Bulimia Nervosa is an eating disorder brought about by society’s huge pressure on people to look good. What society has failed to do is explain that looking good could also be done by living a healthy lifestyle. This has affected some people psychologically that more often than not, they undergo shortcuts just to maintain a slim-body figure.

People who suffer from bulimia spend most of their time thinking about how to keep an ideal body image and weight. Symptoms of bulimia are similar to those suffering from anorexia nervosa. However, it is harder to detect people who suffer from bulimia because they show no outward symptoms like thin figures. People who suffer from bulimia, in fact, have a good physique and show no obvious eating or health disorders.

Signs and Symptoms of Bulimia

One of the major signs that a person might be suffering from bulimia are episodes of binge eating. This, however, is not easily visible and as most patients binge in secret. Changes in eating habits are mainly due to a person’s psychological condition. Feelings of guilt, shame, depression or self-contempt characterize the emotional state of the patient. This in turn forces a person to indulge in episodes of binge eating followed by vomiting in an ever-unconscious effort to maintain that ideal appearance. Here are some indications of bulimia nervosa:

• Going to the bathroom during meals.
• Preoccupation with body image and weight.
• Weight usually is within the normal range, but there are some who could be overweight or underweight.  However, the weight is not constant.
• Self-induced vomiting, misuse of laxatives, diuretics, or other medications, and over-exercising as a compensatory behavior.
• Depressed or anxious.
• Foul-smelling breath.
• Using substances such as alcohol or stimulants.
• Dental cavities, and ragged or chipped teeth because the enamel of the tooth is destroyed due to the recurrent vomiting.
• Irregular menstruation.
• Constipation, diarrhea, abdominal pain.

Factors that cause Bulimia

There are no definite reasons or factors which cause bulimia. Some studies suggest that this medical condition maybe genetic because incidents of bulimia increase with patients whose family members also suffer from this medical condition. Pressure from society and the huge value it places in outward appearance is believed to be the main cause for people suffering from bulimia.

This pressure affects the patient’s psychology that looking good is confused with feeling good. Depression, substance abuse, self-mutilation, and obsessive-compulsive behavior are also factors which may cause bulimia.  Athletes and those in the Entertainment Community also have a greater risk of acquiring this eating disorder.

Management and Treatment

People suffering from bulimia may suffer for years from this eating disorder before being detected. This has been a part of their lives for so long that they find themselves in denial that they are suffering from this medical condition. Like any type of psychological condition the first step of treatment is to help the patient realize that he is suffering from an eating disorder. Psychotherapy and consultation with a dietitian are the next steps in medical treatment.

Winning the patients trust is the first step for the treatment of Bulimia

Psychotherapy, family therapy and medications are the major types of treatments open for people suffering from bulimia nervosa. The most effective treatments are often those involving a combination of psychotherapy and medications. Winning the patients trust is, however, the first step in any type of treatment.

Medications

Doctors may prescribe antidepressants; symptoms of bulimia are similar to anorexic patients where depression is one of the main symptoms of the eating disorder. Medications, however, must be closely supervised as they could lead to addiction or even suicides.

Psychotherapy

This type of treatment involves behavior conditioning and replacing unhealthy habits.  This helps the patient gain a more positive outlook and improves self-esteem.

Dietitians

Doctors, psychologists and dietitians often work with each other in restoring the patient into full health. The major complication of bulimia are poor nourishment because of a poor diet. Patients are likely to have vitamin and mineral deficiencies which result in poor judgment or memory gaps.

Patients suffering from bulimia require continuous care because relapses of the eating disorder may cause major complications which pose a serious threat to the individual. Medications are often prescribed for treatment, but continuous monitoring is required as these medications have serious side effects. For patients who have a long history, scheduled visits and follow ups with their local physician are needed to monitor the patients progress.

Written by Ronald Uy RN

Sources:

Bulimia Nervosa. Retrieved November 9, 2009 from Bupa: http://hcd2.bupa.co.uk

Bulimia Nervosa. Retrieved November 9, 2009 from HELPGUIDE.org: http://helpguide.org

© H.I.C 2009

In our world today where everyone wants to be a celebrity, an athlete or a model, it is always a requirement to look good in public.  Unfortunately, most people equate looking good to being thin.  This has brought a major impact in the mindset of people with all the media hype of skinny females as being models of good health.  Some people become so obsessed in becoming thin that they sometimes starve themselves to death. Unknowingly, these people might already be suffering from a disorder called Anorexia Nervosa.

