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News Articles About Eating Disorders

Anorexia may be ancient survival mechanism
Why do some men sexually harass women, risking marriage and career? Why do some women starve themselves to become dangerously thin? Dr. Charles Crawford (Psychology) is a practitioner in the new dis-cipline of "evolutionary psychology." He studies human behaviour from an evolutionary viewpoint. He's especially interested in why some people feel compelled to do things that harm them.

"These actions can make sense if we view them as an inheritance from our early ancestors," he says. "A million years ago, sexual harassment and fasting may have contributed to the reproductive success of some of our ancestors. Anorexia may have been a mechanism for adjusting women's reproduction to current and future reproductive conditions.

"Reproduction would have been a costly process a million years ago - especially for women. Being able to postpone it in difficult times could have increased a woman's survival chances."

We know that stresses, such as severe depression, grief and intense athletics, can depress the appetite and cause a woman's reproductive system to shut down. "When body fat is down to 22% of body weight," Dr. Crawford continues, "ovulation ceases. At 17%, menstruation ceases. Ancient hunter-gatherer women would have had little body fat, for they had to work constantly to accumulate and maintain it. Like female athletes today, they could turn menstruation off and on."

Binge-eating disorder: more than just eating too much
Overindulgence is not generally the same as binge eating. Binge eating is defined as consuming a large amount of food within two hours and being unable to control the amount consumed and to stop eating.

By Linda Krug Porzelius, Ph.D., and Burt G. Bolton, M.S.

(WebMD) -- Overindulgence is not generally the same as binge eating. Binge eating is defined as consuming a large amount of food within two hours and being unable to control the amount consumed and to stop eating.

The amount of food eaten during a binge exceeds what most people would consume in the same time under similar circumstances. Holiday overeating, for example, would not meet this definition because it generally involves a conscious decision to overindulge and the amount consumed does not differ that much from that of the other diners. Research on binge eating indicates that binges typically occur at times of stress, often in the evening.

What is binge-eating disorder?

Binge-eating disorder (BED) was identified in 1959 but was not included as a medical diagnostic category until 1994. BED is characterized by frequent episodes of binge eating, occurring at least two days a week for six months.

Binge-eating episodes are associated with at least three of the following:

• eating rapidly.
  
• eating until feeling uncomfortably full.
  
• eating when not hungry.
  
• eating alone because of embarrassment.
  
• feeling disgusted, depressed or guilty after overeating.
  

  To meet criteria for BED, a person must also experience marked distress about the binge eating and not regularly engage in self-induced vomiting, fasting or abuse of laxatives or diuretics.

  Unlike other eating disorders, such as bulimia nervosa or anorexia nervosa, BED affects a substantial number of men. BED is more common among the severely overweight but can be found among people of any weight. Regardless of a person's weight, it is typical for the BED sufferer to feel overweight and to have a history of many attempts to lose weight. The onset of binge eating is often closely associated with dieting, typically occurring in late adolescence.

  If individuals with BED are overweight, they may get considerable pressure to lose weight from health professionals and family. Yet many failed diets may lead them to feel powerless over the binge-eating pattern.

  Psychological treatments

  While individuals with BED often feel helpless to make changes, several effective treatments are available.

  Cognitive behavioral treatment of binge-eating disorder resembles treatments developed for bulimia nervosa. Typically, it involves keeping a diary of food eaten, binge episodes and moods to identify patterns of events, situations or moods that trigger the binge-eating episodes. Individuals are taught coping skills to help deal with stressors that contribute to binge eating.

  Studies indicate that cognitive behavioral treatment can eliminate or greatly reduce binge eating in most people. nterpersonal psychotherapy, another short-term treatment handled individually or in groups, also has been used effectively to treat binge-eating disorder. Initial research indicates that such antidepressants as Prozac may also be helpful in treating BED.

  Weight-loss treatments

  Obesity, a common problem among people with BED, is associated with many health problems. On the other hand, dieting and weight dissatisfaction appear to contribute to binge eating, so most BED treatments prescribe no dieting. Indeed, many popular treatments for "compulsive eating" advise people to give up any goals to lose weight if they are to gain control over eating. Such treatments focus on helping individuals accept their current weight.

  Regardless of the attitude about weight loss, it seems clear that treatment should address poor body image, which individuals with BED often have. The message that needs to be communicated is that it is possible to feel good about themselves and their bodies despite their weight.

  Copyright 1999 by WebMD, Inc. All rights reserved.

Dieting may be an early sign, rather than a cause of an eating disorder
Although the 37 incident cases may not have displayed, at baseline, all the signs necessary for the diagnosis of an eating disorder, some of those who were on a diet at the beginning of the study may actually have been in the early stages of an eating disorder; dieting might be an early, non-specific sign of later development of eating disorders and not a cause.

Editor Patton et al reported a positive association between dieting and the development of eating disorders in adolescents. A causal effect of dieting on the development of these serious psychiatric conditions was implied in the conclusion. We believe, however, that the data presented did not support the suggested causal effect.

