Orthorexia September 17, 2009
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Eating healthy foods is certainly beneficial, especially these days when fast food and junk food are the norm for so many individuals and families. However, it is possible to overdo a good thing, even in this arena. Some people have succumbed to an eating disorder sometimes referred to as orthorexia. This is when an individual is completely obsessed with healthy foods; indeed, orthorexia nervosa is considered by some authorities to be a medical condition in which the sufferer systematically avoids specific foods in the belief that they are harmful.
As with any obsessive behavior, the problem stems from a complete preoccupation with one thing to the exclusion of everything else. Those with orthorexia spend shocking amounts of time on ensuring what they consider to be a healthy diet.
Orthorexics are consumed by a need to eliminate “bad” foods from their diets. This desire to be as healthy as possible starts innocently enough. They may initially cut out “white” products: sugar, bleached flour, rice. But they don’t stop there, and perhaps all processed foods are the next to go. The problem is, anyone looking hard enough, can and will find fault with every food. Slowly, the list of “good” foods becomes more and more limited. In turn, someone with orthorexia must spend inordinate amounts of time researching food products, then planning and preparing their own meals. Indeed, this focus becomes so time and labor intensive that it starts cutting into the time normally spent at work, leisure pursuits, and time traditionally reserved for friends and family. This obsession with dietary rules and restrictions truly takes over their lives.
If you think you might be heading in this direction, consider the following questions:
- Are you obsessed with maintaining a healthy weight?
- Does food preparation and planning occupy a disproportionate amount of your time?
- Do you feel isolated from your friends and family by your dietary requirements?
- Have friends or loved ones suggested that your interest in healthy eating has become an obsession?
Answering “yes” to any or all of the above questions should be considered a red flag. You might want to consult a health professional, such as a dietitian or primary care provider for help and guidance. Food, like all things, should simply be an aspect of life, not the exclusive focus of any life.
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Pregnancy and Eating Disorders August 16, 2009
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It is hard to imagine two medical conditions that are seemingly more diametrically opposed: eating disorders and pregnancy. While one condition is concerned with bringing a new life into the world, the other is focused on the damage or outright destruction of a current life. Though seemingly at odds, this situation does occur.
Because anorexia centers on starvation, the woman’s body usually shuts down the reproductive function. Indeed, one of the primary physical indicators of anorexia is amenorrhea, which is the discontinuation of the menstrual cycle. This is why many women going to fertility clinics right now are either actively anorexic, or have been previously involved in the behavior. Unfortunately, the doctors do not always ask questions about weight, eating habits or exercise history. Ovulation can be induced and pregnancy can occur. With these women, the odds aren’t good. There is a higher miscarriage rate than in the general population, 38% vs. 16%. If the pregnancy continues, often there is poor fetal growth, especially in the third trimester. The baby’s health can certainly be compromised, as can the mother’s. When it comes to reproduction, the female body provides for the baby first. This means that any available nutrition will go to the child, causing the mother’s body to suffer even greater depletion.
For those women who have actually recovered from anorexia, pregnancy can trigger relapse. This can be do to weight gain, the out-of-control nature of the changes that are occurring, or insensitive remarks made by those around her regarding her growing body.
Different from anorexia, bulimia focuses on consuming huge quantities of food, then purging the food from the system, usually by vomiting. These women often use diet products, laxatives and diuretics to an excessive degree. Unlike anorexia, it is difficult to tell exactly who suffers from this disorder by simply looking; this is because these women maintain an average, or even above average, weight. This is important because, despite the fact that menstrual periods may be irregular, they can achieve pregnancy at any time. A full 75% of pregnancies occurring in women with bulimia are unplanned and the rate of early miscarriage is two-and-a-half times higher than with healthy women. A woman could easily still be abusing substances far into a pregnancy without even knowing she was carrying a child. Fortunately, studies show that those with bulimia do tend to binge and purge less often when pregnant and abuse substances less frequently.
Certain obstetrical complications are common to both disorders. Pre-term delivery is 70% higher in eating-disordered mothers and their babies are at twice the risk of having a low birth rate. In addition, there is a heightened risk of still births, breech presentation, and congenital malformation. The baby’s health immediately after birth, as indicated by the APGAR scores, is not as positive as babies born to healthy women.
Once no longer pregnant, the incident of postpartum depression is significant: 60% for those with bulimia; 40% for those with anorexia. Compared to the general population where this condition is experience by only 13-18% of women, these numbers are very high.