Anorexia Nervosa is a type of psychological eating disorder.  An anorexic person will go far beyond the dieting process, which at first will lead to weight loss, before they will discover that they have lost more than their ideal body weight.  They have the drive to be thinner, and they have this irrational fear of gaining even just a little amount of weight.  Other than consistent withholding of food intake to almost starvation with excessive exercising, they will also have the tendency to use diuretics, laxatives, enemas just to lower their weight.  This is their means of having a sense of control over their body, and it becomes an obsession or more like an addiction to weight loss.

More often than not, those people who suffer this type of eating disorder belong to the female gender, but this does not mean that males are exempted.  Years ago, it was common during the adolescent years but as of today, even younger children and adults are at risk.  While it can affect other races, most of those who are at risk are Caucasians.  Middle and upper socioeconomic groups are also prone to suffering from this disorder. Other risk factors are those who work as models, athletes, actors, and dancers.

What are the causes of Anorexia?

There is no definite cause of anorexia nervosa.  Most often, it is the pressure and influence of the media that being thin is attractive.  This means that it may be because of the lack of self-confidence that leads to poor self-image. Some experts, however, claim that this could be a genetic problem. It is believed that the part of the brain that controls metabolic functions, which is called the hypothalamus is affected in an anorexic person.  Other research suggests that it is due to chemical imbalances of the brain’s neurotransmitter.

How do doctors diagnose Anorexia?

Because this is more of a psychological disorder, it can be very difficult to diagnose.  Most patients will deny that they are anorexic and will not seek medical attention.  When complications have developed, this is the only time that the actual diagnosis is made.  In this case, the doctor will have to obtain information from the parents of the patient and friends to identify the extent of weight loss.

There are four criteria set under the American Psychiatric Association to diagnose anorexia.  First, the client will refuse to maintain the expected normal weight for age and height.  Second, they have an irrational fear of gaining weight, and they think they are becoming fat, even if they are below the normal body weight.  Third, they have distorted self-perception.  And lastly, they have amenorrhea (they have missed their menstrual cycle for consecutive three times).

In addition, anorexics binge and purge.  They will induce vomiting or use laxatives and diuretics.  While some will almost starve themselves without binging or purging.

Symptoms of Anorexia

Clients with anorexia have severe weight loss leading to depression and self-isolation.  Since their psychological aspect is affected, they become irritable and get upset easily.  They tend to withdraw from social interactions. Anorexics have sleep disturbances, so they feel fatigued during the day. Less food intake can lead to decreased concentration and attention.

Anorexics are obsessed with food often collecting recipes and hoarding food. In addition, they tend to be perfectionists. They try to please everybody, going beyond what is expected.  When their family pressures them to look good, they may over-exercise.

On the physical aspect, complications due to starvation could lead to the following problems:

• Slow heart rate, irregular heart rhythm and low blood pressure.
• Abdominal pain and constipation.
• Irregular menstrual cycle with absence of menstrual periods.
• Low blood potassium; increased or decreased urination.
• Increased risk for fracture because of the thinning of bones.
• Loss of essential amounts of electrolytes due to self-induced vomiting.
• Anemia or decreased red blood cells.
• Dry and flaky skin
• Fine hairs seen on the face, back, arms, and legs.
• Hair loss.
• Brittle nails.
• Frequent sore throat, tainted teeth and eroded dental enamel due to frequent vomiting.

Can Anorexia be Treated ?

Definitely, in fact it can be treated without having to admit the person to the hospital, unless there are  medical complications.  The malnutrition may have to be treated in severe cases through intravenous feeding or a tube.  The patient should gain at least 1-3 pounds per week.  A team composed of a nutritionist, mental-health-care provider, and a medical-health-care provider is needed to provide care for the patient.

Counseling is also available for anorexics.  Some need group and family therapy which has proven effective in treating anorexia nervosa.  They are taught to understand more about self-control and self-perception.  Either way, the main focus of therapy is to attain a healthy life in both physical and psychological aspects. In terms of medications, some will have to be treated for their compulsions.  Anti-depressant drugs have shown remarkable success in helping control mood and anxiety symptoms.

Anorexia Nervosa: when left untreated can lead to suicide. Other dangers posed by anorexia are death due to medical complications.  Early detection and treatment can avoid such problems.  While some may have relapses, it is important also that individuals suffering from anorexia nervosa have support from their families and friends to ensure successful treatment.

If you have time watch the PBS special on Eating Disorders below.

