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Volume CXXXII, Number 8 |
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Eating disorders revisited
JEFF BENSON, M.D.
DUDLEY COE HEALTH CENTER
Dear Dr. Jeff: "It seems like there are a lot of people here struggling with eating disorders. What can we do to help out?" P.W.
Dear P.W.: We don't know the exact prevalence of eating disorders on campus, but we do know that it's too high.
According to the National Institute of Mental Health, over 5 million Americans suffer from eating disorders. Studies have estimated that up to half of female college students consider themselves "extremely worried" about body image, weight management, or out-of-control eating. At Bowdoin, according to last Spring's Survey of students, over 40 percent of women describe themselves as only "sometimes" or "never" satisfied with their weight, and an even higher number report "feeling fat". Over one-third of Bowdoin students report feeling pressured to eat or limit their eating at least once or twice weekly, and nearly half report feeling negatively impacted by someone else's eating habits.
Nationally, the statistics are somewhat clearer. Some 15 percent of young women have at least substantially disordered eating troubles. Some 1,000 of those women die each year from complications of anorexia nervosa alone, most commonly from suicide.
The non-fatal medical complications of eating disorders can be debilitating. Anemia, lowered immune function, bleeding disorders, pancreatitis and kidney stones are not uncommon. Loss of body fat and malnutrition quickly lead to hormonal dysfunction and thinning of the bones (osteoporosis). Bone loss can certainly lead to stress fractures, but more importantly, can rob young women of the skeletal strength they will need for the rest of their lives. Osteoporosis in undernourished women cannot be prevented by taking birth control pills, and if prolonged, can be irreversible.
The most common eating disorders include bulimia nervosa (binging and purging) and anorexia nervosa (food restricting). Compulsive exercising and over-exercising, either in combination with restricting, binging or purging, or on their own, belong to this same family of troubles.
Even normal exercising by an underweight, undernourished individual can be quite dangerous. With excessive weight loss, the heart (a muscle, after all) thins and gets smaller and weaker. Its ability to pump harder and faster on demand is compromised, and normal elevations of heart rate, blood pressure and oxygen consumption, all healthy responses to the aerobic challenge of exercise, become impaired. Abnormal heart beats and conduction abnormalities commonly result, and these can prove dangerous indeed.
In trying to help a friend with a possible eating disorder, it's important to remember that the disordered eating likely represents an attempted solution to other problems. It may represent an effort to cope with other inner struggles, and to communicate the pain of those struggles. A friend might be trying to manage the anxiety of low self-esteem, feelings of helplessness, problems at school, or troubled relationships with family or others. Disordered eating and exercising behaviors are intended to be self-protecting, but in reality become self-destructive and very dangerous.
If you speak to a friend about a possible eating disorder, stay focused on how you feel about what's happening to her or him. Express your concerns about specific changes you've noticed or observations you've made (about her or him as a person, not about the disordered eating itself). You'll need to have realistic goals for your conversation. Prepare yourself for the possibility that you'll make your friend defensive and even angry. Hopefully, you'll be able to open the door to talking more, to show your support and concern, and to offer to help get help.
There are many resources on campus for help with eating disorders. Feel free to contact someone at the Health Center, the Counseling Center, or W.A.R.R.I.O.R.S. The Health and Counseling Services both have on their websites a quick and confidential on-line screening test for eating disorders, depression, and alcohol problems. Both websites also have information and links for further reading about eating disorders. Check out the American Anorexia and Bulimia Association at www.aabainc.org, "Go Ask Alice" at www.goaskalice.columbia.edu, "Something Fishy" at www.somethingfishy.org, or "About Face" at www.about-face.org.
We live in a culture that idealizes distorted body images and equally distorted lifestyle expectations. We all need to do our part to start changing our culture. We must also be willing to reach out to each other, to try to understand each other, to support each other in our struggles. This means trying to build a sense of true community here at Bowdoin. Maybe it is our obligation to each other-and to ourselves. Certainly the effects can be life-changing. They might also be life-saving.
To all of our healths!
Jeff Benson, M.D.
Dudley Coe Health Center