Eating disorders are mental illnesses in which food is involved, but food itself is not the problem. Recovery is difficult because, in the case of addictions such as tobacco or alcohol, food cannot be given up; it is necessary for life. There is still a lot of ignorance about these disorders, even in healthcare settings. The best known are anorexia and bulimia, but even these are not free from myths. For example, bulimia is often associated with self-induced vomiting, but there are people who suffer from bulimia and do not vomit; they may use other means of purging or compensating.
While the WHO The US is very concerned about an obesity epidemic and is warning us about it. Eating disorders (ED) are on the rise; and even more so since 2020, as a by-product of the pandemic. The lockdown caused cases to increase by 20% and social media exacerbated the problem later. Epidemiological data showed that, before the pandemic, 5% of the female population suffered from ED, now it is between 8% and 10%. According to the most recent data, approximately 9% of the world’s population suffers from some type of these diseases, which is equivalent to about 70 million people.
There is atypical anorexia, which was recorded in the Diagnostic and Statistical Manual of Mental Disorders (DMS-V) to recognize people who suffer from anorexia nervosa without being significantly underweight. Atypical anorexia is diagnosed when all the other criteria for anorexia nervosa are present: those with it may be of normal weight —or even above normal weight, according to the body mass index (BMI)— and have an intense fear of gaining weight and restricted food intake.
Due to ignorance, as we live obsessed with weight and BMI, there are many people who suffer from anorexia, but because their weight is not low enough, they do not dare to ask for help. They do not believe they deserve it.
Anorexia without being underweight
If family doctors and other specialists are not informed that eating disorders can occur in people of any weight, not just those who are underweight, the diagnosis fails and puts patients at risk. Most cases are not diagnosed or treated appropriately if the patient’s body mass index is not below 17 or 16, which can aggravate and make the situation chronic for those who suffer from an eating disorder.
For a person who is beginning or going through an eating disorder, asking for help is a tremendous challenge due to the shame they feel. These disorders begin in private and the most problematic parts are often hidden, even from the people they live with. Added to this situation is often the fact that, when they finally decide to take the step of seeking help, either their doctor does not recognize the seriousness of the situation due to an apparently normal weight, or their family, friends or partner do not understand that there is a problem. Both factors can contribute to the chronicity of the disease.
It is crucial for healthcare professionals to recognise that eating disorders can affect people of any weight and that assessment and treatment should not be based solely on BMI. Failure to recognise the severity of an eating disorder can delay appropriate treatment and worsen long-term outcomes for patients.
It is common for eating disorders that cause significant weight loss to be treated medically with concern that the patient might go to the other extreme and begin to overeat or gain a lot of weight. This perspective can hinder recovery by maintaining restrictive behaviors throughout the recovery process. What can happen if someone gains weight during recovery? It is normal for him to do so, because there will be no restrictions or purges. Regardless of what your BMI says, it should be a weight that allows you to have a better quality of life and a full life.
Night eating syndrome
Pica is an eating disorder characterized by regularly eating things that are not food. Until the age of two, it is normal, as children tend to put everything in their mouths. From the age of two onwards, if they consume things that are not food for at least a month, it is considered pica. They may eat chalk, cushion stuffing or hair, among other things that in principle will not harm their health, but can cause blockages and infections. It is more common in pregnant women.
Another little-known but very common eating disorder is night eating syndrome. These people consume most of their calories from the afternoon onwards. During the day, they have morning anorexia and hyperphagia in the evening. They suffer from depression and other comorbidities and at night they have episodes of binge eating with high-calorie foods, but without purging. They are associated with insomnia, a deregulation of circadian cycles and the belief that if they don’t eat, they won’t be able to sleep. This eating disorder occurs in overweight and obese people, but it is also common in normal weight people.
An excessive focus on body mass index as an indicator of health ignores other important factors such as overall mental and physical well-being. We need awareness and prevention. Eating disorders are not diseases of capricious people, they are serious diseases with a high level of suffering.
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