Written by Ronald Uy, RN

© 2011 H.I.C. Digestive Health

References:

Anorexia. Retrieved October 17, 2009 from Mama’sHealth.com: http://www.mamashealth.com

Eating Disorders. Retrieved October 17, 2009  Something Fishy: http://www.something-fishy.org

Anorexia Nervosa. Retrieved October 18, 2009 from FamilyDoctor.org: http://familydoctor.org

Obesity is not only the biggest health concern in the United States, but in growing numbers around the world. In America and globally segments of society that were once never included in obese statistics are now part of the mix. This escalates every year at an increasingly alarming rate and unfortunately the United States has the highest obesity rates in the world, with 74.1% of adults being overweight or obese. It’s a cold hard fact almost two-thirds of the American population is overweight and half of them have graduated into full-blown obesity.

Latest Gallup-Healthways Well-Being Index

Estimates of the number of obese American adults have expanded from 19.4% to 26.6% in 2007.  The staggering direct medical costs topped the charts at $61 billion while indirect economic loss is a whopping $117 billion in 2000.  Obesity rates have increased across the board in all population demographics in the United States over the last several decades.  The prevalence of severe obesity quadrupled from one in two hundred Americans to one in fifty while extreme obesity in adults increased by a factor of five, from one in two thousand to one in four hundred. The most dramatic increases have been in children and adolescents, nearly tripling over the same period. About nine million children over age six are classified as obese. Numerous warnings from the American Heart Association, National Institute for Health and Center for Disease Control and Prevention have released numerous warnings about obesity. Things haven’t been moving in a positive direction. Two decades ago the incidence of being overweight in adults was just 50% and rates for kids were one third of today’s figures.

Obesity would not be such a big problem if it was just about appearance. Being overweight puts great amounts of pressure on the body. Obesity is known for causing dangerous medical conditions such as cardiovascular disease, diabetes, infertility, gallbladder disease and cancer to name a few.

Obesity isn’t entirely based on weight; a 200 pound (90 kilograms) man is not always overweight. Obesity or being overweight is based on factors like age, sex and height. A person who is overweight means that his weight is above what is considered healthy.

Age Groups

Traditionally, adults have been most at risk for obesity, but in the last two decades children and adolescents are the fastest rising groups with 15 to 20 percent now- officially obese.  What’s alarming is that with these statistics, our nation’s youth are now bringing a level of serious health risks to adulthood long before their parents had, setting up a scenario for a population segment already on dangerous ground.  It’s estimated that almost 25 percent of our youth are either overweight or obese.  Looking at the long-term consequences, overweight adolescents have a 70 percent chance of becoming overweight or obese adults, and that increases to 80 percent if one or more parent is overweight or obese.

As a person ages, metabolic processes slow down, making it more difficult for older people to maintain their weight. An understanding on how aging affects the body and a proper diet could go a long way in avoiding obesity and other medical disorders.

Anti Obesity Efforts

Under pressure from parents and anti-obesity advocates, many school districts have banned sodas, junk foods and candy from vending machines and cafeterias.  State legislators in California passed laws that ban selling machine-dispensed snacks and drinks in elementary schools in 2003 – despite objections by the California-Nevada Soft Drink Association.

In 2006, the American Beverage Association agreed to a voluntary ban on the sale of all high-calorie drinks in elementary, middle and high schools.

The American First Lady Michelle Obama is leading an initiative to combat childhood obesity entitled “Let’s Move.” Mrs. Obama says she aims to wipe out obesity “in a generation.” Let’s Move! has partnered with other programs.

The fastest growing fast-food chain is now Subway, whose menu offers a proportionately larger selection of healthier foods low in fat, carbohydrates and salt.

The diet/exercise industry continues to boom with high-profile TV ads and infomercials selling exercise videos equipment and the more drastic surgical options, such as gastric bypass and lap band procedures.

“Americans spend an estimated $40 million a year on weight-loss programs and products. Clearly the diet industry continues to boom, as the consumer market is flooded with books, pills, gadgets and fads all to tantalize our fantasies our achieving that “perfect” size.”  Bloomberg Businessweek

Medical Costs

A marked rise in obesity-related medical issues includes Type II diabetes, hypertension, cardiovascular disease, and a host of other disabilities.  Diabetes has become the seventh leading cause of death in the United States, with the U.S. Department of Health and Human Services estimating that fifty-seven million adults aged twenty and older were pre-diabetic in 2008; 23.6 million were diabetic, with 90–95% of the latter were Type II.  Obesity has also been shown to increase the prevalence of complications during pregnancy and childbirth.

