Treatment depends on the degree of obesity. Surgery to remove body fat may be required for those who are moderately or greatly overweight. But for most people, a knowledge of good eating habits along with behavior modification may suffice, particularly if a balanced diet is accompanied by a sensible exercise program. A lifelong commitment to a properly planned program is the best way to prevent a cycle of weight gain followed by weight loss. Such a cycle is not conducive to good health.
Bulimia nervosa can coexist with either obesity or anorexia nervosa, which is discussed next. People with this condition have the habit of eating to excess (called binge eating) and then purging themselves by some artificial means, such as self-induced vomiting or the use of a laxative. Bulimic individuals are overconcerned about their body shape and weight, and therefore they may be on a very restrictive diet. A restrictive diet may bring on the desire to binge, and typically the person chooses to consume sweets, such as cakes, cookies, and ice cream (Fig. 15.13). The amount of food consumed is far beyond the normal number of calories for one meal, and the person keeps on eating until every bit is gone. Then, a feeling of guilt most likely brings on the next phase, which is a purging of all the calories that have been taken in.
Authorities recognize three primary eating disorders: obesity, bulimia nervosa, and anorexia nervosa. Although they exist in a continuum as far as body weight is concerned, all represent an inability to maintain normal body weight because of eating habits.
Obesity is most often defined as a body weight 20% or more above the ideal weight for a person’s height. By this standard, 28% of women and 10% of men in the United States are obese. Moderate obesity is 41-100% above ideal weight, and severe obesity is 100% or more above ideal weight. Obesity is most likely caused by a combination of hormonal, metabolic, and social factors. It is known that obese individuals have more fat cells than normal, and when they lose weight, the fat cells simply get smaller; they don’t disappear. The social factors that cause obesity include the eating habits of other family members. Consistently eating fatty foods, for example, will make you gain weight. Sedentary activities, such as watching television instead of exercising, also determine how much body fat you have. The risk of heart disease is higher in obese individuals, and this alone tells us that excess body fat is not consistent with optimal health.
Figure 15.13 Recognizing bulimia nervosa.
Bulimia can be dangerous to your health. Blood composition is altered, leading to an abnormal heart rhythm, and damage to the kidneys can even result in death. At the very least, vomiting can lead to inflammation of the pharynx and esophagus, and stomach acids can cause the teeth to erode. The esophagus and stomach may even rupture and tear due to strong contractions during vomiting.
The most important aspect of treatment is to get the patient on a sensible and consistent diet. Again, behavioral modification is helpful, and so perhaps is psychotherapy to help the patient understand the emotional causes of the behavior. Medications, including antidepressants, have sometimes helped to reduce the bulimic cycle and restore normal appetite.
In anorexia nervosa, a morbid fear of gaining weight causes the person to be on a very restrictive diet. Athletes such as distance runners, wrestlers, and dancers are at risk of anorexia nervosa because they believe that being thin gives them a competitive edge. In addition to eating only low-calorie foods, the person may induce vomiting and use laxatives to bring about further weight loss. No matter how thin they have become, people with anorexia nervosa think they are overweight (Fig. 15.14). Such a distorted self-image may prevent recognition of the need for medical help.
Actually, the person is starving and has all the symptoms of starvation, including low blood pressure, irregular heartbeat, constipation, and constant chilliness. Bone density decreases, and stress fractures occur. The body begins to shut down; menstruation ceases in females; the internal organs, including the brain, don’t function well; and the skin dries up. Impairment of the pancreas and alimentary canal means that any food consumed does not provide nourishment. Death may be imminent. If so, the only recourse may be hospitalization and force-feeding. Eventually, it is necessary to use behavior therapy and psychotherapy to enlist the cooperation of the person to eat properly. Family therapy may be necessary, because anorexia nervosa in children and teens is believed to be a way for them to gain some control over their lives.
Figure 15.14 Recognizing anorexia nervosa.