Even today, most people in India have not heard of “anorexia.” Among those who have, the knee-jerk image that the word conjures up is of silly teenage girls starving themselves to emaciation in their attempts to copycat the mass-market images of stick-thin models and starlets.
But doctors, nutritionists and therapists see something else: a creeping, insidious rise in the number of those falling prey to an eating disorder that can be life-threatening. Even more alarming is the fact that they are seeing this drive – literally “dying to be thin” – appearing in children at a younger age than before. Today 10-11-year-olds are being brought in to clinics by parents who are frightened that their pre-pubescent, or barely-pubescent, child has already started echoing the anorexic’s familiar and recurring cry: “I’m so FAT!”
Compared to 10 years ago, the rise in eating disorders (of which anorexia is the chief one) amounts to a virtual explosion on the Indian landscape. Psychiatrists reportedly put the numbers today at 5 to 10 times those of a decade ago. Although the trend has not quite reached the epidemic proportions that it has in the West, the signs are portentous.
Eating disorders like anorexia occur predominantly among girls and young women. But boys in their teens and young men in their 20s become victims of anorexia, too. No figures are available for India, but large population studies in the US suggest that about 1 in 4 anorexics is male. In addition, under-diagnosis and cultural stigma mean the figure could be even higher.
When pre-teen children fall prey to anorexia, it can be much more difficult to identify because it is less commonly suspected in this age group.
In their deliberate attempts to lose weight, anorexics may:
● miss meals, eat very little or avoid eating any sweet or fatty foods
● obsessively count the calories in food
● exercise excessively
● take appetite suppressants, such as diet pills
● take laxatives or diuretics (medications that help remove fluid from the body).
Over the long term, anorexic eating can lead to a labyrinthine snarl of health problems: constipation, hair loss, fragile bones, delayed puberty in children, amenorrhoea (absence of periods in a woman of reproductive age), infertility, dangerous heart rhythms, kidney and liver damage and, in the terminal stage, multi-organ failure. Sudden death can also occur, mainly from cardio-vascular complications.
But anorexia is not simply about deliberate starvation in the pursuit of a lithe and lissom figure. It is a mental illness that is wrapped up in anxiety, depression and low self-esteem. The eating patterns and the physical appearance of the affected person are merely the visible symptoms of a complex disease.
Its clinical name (anorexia nervosa) says it all. “Anorexia” means “lack of appetite”, and “nervosa” signifies its origin in nervous causes. In the 19th century it was widely regarded in the medical profession as a form of hysteria. Today, it is viewed as a disorder that is rooted in an absence of control. Dieting and losing weight give anorexics a sense of being in control of their bodies, if nothing else in their lives.
Anorexia is not immediately self-evident because its victims often keep negative feelings and unhealthy behaviors secret, and may deny they have a problem. Often it takes another person to recognize the subtle early warning signs that someone they love needs help and to encourage and support them in getting to professional care.
THE RED FLAGS
Although excessive weight loss is the most overt symptom in full-blown anorexia, in the early stages of the disorder the anorexic’s weight loss may actually be relatively modest. That is because the body is fighting tooth-and-nail, slowing down its metabolism to stay at a functioning weight. In other words, in the beginning stages, you can’t tell a person is on the road to anorexia just by looking at her.
But you don’t want to wait till the body gives up the uneven battle and you see your loved one beginning to waste away right before your eyes. Long before you see the bones sticking out of her body, long before the rush to the hospital to treat life-threatening imbalances in the electrolytes count, there are the far less dramatic but unmistakable signs that point to the likelihood of an eating disorder. They include:
1. Poor and distorted body image. Negative and obsessive thoughts about body size, a key factor in all eating disorders, can occur very early on. Anorexics-in-the-making seem to have a morbidly obese image of themselves burned in their unconscious like a horror movie. Warning signs of poor body image include negative self-talk (“I’m so fat”, “I have no self-control”), and misinterpreting other people’s remarks. ‘Hey, you’ve filled out nicely since we last met’ can be received as ‘You’re looking fat’. This body insecurity sometimes emerges — or gets worse — when young girls derive “thinspiration” from anorexic celebrity figures whose pictures appear on the Net. Not only do anorexics have a poor body image, but this self-defeating image is also a distorted one. So, even if they have started losing weight, they remain convinced they are still fat, and that they look “terrible”, “awful” or “disgusting”. In the early stages, they express these feelings quite freely. At this point in the illness, they have no idea that their self-image is so distorted and they assume that everyone is seeing them the same way that they see themselves in the mirror. (Later, as they realize that their behaviour is raising suspicions, they become more reticent about sharing their feelings about their appearance).
