Do you have an eating disorder?

I was walking on campus and saw a flier with a grizzly photo. The photo shows two hands bound at the wrists with measuring tape, poised over an empty plate. Above the stark image, the question, “Taking Extreme Measures Toward Food? Below, details of an event for Eating Disorders Awareness week.” As I gazed at the picture, memories rose in my mind, passing through my heart with a pang. Patients with eating disorders are not soon forgotten. I’m going to share two of them with you. Names and identifying details have, of course, been changed.

Deanna was a skinny girl who thought she was fat. She was a smart and friendly pre-law student who would have been attractive if she hadn’t looked like a skeleton with skin. But she didn’t see herself that way. Like most anorexics, her body image was totally distorted. She wanted to be thinner. She hardly ate anything; constantly worried she’d gain weight. When I asked what she had eaten that day, a typical answer would be, “Half a bagel, plain. Three grapes. A quarter of an apple.” She measured carefully, amounts that would barely qualify as a snack for most people.

Not satisfied with severely restricting her calorie intake, she tried to burn up more by exercising it off. I used to see her around campus, running — always running. When she first came to see me she was having dizziness, and it’s a wonder she didn’t have worse. I was amazed she could even function. Her heart rate was very low, and her electrolytes were borderline.
Thankfully we didn’t have to put her in the hospital, although we considered it. We got her back in a little bit of better shape with weekly weigh-ins, therapy and a contract, but I always felt that she was teetering on the edge, walking the line between health and disaster. For anorexics, the line can be as thin as they are.

When you don’t feed your body, it suffers. Heart rhythm problems are the most deadly, usually caused by electrolyte depletion. Also very serious and potentially lethal are liver and kidney damage. Gut motility can go way down. Anorexic women usually stop having periods and become infertile, or, if they do get pregnant, their babies are more likely to have birth defects. Other hormone problems, anemia and bone loss round out the list. The death rate for people with anorexia is about half a percent per year.

Deanna got accepted into law school and left the state. I often wonder how she is faring.

Pat was a fat girl who wanted to be thin. To this end, she vomited, or purged, on a regular basis, sometimes several times a day. She had bulimia. She also binged, which means she ate large amounts at one sitting. Usually the binges were followed by purges. Pat had suffered sexual abuse as a child and teen, which is not uncommon in people with bulimia. She had a very low opinion of herself, but I liked her a great deal. Pat knew she had a problem, and wanted to get better, but, like many people with eating disorders, she just couldn’t stop. Her weight seesawed dramatically over the months. Finally it got so bad that she spent some time in a residential treatment program in another state. When she came back to school, we made an agreement. I’d see her and prescribe her medications, and she’d agree to regular weigh-ins.

When we weigh patients with eating disorders, we try to minimize any complicating factors. They usually wear only a hospital gown, or shorts and a T-shirt, and we use the same scale every time. Typically the patient will stand on the scale backwards, so they can’t see the numbers over which they’re likely to obsess.

Pat eventually blew our agreement by putting rocks in the pockets of her shorts to inflate her weight. I referred her to a specialist, and she continued to struggle. The last I heard, she had dropped out of school.
People with bulimia risk many of the same health problems as those with anorexia, plus damage to the esophagus from throwing up and destruction of tooth enamel from stomach acid.

The best known eating disorders are anorexia and bulimia, but some people have features of both. Some fall under the third official diagnosis of the eating disorder NOS (not otherwise specified). Another binge eating disorder (without vomiting), is being considered for inclusion on the list. These are very difficult disorders, for those who have them and for those who try to help. Many who suffer from eating disorders also suffer from very low self esteem. And a preoccupation with food and eating that often dominate their thoughts. They eat and vomit in secret, struggling with shame and self doubt.

The causes of eating disorders are poorly understood but probably multi-factorial. That means that biology, psychology, genetics, environment, family, trauma and social factors can all contribute to the development of an eating disorder. They affect women more than men, but men do get them too.
I began this story with the flier that prompted my memories of Deanna and Pat. The event to which it refers to is a free “Healthy Body” screening on Wednesday from 10 a.m. to 2 p.m. at Student Health and Counseling. If you even think you might have an eating disorder, please come to this event. Or if you prefer you can do an online screening. Go to Shac.unm.edu and click on Self Help Tools. For more information about the event call 505-277-4537 or go to Shac.unm.edu/counseling/html. For more information about eating disorders check out NationalEatingDisorders.org or MentalHealthScreening.org.

Peggy Spencer, MD is a board certified Family Physician. She has been a UNM Student Health physician for 17 years, and a Daily Lobo contributing columnist for 3 years. She is co-author of the book 50 Ways to Leave Your 40s, released in March, 2008.

Drop your questions in her box in the lobby of Student Health and Counseling, or email her directly at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous. This column has general health information only and cannot replace a visit to a health provider.