An Obsession With Dieting

Thursday's New England Journal Of Medicine takes a look at eating disorders, a problem that affects about 5 million Americans every year.

But these days, when everyone seems weight-conscious, it may not be clear when an eating behavior is unhealthy. CBS This Morning's Health Contributor Dr. Bernadine Healy clears up the confusion by answering some questions.

Most of us are concerned with our weight. Where is the line between a healthy concern with your weight and an eating disorder?

Healthy eating means consuming well-balanced nutritious meals that add up to at least 1500 calories a day and include adequate vitamins, minerals, proteins, carbohydrates and yes, fat. It also involves an "everything in moderation" approach to treats - allowing yourself the occasional cookie or ice cream indulgence.

We hear about disorders such as anorexia, bulimia, or binge eating. What's the difference?

• Those with anorexia nervosa have an extreme fear of gaining weight. They want to be a runway model or a Barbie doll. We can't be that way so they act out this conflict with bizarre relationships with foods and compulsive dieting. They either don't eat enough food or eat almost nothing. As a result, they rapidly lose weight and can become very underweight. Even then, anorexics often believe they are still overweight.
• Someone with bulimia nervosa exhibits a cycle of binging, that is, an episode of overeating, followed by purging. Purging could be by vomiting, laxatives or excessive exercise. In bulimia, the body weight tends to fluctuate around normal.
• Binge eating resembles bulimia, in that it is characterized by overeating, but bingers do not purge. They have recurrent episodes of overeating, and feel a loss of control when doing so. Most have a problem with obesity and dramatic weight fluctuations.

We usually hear or read about high school girls or college women with eating disorders. Does it ever affect men?

While eating disorders do typically occur in young women, 5 to 15 percent of cases of anorexia nervosa and bulimia and 40 percent of cases of binge eating occur in boys and young men. And those numbers are rising. Doctors also see these disorders in people 40 or older and, sadly enough, they are being seen more and more in young children.

What are some signs that one can look for when concerned about a friend or relative who may have an eating disorder?

• In anorexic women, loss of the menstrual cycle is usually the first symptom. In addition, their skin can become dry. With very little body fat, an anorexic's body compensates by growing a fine coat of soft hair. You may also notice strange eating habits - they may hide their food, cut it up into many tiny pieces, avoid eating in public or obsessively count calories.

  And then there's their weight. An anorexic can be very underweight. For example, a 5'3 woman who weighs under 95 pounds, or a 5'7'' woman under 110 pounds would be characterized as anorexic.

• Bulimia - Bulimics eat large amounts of food and soon after retreat to the bathroom. Stomach acid brought up by vomiting can wear down tooth enamel.

  If you have reason to believe that a friend or family member has an eating disorder, your ultimate goal should be to get that person to seek professional help.

What causes eating disorders?

For years researchers have tied eating disorders to severe psychological problems. Now they appear to be caused by a combination of genetics and brain chemistry. People with anorexia and bulimia appear to have deficient levels of serotonin, which is associated with moods and emotions; social and cultural factors; and psychological factors.

Can eating disorders be cured?

About half of those who are anorexic or bulimic have a full recovery, but it may take years. Doctors often treat anorexics with prescription drugs, such as antidepressants, and psychotherapy. But a new treatment may result from studies at the University of Texas Southwestern Medical Center. Researchers have identified a pair of hormones called orexin A & B that seem to influence feeding behavior in rats. It's hoped that drugs that mimic orexin might increase hunger in anorexics and induce them to eat.

Can eating disorders be prevented?

Absolutely. We do know that there are many causes. We do know it is probably a nature/nurture issue. Some people have a predisposition to it, aggravated by a combination of peer pressure, media images of what we should look like, and the parental environment.

Parents, both mother and father, have a major role in terms of building up self-confidence and being sensitive to how young girls and women talk about themselves and their eating patterns. The important thing is that young women need to appreciate who they are and their value to the world, and they need to be self-confident in the home environment.

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