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Women and Eating Disorders

Obesity and Overweight in Women
Women seem to be especially vulnerable to weight gain during three key periods of their lives: at the beginning of their menstrual cycle, after pregnancy, and after menopause. Women who are obese (with a BMI greater than 30) or overweight (BMI of 25-29.9) are at greater risk for gallbladder disease, respiratory disease, gout, sleep apnea, osteoarthritis, and several types of cancer. Overweight and obesity are also linked to a higher risk of hypertension, high cholesterol, and Type 2 diabetes, which all contribute to mortality in women. Furthermore, being obese or overweight is associated with poor pregnancy outcome, miscarriage, infertility, and polycystic ovarian syndrome.

Fact: According to the U.S. Surgeon General, overweight and obesity are increasing in both men and women. The latest estimates are that 34 percent of U.S. adults ages twenty to seventy-four are overweight, and an additional 27 percent are obese. About half of all women ages twenty to seventy-four are overweight or obese. The percentages of obese women among African-, Native-, and Mexican-American women are even higher.

Besides increasing the risk of several health problems, overweight and obesity place a great psychological burden on women. People who are obese can suffer from prejudice in society and enjoy a reduced quality of life. Eating disorders and perceptions of altered body images can begin early in a woman's life and continue throughout most of her life. Many women end up being dissatisfied with their bodies, having low self-esteem, and engaging in phases of dieting throughout life. Leading a healthy lifestyle that includes a healthy diet and plenty of physical activity is essential for women to reach and maintain a healthy weight.

Eating Disorders in Women
Eating disorders are complex and chronic illnesses that tend to be misdiagnosed and highly misunderstood. Some of the most common eating disorders include anorexia nervosa, bulimia nervosa, and binge eating. Another type of disorder under examination is extreme exercise to control weight. All of these disorders are on the rise in the United States and worldwide.

Many factors play a role in the development of an eating disorder, including personality, self-esteem, genetics, environment, and body chemistry.

Fact: Women seem to make up more than 90 percent of the people who have eating disorders. It is estimated that in the United States, at least 5 to 10 million females and 1 million males between the ages of fourteen and twenty-five have an eating disorder.

Eating disorders should be taken seriously. They require the help of a health-care provider as soon as symptoms begin to surface.

Anorexia Nervosa
Anorexia nervosa is an eating disorder characterized by a person who literally starves himself or herself by eating little to no food. People who have this condition have a strong fear of body fat and weight gain. Anorexics refuse to eat. They exhibit an intense desire to be unrealistically thin, consistently repeat attempts at dieting, and experience excessive weight loss. To maintain their abnormally low body weight, anorexics may diet, fast, or overexercise. People with anorexia will do just about anything to get or stay thin, such as self-induced vomiting and/or the misuse of laxatives, diuretics, or enemas. People with anorexia see themselves as fat, even though they are extremely thin.

One of the most dangerous hazards of anorexia is starvation. The body reacts to starvation by extreme thinness, brittle nails and hair, dry skin, a slow pulse, cold intolerance, constipation, and occasional diarrhea. In addition, a person may experience mild anemia, a loss of muscle mass, loss of the menstrual cycle, and swelling of joints. Malnutrition caused by anorexia may result in irregular heart rhythms and heart failure. The lack of nutrients can place anorexics at even greater health risk. For example, the lack of calcium places them at increased risk for osteoporosis both during their illness and in later life. Many anorexics suffer with clinical depression, anxiety personality disorders, and/or substance abuse. Unfortunately, many more are also at risk for suicide. It is estimated that one in ten anorexics will die from starvation, heart attack, or another serious medical complication, making this disorder's death rate among the highest for a psychiatric disease.

A person with anorexia may do the following:

• Eat only certain or "safe" foods, usually those with very few calories and/or little fat.
• Adopt strange rituals when eating, such as cutting food into very small pieces.
• Spend more time playing or pushing food around on the plate than actually eating it.
• Cook meals for others without eating any.
• Engage in exercise compulsively.
• Dress in layers to hide excessive weight loss.
• Become more isolated, spending less time with family and friends.

Bulimia Nervosa
Bulimia nervosa is an eating disorder characterized by a person who binges, or consumes a very large amount of food all at once, and then purges. Purging means forcing yourself to vomit, or taking laxatives or diuretics (water pills). Bulimics may also fast or use excessive exercise as a means of ridding the body of what they ate during a binge. Their binge eating is usually very secretive and uncontrolled. As with anorexia nervosa, those with bulimia are overly concerned with food, body weight, and shape.

Binge sessions can occur one or twice a week up to several times per day, and can be triggered by a wide range of emotions. With bulimia, the disorder can be constant or have periods of remission.

Medical complications that are attributed to bulimia nervosa usually result from an imbalance of electrolytes from repeated vomiting. There is usually a loss of potassium, which can damage the heart muscle, and an increased risk of heart attack. Repeated vomiting can also cause an inflammation of the esophagus and erosion of tooth enamel, as well as damage to salivary glands.

Essential: Bulimia is different from anorexia in that many individuals with bulimia "binge and purge" in secret and maintain normal or above normal body weight, so they can often hide the disorder from others for years.

Like those with anorexia, many people with bulimia suffer from clinical depression and anxiety as well as obsessive-compulsive disorder and other mental illnesses.

A person with bulimia may do the following:

• Become very secretive about food, usually planning the next binge session.
• Take frequent trips to the bathroom, especially right after eating.
• Steal food and/or hide it in strange places.
• Engage in compulsive exercising.

Binge Eating Disorder
Binge eating disorder is probably one of the most common types of eating disorders and is more common in women than in men. A majority of the people who are afflicted with this disorder are overweight or obese, but not all. A binge eating disorder results in a person's inability to control the desire to overeat. Most people with this disorder keep it an exclusive secret. Unlike bulimia, people with a binge eating disorder do not purge their food. Binge eating does show up in bulimia.

People with binge eating disorder do not eat highly nutritious diets and are at a greater risk for illness because they may not be getting the correct nutrients. They usually eat large amounts of fats and sugars, which don't have a lot of vitamins or minerals.

People with binge eating disorder may do the following:

• Feel their eating is out of control.
• Eat what most people would think is an unusually large amount of food.
• Eat much more quickly than usual during binge episodes.
• Eat until so full they are uncomfortable.
• Eat large amounts of food, even when they are not really hungry.
• Eat alone because they are embarrassed about the amount they eat.
• Feel disgusted, depressed, or guilty after overeating.

People with binge eating disorder should be advised to get immediate help from a mental health professional. For help with weight loss, they should also be advised to seek out help from a registered dietitian. Even those who are not overweight are usually upset by their binge eating, so treatment can help them.

Treating Eating Disorders
There are several different ways to treat eating disorders; presently there is no universally accepted standard of treatment. It is ideal to take an integrated approach to treatment, including the skills of registered dietitians, mental health professionals, endocrinologists, and other medical doctors. Types of psychotherapy that are often used include cognitive-behavioral therapy, interpersonal psychotherapy, and family and group therapy. Drug therapy, such as antidepressants, may be helpful for some people.

If an individual displays any of the characteristics described here for any type of eating disorder, he or she should be taken to a physician, nutritionist, or other professional with expertise in diagnosing eating disorders as soon as possible.