The truth is if a woman continues to practice eating-disordered behaviors throughout a pregnancy, it can be very harmful to both her and her child. However, if she can eat well and gain normal weight, the heightened risk of pregnancy complications or birth defects will be negated.
In fact, if she can concentrate on the health of her developing infant and the subsequent desire to be the best mother she can be for her new baby, a woman may discover a new commitment to recovery.
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Hazards of Anorexia Nervosa and Bulimia Nervosa July 7, 2009
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Several physical complications are associated with anorexia nervosa and bulimia nervosa. Many of these problems are caused by behavior aimed toward controlling body weight in an unhealthy manner, and most of these problems resolve once eating habits and weight have returned to normal.
Effects of binge-purge behavior:
•Injury to the esophagus (the tube connecting the mouth and stomach) can result from repeated vomiting. Acid and bile from the stomach irritates and inflames the membrane that lines the esophagus causing a condition known as esophagitis, which is sometimes severe enough to cause scarring and narrowing. This passageway may become so narrow that it is difficult for food to pass through. The physical stress of vomiting can cause tears in the lining of the esophagus. These tears may bleed massively or cause the esophagus to rupture. This is a life-threatening condition that requires immediate surgery.
•Injury to the stomach may occur due to binge eating. Frequent vomiting commonly causes gastritis, an inflammation of the stomach lining. Also, eating a large meal very rapidly, combined with slower emptying of food from the stomach, on very rare occasions, may cause the stomach to rupture, causing death from peritonitis.
•Injury to the intestines, particularly the colon, commonly results from laxative abuse. Damage to the muscle and nerves causes loss of normal movement.
•Lung complications occur when self-induced vomiting leads to aspiration of food particles, gastric acid, and bacteria from the stomach into the lungs, producing pneumonia.
•Kidney and heart complications are often severe. Fasting, vomiting and other forms of purging result in loss of fluid and crucial minerals from the body. Chronic dehydration and low potassium levels can lead to kidney stones and even kidney failure. Frequent vomiting leads to high alkali levels in the blood and body tissues. This may cause weakness, constipation and fatigue. Severe alkalosis and potassium deficiency can lead to an uneven heart rate or sudden death.
•Injury to the skin occurs in various ways. Most over-the-counter laxatives contain phenolphthalein, which may cause sores in the skin and hyperpigmentation (brown or gray spots). Excessive and forceful vomiting may result in hemorrhages in the blood vessels in the eye.
•Injury to the teeth is quite common. Chronic vomiting increases the acidity of the mouth and results in erosion of the teeth’s’ enamel and dentin.
Laxatives may seem to move food through the body more rapidly and may relieve abdominal distention after bingeing, but they do not prevent the calories in the food from being absorbed. The temporary weight loss that is seen after using laxatives is mostly due to loss of water and minerals in the bowel movement, and will be naturally regained. Misuse of laxatives is harmful in several ways: they upset your body’s mineral balance; they lead to dehydration; they damage the digestive tract lining; and they burn out your colon, so that you may experience severe constipation when you don’t use them.
Diuretics, or water pills, increase urine excretion and can cause a sudden weight loss. A person who fails to distinguish between loss of body fat and loss of water may see this as a desirable effect and start using diuretics to lose weight. But because the only loss induced is water, the only gain is dehydration. In addition to causing dehydration, diuretics are also dangerous because they can increase the loss of calcium, potassium, magnesium, and zinc. They can also cause a rebound retention of salt and water, making your body more sensitive to diet changes.
Ipecac syrup, which is taken to induce vomiting, has been linked to deaths of several patients with eating disorders. Emetine, the active ingredient, can build up in tissue and cause muscle or heart weakness. Ipecac is toxic, whether taken as a single large dose or as small dose that can build up over time.
Diet pills are often taken to help with weight loss. The best-known prescription pills are Dexedrine and Benzedrine, but over-the-counter drugs are also misused. These reduce appetite, but only temporarily. Typically the appetite returns to normal after a week or two, the lost weight is regained, and the user then has the problem of trying to get off the drug without gaining more weight. Warning: these drugs are of little use in achieving and maintaining weight loss and can become dangerously addicting and cause abnormal heart rhythms that can be fatal.
