psychiatrist. “So it is important to try to establish a good relationship. This means listening to the patient’s views, explaining the treatment alternatives, and being willing to consider compromises. A thorough history should be taken of the development of the disorder, the present pattern of eating and weight control, and the patient’s ideas about the body weight. Most patients should be managed on outpatient basis, with psychological treatment and monitoring of their physical condition. Outpatient psychological treatment should be at least six months duration. Failure to improve or deterioration should lead to more intensive forms of treatment like day care or inpatient care.”
Antidepressants are also apparently used to treat depression in Anorexia Nervosa. “It should be made clear that achieving an adequate weight is essential to reverse the physical and psychological effects of starvation. It is important to agree a specific dietary plan, while emphasising that weight control is one aspect of the problem, and help should be offered with the accompanying psychological problems, as well as dealing with any medical complications.
In Bulimia Nervosa, antidepressants are also effective in reducing the frequency of binge eating. However , antidepressants should be used rarely and viewed as second line treatment and only if effective psychological treatment unavailable or unsuccessful, added Dr Kumar.
How do I know I have an eating disorder?
The main features of Anorexia nervosa are:
• Very low body weight (defined as BMI of less than 17.5 kg/m2) which is maintained by restriction of energy intake.
• Extreme concern about weight and shape, characterized by an intense fear of gaining weight and becoming fat & strong desire to be thin.
• An undue influence of body weight or shape on self-evaluation.
• Lack of recognition of seriousness of low body weight.
• Amenorrhea in women.
The main features of Bulimia Nervosa are:
• Preoccupation with eating, with an irresistible and recurrent urge to eat, manifested in repeated ‘binges’ when large amounts of food is consumed in a short time, accompanied by a sense of loss of control.
• Use of excessive measures to control body weight, especially self-induced vomiting and use of laxatives as well as periods of starvation or excessive exercise.
• Overvalued ideas concerning shape and weight, of the type seen in anorexia nervosa.