A friend complained of her daughter’s obsessive concern with weight and diet. We’d met at a gathering and her frankness led everyone to share their own experiences with weight control, diets and moods.

It seemed everyone had a story to tell.

My friend’s daughter was 16 years old, 5’3” tall and weighed 100 lbs; underweight. Her obsession with weight had worsened over the past year.

I asked if there were any emotional issues as well. Unprovoked aggression with siblings, anger management issues and extreme anxiety regarding tests at school were the features now, of this once “sweet girl”.

Another mother complained of her adolescent son’s addiction with food. He eats and eats and eats. And then eats some more. His weight? 108 lbs at a height of 4’6”; obese.

Being a doctor myself with some knowledge of such matters, I suggested that both mothers should see a psychiatrist for their children. Wanting to know more myself, I started reading about eating disorders.

Starting from emotional binge eating to bulimia to anorexia nervosa, it seemed that these disorders are far more common than visible.

Reaching out for comfort foods as a regular habit, leads us to the feeling of mental satiety which, although short-lived gives that “high” needed at a particular moment of “feeling blue”. Such a habit is very easy to form and very hard to break.

Further problems lie in the choice of comfort foods which are very fattening and never seem to include vegetables. I would admit that I too stand guilty!

Eating disorders are not a fad, a passing phase or a lifestyle choice. They are real and complex conditions, which, if left untreated, can have serious consequences for physical and mental health, productivity and relationships. Potentially, they may also be life-threatening.

Body dissatisfaction remains the best-known contributor to the development of eating disorders such as anorexia nervosa and bulimia nervosa. Girls as young as six years may express concerns about their own weight. Such concerns are carried on to adolescence by almost 40 per cent of these girls and about half of these girls will show moderate to severe symptoms.

Also read: Eating in the dark

Contrary to popular belief, eating disorders are not restricted to females only. An estimated 10-15 per cent of people with anorexia or bulimia are male and they are less likely to seek treatment for it because of the perception that these are ‘women diseases’.

As with all chronic diseases, eating disorders exhibit certain warning signs. Such changes in attitudes and behaviour need early intervention, which is vital in promoting recovery.

Detection of these warning signs is quite difficult as the person suffering from an eating disorder experiences shame or guilt about their behaviour and may go to extreme lengths to hide them.

Also, many people may not realise or even accept that they have a disorder, or even if they do, they will not want to give up their behaviour as it is their mechanism for coping with the underlying issue.

Behavioural warning signs may include:

• Being on a constant diet; strict calorie counting, fasting, avoidance of fattening foods and replacing meals with liquids.
• Dividing foods into “good” or “bad”.
• Avoiding social occasions involving food.
• Giving excuses to avoid food at meal times.
• Strong focus on body weight and shape to the extent of obsession.
• Excessive use of weighing scale and mirrors.
• Continuous denial of hunger.
• Significant decrease in portions when eating with family and ‘playing’ with food.
• Deceptive behaviour around food like secretly throwing it in garbage.
• Wearing baggy clothes.
• Sudden interest in ‘healthy eating’.
• Excessive and compulsive exercise pattern; exercising in bad weather or with injury and exhibiting distress when unable to exercise.
• Hidden stashes of food for binge eating, typically sweet and cold foods.
• Evidence of binge eating like sudden disappearance of food from fridge or wrappers found in the bin.
• Evidence of forced vomiting or use of laxatives.
• Frequenting the washroom during or shortly after meals.
• Social withdrawal from friends and previously enjoyed activities.

Physical warning signs include:

• Sudden changes in weight, especially alarming weight loss.
• Complaining of feeling cold all the time.
• For females, disturbance in regular monthly period is a very important sign.
• Dizziness or fainting spells.
• Complaints of feeling tired all the time.
• Signs of frequent vomiting like damage to teeth or swollen gums.

A combination of these symptoms may be present in a particular eating disorder. Barring a few ground signs, no two cases are alike. It is entirely possible for a person to exhibit several of these symptoms and not have an eating disorder.

It is always best to seek professional opinion.

Also read: Eating disorders — Thick and thin

Psychologically, a person may also be depressed or irritable with low self-esteem. Having a distorted, unrealistic self-body image is also a hallmark symptom of eating disorders. He or she may complain of life being ‘out of control’ and display uncontrolled affection / aversion towards food.

Anorexia, bulimia and binge eating disorder may even be genetically linked. But the environmental impact of negative situations cannot be overlooked.

The adage, ‘a family that eats together, stays together’, appears to be drenched in old-age wisdom. People suffering from eating disorders are likely to be coming from dysfunctional family.

Also careers which promote being extra lean (modelling and ballet), sports where emphasis is on maintaining low weight (rowing, race horse riding, gymnastics), peer pressures, cultural influences and sudden drastic changes in life play a big role in determining whether a person will succumb to eating disorders in a moment of emotional weakness or not.

There is no standard treatment for eating disorders, as each case is different from another; it is rather tailored to individual needs and is often carried out at a specialised centre by a team of medical doctor, nutritionist, psychiatrist and behavioural psychologist / therapist.

The highest priority is given to medical care and monitoring for management of physical and often fatal symptoms produced by over-eating, chronic starvation or excessive purging.

Individual meal plans are prepared by the nutritionist aimed at weight restoration and stabilisation. However the success of treatment depends on cooperation of the patient, without which even the best laid plans could fail.

Individual, family or group psychotherapy are helpful in addressing the underlying cause of eating disorder. Healing from traumatic events, expressing emotions, effective communicating skills and healthy coping skills are the main targets of this part of the treatment.

Psychiatric medications may also be prescribed to treat depression, anxiety and for mood stabilisation.

However, it may be pertinent to point out here that no medication can actually cure a full blown eating disorder without acceptance of the disease by the patient, family and friends.

Acceptance remains the first step closely followed by the will to get better and live a normal life.

As with all diseases, ‘prevention is better than cure’, a vigilant eye on our young wards may help nip the evil in the bud.

Published in Dawn, Sunday Magazine, October 18th, 2015

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