Eating Disorders (ED) are one of the most common mental health problems among adolescents and young people worldwide. They affect women more, especially the anorexia nervosawith an estimated prevalence in Europe in women of between 1% and 4%.
Patients with anorexia nervosa suffer from numerous emotional problems that cause enormous suffering both to themselves and to those around them. They are also accompanied by significant physical consequences.
That’s why he talks about Anorexia goes far beyond stopping eating.
What is anorexia?
Xandra Romero, a dietitian-nutritionist specialized in addressing eating disorders and coordinator of the Nutrition Specialization Group on Eating Disorders (GE–NuTCA) of the Spanish Academy of Nutrition and Dietetics, defines it like this: “Anorexia nervosa (AN) ) is the best known eating disorder. It refers to refusal to maintain body weight equal to or above the minimum ‘normal’ value considering age and height.»
This disorder is first characterized by the rrestriction of energy intake in relation to the Needs, which leads to a significantly low body weight in relation to age, sex, developmental course and physical health. In addition, those who suffer from it report “intense fear of gaining weightaccompanied by persistent behaviors that interfere with weight gain, even in situations of being significantly underweight.”
People with anorexia nervosa do not sell themselves in the same way as others when they look in the mirror. “Characteristics of this disorder are a changes in the way one perceives one’s own weight or buildthe inappropriate influence of weight or body shape on self-assessment, and the persistent lack of recognition of the severity of current low body weight.” That is, even weighing 85% less than they should, they continue to see an image of themselves in the mirror that does not correspond to reality.
Types of anorexia nervosa
Anorexia nervosa is divided into two large groups, restrictive and purgative, although there are some more:
restrictive anorexia nervosa
Weight loss is due to the Diet, fasting and/or excessive exercise.
purgative anorexia nervosa
The patient has Recurrent episodes of binge eating and purging. Purges are understood as self-induced vomiting or the incorrect use of laxatives, diuretics or enemas for compensatory purposes.
atypical anorexia nervosa
Outside of the two previous categories and without complete diagnostic criteria developed at the moment, this type of anorexia nervosa has a high prevalence today. “It shares the same diagnostic criteria as anorexia nervosa, except that People who suffer from it are within or above the normal range of body mass index (BMI) despite experiencing significant weight loss,” Romero says
This group is diverse and includes boys and men, people who were overweight or obese prior to the disease, or those in a residual phase of anorexia nervosa. “Despite the normal weight status, the psychological symptoms and physiological complications of these people are generally similar to those of individuals who suffer from this disorder in any of the other subtypes,” concludes the dietitian-nutritionist.
Anorexia in men
This ED has a much higher prevalence among women. Studies say that only One man for every nine women presents this pathology. This situation adds a stigma males with this disorder. “This difference between men and women is related to both biological and psychosocial factors,” says the expert. One of the reasons is that “the transition from girl to woman is accompanied by significant hormonally regulated changes in behaviour and thinking, which can interfere with awareness of one’s own body.”
In contrast, in boys, “puberty is not only later, but there is not such a significant impact at the hormonal level because it is more progressive.” In the case of men, social weight is determined by what they understand is expected of a man. “Masculinity is related to physical strength, so in cases of Male anorexia is more common when the obsession focuses on physical exercise.which is usually the main symptom and is more difficult to control.” The film to the boneAlthough it focuses on the anorexia of its female protagonist (Lilly Collins), it also addresses how the disorder affects a young boy (Alex Sharp).
Causes of anorexia nervosa
There is no specific cause for anorexia nervosa, but rather a combination of factors biological, psychological and social.
Biological factors
In this section a genetic predisposition is located, which cannot be changed.
Psychological factors
These are the most relevant:
- To feel down
- Frequent mood swings.
- Irritability and anxiety
- Increase in study hours and, at the same time, difficulty concentrating.
- Feelings of guilt after eating.
- High sensitivity to rejection; Constant need for relief and security.
- Perfectionist, obsessive and rigid tendencies
Sociocultural and family factors
“Here I would emphasize the importance of western ideal of thinness. The internalization of this ideal of beauty and the resulting concern about weight, as well as dissatisfaction with body image, constitute significant predictors for the development of an ED,» the Academy’s ED expert categorically states.
