In recent weeks I have been busily working on an e-book on dealing with ’emotional eating’ and a training module on eating disorders. I have been busy and reflecting a lot on eating issues in our society. In fact, there was an article in the paper last weekend about a model, who is a size 12, being classified as a ‘plus-size model.’ Apparently this applies to a model whose dress size is bigger than a size 10. The average Australian woman wears a size 14, and so this is ridiculous! This is why I will be posting a couple of blogs on my website about eating disorders. Having a low weight or struggling with being overweight can be very challenging, and I think it is time we made some changes as a society to assist with preventing eating disorders (EDs) as they can be debilitating and lethal.
EDs involve serious abnormalities in eating and weight control behaviours. They can cause severe distress and disruption to individuals and their families and can result in multiple medical problems and poor psychological health. The most common EDs are Anorexia nervosa (AN) and Bulimia nervosa (BN). A disturbance in perception of body shape and weight is an essential feature of both. EDs are relatively common in particular community groups e.g. adolescents and women. The lifetime prevalence of Anorexia Nervosa is 4%, Bulimia Nervosa is 2% and Binge Eating Disorder is 2% (Smink & Hoeken, 2012).
First, here is some information about different types of EDs:
1. Avoidant or restrictive intake disorders refer to an eating or feeding disturbance such as lack of interest in eating, avoidance based on the sensory characteristics of food (e.g. texture) or worry about consequences of eating, resulting in significant weight loss or nutritional deficiency, and with significant interference with functioning.
2. Anorexia Nervosa involves restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, development, and physical health. Significantly low weight is defined as a weight that is less than minimally normal. Anorexia may be the restricting type (during the last 3 months, no binge eating or purging behaviours), and weight loss is accomplished through dieting, fasting or excessive exercise; or the binge-eating/purging type (recurrent episodes of binge eating or purging behaviours including self-induced vomiting, misuse of laxatives, diuretics or enemas).
3. Bulimia Nervosa refers to recurrent episodes of binge-eating, characterised by eating in a discrete period of time an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances, and a sense of lack of control over eating during the episode (i.e. a feeling that one cannot stop eating or control what or how much they are eating). There are also recurrent compensatory behaviours in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, medications, fasting or excessive exercise.
4. Binge Eating Disorder involves recurrent episodes of binge eating. An episode of binge eating is characterized by eating, in a discrete period of time an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances, with a sense of lack of control over eating during the episode. The binge-eating episodes are often associated with eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of being embarrassed by how much one is eating, or feeling disgusted with oneself, depressed, or very guilty after overeating. Marked distress regarding binge eating is present, and the binge eating occurs, on average, at least once a week for three months.
In Anorexia, around 40% of patients will make a 5-year recovery; 40% will remain symptomatic but function reasonably well, and 20 % of patients remain severely symptomatic and are chronically disabled. For Bulimia Nervosa, about 50 % of patients make a full recovery; about 30% make a partial recovery, and 20 % continue to be notably symptomatic. On average, the course of EDs can vary from 4 years to 7.5 years, but some patients are ill for more than 20 years. Lifetime mortality with EDs is significant (almost 20% mortality rate over 20 years), due to starvation, suicide and alcohol abuse (Eating Disorders Association, 2013).
EDs are thought to result from a range of bio-psycho-social factors, which may include relationship and family factors, life events, genetics and socio-cultural influences (such as media). Certain risk factors for EDs have been identified:
1. Predisposing factors – individual, genetic, familial and socio-cultural influences e.g. perfectionistic tendencies, a high achiever, societal pressures on appearance.
2. Precipitating factors – developmental stages in life (e.g. adolescence), a life crisis which may involve trauma, loss or grief), or an illness or personal disappointment.
3. Perpetuating factors – dietary restriction, binge eating, weight control behaviours and unhelpful cognitions such as over concern with weight and shape, low self-esteem (Eating Disorders Association, 2013).
ED prevention may be:
• Primary, that is, programs designed to prevent the occurrence of EDs and aiming to promote healthy development.
• Secondary– the early identification of ED to enable prompt treatment.
It is important to recognise that ED arise from a range of issues. We need to tackle our obsession with thinness in society, in the home, at school, in the media and across society. We need to look at how we are influencing young people to develop unrealistic expectations about body image, impacting on their sense of self-worth and eating patterns. And if there is an ED emerging, it is vital to get help early. My next blog will look at what help is available, but in the mean-time, some useful website resources are provided below.
• Eating Disorders Association. (2013). An Information Pack for General Practitioners, retrieved 3rd Feb 2015 www.eda.org.au/wp-content/uploads/Complete-GP-Information-Kit-2013.pdf
• Smink, F. & Hoeken, D. Epidemiology of Eating Disorders: Incidence, Prevalence and Mortality Rates. Current Psychiatry Reports, 2012; 14(4): p 406-414.
Beyondblue website for young people: www.ybblue.com.au
Centre for Adolescent Health: www.rch.org.au/cah
Centre for Clinical Interventions (CCI): www.cci.health.wa.gov.au
o Excellent website for clinicians or consumers – with workbooks on range of mental health topics e.g. panic, assertiveness, mindfulness.
o All about treatment of anxiety disorders, including practical tools. Also have online treatment program.
Eating Disorders Association of SA www.edasa.org.au/
o For young people.
o Online treatment program for depression (CBT).
NEDC National Eating Disorders Collaboration www.nedc.com.au
o Centacare’s Programs for Panic, Anxiety and Eating Disorders.
o For young people.
SANE Australia: www.sane.org/
o Information about mental health issues, started by a parent.
Statewide Eating Disorders Service (SEDS) http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+services/eating+disorder+service/about+statewide+eating+disorder+service
o Located at Brighton, SEDS is a specialised mental health service providing assessment, care and information for people living with an ED, or where an ED may be developing, their families and carers. Education and support is available for those needing further information and assistance.
The Australian and New Zealand Academy of Eating Disorders (ANZAED)
The Butterfly Foundation: http://thebutterflyfoundation.org.au/
o Excellent website about eating disorders.
The Eating Disorders Association of South Australia (EDASA) http://www.edasa.org.au/