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Eating disorders are common in America - between 5 and 10 million people have them, and experts estimate that 1% of American teens have an eating disorder. That means if your class has 400 students, probably about four of them have this condition.

Anorexia Nervosa and Bulimia Nervosa
The two most common types of eating disorders are anorexia nervosa and bulimia nervosa, more commonly known as anorexia and bulimia. The two disorders can be difficult to distinguish from each other because they have similar characteristics: With both anorexia and bulimia, the person will have a distorted image of his or her body. That person will seem to be obsessed with what he or she eats.

Both anorexia and bulimia tend to affect girls more than guys, but 10% of the people with eating disorders are guys. And, because we typically think of eating disorders as only affecting girls, they often go unrecognized in guys. Guys with eating disorders also tend to focus more on athletic appearance or success than on just looking thin.

People with anorexia have an intense fear of being fat. When a person has anorexia, he or she hardly eats at all - and the small amount of food that is eaten becomes an obsession. A person with anorexia may weigh food before eating it or compulsively count the calories of everything. It is not unusual for a person with anorexia to also exercise excessively in an attempt to lose weight.

A unique feature of anorexia is not only the strong desire to be very thin, but also the altered body perception that goes with it. Even though they might be shedding pounds at a dangerous rate, people with anorexia don't see themselves as thin. A person with the condition can look in the mirror and actually see a fat person.

Bulimia is a bit different from anorexia because the person with bulimia doesn't avoid eating. Instead, he or she eats a large amount of food then gets rid of it quickly by vomiting or taking laxatives. This is commonly known as "binge and purge" behavior. Like anorexia, bulimia tends to affect girls and young women more than guys. Unlike anorexia, you can't always tell by looking whether a person has bulimia. In fact, someone with bulimia may appear average or even above average in weight.

Warning Signs
So how can you tell if a person has anorexia or bulimia? You can't only tell by looking, of course - someone who loses a lot of weight may have another health condition. But if you know of someone who fits the patterns described below, you may want to try to 
help your friend.

Anorexia:

  • drops weight to about 20% below normal
  • denies feeling hungry
  • exercises excessively
  • feels fat
  • withdraws from social activities

Bulimia:

  • makes excuses to go to the bathroom immediately after meals
  • eats huge amounts of food, but doesn't gain weight
  • uses laxatives or diuretics
  • withdraws from social activities

What Causes Anorexia and Bulimia?
No one is really sure what causes eating disorders, although there are many theories as to why people develop them. Most people who develop an eating disorder are between the ages of 14 and 18 (although they can develop even earlier in some people). At this time in their lives, many teens don't feel as though they have much control over anything. The physical and emotional changes that go along with
puberty can make it easy for even the most confident person to feel a bit out of control. By controlling their own bodies, people with eating disorders feel as though they can regain some control - even if it is done in an unhealthy way.

For girls, even though it's completely normal (and necessary) to gain some additional body fat during puberty, some respond to this change by becoming very fearful of their new weight and feel compelled to get rid of it any way they can. It's easy to see why people may develop a fear of any weight gain, even if it's healthy and temporary: We're overloaded by images of thin celebrities - people who often weigh far less than their healthy weight. When you combine the pressure to be like these role models with a changing body, it's not hard to see why some teens develop a distorted body image.

Some individuals who develop eating disorders can also be depressed or anxious. Experts also think that some people with eating disorders may have obsessive-compulsive disorder (OCD). Their anorexia or bulimia gives them a way to handle the stresses and anxieties of being a teen and allows them to have control and impose order in their lives.

There is also evidence that eating disorders may run in families. Our parents influence our values and priorities, of course, including those toward food - which may be one reason eating disorders seem to run in families. But there also is a suggestion that there may be a genetic component to certain behaviors, and eating disorders could be one such behavior.

Sports and Eating Disorders
Some girls might be more apt to develop an eating disorder depending on the sport they choose. Gymnasts, ice-skaters, and ballerinas often operate in a culture where weight loss is important, and even runners might be encouraged to go on a diet. But in an effort to make their bodies perfect and please those around them, these athletes can end up with eating disorders.

Though it's unusual for guys to have anorexia or bulimia, it can occur, especially with the demands of certain sports. A sport like wrestling, for example, has specific weight categories that can lead some guys to develop an eating disorder. In some cases, eating disorders in male athletes are even unintentionally encouraged; they are taught that winning is the most important thing.

But the truth is that an eating disorder does much more harm than good. Athletes with eating disorders, whether girls or boys, may find that because of a lack of energy and nutrients, their athletic performance deteriorates and they become injured more often.

Effects of Eating Disorders
Whatever the cause of an eating disorder, the effects can be damaging - if not downright devastating and life threatening. People who weigh at least 15% less than the normal weight for their height may not have enough body fat to keep their organs and other body parts healthy.

