Ailments around eating

My 14-year daughter was recently losing a lot of weight to a point of worry. I took her to the pediatrician, and she mentioned the words eating disorder to me. I am not sure how to approach the topic with my child and whom to seek help from?

Our relationship with food can be rather interesting. We celebrate with food and some of us even fight with food when we are stressed. Others may resort to indulging in too much to "eat their feelings".

An eating disorder is a psychological and physiological condition — characterised by unhealthy preoccupation with eating, exercising and body weight or shape. Eating disorders can have a variety of symptoms. However, most include severe restriction of food, food binges, or purging behaviours like vomiting or over-exercising. Final week of February is designated as National Eating Disorders Awareness (NEDAwareness) Week.

Eating disorders are widely prevalent in society and, in the Western world, there is a lot of awareness around it. In the United States, eating disorders are the second-most fatal mental illness. Interestingly, in India, awareness has been coming up lately. Educating ourselves and others about the dangers and causes of eating disorders is imperative.

Common eating disorders

Anorexia nervosa: It is a condition in which the restriction of energy intake is made consciously in relative to requirements, leading to significantly low body weight in the context of age, sex and health. There is an intense fear of gaining weight or becoming fat, and the way one appraises their body weight or shape. The two subtypes of anorexia nervosa include the restricting type and the binge-eating/purging type.

Bulimia nervosa: Recurrent binge eating followed by compensatory behaviours such as purging (self-induced vomiting, eating to the point of vomiting, excessive use of laxatives/diuretics or excessive exercise). However, unlike anorexia nervosa, body weight is maintained at or above a minimally normal level.

Binge eating disorder: This condition is characterised by recurrent episodes of binge eating without use of inappropriate compensatory behaviours that are present in bulimia and anorexia. One tends to resort to eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of feeling embarrassed by how much one is eating, then later feeling disgusted with oneself, depressed or very guilty after eating. We all may binge eat sometimes but for a diagnosis, it must occur an average of once a week for 3 months.

Pica: Persistent eating of non-nutritive, non-food substances such that it is not developmentally appropriate or culturally supported. It can vary from eating paper, soap, hair, chalk, paint, and clay. Pica can occur in iron-deficiency anemia, malnutrition, and pregnancy.

Rumination disorder: The repeated regurgitation of food, which may be re-chewed, re-swallowed, or spit out. For this diagnosis to be warranted, behaviours must persist for at least one month. Also, regurgitation of food cannot be attributed to another medical condition.

Reasons why eating disorders can occur?

Biological: Those with a family history have higher chances; history of drug abuse and severe hormonal changes could be other factors.

Psychological: Comorbid conditions like anxiety, OCD, depression can lead to eating disorders. Those whose personalities that thrive on perfection, obsession and impulsivity are also under risk.

Social: Subscribing to the societal norms of beauty standards of "thinness" or certain shapes can induce pressure.

What to look out for in your young one?

✲ Notice the change in eating patterns

✲ Extreme weight loss

✲ Wanting to eat alone or in secret

✲ Wearing baggy clothes

✲ Vomiting or going to toilet immediately after eating

✲ Eating large quantities of food without appearing to gain weight

✲ Preoccupation with calories, dieting and food

✲ Avoiding eating with other people or avoiding mealtimes

✲ Making elaborate meals for other people but not eating themselves

✲ Excessive exercising

✲ Constantly calling themselves fat

How to talk to your loved one about eating disorders?

Movies are a great way for families to begin discussions. 'To the Bone' is a movie based on anorexia nervosa. Another great way is to have a heart-to-heart talk with your young ones, sharing your own vulnerabilities and allowing them the space to share non-judgmentally.

Whom to approach?

A team of mental health professionals (psychiatrist, psychologists and counsellors) can ideally help formulate a plan. Along with them a gynaecologist can help look into issues related to menstrual cycle, hormones etc. A nutritionist can help rebalance the diet and some form of balanced movement like yoga, exercise can be introduced.

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