Obesity has been recognized as a major contributing factor to about 100,000–400,000 deaths in the United States per year and increasing health care use and expenditures, costing an estimated $117 billion in direct (preventive, diagnostic, and treatment services) and indirect (absenteeism, loss of future wages due to early death) costs.  This far outstrips costs associated with smoking or drinking issues, accounting for 6% to 12% of national health care expenditures in the United States.

BMI (Body Mass Index)

Obesity is defined as abnormal or excessive fat accumulation that presents a risk to health. A crude population measure of obesity is the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in meters). A person with a BMI of 30 or more is generally considered obese. A person with a BMI equal to or more than 25 is considered overweight. (World Health Organization)

BMI or the Quetelet Index is a simple tool for determining if a person has a healthy height to weight ratio. This does not represent the actual percentage of fat in a person’s body but gives an estimate if a person is overweight, normal or underweight. BMI is computed by dividing a person’s weight in kilograms by his height in meters. The result is then compared to a chart which shows normal ranges for a person’s height.

A person is found to be in his optimal weight range if results are found to be between 18.5 and 25. People who are below 18.5 are said to be underweight, eating disorders such as anorexia nervosa are considered for some whose BMI score is 17.5 or less. BMI scores which are above 25 are considered overweight and results more than 30 are found to be obese.

It is important to understand that BMI is not an accurate indicator of a person’s state of health. Other factors may affect a person’s weight must also be taken into consideration. People with high bone density and athletes with a highly developed physique are found to be above normal BMI levels, but are perfectly normal.

Here is the formula for computing BMI:

BMI = Weight (kilograms)/ Height² (meters)

• It is important that units of measurement like weight (pounds to kilograms) and height (feet to meters) should be converted first for accurate results.

Categories/Results:

• Starvation          less than 16.5
• Underweight     from 16.5 to 18
• Normal              from 18.5 to 25
• Overweight        from 25 to 30
• Obese Class I     from 30 to 35
• Obese Class II    from 35 to 40
• Obese Class III   40 and above

What Causes Obesity?

Why is this happening? The obvious reason is that we’re simply eating too many calories.  Lifestyle is the leading cause of obesity today. Attitudes towards the food we consume and towards exercise have created the problem it is today.

It is always important to find a balance in everything. Eating should be balanced by physical activity. Obesity is often caused by eating large amounts of food and living a sedentary lifestyle. Some people maintain their weight by living an active lifestyle through sports activity or working out in a gym.

Environmental factors also influence obesity. Workplaces and long work hours requiring an individual to sit for long periods of time increase the risk for obesity. Infrastructures and equipment which promote a lazy attitude such as elevators also influence attitudes towards health and physical exertion.  Advertisements promoting unhealthy foods tend to condition our minds into believing it’s okay to consume high-fat diets.

Genetics or a family history of obesity is also an indicator that one might be at risk. Metabolic disorders which determine how much and how fast your body breaks down certain types of food may be passed down from your parents.

Medical conditions such as metabolic disorders or hormonal abnormalities may cause abnormal weight gain. Some digestive disorders also increase your risk for obesity.

Taking medicines like corticosteroids and anti-depressants can lead to abnormal weight gain. These medicines affect the rate at which your body burns calories as well as water retention factors that contribute to weight gain.

Psychological conditions affecting a person’s appetite can increase a person’s food intake. Some people turn to eating when upset or stressed out. Over time, eating becomes a reaction towards stressful situations, subconsciously fueling excessive food intake.

The aforementioned aging factor is one that cannot be changed. Greater care in maintaining weight as one ages is essential for a longer quality of life.

Lifestyle Changes

Obesity is a lifestyle disease. As with any other disease which is mainly due to poor diets and unhealthy lifestyles, discipline and information is the best way of preventing these diseases. Successful government campaigns against smoking and drunk driving has increased national consciousness and about those issues. A more aggressive campaign spotlighting obesity could certainly pave the way to reducing the number of Americans found to be overweight and preventing future generations from suffering the same fate.

Written by Ronald Uy, RN

© 2009 H.I.C. Digestive Health

Sources:

1. Wikipedia:  Obesity  (4/18/11)
   http://en.wikipedia.org/wiki/Obesity
2. Center for Disease Control (3/1/11):
   http://www.cdc.gov/obesity/index.html
3. Wikipedia:  “Obesity in the United States (4/18/11):
   http://en.wikipedia.org/wiki/Obesity_in_the_United_States
4. CBS News (2/11/09):
   http://www.cbsnews.com/stories/2006/12/01/eveningnews/main2222867.shtml

Metabolic disorder is a general term that describes a wide range of diseases that affect normal body metabolism. Causes vary ranging from hereditary factors, such as those being passed on from your parents, to diseases which affect the production of enzymes needed for the metabolic process.