Fad diets promise rapid weight loss but actually encourage unhealthy dietary habits. They prey on the dieter’s wish for quick results with little effort or make the diet seem exciting because the types of combinations of foods consumed are different from those normally eaten. People are attracted to such diets because of the dramatic weight loss (mostly water) brought about within a few days. Unfortunately, such quick weight-loss schemes do not help the body lose fat or provide the nutrients that are required to keep the body in optimal health.
Starvation symptoms include:
•Preoccupation with food
•Impaired concentration
•Indecisiveness
•Mood swings
•Sleep disturbance
•Social isolation
•Loss of control when food is available
•Depression
•Depressed immune system
•Reduced energy expenditure
•Water retention
•Binge eating
•Osteoporosis
•Fluid and mineral abnormalities
•Constipation due to low calories and fiber intake
•Slower emptying of food from the stomach, which can cause bloating and early satiety during a meal
•Modified sense of taste, leading to changes in appetite
•High cholesterol levels (This does not signify a cholesterol problem and does not warrant a low-cholesterol diet)
•Amenorrhea, related to overall malnutrition
The dieting cycle – You probably know someone who claims to have tried every diet known, but still can’t lose excess weight. The fad diets have backfired and he or she is caught in the dieting cycle. For example, a woman may go on a quick weight-loss diet and boast of losing seven pounds in two days. However, at best she has lost a pound or two of fat and five or six pounds of water, muscle and minerals. When she stops her diet, her body retains the needed water and minerals. Weight lost as muscle is frequently regained as fat. Over time, her body is composed of less muscle and more fat, even if her weight remains unchanged. Since fat tissue requires less energy to maintain itself than does muscle tissue, her basal metabolic rate decreases and caloric needs actually become less – and she must eat even less in order to lose weight! This makes the next dieting cycle increasingly difficult. This “yo-yo” weight loss and gain that results from fad diets is very stressful for the body, which finds it hard to adjust to such rapid changes.
In addition to the physical stress, this dieting cycle is psychologically stressful, and often leads to alternate bingeing and fasting behavior. When the woman goes off her quick weight-loss diet and regains weight, she becomes depressed and feels that she has failed again. To ward off these feelings of depressions, she may overeat or binge. This is followed by feelings of guilt or remorse for having “lost control” and she again fasts to regain control or to punish herself and to lose weight. The cycle of fasting and bingeing continues, and a pattern of healthy eating and exercise is lost.
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How Can a Parent Help a Teenager Who Refuses Help with an Eating Disorder? June 4, 2009
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The importance of healthy parent-child communication can never be stressed enough. Parents first need to talk with their teenager. Asking questions about friends, school, or activities may open doors to a discussion of feelings, moods, etc. Simply opening lines of communication, when done with love and concern, can render positive results. The parents may discover what is motivating the eating disorder and be able to provide help.
In addition to talking, a second essential ingredient is time. Spending more time together is recommended. This can improve communication about difficult issues and allow for parents to more carefully observe possible problem behaviors. Having meals together is especially important. Not only is this a good venue for increased interaction, but it gives parents the opportunity to observe first-hand any changes in the teen’s eating habits. In two-parent households, both must be equally involved, presenting the child with a unified front.
If, according to the adolescent, nothing appears to be “wrong,” then a therapeutic assessment is advised. This is best done by a counselor who specializes in eating disorders. Assessment by a registered dietician is also beneficial. If the assessment reveals a full-blown eating disorder, certain steps must be taken. If the disorder is anorexia and involves high levels of exercise, restrictions must be put in place to curtail the teen’s activity. With bulimia, if parents suspect the child is leaving the home to binge and purge, restriction may be placed on driving. The child must start seeing a therapist on a regular basis. Therapy appointments should be presented as non-optional. If the teen refuses or conveniently forgets about scheduled sessions, additional restrictions may be required. Privileges including extra-curricular and social activities may have to be denied. When the teenager attends appointments, parents may want to reinforce this with a movie or special outing. However, it is always ill advised for parents to bribe the child by promising to purchase things, especially large material items. This skews the teenager’s motivation and ultimately proves counter-productive.
The parents might also consider marital or family therapy. This will send a positive signal to their child about the value of therapy. It also shows how much they care about her and how far they are willing to go to help her. It indicates that they don’t blame her exclusively for the eating disorder or believe it is all her fault.
Although parental actions must convey love and concern, there must never be ambiguity regarding the seriousness of the situation or of the parents’ intent. The teenager must understand that if outpatient therapy proves ineffective, a higher level of care will be sought. Knowing this may actually help motivate the adolescent to take the current therapeutic approach more seriously.
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