Another risk factor is the parenting stylessuch as “a previous history of eating disorders or eating symptoms in a family member (very common),” says Romero. “We know that parents who have greater body dissatisfaction and a desire to be thin tend to project these ideals and behaviors onto their children and encourage their desire to be thin. They also tend to criticize their physical appearance more and control their weight more.” These parental criticisms can lead to body image dissatisfaction and problematic eating behaviors.
Along the same lines, also the Eating styles in childhood They are relevant. “Most people with eating disorders recognize attempts at self-imposed dieting in childhood or adolescence,” concludes Xandra Romero.
How do you know if someone suffers from anorexia?
In Something Happened to Him. A Guide to Detecting the Warning Signs of an Eating Disorder, prepared by the Nutrition Specialization Group for Eating Disorders (GE-NuTCA) of the Spanish Academy of Nutrition, some keys are offered to detect a problem of anorexia nervosa. Some of them are the following:
- That the person Constantly verbalizing feeling afraid of gaining weightregardless of weight at that moment
- que restrict the amount of food what he ingests
- que avoid food groups specifics (fats, carbohydrates)
- What to do mealtime rituals, How to separate and disperse food on the plate
- Have a nice day obsessive behaviors, How to weigh yourself daily and, depending on the result, eat more or less
- Let them realize more or less physical exercise
Symptoms and consequences of anorexia
The main cause of medical complications in anorexia nervosa is the imbalance between energy intake and needs. “This situation leads to a hypometabolic state in which, in an effort to maintain balance, the body downregulates,” explains Romero.
This downward balance causes many of the characteristic signs and symptoms of malnutrition. “The most notable are gastrointestinal, cardiac, pulmonary, hematological, endocrine, neurological, dermatological and, especially, musculoskeletal disorders, which can be permanently affected during the course of the disease,” explains the expert.
These are some of the consequences:
- Reduction in heart rate and arrhythmias
- Amenorrhea or disappearance of menstruation
- Decreased bone mass
- Decreased intestinal motility.
- Yellowing on the palms of the hands and soles of the feet
- Problems with teeth and peripheral edema
- Depression, low self-esteem
How to prevent anorexia
According to the expert in eating disorders, «it is essential to food-nutritional education who worked to eradicate food myths, to make us understand that health lies in a wide variability of body shapes and weights and that eating healthy does not imply restriction and sacrifice, but rather enjoyment.” Avoiding behavior patterns that are too rigid and understanding that you do not have to feel guilty for enjoying food, even if one day you exceptionally eat high-calorie foods, help to have a healthy relationship with food and the act of eating. .
He adds, forcefully: “To prevent this and any type of TCA, the essential thing is stop perpetuating food restriction in society in general and in healthcare settings.”
He points out one last behavior as a risk factor: “The habit of compare different bodiesas is done now in many schools within the activity of calculating BMI in class, it seems to me to be a total aberration.”
Anorexia treatment: how to eat again without fear
Treatment should always be administered by professionals who are specialists in this area. “It is very common for some health professionals without experience in this pathology to treat it,” says Romero. For the expert, a multidisciplinary approachwhich includes psychologists, dieticians-nutritionists, psychiatrists and endocrinologists, regardless of the severity of the case, with extensive knowledge and experience in dealing with eating disorders. The only thing that will vary, depending on the severity of each case, is whether care is outpatient, in a day hospital or with an admission.
Regarding how to eat again without fear, “it is important not to treat renutrition from the perspective of reward-punishment, which sadly continues to be used in many treatment facilities in our country. That is why it is so important to have dieticians-nutritionists well trained in this disorder to work on food-nutrition education.”
The ALDI Council
Healthy weight loss should be gradual and controlled. If you have any questions, always consult with a dietitian-nutritionist.
xandra romero. Graduate in Human Nutrition and Dietetics from the University of Paris and PhD from the University of Barcelona. Member of the Academy, coordinator of the Nutrition Specialization Group in Eating Disorders (GE-NuTCA) of the Spanish Academy of Nutrition and Dietetics, and member of the Scientific Advisory Committee of the Academy. She is a clinical dietician-nutritionist specialized in the approach to Eating Disorders (ED) and in charge of the Day Hospital for Child and Adolescent ED at IMQ-AMSA.