A person with anorexia can do damage to the heart, liver, and kidneys by not eating enough. The body slows everything down as if it were starving, causing a drop in blood pressure, pulse, and breathing rate. (For girls, this starvation mode may mean they stop getting their periods.) Lack of energy can lead people with anorexia to feel light-headed and unable to concentrate. Anemia (lack of red blood cells) and swollen joints are common in people with anorexia, as are brittle bones. Anorexia can cause a person's hair to fall out, fingernails to break off, and a soft hair called lanugo to grow all over the skin. In severe cases, eating disorders can lead to severe malnutrition and even death.

People with bulimia often have constant stomach pain. In fact, bulimia can actually damage a person's stomach and kidneys as a result of constant vomiting. Bulimia can also cause a person's teeth to decay because of the acids that come up into the mouth while vomiting. The person may also develop "chipmunk cheeks," which occur when the salivary glands permanently expand from throwing up so often. Like girls with anorexia, girls with bulimia may stop getting their periods. And, most dangerous of all, the constant purging can lead to a loss of the mineral potassium, which can contribute to heart problems and even death.

The emotional pain of an eating disorder can take its toll, too. When a person becomes obsessed with weight, it's hard to concentrate on much else. Many times people with eating disorders become withdrawn and less social. Teens with anorexia can't join in on snacks and meals with their friends or families, and they often don't want to break from their intense exercise routine to have fun. Individuals with bulimia often spend a lot of mental energy on planning their next binge, spend a lot of their money on food, and hide in the bathroom for a long time after meals.

Eating disorders are not fun. Both anorexia and bulimia can lead to feelings of guilt and depression. Some individuals with eating disorders begin using drugs or other substances to help mask their feelings, which only makes the situation worse.

Treatment for Eating Disorders
Fortunately, people with eating disorders can get well and gradually learn to eat normally again. Because anorexia and bulimia involve both the mind and body, medical doctors, mental health professionals, and dietitians will often be involved in a person's treatment and recovery.

Therapy or counseling is a critical part of treating eating disorders - in many cases, family therapy is one of the keys to eating healthily again. Parents and other family members are important in helping a person see that his or her normal body shape is perfectly fine and that being thin doesn't make anyone happy.

The most critical thing about treating eating disorders is to recognize and address the problem as soon as possible - like all bad habits, unhealthy eating patterns become harder to break the longer a person takes part in them. If you have an eating disorder, don't wait to get help - anorexia and bulimia can do a lot of damage to the body and mind if left untreated. At worst, eating disorders can kill, and at best, they leave a person feeling and looking terrible.

If you want to talk to someone about eating disorders and you don't feel as though you can approach a parent, try talking to a teacher, a neighbor, your doctor, or another trusted adult. Remember that eating disorders are common among teens, and more importantly, that treatment is out there.

Courtesy of TeensHealth.com

Statistics: How many people have eating disorders?

  • Anorexia nervosa

Research suggests that about one percent (1%) of female adolescents have anorexia. That means that about one out of every one hundred young women between ten and twenty are starving themselves, sometimes to death. There do not seem to be reliable figures for younger children and older adults, but such cases, while they do occur, are not common.

  • Bulimia nervosa

Research suggests that about four percent (4%), or four out of one hundred, college-aged women have bulimia. About 50% of people who have been anorexic develop bulimia or bulimic patterns. Because people with bulimia are secretive, it is difficult to know how many older people are affected. Bulimia is rare in children.

  • Males with eating disorders

Only about 10% of people with anorexia and bulimia are male. This gender difference may reflect our society's different expectations for men and women. Men are supposed to be strong and powerful. They feel ashamed of skinny bodies and want to be big and powerful. Women, on the other hand, are supposed to be tiny, waif-like, and thin. They diet to lose weight, making themselves vulnerable to binge eating. Some develop rigid and compulsive overcontrol. Dieting and the resulting hunger are two of the most powerful eating disorders triggers known.

  • What age groups are affected?

Anorexia and bulimia affect primarily people in their teens and twenties, but studies report both disorders in children as young as six and individuals as old as seventy-six.

  • Overweight and obesity

Studies suggest that about sixty percent of adult Americans, both male and female, are overweight. About one third (34%) are obese, meaning that they are 20% or more above normal, healthy weight. Many of these people have binge eating disorder.

In addition, about 31 percent of American teenage girls and 28 percent of boys are somewhat overweight. An additional 15 percent of American teen girls and nearly 14 percent of teen boys are obese. (Archives of Pediatrics and Adolescent Medicine, January 2004) Causes include fast food, snacks with high sugar and fat content, use of automobiles, increased time spent in front of TV sets and computers, and a generally more sedentary lifestyles than slimmer peers.

  • Binge eating disorder

A recent study reported in Drugs and Therapy Perspectives reports that about one percent of women in the United States have binge eating disorder, as do thirty percent of women who seek treatment to lose weight. In other studies, up to two percent, or one to two million adults in the U.S., have problems with binge eating.

  • Eating disorders and substance abuse

About 72% of alcoholic women younger than 30 also have eating disorders. (Health magazine, Jan/Feb 2002)

  • What about compulsive exercising?

Because anorexia athletica is not a formal diagnosis, it has not been studied as rigorously as the official eating disorders. We have no idea how many people exercise compulsively.

