Eating disorders are health problems that were first reported in the seventeenth century but increased dramatically in the late twentieth century. Before the 20th century in America, the “ideal” body shape of a young woman was a full-body woman. By the late 1960s, women had lost much of their curves. The media constantly presents us with images of the “ideal” body shape, for both men and women. As a result, many young women are inspired to be thin, while young men feel they need to lift weights excessively to increase their muscle mass. These types of messages and social pressure can cause body dissatisfaction, extreme diets, and unhealthy weight management methods, which eventually lead to the development of eating disorders.
Eating disorders can affect people of all sexes, ages, races, ethnicities, body shapes, weights, sexual orientations, and socioeconomic status. Women have a prevalence higher than men (2 to 3 times higher), possibly due to greater body dissatisfaction and greater tendency to experience depression, stress, and anxiety than men. Most importantly, Eating disorders can cause a wide variety of health problems, such as obesity, type 2 diabetes, hypertension, high cholesterol, heart disease, gallbladder disease, or even death. Fortunately, with treatment, 60% of patients can fully recover. However, only about half of people with an eating disorder will seek and receive treatment.
Types and Diagnoses of Eating Disorders
There are three main types of eating disorders, according to the Diagnostic and Statistical Manual of Mental Disorders published in 2022:
- Anorexia nervosa can be diagnosed if someone meets the following criteria: restricted energy intake leading to a significantly low body weight, fear of gaining weight, and inaccurate perception of their weight or body shape.
- Bulimia nervosa includes repeated binge eating (eating a large amount of food in a short period of time) and repeated inappropriate compensatory behaviors, such as vomiting, excessive exercise and use of laxatives. Both behaviors occur at least once a week for 3 months.
- Binge eating disorder includes binge eating with marked distress, no inappropriate compensatory behaviors, and occurring at least once a week for 3 months.
Eating disorders are very complex diseases. We still don’t fully understand what causes them. Some problems are psychological, such as low self-esteem, depression, anxiety, feeling of loss of control or worthlessness, identity concerns, family communication problems, inability to deal with emotions, or perfectionism. Sociological factors include messages that indicate “to be happy and successful you must be thin,” dysfunctional families, physical or sexual abuse, domineering coaches, or controlling relationships. Other biological factors may be genetic factors, altered function of some hormones or neurotransmitters such as serotonin, norepinephrine, cortisol, GABA and the area of the gut microbiota has been newly discovered.
Comorbidities Associated with Eating Disorders
Overall, the risks of metabolic diseases vary according to the type of eating disorder. For anorexia nervosa, there is not enough evidence of metabolic syndrome risk. There is a decreased risk of obesity and possibly decreased risk of type 2 diabetes mellitus. For bulimia nervosa, current data are conflicting, showing a possible increased risk of metabolic syndrome, obesity and diabetes. The effect is largely explained by body weight. For binge eating disorder, the data show increased risk of metabolic syndrome, obesity and diabetes.
Psychiatric Disorders
Patients with eating disorders have high rates of psychiatric comorbidities. The most prevalent psychiatric comorbidities include mood and anxiety disorders, alcohol and substance abuse, and bipolar disorder. Lifetime suicide rates also increased 3-5-fold in adolescent patients with eating disorders. Morbidities intensify eating disorder symptoms and impact treatment in relation to recovery, level of care, and dropout rates. Therefore, treatment should address coexisting conditions and eating disorders.
Obesity
Obesity and eating disorders have a bidirectional impact. On the one hand, there are higher risks of eating disorder in overweight or obese individuals., especially with binge eating disorder. For example, overweight or obese adolescents had a higher risk of developing eating disorders (28.2% higher with overweight and 33% higher with obese) than those who are not overweight or obese. College students with obesity compared to those at healthy weight had higher rates of clinical and subclinical binge eating disorder and lower rates of bulimia nervosa.
On the other hand, a higher rate of obesity is observed among patients with binge eating and bulimia. It has been reported that 30% of female patients with eating disorders have had obesity throughout their lives. Those with binge eating are 3 to 6 times more likely to be obese than individuals without binge eating. Consistently, in another study, the lifetime prevalence of obesity is close to 90% in patients with binge eating.
Diabetes Mellitus
Eating disorders and diabetes also have a bidirectional impact. Studies have reported that eating disorders are more prevalent in people with type 1 diabetes mellitus. Adolescent girls with type 1 diabetes are twice as likely to have eating disorders than those without a diagnosis. This suggests that patients with type 1 diabetes mellitus may have experienced more psychopathological factors, such as feeling overwhelmed when adhering to healthy eating, which leads to behaviors such as binge eating, vomiting, or insulin retention among individuals prone to eating disorders. For patients with type 2 diabetes mellitus, prevalence rates of eating disorder ranged widely from 1.4% to 25%. Disordered eating behaviors affect up to 40% of patients with T2DM. These individuals report lower self-efficacy to follow dietary recommendations established by experts.
Metabolic Syndrome
Metabolic syndrome is a group of risk factors for diabetes and cardiovascular disease, including abdominal fat, high blood pressure, high blood sugar, and hyperlipidemia. Metabolic syndrome is a comorbidity of some eating disorders. For example, participants adolescents with metabolic syndrome were twice as likely to have abnormalities in eating behavior, for example, more restrictive eating or emotional eating than in patients without metabolic syndrome. In obese patients with binge eating, nearly half of participants met the criteria for metabolic syndrome in two studies. In addition, it is consistently found that men are more likely to encounter metabolic syndrome than women. Therefore, male eating disorder patients may experience more adverse clinical consequences than women.
Treatment and Guidelines for Eating Disorders
Treatment of eating disorders requires professional help from a multidisciplinary group of specialists. It usually starts with a primary physician who will refer you to a mental health professional who works with cognitive behavioral therapy and family therapy, especially if the patient is young; a registered dietitian for nutritional advice, for example, restoration of energy intake and nutrients, such as zinc, vitamin D, copper, for the patient with anorexia; dental for eating disorder problems with teeth. In extreme cases, the patient may be admitted to a hospital for admission. In addition, it may be necessary to use medications such as antidepressants, antiepileptics, anti-obesity and stimulant medications.
Clinical practice
Eating disorders are not a choice. They are serious mental and physical illnesses that involve complex and harmful relationships with food, food, exercise and body image. The comorbidities of eating disorders with metabolic diseases are connected and present new clinical and public health challenges that deserve more attention and more research. Early detection and intervention are important for the treatment of eating disorders.
Bibliographic references
Study suggestion:
Biochemical Markers in Anorexia Nervosa – Science Play
Watch the video on Science Play with Thiago Freitas:
Body Image and Eating Behavior
Article: Yu Z, Muehleman V. Eating Disorders and Metabolic Diseases. International Journal of Environmental Research and Public Health . 2023; 20(3):2446. https://doi.org/10.3390/ijerph20032446
