Wanting More and More

In the second part of our series on Eating Disorders, Smriti Daniel speaks to Consultant Dietician Sigrid de Silva about Compulsive Overeating
Guilt, helplessness and self- loathing are not emotions one would usually associate with sitting down to a big meal. Unfortunately, for those with an Eating Disorder ED) these feelings dominate their experiences with food. ED has its share of famous victims – Princess Diana struggled with bulimia and one time Spice Girl, Victoria Beckham confessed to being anorexic – but all the publicity seemed to point in one direction. ED was seen primarily as a problem in Western countries, while we in Asia were spared.

In recent decades though, ED has begun to go global. Cases of ED have been reported in many Asian cities, including Taipei, Singapore and Hong Kong. Now, we’re beginning to see it in Colombo as well, says Consultant Dietician Sigrid de Silva, explaining that in a disturbing trend, many of the ED patients she sees are even younger than average.

In part 1 of our series we discussed the rising incidence of ED in Sri Lanka and its appearance in the school yard. We also addressed the conditions of Bulimia and Anorexia. Now in part 2, we sit down with Sigrid to talk about Compulsive Overeating.

Addicted to food

Compulsive overeaters have a complex relationship with their food. A meal is clearly motivated by more than simple hunger as food is typically consumed in excessive, even dangerous quantities at a very fast pace. After having been sucked into such an episode, a binge eater is likely to feel self-loathing and guilt.

Almost everyone overeats from time to time. With binge eaters however, such episodes are a regular and uncontrollable habit. Food is used as a way to deal with overwhelming emotions, battle anxiety and to cope with daily stresses, says Sigrid.

Compulsive overeaters differ from bulimics in that while they also indulge in episodes of uncontrolled binge eating, they do not attempt to purge themselves of all those extra calories by inducing vomiting or purging. This is why, unlike bulimics, compulsive overeaters tend to be overweight.

As the pounds pile on, social disapproval might contribute further to making the person feel unattractive and alone. In addition, knowing their dietary choices are abnormal means that the individual is compelled to eat alone or in secret, leading to further isolation.

In order to feed their habit, individuals might hide food in unlikely but accessible places, says Sigrid, speaking of patients who attempt to keep food handy at all times. Compulsive overeaters are locked in a constant struggle with weight gain, and more often than not are overweight or obese.

Unfortunately, obesity is in turn linked to a host of medical complications. In the short term, the additional weight can mean that patients have trouble with even relatively light exercise. Frequent joint pain may be reported as their bodies struggle to carry the additional kilos. Such patients are at risk of a heart attack and often have high blood-pressure, blood glucose levels and cholesterol, says Sigrid, explaining that kidney disease, arthritis and bone deterioration, and stroke are all long term risks for those with such a poor diet. Other symptoms include mood swings and insomnia. While some patients report a lowered sex drive, others lean toward promiscuity.

The underlying problem

The causes of eating disorders are difficult to pinpoint with accuracy, but they are currently believed to arise from a combination of genetic, neuro-chemical, psycho-developmental, and socio-cultural factors. At their heart, all forms of ED are heavily linked to psychological issues such as poor self-esteem, emphasises Sigrid, explaining that the multi-faceted nature of the disease requires that a team composed of a psychologist, a physician and a dietician oversee the treatment of a patient with ED.

Existent research says that the symptoms of binge eating disorder usually appear in late adolescence or early adulthood. A binge eating episode typically lasts around two hours, but some people binge on and off all day long.

However, ED patients are getting younger all the time. One reason might be that children are increasingly exposed to stereotypes of beauty as propagated by mass media. While thin is seen as beautiful, being overweight can earn a child critical remarks from his or her peers. When a body falls into the grip of ED at such a young age, the long-term effects can be devastating, says Sigrid, explaining that ED plays havoc with normal development and hormonal levels.

However, studies on the effect of ED on pre-pubescent children in Asia are few and far between and Sigrid says that reliable statistics for their incidence in Sri Lanka appear to be non-existent.
From the perspective of a dietician, treating Compulsive Overeating is based on teaching a patient to develop a healthy relationship with their food, one in which food is used to meet nutritional needs instead of emotional ones. Specialists like Sigrid will help you focus on creating a balanced meal plan that helps undo the damage inflicted by ED.

Mixed ED

Diagnosing an ED is not always a straight forward process. Studies have shown that patients can swing between anorexia and bulimia, while some of the symptoms are shared across the various categories. For instance, there are those with symptoms of anorexia who have normal menstrual cycles. For some, episodes of binge eating follow attempts to stick to a strict diet, says Sigrid.

Over-exercising

Can there be too much of a good thing? Compulsive exercise can sometimes be just an extension of an eating disorder. Here, the patient uses exercise to compensate for overeating, opting for the treadmill instead of laxatives or diuretics. In the grip of one of these episodes of over exercising, a patient might repeatedly stretch themselves past the point of safety. There is little fun or satisfaction to be had, instead they are compelled by guilt to burn the calories up.

Long term damage to the body is not uncommon in those who over-exercise: dehydration, bone damage, stress, degenerative arthritis, disruption of the menstrual cycle (amenorrea) and reproductive problems, and heart problems have all been reported.

Are you a binge eater?

The more times you answer ‘yes,’ the more likely it is that you have a binge eating disorder.

• Do you feel out of control when you’re eating?
• Do you think about food all the time?
• Do you eat in secret?
• Do you eat until you feel sick?
• Do you eat to escape from worries, relieve stress, or to comfort yourself?
• Do you feel disgusted or ashamed after eating?
• Do you feel powerless to stop eating, even though you want to?

Credit: Sunday Times –
MediScene  http://www.sundaytimes.lk/110515/MediScene/mediscene_6.html