Unlike in a randomised clinical trial, in a cohort study the participants select themselves; in this case the exposure of interest was dieting. Participants at risk of developing eating disorders may have been more likely to expose themselves to dieting. To avoid bias the exposed and unexposed participants in a cohort study should be similar for other important determinants of outcome. There is no evidence that this was true in this study. In fact, after adjustment for psychiatric disorders at baseline the hazard ratio of severe dieting decreased threefold, which suggests that the exposed and unexposed groups differed for other, unadjusted, factors.

In a cohort study the participants must be free of the disease at inclusion. Although the 37 incident cases may not have displayed, at baseline, all the signs necessary for the diagnosis of an eating disorder, some of those who were on a diet at the beginning of the study may actually have been in the early stages of an eating disorder; dieting might be an early, non-specific sign of later development of eating disorders and not a cause.

Although some of these points were raised in the discussion, the conclusion and key messages emphasised that adolescents who diet are at increased risk of developing an eating disorder. We agree that inappropriate dietary behaviours should be discouraged; given the global epidemic of obesity, the importance of promoting a healthy lifestyle, including weight control by a reasonable diet and exercise, should be emphasised for all adolescents.

Nicolas Stettler, Nutrition fellow a. 
Andrew M Tershakovec, Associate professor of paediatrics. 
Department of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399, USA

Mary B Leonard, Assistant professor of paediatrics and epidemiology. 
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA

Anorexia Nervosa Linked To Serious Bone Loss
Besides a host of medical problems ranging from amenorrhea (cessation of monthly periods), opportunistic infections and the increased risk of suicide, Harvard Medical School doctors now report that young girls with anorexia nervosa are also susceptible to significant loss in bone mineral density (BMD). The researchers say the loss of BMD seen in a small group of girls averaging 19 years of age was significant and could put them at risk for skeletal problems such as spine deformations, increased risk of fractures and perhaps osteoporosis.

SAN DIEGO, CA -- June 17, 1999 -- Besides a host of medical problems ranging from amenorrhea (cessation of monthly periods), opportunistic infections and the increased risk of suicide, Harvard Medical School doctors now report that young girls with anorexia nervosa are also susceptible to significant loss in bone mineral density (BMD).

The researchers say the loss of BMD seen in a small group of girls averaging 19 years of age was significant and could put them at risk for skeletal problems such as spine deformations, increased risk of fractures and perhaps osteoporosis.

These findings were presented at the annual meeting of the Endocrine Society which wrapped up in San Diego yesterday.

Neuroendocrinologists at Harvard and in the Massachusetts General Hospital eating disorders clinic examined 14 girls with anorexia of a mean duration of 14 months. Their biochemical markers were compared with a group of 27 age-matched controls.

The girls underwent bone scans and were evaluated as to bone age and pubertal status (bone age is an indicator of bone strength and maturity). Females are normally considered mature at the age of 15 to 16, whereas males age slightly later, around the age of 17 to 18.

The researchers divided the girls into two groups: 11 whose bone age was greater than 15 years; and three with bone age of less than 15 years.

Not surprisingly, researchers found that body mass index (BMI), lean body mass and fat mass were all significantly lower in mature bone age anorexics compared with the control group.

The girls whose bone age was normal were also considered to be in late puberty, while 30 percent of those who had an immature bone age were considered to be immature sexually, with small breast development. The researchers also found that anorexics in the mature bone age group had significantly lower BMDs in the lumbar spine and lateral spine than those in the control group. The total body BMD was also lower in the mature bone age group, but not statistically different, researchers said.

In the immature bone age group, total BMI and total fat mass were significantly lower than in the control group, but their lean mass index was not different.

Interestingly, the number of anorexic girls who were calcium deficient was not significantly greater than the controls who were lacking in calcium (77 percent versus 64 percent). Furthermore, there were actually more controls with deficiency of vitamin D (92 percent) compared with the anorexic study group, where only 85 percent were vitamin D deficient.

The researchers also pointed out that the body’s fat content did not correlate with the likelihood of them losing BMD, whereas the body’s lean mass did.

Researchers said that based on biochemical markers that are excreted in the urine, it appears that the bone loss in anorexic girls is caused by a lack of bone formation rather than any abnormality in bone resorption. Researchers added that the majority of young girls are deficient in both calcium and vitamin D during puberty when these nutrients are needed most.

Researchers concluded that this study doesn’t allow them to make any hard and fast predictions about BMD in girls with anorexia. However, they maintain that bone age and pubertal stage are closely correlated in healthy adolescent girls, but not in anorexic subjects. Therefore, they conclude that bone age might be a better index of maturation than pubertal stage in these subjects.

Eating disorders in pregnancy retard baby's growth
Women who diet during pregnancy deprive their babies of essential nutrients for growth and development, Sydney research has shown. The study, which is the first to link retarded growth in babies with poor maternal eating, shows that the way mothers eat during pregnancy impacts directly on the weight and health of the baby. Previously, it was thought that the baby drew essential nourishment from the mother's body to compensate for and protect itself against any shortcomings in the maternal diet during pregnancy.

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