Causes and treatments
A full discussion of the causes and treatment of these serious eating disorders have filled books of their own.
A team consisting of a psychologist and/or a psychiatrist, a dietitian and a medical doctor should be involved in the treatment of a patient with an eating disorder. It is also important to bear in mind that treatment could stretch over many months before it has any significant effect and that even then the results are not always positive.
Generally speaking, the outlook for both anorexia nervosa and bulimia is not encouraging. In the case of the former, the outcome may vary from sudden recovery with little or no treatment, to death. Someone may be a victim of it for a few months or for a lifetime and it appears that only 40-60% of significantly ill patients make a good physical and psychosocial recovery. The mortality rate is estimated at between 5% and 18%, with the most frequent causes of death being suicide and the effects of starvation. Although not much literature has been published on bulimia, it is estimated that only 40-50% of treated bulimics can eventually be regarded as cured. Some are cured with relatively little effort, while others seem to return to normal eating habits and discontinue their purging behaviour after intensive treatment, only to relapse during periods of stress.
Serious medical complications - including death - are more likely to occur in bulimics and prugers, due to excessive losses of essential body fluids and electrolytes (such as potassium and sodium).
The risk of suicide is also believed to be higher, possibly because bulimia is often associated with depression.
Preventing the preventable
Because these eating disorders so often have a negative outcome, it is vital to either prevent their development or at least take action as soon as warning signals appear. You can help to guard against the development of anorexia nervosa and bulimia in a young person by following these guidelines:
- Make a practice of discouraging restrictive dieting, meal-skipping and fasting.
- Avoid unnecessary emphasis on and talk about figures, being fat and food which is 'fattening'.
- Carefully phrase any weight-related recommendations or comments.
- Try to correct misconceptions about nutrition, normal body weight and encourage a healthy approach to weight loss.
- Place the 'ideal' female portrayed by the media into perspective.
- Provide information about the normal physical changes which occur during puberty.
- Refer an adolescent who appears to have a problem - or is at risk of developing one - to a physician, a mental health professional (psychologist/psychiatrist) or a dietitian skilled in working with patients who have eating disorders.
Reading the signs
Clearly, it is very important to identify someone who is at risk of developing - or already suffering from - an eating disorder in good time, so that treatment can be effective. But how would you know if your daughter or an acquaintance was in clanger of becoming a victim? The possible warning signals for anorexia nervosa and bulimia are summarised in the table
In conclusion, it must be said that in man the control of food intake is a very complex and delicate process. Unfortunately, the primitive reflexes which control our need for food - and thus our hunger - have become buried under so many layers of conditioning and social factors that we are hardly aware of them anymore. Perhaps the time has come for modern man to realise once more that the primary reason for food intake is to support life and encourage good health. All the other reasons - whether to do with the emotions, society, taste or simply habit - are secondary. Or, in the well-known words of the famous French playwright, Jean Moliere, which are as apt today as they were in the 17th century: 'One should eat to live and not live to eat'.