  • Body dysmorphic disorder (includes muscle dysmorphic disorder)

Not yet an official diagnosis, but may achieve that status soon. BDD affects about two percent of people in the U.S. and strikes males and females equally, usually before age eighteen (70% of the time). Sufferers are excessively concerned about appearance, body shape, body size, weight, perceived lack of muscles, facial blemishes, and so forth. In some cases BDD can lead to steroid abuse, unnecessary plastic surgery, and even suicide. BDD is treatable and begins with an evaluation by a mental health care provider.

  • Subclinical eating disorders

We can only guess at the vast numbers of people who have subclinical or threshhold eating disorders. They are too much preoccupied with food and weight. Their eating and weight control behaviors are not normal, but they are not disturbed enough to qualify for a formal diagnosis.

  • Eating disorders in Western and non-Western countries

In a study reported in Medscape's General Medicine 6(3) 2004, prevalence rates in Western countries for anorexia nervosa ranged from 0.1% to 5.7% in female subjects. Prevalence rates for bulimia nervosa ranged from 0% to 2.1% in males and from 0.3% to 7.3% in female subjects.

Prevalence rates in non-Western countries for bulimia nervosa ranged from 0.46% to 3.2% in female subjects. Studies of eating attitudes indicate abnormal eating attitudes in non-Western countries have been gradually increasing, presumably because of the influence, at least in part, of Western media: movies, TV shows, and magazines. Researchers conclude that the prevalence of eating disorders in non-Western countries is lower than that of Western countries, but it appears to be increasing.

  • Mortality and recovery rates

Without treatment, up to twenty percent (20%) of people with serious eating disorders die. With treatment, that number falls to two to three percent (2-3%).

With treatment, about sixty percent (60%) of people with eating disorders recover. They maintain healthy weight. They eat a varied diet of normal foods and do not choose exclusively low-cal and non-fat items. They participate in friendships and romantic relationships. They create families and careers. Many say they feel they are stronger people and more insightful about life in general and themselves in particular than they would have been without the disorder.

In spite of treatment, about twenty percent (20%) of people with eating disorders make only partial recoveries. They remain too much focused on food and weight. They participate only peripherally in friendships and romantic relationships. They may hold jobs but seldom have meaningful careers. Much of each paycheck goes to diet books, laxatives, jazzercise classes, and binge food.

The remaining twenty percent (20%) do not improve, even with treatment. They are seen repeatedly in emergency rooms, eating disorders programs, and mental health clinics. Their quietly desperate lives revolve around food and weight concerns, spiraling down into depression, loneliness, and feelings of helplessness and hopelessness.

Please note: The study of eating disorders is a relatively new field. We have no good information on the long-term recovery process. We do know that recovery usually takes a long time, perhaps on average three to five years of slow progress that includes starts, stops, slides backwards, and ultimately, movement in the direction of mental and physical health.

If you believe you are in the forty percent of people who do not recover from eating disorders, give yourself a break. Get into treatment and stay there. Give it all you have. You may surprise yourself and find you are in the sixty percent after all.

  • Miscellaneous statistics

From England: A 1998 survey done by Exeter University included 37,500 young women between twelve and fifteen. Over half (57.5%) listed appearance as the biggest concern in their lives. The same study indicated that 59% of the twelve and thirteen-year-old girls who suffered from low self-esteem were also dieting.

Dieting teens: More than half of teenaged girls are, or think they should be, on diets. They want to lose all or some of the forty pounds that females naturally gain between 8 and 14. About three percent of these teens go too far, becoming anorexic or bulimic.

Unrealistic expectations: Magazine pictures are electronically edited and airbrushed. Many entertainment celebrities are underweight, some anorexically so. How do we know what we should look like? It's hard. The table below compares average women in the U. S. with Barbie Doll and department store mannequins. It's not encouraging. (Health magazine, September 1997; and NEDIC, a Canadian eating disorders advocacy group)

 Average woman

 Barbie

  Store mannequin
 Height

 5' 4"

 6' 0"

 6' 0"
 Weight

 145 lbs.

 101 lbs

 Not available
 Dress size

 11 -14

 4

 6
 Bust

 36 - 37"

 39"

 34"
 Waist

 29 - 31"

 19"

 23"
 Hips

 40 - 42"

 33"

 34"

  • Determining accurate statistics is difficult.

Because physicians are not required to report eating disorders to a health agency, and because people with these problems tend to be secretive, denying that they even have a disorder, we have no way of knowing exactly how many people in this country are affected.

We can study small groups of people, determine how many of them are eating disordered, and then extrapolate to the general population. The numbers are usually given as percentages, and they are as close as we can get to an accurate estimate of the total number of people affected by eating disorders.

Now, that having been said, the journal Clinician Reviews [13(9]) 2003] estimates that each year about five million Americans are affected by an eating disorder. But there is disagreement.

The National Association of Anorexia Nervosa and Associated Disorders states that approximately eight million people in the U.S. have anorexia nervosa, bulimia, and related eating disorders. Eight million people represents about three percent (3%) of the total population. Put another way, according to ANAD, about three out of every one hundred people in this country eats in a way disordered enough to warrant treatment.

Courtesy of ANRED.com

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