Walk by a magazine rack, turn on your TV or scroll through social media and you’ll likely be reminded that our culture celebrates thinness, and shames those deemed fat. This societal pressure leaves many people chasing the “ideal” body through endless diets and exercise.
But for some, the ideal body is never attainable, even if they already have it. And when they look in the mirror, they see not just flaws, but a distortion of reality. This psychological obstacle is called anorexia, and it has the highest mortality of all mental illnesses.
We talked to OhioHealth sports medicine dietitian Dawn Holmes, MS, RD, CSSD, and primary care and sports medicine physician Marguerite Weston, MD, to gain a better understanding of this serious eating disorder and learn how to overcome it.
What is anorexia?
Anorexia is one of the most commonly known eating disorders. It is considered a very dangerous psychological condition. People with anorexia are obsessed with their body image and believe they are overweight even if they look healthy or very thin. They will forgo food and exercise excessively to reduce their weight.
What are the symptoms of anorexia?
Anorexia affects all kinds of people, regardless of gender, ethnicity, weight, age or life experiences. So like any condition, anorexia can present differently in different people. Someone can be anorexic even they are not actively losing weight, or have a normal body mass index (BMI). Those with anorexia also tend to be high achievers, so they may successfully develop methods of masking their habits.
Some signs of anorexia include:
- Dramatic weight loss.
- Withdrawal or isolation from social occasions involving food.
- Eating small bites or playing with food.
- Serving meals to others, but not partaking.
- Hiding food in napkins.
- A heightened focus on calorie intake.
- Specific rules for eating.
- Excessive exercising.
- Wearing extra layers to hide weight loss.
- Significant mood fluctuations, especially if encouraged to eat.
- Increased anxiety.
- Disordered thoughts, or trouble thinking properly.
- Family members who have anorexia.
How does anorexia affect the body?
Your body needs nutrition and energy from food to function properly, so anorexia is extremely devastating for physical health.
Hair becomes thin and brittle, menstrual cycles become irregular or stop entirely, and low blood sugar will cause episodes of lightheadedness or dizziness. As weight loss becomes more significant, the body struggles with regulating temperature and digestion. People with anorexia often stay cold, wearing layers even on warm days, and may have stomach cramps, feel bloated or constipated.
Eventually, the body begins to seek fuel from protein in muscles, particularly the heart. A weakening of the heart combined with low potassium, which regulates heart rate, can be deadly. Around 10% of people diagnosed with anorexia do not survive. And because eating disorders are stereotyped as a female condition, anorexia often is overlooked in men, making them 25% more likely to die than women.
How is anorexia diagnosed?
If you suspect anorexia, start by asking the questions on the SCOFF questionnaire, which is used in the evaluation of all eating disorders. If the answer to one or more questions is yes, seek help from a psychologist.
A psychologist will also evaluate whether the individual has:
- Restricted energy intake, leading to significantly low body weight.
- Intense fear of gaining weight, even if underweight.
- Body image distortion.
How do you treat anorexia?
As with all eating disorders, the longer the symptoms persist, the harder the disorder is to treat. Early intervention with a multidisciplinary care team is critical to a successful recovery. Find a physician who is educated about eating disorders, a dietitian who can help restore health by ensuring adequate calorie intake, and a psychologist will explore underlying causes of the disorder once the patient is nourished enough to think clearly.
Depending on the severity, some anorexic patients may need an inpatient program where meals are regulated, calorie supplements can be provided and very specialized care is delivered. Other people may need regular outpatient visits with their care team or support group.
Overcoming any eating disorder is challenging, and relapses are not uncommon. But with proper treatment and nutrition, patients with anorexia can recover and live a healthy life.