Eating disorders still no answers

Press, 26 June 1989, Page 14

Eating disorders still no answers

I have two patients at the moment struggling with eating disorders. I have looked after these two and their families for years and know them well.

The first is a girl, aged 14. She is the third child and has two academically successful brothers. She began dieting several months ago before a ballet examination and went from 45kg to 35kg combining dieting with up to 10 hours of dancing a week.

In many ways, this teenager is a classic example of anorexia nervosa. She is bright, conscientious, from a striving family, and not originally obese.

She has a distorted body image, seeing herself as fat despite her obsession with dieting and

exercise. She has had one period only and this was before her weight loss. Her parents have undergone much soul searching, blaming themselves for their daughter’s illness. Despite counselling and weekly weigh-ins, and apparently eating better, this girl’s weight remains at 36kg and her ballet teacher feels she does not have the stamina to sit her exam. The second is an attractive woman in her late 20s with one little boy, aged four. Her eating disorder began after losing her first child six years ago. She lost over 15kg by a combination of starving and binge eating followed by forced vomiting. She is still pitifully thin at 42kg, but enjoys her waitress job, serving up lovely food to other people.

Her marriage has broken up but she has formed a relationship with a solo father and

From Doctor Tessa Turnbull for the Royal New Zealand College of General Practitioners

Family Doctor

they are trying to put together a family. She, too, has had counselling and understands her problem well. Her partner has no insight into it, and little tolerance for her periods of starvation and compulsive eating.

He is unaware of the vomiting episodes and came with her recently to see me, demanding that she be “made right.” Eating disorders are common in our society, which believes attractive women are slim. In childhood, the offer and refusal of food between children and their parents has symbolic significance — refusal to eat expresses negative feelings and the offer of food expresses love and security. Research has looked for hormonal, genetic and endocrinal factors in eating disorders without a decisive answer being

found. Eating disorders vary from a teenager dieting compulsively and exercising strenuously in order to attain the thin image of society to the out of control problems of anorexia nervosa or gross obesity. The most common problem is bulimia. The person secretively and regularly vomits after eating in order to maintain an ordinary weight, not an abnormal degree of thinness. This follows compulsive eating, often large amounts of carbohydrate foods. It can be difficult to detect because normal weight is maintained and menstruation continues. The risks are those of dental decay and damage to the gullet from the enforced vomiting.

Eating disorders are akin to addictions. There is a compulsive tendency to starvation, hiding of food, overeating, purging, excessive exercise or enforced vomiting. Relapse to obesity or anorexia is common after weight loss or gain. There are wide variations in severity — some resolve spontaneously and some are lifetime afflictions producing extremes of excessive thinness and gross obesity. Obesity involves problems of hypertension, heart disease and diabetes and possibly certain hor-mone-dependent cancers such as breast cancer. Anorexia nervosa may bring infertility, heart problems, anaemia and death. I do not believe either of these problems can be “made right” quickly. Both the women are developing insight and understanding to control better their eating disorder.