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Ron Brown, Author of The Body Fat Guide
ANOREXIA, clinically referred to as anorexia nervosa, is an eating disorder based on the drive to be thin. The anorexic has an obsessive fear of being fat. Anorexics are well below normal weight and often have disturbed body images that cause them to see themselves as being fat, even if they are down to skin and bones. They usually have disturbed eating patterns that may include prolonged crash dieting, bingeing and fasting. In addition, anorexics may purge their bodies of food by self-induced vomiting and/or by over-exercising.
Ninety percent of anorexia sufferers are women. For every 200 women in the general population, one to six will be affected by anorexia. Five to 18 percent of these affected women will die from this disorder. It is the leading cause of death among people seeking psychiatric help.
Although fewer in number, men also suffer from eating disorders such as anorexia and bulimia. Studies show that the clinical features of eating disorders in men and women are the same. Men with eating disorders share the same beliefs and attitudes toward body weight and body shape as do women with eating disorders. The only differences found between men and women with eating disorders are in motivating causes.
Emphasis on leanness in athletics is a strong contributing factor to the occurrence of anorexia and purging among men as well as among some athletic women. In general, men tend to develop eating disorders due to concerns about health and fitness; women, due more to concerns about appearance and social acceptance. As a group, women are more receptive to the concept of dieting than men, which may account for the greater number of women suffering from eating disorders.
Although anorexia nervosa has been recorded as a mental disorder in medical books for many years, it wasnt until the 1960s, with its emphasis on thin-as-a-rail fashion, that awareness of the problem starting becoming prevalent.
Prolonged dieting on ultra-low calories can actually be the cause of the mental and emotional suffering seen in anorexia and can even lead to suicidal tendencies. The famous 1950 University of Minnesota Study demonstrated the devastating effect of malnutrition on the mental state of healthy volunteers who were subjected to a prison-camp diet. Note that malnutrition and muscle atrophy are not the same as low body fat. The assertion that low body fat in itself causes illnesses such as osteoporosis and endocrine problems is invalidated by many examples of healthy, well nourished, normal weight individuals who eat balanced diets and maintain low body fat percentages.
Since body fat percentages are expressed as a ratio between body fat levels and lean body mass levels, the body fat percentages of anorexics are not always as low as one may suspect, mainly because their lean body mass levels are also low. Gaining healthy lean body mass would actually lower their body fat percentage. Losing even more lean body mass would raise their body fat percentage, but this is obviously not the solution to the anorexic's problem. The fact is that low body fat percentage is not the anorexic's problem; the problem is their low level of lean body mass and malnutrition!
Depriving oneself of essential nutrients for a prolonged period may eventually drive the anorexic uncontrollably toward food and set off a binge. This may then result in a continued pattern of yo-yoing between fasting and bingeing. Anorexia allowed to progress to advanced stages requires emergency medical attention. The patient may be fed intravenously, and in some cases feeding may take place through a thoracic tube. Disturbances in tissue electrolyte balance need to be corrected, and weight gain is indicated before the patient is discharged. Unfortunately, if the patient has not received the proper counseling about the cause of their anorexic behavior, they are at risk of repeating the behavior.
Is anorexia a mental disorder or simply errant behavior? While noting that some anorexics may also be suffering from mental disorders, it is the authors opinion that anorexia is a lifestyle behavior, adopted in response to pressure from peers, parents, coaches and cultural images, and based upon a central misconception. The misconception is that reducing ones body weight by crash dieting or by prolonged dieting will improve body composition; that being thin is the same as being lean. In fact, the reality is that one can be large and have very low body fat, or one may be small and still be fat and flabby!
The anorexic often does not distinguish losses in body weight from losses in body fat. Anorexics succeed in reducing their body weight well below normal, but much of this is due to having reduced lean body mass levels. See: Minimum Lean Body Mass Levels. If a person believes that simply reducing body weight by crash dieting, purging or fasting will improve body composition, it can easily be shown that this is not the case. In fact, it can be shown that losing lean body mass makes one flabbier. Ones percentage of body fat increases! Anorexics may have loose skin resulting from the loss of muscle mass and tone. This sagging skin makes it appear to them that they are still fat and often causes them to continue on dieting. In very extreme cases they may even suffer from kwashiorkor, which is an impoverishment of blood plasma proteins that causes disturbances in osmotic pressure. Water leaks into the abdominal tissue causing abdominal distension and gives the impression to the anorexic that they are fatter.
The anorexic may be alarmed at how quickly their weight rises if they attempt to feed themselves normally. This is often due to their depleted muscle mass replenishing with water and glycogen. Athletes call this rapid increase in muscular weight carbohydrate loading.