2. Food Obsessions. In most instances, the first signs of trouble will include an obsessive pre-occupation with food. Those who are sliding down toward anorexia will suddenly begin treating food as if it were an enemy, becoming very calorie-conscious and rejecting things that they happily ate in the past. In their minds, the equation is simple enough: Food = Body Fat. One by one, they will keep adding foods to their taboo list, until the menu of items they are willing to eat becomes quite restricted and they end up eating the same foods over and over.
3. And a touch of eccentricity. Unlike those who begin cutting junk foods, sweets, and other nutritionally-empty products from their diets, fledgling anorexics tend to compile rather eccentric lists of what they will or won’t consume, and in some cases junk foods may actually pre-dominate over more healthy choices.
4. Changes in eating habits and patterns. Those who are slipping into anorexia may begin by filling their plates with normal amounts of food at meal times, only to end up throwing much of it in the garbage later, often when they think no one else is looking. They will be not only reading nutrition labels (which is a health-conscious thing to do), but they will also be compulsively toting up the fats, carbs, total calories, in everything that they eat. Their goal, of course, is to try to eat less and less each day. Towards that end, the anorexic’s eating behaviors will include many (and sometimes, all) of these:
● Skipping meals and making excuses for not eating (e.g., saying they don’t feel hungry, or saying they’ve just eaten something, or saying they feel ill).
● Avoiding eating in public. This can be a body-image issue — a person may feel that others are watching and judging, for instance. But it can also be an indication that eating has become nerve-wracking. The act of eating can be enormously anxiety-provoking for someone with anorexia. Doing it in public just compounds the anxiety.
● Eating rituals. Compulsive behaviors similar to those seen in obsessive-compulsive disorder (OCD) can also appear with anorexia. These so-called “eating rituals” can take the form of cutting food into tiny morsels, or arranging food in certain patterns. Apart from being part of the obsessive-compulsive pattern, rituals also serve as a tactic not to eat. In the beginning stages of anorexia, a person will try to make it look like she is eating by cutting up food and shifting it around on the plate so as not to draw attention to how little she is actually eating
5. Excessive and obsessive exercise. Over-the-top workout habits — sometimes referred to as “exercise anorexia”— can go hand-in-hand with disordered eating. Often, the exercise schedule will be overly harsh. Defining “excessive” exercise can be tricky, however, especially in the case of athletes or highly-active young people. Here are two finger-snap checks: Do you panic if you miss a day of exercise? And, do you work out even when you are injured or sick? These are pretty good indices that things have gone too far.
6. Body checking. Many anorexics also resort to behaviour known as “body checking”, which involves repeatedly:
● weighing themselves
● measuring themselves, such as their waist size or hip size
● checking their body in the mirror
7. The emotional roller-coaster. Those caught in the downward spin of an eating disorder will go through changes in mood and behaviors. A few of the indicators that often accompany the onset of anorexia are: irritability, over-sensitivity to criticism, perfectionism, compulsiveness, depression, unprovoked anxiety, and a desire to be alone. If any of these characteristics are manifesting at the same time as a food obsession and/or a distorted body image, there is unquestionably good reason to be concerned.
8. Social isolation. Because anorexics are plagued by low self-worth and confidence, they may begin withdrawing from relationships, and from normal social activities. School work or job performance may also be affected.