Metabolism is the process of breaking down food into their simpler components which the body can use for normal body functioning and growth. Food is broken down into three basic components– fats, proteins and carbohydrates. People with slow metabolism will find it harder to keep their weight down because fats are not broken down fast enough to be used by the body. The excess fat is stored, which is why some people even those on a diet have a hard time keeping their weight down.

Genetics

Some people are more prone to being fat than others; this is not a myth, but a fact. A careful study of your family’s medical history could also give you an idea if you are at risk of developing a metabolic disorder.

Medical Conditions or Diseases

A wide range of medical conditions display metabolic disorders as a major symptom of the disease. Effects on the body vary with regards to what the disease affects. Below are two common diseases associated with metabolic disorders.

• Diabetes is one of the most common metabolic disorders. People suffering from diabetes have a difficult time breaking down sugar. Insulin is taken to breakdown sugar and it prevents a dangerous accumulation of sugar in the blood. Mild types of diabetes are treated with simple diet and exercise.

• Gout is a medical condition commonly found in men. Gout is characterized by excess uric acids in the body. Being overweight predisposes a person to this condition. Arthritis or swelling in the joints is one of the common symptoms of gout. Because of high uric acids in the body, these acids find their way into the different joints in the body causing swelling and pain.

Newborn Screening Tests

One of the first medical checkups a person undergoes in his life is taken just before a baby leaves the hospital. Newborns are tested for any life-threatening medicalconditions before symptoms develop. These diseases are related to metabolic disorders which can affect the normal body and brain development of an infant. Newborn screening is done by getting a few drops of blood by pricking the heels of the baby. Blood samples are then submitted for study and then tested for these medical conditions. Newborns found positive with metabolic disorders are referred to a medical specialist for treatment. Normal growth and development of the baby can be facilitated by your doctor’s treatment  plan which can save your baby from lifelong health and developmental problems.

Below are the 5 conditions and their long-term effects for which newborns are tested:

• CH Congenital Hypothyroidism. This causes severe mental retardation, CH results from lack or absence of thyroid hormone, which is essential to the growth of the brain and the body. If the disorder is not detected and hormone replacement is not initiated within 4 weeks, the baby’s physical growth will be stunted and she/he may suffer from mental retardation.

• CAH Congenital Adrenal Hyperplasia. CAH is an endocrine disorder that causes severe salt loss, dehydration, and abnormally high levels of male sex hormones in both boys and girls. If not detected and treated early, babies may die within 7-14 days.

• GAL (Galactosemia). GAL is a condition in which the body is unable to process galactose, a sugar present in milk. Accumulation of excessive galactose in the body can cause many problems, including liver damage, brain damage and cataracts.

• PKU (Phenylketonuria). PKU is a metabolic disorder in which the body cannot properly use one of the building blocks of a protein called phenylalanine. Excessive accumulation of phenylalanine in the body causes brain damage.

• G6PD Severe Anemia, Kernicterus Normal. G6PD deficiency is a condition where the body lacks the enzyme called G6PD. Babies with this deficiency may have hemolytic anemia resulting from exposure to certain drugs, foods and chemicals.

Treating and Managing Metabolic Disorders

are lifelong or long-term diseases. Treating these metabolic disorders require positive identification of the underlying disease or causative factor. Management of the disease may require taking in dietary supplements to replace those nutrients which the body could not produce. If the disease is discovered in its early stages such as those done during newborn screening, a child could live a normal and productive life.

Metabolic Disorders and Weight

Metabolic disorders and being overweight are often linked with each other. Other serious conditions such as poor brain development are also caused by certain metabolic conditions. Maintaining a healthy lifestyle and a proper diet helps avoid a wide variety of diseases. Obesity is considered to be a metabolic disease because the body was not designed to carry so much weight, and the additional pounds put a great amount of stress on the metabolic process. Obesity is not just a sign or symptom of a medical condition, but it also leads to other medical conditions such as heart and metabolic disease. If you are having problems maintaining your weight even with exercise and a healthy diet, it is best that you consult your doctor.

Written by, Ronald Uy, RN

© 2009 Hemorrhoid Information Center

Sources:

Newborn Screening FAQ. Retrieved October 6, 2009 from Philippine Department of Health.  http://www.doh.gov.ph/

Metabolic Disorders. Retrieved October 7, 2009 from Mayo Clinic: http://www.mayoclinic.org

Metabolic syndrome. Retrieved October 7, 2009 from MedicineNet.com: http://www.medicinenet.com