In the following discussion the term “eating disorders” has been used to mean anorexia nervosa, bulimia nervosa and binge eating disorder. The article talks about risk factors of these conditions and provides steps on how to prevent these.
INTRODUCTION
The lifetime prevalence of eating disorders among adolescents in the United States is 2.7% according to the National Institute for Mental Health (NIMH). It is more common among females than males and is the third most common chronic disorder in adolescent females. [1]
WHAT ARE EATING DISORDERS?
Eating disorders can present in a couple of different ways.
In Anorexia nervosa, the patient has a disturbed body image and strives to reduce weight inspite of a low Body Mass Index (BMI).
Bulimia nervosa entails binge eating followed by abnormal weight loss attempts
In Binge eating disorder, patients experience a lack of control during eating, and eat in obvious and great excess of those around them.
In the following discussion the term “eating disorders” has been used to mean anorexia nervosa, bulimia nervosa and binge eating disorder. Eating disorders generally have their onset during adolescence, especially late adolescence. [1] This condition is of a special concern because adolescence is a time of increased growth and nutrient utilization and therefore these young adults are especially vulnerable to malnutrition caused by eating disorders.
CLINICAL PREDICTORS OF EATING DISORDERS
“ Pursuit of the thin ideal and body dissatisfaction are highly predictive of eating disorders.”
Since early times, it has been believed that familial influences (both genetic and environmental) as well as neurotic personality traits are important risk factors. [2] However, recent research indicates other risk factors too, some of which might seem, at first, to be counter-intuitive.
One of the issues that shows a more or less consistent association with eating disorders, is food insecurity. [3] Food insecurity is associated both with obesity and eating disorders, especially binge eating and unhealthy weight control mechanisms. This may affect vulnerable communities even more, such as Hispanics, who show a higher prevalence of these disorders. [4]
Another risk factor for pathological eating, especially binge eating, is obesity.[5] Similarly, diabetes mellitus (DM), too, is a risk factor for this condition. [6]
With regards to risky attitudes, pursuit of the thin ideal and body dissatisfaction are highly predictive of eating disorders. [7] Those with pre-existing leanness are more at risk for anorexia nervosa, while those with higher BMI may have bulimia nervosa instead.
Eating disorders are also associated with other psychiatric conditions like negative affect and anxiety. [8] A rise in social media and mass media consumption, too, has led to a rise in eating disorders. [9, 10]
UNDERSTANDING THE RISK FACTORS
"Higher prevalence of eating disorders is seen among adolescents who are elite athletes, especially sports with an aesthetic component, like rhythmic gymnastics."
Some of these risk factors are more obvious, while others are not. For instance, it is easy to see how propaganda of the thin ideal on mass media, as well as comparison and insecurity from the use of social media, could impact an adolescent’s idea of the perfect body.
Eating disorders are also common among adolescents with a perfectionist attitude, and those in whom the profession demands aesthetic perfectionism. For instance, a lot of recent research shows a higher prevalence of eating disorders among adolescents who are elite athletes, especially sports with an aesthetic component, like rhythmic gymnastics. [11, 12] Perfectionism and pre existing psychiatric problems like anxiety and negative affect, amplify this.
Food insecure adolescents often find themselves binge eating when they find enough food to do so, probably out of anxiety of not having ample food in future. They also exhibit unhealthy weight control mechanisms as their weight increases, being unable to reduce their binge eating episodes.
Obese adolescents behave similarly. They may also be more prone to other psychiatric risk factors like negative affect due to widespread ridicule and thin ideal propaganda.
Adolescents with DM often show associated psychiatric risk factors, or there might be as of yet unknown metabolic risk factors. [13]
PREVENTIVE STEPS
Prevention of eating disorders with educational sessions in school about problems associated with thin idealization and media literacy has been shown to be effective. [14] Family education can be effective too, when implemented properly, however it has been shown that families are generally not motivated enough to take the preventive steps. [15]
CONCLUSION
Eating disorders are a topic ripe for research. Further research could be based on the reasons why factors like food insecurity, obesity and DM are associated with eating disorders. Although research shows that Hispanics are more prone to eating disorders in the US, similar studies have not been done in all countries. Local epidemiology in different regions would pinpoint other such vulnerable communities, and also contribute to the understanding of why they are more vulnerable. More research can also be performed to find additional ways for primary prevention of eating disorders.
REFERENCES
https://pubmed.ncbi.nlm.nih.gov/27086237/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719561/
https://experts.umn.edu/en/publications/household-food-insecurity-associations-with-disordered-eating-beh
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431477/
https://pubmed.ncbi.nlm.nih.gov/12898560/
https://www.semanticscholar.org/paper/Eating-disorders-among-Jordanian-adolescents-with-a-Hourani-Ababneh/02aeb3908f94126d964419d58456321a9064fb94
https://pubmed.ncbi.nlm.nih.gov/27709979/
https://link.springer.com/article/10.1007/s40519-019-00689-6
https://www.sciencedirect.com/science/article/pii/S1471015313000457
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540021/
https://pubmed.ncbi.nlm.nih.gov/14712163/
https://pubmed.ncbi.nlm.nih.gov/26876906/
https://pubmed.ncbi.nlm.nih.gov/29412336/
https://pubmed.ncbi.nlm.nih.gov/31084425/
https://pubmed.ncbi.nlm.nih.gov/30552078/
Author - Dr. Chayanika Biswas
Editor - Dr. Rushil Dalwadi
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