Eating Disorders: a contemporary issue in global mental health
27 February 2019
Far from just being a 21st century problem, records of eating disorders exist throughout history and different cultures around the world. Since the 1950s, however, there has been a dramatic increase in incidence, especially in the West, which seems to be linked to behavioural and cultural changes.
The uplift in eating disorders incidence noticed in the past 50 years, has coincided with upward trends in dieting for weight loss - as opposed to dieting to manage other health conditions e.g. diabetes, increased availability of nutritional ‘advice’, and greater focus on body size, shape and image.
Previously considered an illness of women and dismissed as vanity, over the years a deeper understanding has developed.
Now, there is no doubt that the condition can affect all ages, genders and ethnicities. Today, over 70 million people suffer from some form of eating disorder, with around 10% of those being men. Worryingly, it is believed that the total number could be even larger, due to the stigma that eating disorders still carry for women, that also leads to under-diagnosis of the condition in men.
What are eating disorders?
Eating disorders are a group of related psychiatric illnesses that affect the body and are connected to body image, weight loss and food. Impacting negatively on the body, symptoms include extreme weight loss or gain, low body temperature, abnormal body hair growth, menstrual cycle variations in women, and in extreme cases, abnormal heart and organ function.
Factors leading to the development of an eating disorder can include social, psychological, environmental or biological. Usually present as a combination of eating disorders, comorbidity with other conditions such as body dysmorphic disorder, depression, PTSD, addiction, and ADHD is not uncommon. One particularly strong risk factor is the so called self-oriented perfectionism, which involves setting unrealistically high expectations for yourself. Pressures from social media, together with a focus on trending diets and weight loss are thought to contribute significantly.
There are currently four main recognised types of eating disorders:
- Anorexia nervosa is diagnosed when there is a Body Mass Index (BMI) of 17 for adults or a percentile of 5% or less for children. This variant usually starts during the early teenage years, with patients fearing or wishing to exercise extreme control of weight gain. Food intake is limited, sometimes to the point of starvation. Anorexia nervosa is described as ‘restrictive’- if weight is controlled by limiting food only, or ‘purging’- if there are episodes of binging and purging.
- Bulimia nervosa is diagnosed when there is a cycle of binge eating and compensation, if the compensation behaviour happens at least once a week for at least three months, and the BMI doesn’t fall within the anorexia nervosa diagnosis range. Bulimia usually appears during late adolescence or early twenties, most patients are of normal or higher than average weight and are usually aware of their struggles. Again, there are two sub-types of bulimia nervosa: purging and non-purging. Purging relies on the use of diuretics, laxatives or self-induced vomiting; whilst non-purging involves extreme exercising or fasting periods.
- Binge eating disorder is diagnosed when a cycle of binge eating occurs at least once a week for a minimum of three months. There is no compensatory behaviour and the BMI doesn’t fall within the anorexia nervosa diagnosis range. Binge eating usually appears during the late teens or the early twenties. Unlike anorexia and bulimia, in binge eating disorders there is a 50-50 divide between women and men.
- OSFED or ‘Other Specified Feeding or Eating Disorder’ is diagnosed when there is an eating disorder present that doesn’t fall into any of the other categories. As knowledge develops, more and more patients are moved from OSFED to one of the other three categories, or new categories are created (such as the case of binge eating disorder). As it stands today, almost 60% of patients are considered to be suffering from OSFED.
Treatment for Eating Disorders
Treatment for eating disorders usually involves a combination of medication, nutritional guidance and psychotherapy. Depending on the severity of the case, patients could be admitted as inpatients, receive day treatment or access support as outpatients.
Currently, full recovery rates are between 50-85% depending on the type of eating disorder, with anorexia at the lower end of the spectrum.
Prevention of Eating Disorders
Scientists believe that if risk factors can be reduced, then so can the chances that a person will develop an eating disorder.
Reducing negative risk factors, such as dissatisfaction with one’s body, depression, or basing self-esteem on appearance, can help with prevention. Increasing protective factors, such as encouraging people not to define themselves by their appearance and replacing dieting and body dissatisfaction with intuitive eating and appreciation for the functionality of the body can also help.
Although it may be too soon to say categorically whether any specific prevention programme can reduce the rates of diagnosable eating disorders, promisingly, such initiatives are showing benefits. If risk factors can be reduced, then there will be a better chance of preventing the affliction of eating disorders for millions of people around the world, regardless of age or gender.