HubMob Weekly: Anorexia -- when weight loss for health goes too far

The hub mob is out for health, fitness, and weight loss this week. As with anything, you can take it too far. This article deals with an obsession with eating, food, or weight loss that is in fact a very serious and quite common psychological disorder called anorexia nervosa. At first it's hard to distinguish it from a healthy interest in health, fitness and nutrition. But when you or a loved one starts to look like a refugee, it's time to take some action. Anorexia can do serious and irreparable harm and can even be fatal.

Anorexia is an eating disorder. The most common type of anorexia in the USA is anorexia nervosa, which simply means that the cause is psychological. Anorexia nervosa has been documented for a long time, but it is becoming increasingly common. No matter how thin she gets, the anorexic keeps starving herself, often engaging in bulimia (forced vomiting).

How can you tell if your behaviors have gone beyond dieting and into the slippery slope of anorexia?

• Are you dieting to become healthy or do you think that weight loss will bring you all peace and joy?
• Is your self-esteem 100% pegged to your weight or do you have other things you like about yourself?
• Do you diet to control your weight or do you think that dieting will fix everything that's wrong?
• Do you diet for healthy weight loss or is being thin the only thing that matters and to hell with your health?

Other signs other than being ridiculously underweight, other signs that one might have anorexia are over-exercising, being obsessed with food, having weird or ritualistic ways of eating food, visiting web sites that "help" you be even more anorexic, and being increasingly unhappy with one's appearance.

Anorexia can lead to serious damage of many body systems and can potentially be fatal. Early signs are amennorhea (loss of menstrual periods), feeling cold all the time, impaired thinking due to lack of fuel for the brain, dry skin, lack of energy. Later you can get osteoporosis, your hair and teeth fall out, the heart and kidneys weaken, the skin gets dry and nails get brittle. Attractive, huh?

What is amazing about anorexia is how the sufferers can maintain a high level of activity and energy before the really serious effects land them in the hospital. It is thought that because it primarily affects people who are otherwise young and healthy, and because these people have a tremendously ability to focus.

Enough of the academic and medical. For me, anorexia is personal. I have never had it myself, but I have close relatives who have.

My sister -- the dabbler: My sister had a brief bout of anorexia when she was about 14. She had, like a lot of youngsters, put on a little splodge prior to the mega adolescent growth spurt. All of a sudden she was very thin. When she came to visit me she criticized me for having a piece of toast for breakfast. She seemed to be obsessed with food. Everything we did seemed to be about food.

The thing that convinced me that my sister had anorexia, though, was the incident at the pop machine. She and my roommate and I took a long walk on a very hot summer day. We had enough money on us for one soda each. We were all dying of thirst. My roommate and I went first and we each bought a regular soda, with all its attendant sugar. Sis poked the button for a Diet Pepsi, but the machine delivered for her whatever they were calling half diet/half regular at that time. My roommate and I urged her to drink it anyway, given how hot it was. Any normal person would have done so. She refused to drink it, saying that it had bad sugar. We hung onto it for her figuring she'd change her mind on the way back. But no such luck. My sister was showing signs of heat exhaustion by the time we got home. She must have drunk two liters of water, and spent the rest of the afternoon in bed with a pounding headache. Luckily, my sister's case of anorexia was mild and she outgrew it. She never got skeletal or became 100% obsessed with food and weight loss.

My mom -- chronic low level: Mom grew up in the depression, when just getting enough to eat was the big concern. She was short, curvaceous, and, from looking at old photos of her, pretty babe-alicious. During the 50's and early 60's there wasn't such a thin obsession. Look at Jane Fonda in Barbarella. Dad was the one with the fat-phobia, but his fat-phobia was not about himself -- it was about his women. Mom had five kids, which is enough to run you ragged anyway. As Dad got older he started making more and more disparaging remarks about people we knew who had "let themselves go" even just a little. The women always got it harder than the men. Mom seemed to get progressively weirder and weirder about food as time went by.

Mom was atypical in that she tried to inflict her weirdness on her family. She was famous for her starvation rations at family dinners -- even Christmas dinner! Come on! One chicken wing per person? I remember going home for a visit once from college. Mom always seemed to put off meals for as long as possible and lunch was not until about 1:30 and I had not had any breakfast. She gave me a half piece of bread smeared with "butter flavored oil," a stick of celery, and a cup of tea. I refused to eat the bread because it tasted nasty, ate the celery, and then I said, where's lunch? She said that was it, but dinner would be at 7:00. Dinner was similar rations: a little pile of rice, some tofu, and five or six green beans.

Mom never totally starved herself, but I think that her chronic undereating and borderline anorexia contributed to her osteoporosis and all the GI issues she has now. See my eldercare hub for what her life is like now. When she had her osteoporosis train wreck, she went down to 69 pounds and looked horrible. We are not sure why that happened -- I think she might have been misrepresenting what she and Dad were eating while they were on their own, and Dad probably just filled up on bread and crackers. Mom has given up her quest to be Twiggy and now eats reasonable quantities for her age and activity level, has put on a little weight and doesn't look so freakish.

My niece -- Compulsive: My neice had always been a stalky slender child, but she looked healthy and was active. At 15, suddenly her weight plummeted to about 75 pounds and she was delayed in becoming a woman. At first her mom (yes, the sister who had anorexia herself briefly) thought she was taking an interest in nutrition, but it went way beyond. She developed phobias about a lot of foods, had an unnaturally strong gag reflex, and fiddled with her food rather than eating it. Unlike most adolescent anorexia, hers was not tied to body image. It was strictly a control issue. She underwent therapy, was put on a strict diet that included lots of nuts as snacks, and was disallowed to do cross country or dancing until she got her weight up to normal. My niece, apparently, was not in it to be thin. She did not like the skeletal way she looked and really wanted to cooperate in the quest to make her gain weight. She just really did not want to go through the mechanics of eating, apparently, and was afraid to put food into her body. It was a tough spell, and there were lots of screaming arguments with her mom, but she gained the weight back, became a woman, and is now happy with a boyfriend.

My roommate -- the post anorexic: In college I had a roomie who was considered post anorexic. I personally don't think she was cured. She thought about food all the time. She had gained weight back, actually too much. She never bought any food for herself, but she always hung around other people and mooched food off of them. In her room she had created kind of a shrine to the memory of her thinner self. There was this one picture of her in a drapey shimmery short greek styled dress, with elaborate makeup and hairdo and her skeletal arms and legs sticking out of that thing like a starving refugee child. There were bruises on her arms and legs -- you could see that they had been covered with makeup. She often referred to how cool she looked in that photo and clearly wished she still looked like that. Everyone else thought it was awful. I don't know what ever happened to her. She moved out because of food issues.

Anorexics in their 20's can have the body of an 80 year old. It can affect males as well as females. Anorexics are much more likely to engage in self mutilation. They can destroy their esophagus and rot their teeth with bulimia. No one knows exactly what causes anorexia, but the culture seems to contribute to it. It's far from harmless. Is it those megathin supermodels, or the Barbies that little girls play with, or just a general obsession with appearance. The take away is that it is an illness or a disorder. Sometimes it will subside on its own, as with my sister. People such as my mom can have it at the borderline level for years. We just got used to the way she looked. Some people, such as my niece, require intervention. And even after one leaves the ultrathin phase, sometimes the effects of anorexia haunt you for years. If you catch your teenager surfing any pro-ana websites, block them. Contact me and I'll show you how.