Written by Dr.M.D.Mazumdar, MD
Anorexia Nervosa is a chronic and potentially life-threatening disorder in which a person does not take enough nutrition to maintain the minimum body weight necessary for a healthy body. The body weight is usually 15% or more below the normal weight for that age.
It is commonly seen in young girls in their teens or in the early twenties. But it can affect men as well as older women.
Persons especially at risk for developing Anorexia Nervosa are aspiring models, film stars, dancers, TV personalities and athletes for whom being thin is an important necessity. But young girls who are under a lot of peer pressure to be thin, and who equate thinness with beauty, can also suffer from anorexia.
Food and weight gain becomes obsessions. Most people with anorexia nervosa develop strange eating habits. They like cooking large and elaborate meals for others which they themselves do not eat.
They refuse to eat in public and hide food when they do so. They cut their food into small particles and nibble at only a little of it while giving the impression of eating well.
Loss of weight is achieved mainly by eating only low calorie food like lettuce, spinach and popcorns and excessive exercising. The daily calorie intake may be less than 1000 calories.
Types of Anorexia nervosa
There are two types of Anorexia nervosa:
Restrictive type - In this type, there is restriction of food and the amountnof calories eaten. Low body weight is maintained by a very strict dietary regime and severe exercise.
Binging/Vomiting Type - In this type of Anorexia, the person eats adequately in front of other people, but immediately afterwards, vomits out the food before it can be digested. He/she may also misuse laxatives, diuretics or enemas to emove any digested food.
This picture is that of a 40 year old woman whose only complaint was loss of periods for 1 year. She weighed only 30 kg. She looked alert and happy, insisting that she was eating normally and that her health was normal. She had to be admitted to the hospital when she had a fracture of the right femur which did not heal due to her severe ill-health and she died during treatment.
BMI according to the severity of anorexia The BMI or Body Mass Indicator indicates the weight status of an individual. It varies according to the severity of Anorexia nervosa:
Mild: BMI = 17 kg/ sq.m
Moderate: BMI 16-16.99 kg/sq.m
Severe: BMI 15-15.99 kg/sq.m
Extreme: BMI < 15 kg/sq.m
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Some Features of Anorexia Nervosa
Intense fear of gaining weight.
Distorted body image.
Sometimes purging and vomiting after every meal - a condition known as Bulimia.
Exercising to decrease weight.
Amenorrhea (loss of menstrual periods).
An innate belief that they are healthy.
Use of laxatives or diuretics to lose weight.
Sometimes the person may suffer from psychological conditions like depression, obsessive compulsive disorder or schizophrenia.
The person suffering from anorexia nervosa may complain of feeling cold due to a decrease in the core body temperature.
They may develop fine hair known as Lanugo all over the body. This hair, similar to that of a newborn, is an attempt by the body to conserve heat.
Nails and hair may become thin and brittle and the skin may become yellow and dry due to lack of nourishment.
The patient usually looks happy and alert, insisting that she has no problem other than lack of periods, and that she is eating normally.
Examination reveals an extremely thin and emaciated body. The skeltal frame juts out from under a thin sagging skin. Periods do not occur as the entire genital tract is atrophic with dormant ovaries.
The levels of circulating hormones in the blood are found to be abnormal. The levels of neurotransmitters like serotonin and norepinephrine, which are associated with feelings of happiness and satisfaction, are decreased in those with anorexia. Low levels of these chemicals are assoicated with depression.
But, people with Anorexia nervosa have high levels of hormones associated with stress like vasopressin.
Complications of Anorexia Nervosa
The severe lack of nutrition and calories causes a number of medical problems.
Low pulse and blood pressure.
Irregular heart beat and palpitations.
Osteoporosis due to low calcium intake. Fractures of bones are a common presentation.
In severe cases, the person may starve himself or herself to death.
Treatment of Anorexia Nervosa
Treatment of anorexia nervosa is very difficult. The goal of treatment is to improve the eating habits and restore normal body weight. The aim should be a weight gain of at least 1 to 3 pounds per week
Fortunately, much of the medical complications like amenorrhea and heart palpitations revert back to normal with an improvement in the body weight.
Psychological support and therapy is an esentail part of the treatment of anorexia nerosa.
Medicines to improve depression, a supportive family and a recognition by the person herself that she has an eating disorder is important.
WIth medical marijuana becoming legal, it promises to become an important treatment therapy for Anorexia. Marijuana improves thhe mood, decreases anxiety and stimulates appetite - all important goals in the treatment of anorexia.
The mortality rate or the rate of death of Anorexia nervosa is quite high at 7 - 10%.
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