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Am Fam Physician. 2004;69(7):1731-1732

What is an eating disorder?

If you think about food and weight and diets and being thin almost all the time, you may have an eating disorder. Although all of us worry about our weight at times, people with an eating disorder go too far to be thin and to keep from gaining weight. Some people with an eating disorder use food to control their emotions. There are two main eating disorders, called anorexia nervosa and bulimia.

What is anorexia?

People with anorexia (say: ann-or-ex-ee-ah) think about being thin all the time. They do not eat because they are afraid of gaining weight. They always worry about how many calories they are eating or how much fat is in their food. They may take diet pills, laxatives, or water pills to lose weight. They may exercise too much. People with anorexia think they are fat even when they are very thin. People with anorexia may get so thin that they look like they are sick. Girls and women with anorexia can get so thin that they stop having periods.

What is bulimia?

People with bulimia (say: boo-lim-ee-ah) eat a lot of food at once. This is called binge eating. Then they use laxatives or make themselves throw up. This is called purging. After a binge, some people with bulimia do not eat at all for a while. Some of them exercise a lot after a binge. They may use water pills, laxatives, or diet pills to keep from gaining weight. People with bulimia often try to keep their binge eating and purging a secret. People with this problem usually are close to normal weight, but in some people the weight goes up and down.

What causes eating disorders?

Eating disorders come from a strong feeling of need or pain. People with eating disorders may feel stressed or upset about something in their life. They also might feel like they aren't good enough or that they need to be in control. Our society puts a lot of pressure on people to be thin. This pressure can make people feel they are not good enough if they aren't thin.

Are eating disorders dangerous?

Yes. Eating disorders can cause serious medical problems. They can even kill you. They can damage your heart, skin, muscles, teeth, and stomach. Some women with anorexia stop having periods and grow fine hair all over their body, including the face. If you have an eating disorder, you might get osteoporosis (say: oss-tee-oh-poor-oh-sis). This problem makes your bones weak, so they break easily. You also might develop a serious mental illness.

What is wrong with trying to be thin?

It is healthy to be careful about what you eat and how much you eat, and to exercise. What is not healthy is worrying all the time about your weight and what you eat. People with eating disorders do harmful things to their bodies because othey can't stop thinking about their weight.

What are the symptoms of eating disorders?

If you have an eating disorder, you probably spend a lot of time worrying about how you look. You might feel guilty when you eat. You might feel guilty when you think you have not exercised enough. You might feel bad about yourself when you think you weigh too much. At the same time other people tell you that you have lost too much weight, you are thinking you are fat. If you use water pills or laxatives to lose weight, you might get muscle cramps or have heart problems.

How does my doctor find out I have an eating disorder?

Your doctor will ask questions about how you feel about yourself, what you eat, and how much you exercise. Your doctor will give you a physical exam and might order blood tests or other tests.

Can eating disorders be treated?

Yes. If your doctor thinks you have an eating disorder, you might be referred to a specialist so you can get the treatment you need. Good nutrition and counseling can help you get better. For people with anorexia, the first step is getting back to a normal weight. If you are malnourished or very thin, you may be put in the hospital. Your doctor will probably want you to see a dietitian to learn to choose healthy foods and eat at regular times. For persons with anorexia or bulimia, family and individual counseling are helpful.

Warning Signs of an Eating Disorder

  • Unnatural concern about body weight (even if the person is not overweight)

  • Too much thinking about calories, fat grams, and food

  • Use of medicines such as diet pills, laxatives, and water pills to keep from gaining weight

More serious warning signs may be hard to notice because people who have an eating disorder try to keep it secret. Watch for these signs:

  • Throwing up after meals

  • Refusing to eat or lying about how much was eaten

  • Fainting

  • Exercising too much

  • No longer having periods

  • Worrying about weight

  • Calluses or scars on the knuckles (from forced throwing up)

  • Denying that there is anything wrong

Where can I get more information?

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