People who attempt to persuade the anorexic to simply gain weight must be able to provide the anorexic with a method that assures mainly muscle gain, not just body fat gain! It may be helpful for the anorexic to analyze changes in their body composition as they gain weight. Then, as long as they are not overeating, they will be assured that they are not gaining much body fat. Gaining muscle tissue will actually lower their percentage body fat! See: Percentage Body Fat Page. Filling out their muscle mass will make their skin tighter and their bodies toned. They will actually look leaner and healthier.
A successful approach to recovery from anorexia involves dealing with issues of body image, body weight and food. Like the general public, the anorexic may believe in many myths and misconceptions about dieting and body composition, but often with much more severe consequences. Helping the anorexic build up their strength through proper diet and exercise and educating them about changes in their body composition is important.
Abuse issues, control issues, the desire to escape or disappear; these are also important factors that influence and contribute to the main cause of anorexia. But many people have these issues and do not develop anorexia, and not all who are anorexic have these issues. Treatments that emphasize secondary issues such as abuse, control and escape issues, may not sufficiently deal directly with the dieting and body weight misconceptions of the anorexic. A patient may never fully recover without correcting secondary causes, but anorexia is primarily an energy imbalance problem, i.e. energy imbalance is present in all cases, all the time. Anorexics will never recover without addressing this primary cause.
Drug treatments have limited value in anorexia and often exacerbate the suffering of the anorexic in the long run. Drugs do not correct the cause of anorexic behavior.
LESS THAN 1/3 OF ANOREXICS FULLY RECOVER WITH CONVENTIONAL TREATMENT. Without fully understanding how what they eat affects their weight, the treated patient may continue to fear and obsess over food and fat. Treatments that encourage anorexics to ignore their weight do not appear to provide satisfactory long-term solutions. Therapy that emphasizes body acceptance alone often does not teach the anorexic how to control their weight and reshape their body with proper diet and activity. All of this only succeeds in moving the anorexic around the problem instead of helping them solve it. This is why some anorexics may relapse after treatment or continue to feel overly anxious about their weight and eating. Many treated patients simply slip into a benign state: not harming themselves, but not totally free from the fear of food and fat, and still believing in the misconceptions about dieting and their bodies.
According to some experts, anorexia nervosa is caused by feelings of self-hatred and unworthiness. Not eating is supposed to be self-inflicted punishment. Purging is seen as relieving oneself of inner negative feelings. This type of logic is often associated with low self-esteem and feelings of guilt seen in victims of abuse. These experts may be unintentionally mixing up and confusing abuse issues with more ordinary feelings of not liking what ones body looks like, and of feeling guilty about eating food.
People suffering from poor health and depression may have no desire to eat, whereas the anorexic intentionally fights off hunger because they fear fat. One should not confuse comparing weight loss resulting from general depression or other diseases with anorexia nervosa. The situations are often different and should be carefully labeled as being distinct from each other, even though the patient may have combinations of all of the above. Abuse issues should be sorted out and addressed individually.
Anorexics reward themselves by losing weight. They enjoy food and are often hungry, but they deny themselves food in order to achieve a loftier perfectionist vision of being supremely thin. If they didnt enjoy eating, they wouldnt feel the need to purge their bodies of the food they have eaten. Purging is a technique that one learns from other eating disorder sufferers, often from other patients in a treatment center!
Anorexics are proud of their weight loss achievement and do not see the actual effects on their bodies in the same way as others. They think they have found the quickest and most efficient way to achieve their body weight goals. If dieting and exercise is good, the high-achieving profile of the anorexic causes them to reason that even more dieting and exercise is better! Unfortunately, this is not so.
The fact that the majority of anorexics exercise on a regular basis seems to contradict the premise that they suffer from low levels of self-esteem. Traditionally, people with low self-esteem hardly bother with exercise.
In summation, the author believes that anorexia is a contradictory, misguided solution to the anorexics fears and desires. It often achieves the opposite of what the anorexic originally intended. Thin is not the same as lean. Sacrificing muscle leaves one fatter.
The anorexic does not have to abandon their quest for a beautiful body in order to recover. With treatment that includes education about the effect of dieting on body composition, the anorexic can recover by choosing a more efficient and safe way to achieve their body weight goals. A complete method on how to safely and effectively reshape ones body while helping to avoid anorexia and other eating disorders is contained in the book, The Body Fat Guide, by this author.
Finally, it is extremely important that people seek out and consult closely with an expert who is knowledgeable in this area. It is extremely important that anorexics receive treatment under qualified supervision!
See also: Never Thin Enough
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