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Dangerous Dieting - Eating Disorders on the Rise…in Some Surprising Populations

by Carol Bowes-Lawlor, D.O., Chestnut Hill Hospital

Eating disorders are not a fad or a crash diet, but are serious, potentially life-threatening conditions that affect both psychological and physical health. More than 20 million women and 10 million men develop an eating disorder severe enough to require treatment, according to the National Eating Disorders Association.

Eating disorders have three classifications: anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS), including binge eating disorder. Anorexia nervosa is diagnosed when a patient is at least 15 percent underweight and refuses to gain weight, either by not eating enough food, over-exercising, vomiting or using laxatives. Patients with bulimia nervosa are not necessarily underweight, but engage in binge eating following by purging, either by vomiting or using laxatives.

In addition to emotional damage, eating disorders can cause serious health complications affecting the cardiovascular, gastrointestinal, endocrine, dermatological, hematological, skeletal, and central nervous system. Ultimately, victims may suffer a terminal illness as a side effect of the eating disorder: heart failure, other organ failure, or malnutrition.

Eating Disorders: Who’s Affected?

Eating disorders have the highest mortality – or death rate – of any psychiatric disorder; in fact, anorexia nervosa has a higher mortality rate than any other cause of death among females ages 15-24, according to the National Institute of Mental Health (NIMH). Eating disorders are on the rise in some surprising populations, as well: men, older women, and young children.

A recent study by Harvard University estimated that 25 percent of adults with eating disorders are men. The NIMH reported that eating disorders in men have increased 250 percent in 10 years. Industry experts attribute the increase to social influences and the trend toward more lean and muscular male models over the last 25 years.

Other research shows eating disorders appearing in younger children – as early as age five – due to weight-obsessed older siblings or parents, or emotional/psychological abuse. Data from the National Association of Anorexia and Associated Eating Disorders, Inc. indicates that 42 percent of girls in first through third grades want to be thinner. A 2012 study at the University of North Carolina School of Medicine, published in the International Journal of Eating Disorders, reveals women over age 50 also struggle with body image, with 70 percent on a diet, 8 percent purging, and 3.5 percent engaging in binge eating. Notably, of the study subjects, 42 percent were normal weight.

Certain signs and symptoms are common among individuals with an eating disorder and range from physical to behavioral red flags including fluctuation in weight, cold intolerance, trauma or lacerations in the mouth, constipation, and fatigue or sluggishness. It’s important, however, to know that an eating disorder may occur without any obvious signs.

Eating disorders can develop from a variety of psychological and interpersonal factors: low self-esteem; depression, anger or stress; the need to feel control; troubled relationships, difficulty expressing feelings, a history of discrimination based on appearance; and/or a history of physical or sexual abuse. There are also social factors – those cultural ideals surrounding having the "perfect body" and valuing people by appearance and not inner qualities or strengths.

If a child, friend or loved one shows any signs and symptoms of an eating disorder, contact your primary care doctor who can perform a detailed physical assessment and referral to a nutritionist, psychologist and other experts for treatment, if needed.

Surprising Facts about Eating Disorders

• Almost 50% of people with eating disorders meet the criteria for depression.
• Only 1 in 10 men and women with eating disorders receive treatment.
• Men are less likely to seek treatment for an eating disorders because of the perception it’s a "women’s disease."
• Significantly higher rates of eating disorders are found in elite athletes. Female athletes in aesthetic sports were found to be at the highest risk.
• 95% of all dieters will regain their lost weight in 1-5 years.
• 35% of "normal dieters" progress to pathological dieting. Of those, 20-25% progress to partial or full-syndrome eating disorders.
• Of American elementary school girls who read magazines, 69% say that the pictures influence their concept of the ideal body shape, and 47% say the pictures make them want to lose weight.
• The average body mass index (BMI) of Miss America winners has decreased from around 22 in the 1920s to 16.9 in the 2000s. The World Health Organization classifies a normal BMI as falling between 18.5 and 24.9.

Sources: National Eating Disorders Association, National Association of Anorexia Nervosa and Associated Disorders

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