The Medical Minute: Eating disorders affect entire body

February 25, 2004

By Richard L. Levine, M.D.
Director of Adolescent Medicine and Director of Eating Disorders Program
Penn State Children's Hospital, Penn State Milton S. Hershey Medical Center

Eating disorders have become increasingly more common among young women in our society. We live in a culture preoccupied with being thin. In vulnerable young women these pressures can interact with other biological, psychological and social factors and lead to an eating disorder. These factors combined are often the reasons why eating disorders have become increasingly common in our society. Over the past three decades, eating disorder cases have increased two to five times.

Eating disorders are serious medical conditions that can affect every organ of the body. Anorexia nervosa and bulimia nervosa can have significant, sometimes irreversible medical complications. The prognosis is favorable with early recognition and aggressive treatment.

The majority of patients are typically Caucasian adolescents and young adult women. However, the number of men and women from other ethnic and demographic backgrounds with eating disorders is increasing.

Eating disorders have been found to run in families. Researchers are currently investigating whether a biological vulnerability for the development of eating disorders exists. Current studies are looking for genetic markers for these disorders. A possible biological connection is neuroendocrine dysfunction, particularly the dysregulation of the neurotransmitter serotonin.

Psychological problems also play a large role in the development of eating disorders. Individual issues such as depression, poor self-esteem and poor body image, as well as complicated family issues, such as parental discord, a rigid parenting style, and even abuse, can sometimes lead to symptoms of eating disorders.

Cultural influences play an ever-growing role in the development of eating disorders. It's been argued that the mass media perpetuates the importance of "being thin." Many pictorials and advertisements are computer enhanced to increase the physical attractiveness of the models, meaning young women are repeatedly comparing themselves to unrealistic, often unattainable ideal body images featured in magazines, movies and on television. Female models increasingly reflect a taller, thinner body type. Yet the average model is approximately 23 percent underweight and many fashion models reportedly have eating disorders. For a young woman already vulnerable due to biological and psychological factors, the repetition of the "thin is beautiful" stereotype can lead to the development of eating disorders.

Anorexia and Bulimia
Anorexia nervosa is a refusal to maintain a normal weight for an individual's height. Patients with anorexia nervosa are preoccupied with the issues of food and weight, with an intense fear of gaining weight and a distorted body image.

Patients with anorexia nervosa have an abnormal metabolism with reduced energy expenditures. Their bodies slow their metabolism to cope with a perceived starvation state. Fat mass and lean body mass is reduced. The patients experience what is called auto-cannibalism -- so named because the body literally eats itself, converting proteins from muscle, and other tissues into glucose to provide energy for the body.

Patients with anorexia nervosa demonstrate low blood pressure and a very slow heart rate. They may also have EKG abnormalities, along with shrinkage of heart size and abnormal heart function.

Hormonal complications of anorexia nervosa include the risk of growth retardation, permanent short stature and amenorrhea -- a loss of menstrual cycles. The chronic hormonal imbalance can create significant risk of osteoporosis, even in adolescent years. Currently, the mortality rate among patients with anorexia nervosa is at approximately 4 percent. Causes of death include suicide, electrolyte disturbances and arrhythmia.

Bulimia nervosa is the diagnosis of recurrent episodes of binge eating followed by recurrent, inappropriate compensatory behavior to prevent weight gain. Bulimics will self-induce vomiting, abuse laxatives, and exercise excessively in an effort to stay unnaturally and dangerously thin. There is a significant risk of heart damage from abuse of emetine (Ipecac), sometimes used to induce vomiting. This medication can lead to significant skeletal and cardiac muscle damage.

Because of the purging behavior associated with the disease, bulimics often show significant electrolyte abnormalities and gastrointestinal complications. With vomiting, this can include ulcers and acid reflux, and with laxative abuse, chronic constipation.

Treatment Options
Treatment options might differ for anorexia nervosa and bulimia nervosa. For patients with severe anorexia nervosa, it is clear that medical stabilization and some nutritional rehabilitation must occur before significant psychological progress can be made. The patient and the treatment team would together make the decision on the mode of treatment. Psychological treatment would include individual, group and family therapy to help the patient understand the causes of the eating disorders and to facilitate recovery. Medication can also play a role in treatment. For patients who are clinically malnourished, however the most important medicine is proper nutrition.

The goals of treatment for patients with eating disorders include medical stabilization, nutritional rehabilitation, control of abnormal eating behavior, psychological treatment and prevention of relapse. The American Psychiatric Association emphasizes a multidisciplinary team to help patients overcome this difficult illness: a physician, psychiatrist, psychologist and dietician. Psychological treatment would include individual, group and family therapy.

Prognosis
The prognosis of patients with eating disorders is favorable, especially in adolescents. Studies indicate a 71 to 86 percent satisfactory outcome with long-term follow-up in teens with anorexia nervosa. Adults have a more guarded prognosis with higher relapse rates. There are concerns with a patient crossing over from symptoms of anorexia nervosa to the bingeing and purging of bulimia nervosa.

Patients with bulimia nervosa have also demonstrated a favorable prognosis, but relapse is common. In any case, early detection of the problem and intervention is vital to saving lives. For more information, there are a numerous resources available.

In conclusion, we live in a culture preoccupied with thinness. This is reflected and exacerbated by the media. It places a large burden on young women in our society. In vulnerable young women these pressure can interact with other biological, psychological and social factors and can lead to an eating disorder. Anorexia nervosa and bulimia nervosa are serious illnesses that can have significant, sometimes irreversible medical complications. The prognosis is favorable with early recognition and aggressive treatment.

References:
American Psychiatric Association. Diagnostic and Statistical Manuel of Mental Disorders. 4th ed. Washington, D.C.: The American Psychiatric Association Press; 1994.

American Psychiatric Association. Practice Guidelines for the Treatment of Patients with Eating Disorders (Revision). American Journal of Psychiatry. January 2000 Supplement. 157:1.

Fisher M., Golden N.H., Katzman D.K.. Eating disorders in adolescents: a background paper. Journal of Adolescent Health. 1995; 16:420-436.

Web sites:

Penn State at http://pennstateeatingdisorders.com/

Something Fishy at http://www.something-fishy.com/ed.htm

Gurze Books at http://bulimia.com/

For more information, contact the American Anorexia and Bulimia Association at (212) 575-6200 or Eating Disorders Awareness and Prevention at 1-800-931-2237

(Media Contacts)

Last Updated March 19, 2009