OVERVIEW

In a modern era, where people are concerned about their appearance and weight, one of the key factors which influences these features is one’s eating habits.

Eating habits or behaviors have a major impact on our lives, not only in the area of our health but also in the area of body weight. In view of this, a disorder in eating habits can interfere with our daily life routines and create serious health problems, if not checked and treated appropriately.

Well, what then is an eating disorder?

DEFINITION

An eating disorder is an illness that leads people to overeat, starve or adopt other unhealthy behaviors involving food. This normally involves a disturbance of eating or behavior related to eating including; a change in the what or how much one eats and a measure one takes to prevent absorption of food.

Before an unusual eating behavior can be considered a disorder, the behavior must persist for a period of time, and cause significant damage to the person’s physical health and ability to function at school or work, or negatively affect one’s interactions with others.
In this same vein, what are the forms of eating disorders?

TYPES 

There is a broad constellation of eating disorders. However, the specific types which are of clinical significance are:

• Anorexia nervosa:

It presents with a relentless pursuit of thinness, a distorted body image, an immense fear of obesity, and a strict restriction of food consumption, leading to a significant loss of body weight. Persons with anorexia nervosa restrict their food intake. However, they may also gorge themselves with food. Afterwards, they then compensate by expunging the food taken (normally by vomiting or using laxatives). These persons can restrict their food intake to the point of harming their health. Though the term anorexia, means loss of appetite, people with anorexia nervosa only lose their appetite when they are lean and thin. Anorexia nervosa has been classified into two main subtypes; the restricting type and binge-eating/purging type.

• Avoidant/Restrictive Food Intake Disorder:

It presents with eating very little food or avoiding the consumption of certain foods without the concern of body shape or weight, which is typical of anorexia nervosa or bulimia nervosa. Most people with this disorder are extremely selective about food and its types. This is normally due to a certain color, consistency or odor of food. Moreover, some persons are afraid of the adverse consequences of eating such as choking or vomiting.

• Binge eating Disorder:

This presents with unusual eating of large amounts of food, normally more than what most people eat in a similar period of time under the same circumstances. Persons feel a loss of control before and after binge eating. This is not normally followed by purging (vomiting of food or use of laxatives to prevent food absorption) or other efforts to compensate for the excess food eaten.

• Bulimia nervosa:

This presents with repeated episodes of rapid consumption of large amounts of food, followed by efforts to compensate for the excess food eaten. This is normally done by people inducing themselves to vomit, the abuse of laxatives, fasting, excessive exercise, etc.

• Pica:

This involves the craving and regular consumption of non-food substances such as paint and clay.

• Rumination Disorder:

This is characterized by the regurgitation of food after eating.

EPIDEMIOLOGY

Recent epidemiological study of eating disorders, particularly in Africa is still in its infancy. However, over time particular eating disorders such as bulimia nervosa have been formally assessed.

Currently, no case of anorexia nervosa has been reported. However, with the current DSM-V (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), most African women would have met the criteria for anorexia nervosa.

The prevalence rate of bulimia nervosa in African women is within the range recorded for most western populations, preferably Latin Americans and African Americans.

PATHOPHYSIOLOGY

In the area of eating disorders, its main cause is a psychiatric disorder involving stress, anxiety, depression or boredom. The pathogenesis of these psychiatric disorders is based on the following:

• Genetic causes:

Depressive disorders present in first-degree relatives increases one’s risk of developing a depressive disorder which can progress to an eating disorder.

• Environmental causes:

Depression develops due to a deprivation of acceptance of body shape and appearance. This deprivation occurs particularly among interactions at school, family or the community.

• Endocrinal abnormalities:

An increase in stress hormones, such as cortisol; a reduction in thyroid hormones T4 and T3 and reduction in sex hormones particularly in women, plays a major role in the development of eating disorders in women.

• Neurological abnormalities:

Based on research on depressive disorders, there is a link between the development of depression and anxiety causing eating disorders.

Neurotransmitters such as serotonin, dopamine, and noradrenaline play a role in mediating adaptive responses to stressful events. A defect or disorder in their receptors or production pathway affects the mediation of adaptive response to stress.

SIGNS AND SYMPTOMS

How then can one identify an eating disorder? Well, eating disorders normally manifest with the following features:

Based on the Diagnostic Statistical Manual for Mental Disorders, 5th Edition (DSM-V)

• Eating until feeling uncomfortably full.
• Eating much more rapidly than normal.
• Eating large amounts of food when not feeling hungry physically.
• Eating alone because of feeling embarrassed by how much is being eaten.
• Feeling disgusted with oneself, depressed or very guilty afterwards.

These symptoms must persist once a week for 3 consecutive months.

• Dry skin.
• Breast atrophy (wasting of muscle mass).
• Swelling of salivary glands.
• Peripheral edema.
• Thinning of hair.
• General signs: Dizziness, lightheadedness, palpitations, dry skin.
• Gastrointestinal symptoms: Abdominal pain, constipation, obstipation, bloating, flatulence, difficulty swallowing, blood in vomitus.
• Reproductive symptoms: Amenorrhea, menstrual irregularity and scanty periods.
• Water and electrolyte imbalances such as hypokalemia, metabolic alkalosis and dehydration.

DIAGNOSIS

A heal th practitioner can diagnose you of an eating disorder by checking the following:

• Previous medical history.
• Based on the clinical features of eating disorders.
• Previous psychiatric history.
• Measuring the weight and height to determine the body mass index (BMI) of the patient.

Other clinical laboratory tests that can be performed include:

• Serum electrolytes.
• Bone density test.
• ECG (Electrocardiography).

The key diagnostic measures in determining eating disorders are the BMI determination, clinical features and the previous medical and psychiatric history.

TREATMENT

The principles in the treatment of eating disorders seek to restore the normal caloric intake and weight of the person.

Some measures which could be suggested by a health practitioner include:

• Psychologic therapy.
• Family therapy for adolescents.
• Regular check-ups.
• Antidepressants and stimulant drugs.
• Possible weight-loss and appetite suppressant drugs.
• Conventional behavioral weight reduction groups.
• Self-help groups.