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Eating Disorders and Gynecology

Historically, unfortunately, thought to only affect affluent, white females, it’s now known that eating disorders widely affect anyone, from any sex, gender, race, ethnic, or socioeconomic background. Actually, disordered eating has been discovered as more prevalent among those who identify as lesbian, gay, bisexual, transgender, or questioning. It is not limited in age either. Eating disorders have been reported in those as young as 5 years old and can range all the way to older and middle aged women, but commonly develops when we are teens. 

Eating disorders are knowingly complex in nature and, oftentimes, can pass by unnoticed in those we love, and even in ourselves. Contrary to what many may believe, eating disorders can be present at any weight and some eating disorders are actually more present in those with above average weights. 

In this blog we’ll talk about some of the dangers of eating disorders, the ways it specifically affects us as women, and how to identify some of the signs yourself.

What exactly is an eating disorder?

Eating disorders are classified as persistent changes to eating or eating-related behaviors that cause altered consumption or absorption of food and impairs physical health and psychosocial functioning. In other words, an eating disorder is anything that alters the way you eat or relate to food that also affects both your physical and mental health. 

Eating disorders aren’t just anorexia and bulimia. Currently, there are many different known eating disorders and research is continually evolving these types. Some eating disorders are:

Rumination Disorder -- voluntary regurgitation (chewing and spitting out) of food. Behavior must last for one month or longer. Oftentimes, people with rumination disorder are aware that it is socially frowned upon and will disguise it by coughing, covering their mouth, or eat before social events to avoid eating in front of people.

Avoidant/Restrictive Food Intake Disorder -- eating very little food or avoiding eating certain foods. May avoid eating because they feel that eating has harmful consequences. May avoid certain foods due to color, consistency, odor, etc. Those with this eating disorder do not also have distorted body image or body image preoccupations. Different from picky eating as picky eaters still have a normal appetite.

Anorexia Nervosa -- restricted food consumption along with distorted body image, fear of obesity, and relentless pursuit of thinness that leads to a significantly low body weight. Weight loss measures like excessive exercise or use of laxatives are often used. Those with anorexia nervosa usually deny having a problem, hide their eating habits, deny being thin, skip meals, wear bulky/loose fitting clothing, and more. Oftentimes suffers are intelligent and have high standards of achievement, therefore making it easier for them to conceal their condition. 

Bulimia Nervosa -- rapid consumption of large amounts of food, accompanied by feelings of guilt, and followed by compensation behaviors like purging, excessive exercise, rigorous dieting/fasting, or a combination of these. Those with bulimia nervosa usually have a normal BMI or weight that frequently fluctuates. Sufferers are preoccupied with body shape and weight.

Binge-Eating Disorder -- repeatedly and rapidly eating large amounts of food until uncomfortably full. It is accompanied by feelings of guilt, disgust, or loss of control and without attempts to purge afterwards. Those with this eating disorder are typically overweight and the disorder is nearly as common in men as it is in women. 

Night Eating Syndrome -- repeated incidents of night eating like waking up in the middle of the night and eating, or consuming large amounts of food after the main evening meal has already been consumed. Those with this disorder remember their episodes of eating and deal with feelings of distress caused by the night eating.

Pica -- regularly eating things that are not food (i.e. paper, clay, dirt, hair). Normally what people with pica eat isn’t harmful but it can lead to complications like blockages of the digestive tract or lead poisoning.

In addition to these eating disorders, there are also some other less common disorders that we haven’t outlined above. 

The main takeaway here is that eating disorders are more common than we think, and can often go unseen even in those closest to us, including ourselves. If you feel that you or someone you know might be suffering from an eating disorder, the best thing to do is to see your current GP.

Who and how?

Though anyone can suffer from an eating disorder, we do know that they more commonly affect women, especially young women, than men. They also frequently arise during adolescence, despite affecting people across age groups, showing that it is becoming more and more important to help foster healthy body image from childhood. Though certain social media and pro-eating disorder websites are unlikely to cause an eating disorder, they can be a significant barrier to recovery for those already with eating disorders and can also promote unhealthy body images that we always do our best to discourage.

It’s so easy for us to associate eating disorders with thinness, and, while this is the case for some eating disorders, the truth is that eating disorders can occur at any weight. For example, those with Bulimia Nervosa are usually at or around a normal weight and those with binge eating disorder commonly have an above average weight. More importantly is also understanding that you can also be malnourished at any weight. 

What are the effects of a long term eating disorder?

People with eating disorders can be consistently malnourished, meaning that their bodies lack all the necessary nutrients. This long term malnourishment can lead to several vitamin and mineral deficiencies. 

One of the more serious effects of this is a low bone mineral density, or BMD. Our bones are composed of many minerals, one of the largest being calcium. In our bodies, our bones are constantly being restructured and reformed using our body’s available calcium. When we are not getting enough of this important mineral, our bones can’t restructure themselves properly and end up becoming less dense. If this lack of calcium is consistent, overtime it can severely weaken bones leading to easy fractures or even osteoporosis, or bone disease, an incurable and serious condition that shortens your life. 

Until we are in our 20s, our bones are building themselves up until they reach their peak. After this peak, your bones will slowly lose density as you get older. The key for healthy bones is to get as high a peak as possible so that as your bones become less dense, you still have a high enough bone density to keep you out of the realm of Osteoporosis. One of the greatest risks of eating disorders is that, because they usually arise during adolescence when your bones are in a critical period of growth, they can seriously affect your bone health for life by limiting your body’s ability to significantly build up your bones before your BMD naturally starts to drop after your 20s. 

Here’s a shocking statistic for you: 85% of females with anorexia nervosa have a low BMD putting these women at a 59% higher risk of breaking a bone. 

A low BMD can also cause permanent damage. Some of the ways that it can permanently affect you are postural defects, height restriction, chronic pain, and other physical limitations. 

The best way to increase BMD in those with eating disorders that cause a low BMI is weight restoration. This can be difficult and often requires a combination of people involved to help someone with an eating disorder return to a normal weight. There is also some new hope with research on hormonal therapies and their ability to help restore BMD. Much more research is needed but it could be a fantastic way to protect the bones at this critical time of growth for adolescents who have eating disorders.

Gynecological manifestations

As women, eating disorders also have the potential to show up in many women's health ways. 

Eating disorders can cause: 

Pregnancy with eating disorders also carries serious risks for the infant and yourself. If you are pregnant and have an eating disorder, your baby could be born with a small head circumference, an indicator that the brain has not developed properly. Small head circumferences in infants is associated with several lifetime neurological conditions like epilepsy, cerebral palsy, eye/ear disorders, and mental retardation. In pregnant women, it also causes a greater risk for postpartum depression and anxiety. 

Other signs and symptoms of eating disorders

There are also many other signs and symptoms and come along with eating disorders. 

One difficult to see symptom is altered cognition. The reason that this is difficult to see is that those with this symptom might not even notice that they have it or think to report it if they do. Studies have shown decreased cognitive efficiency and abilities in reading, math, and word recall in sufferers of eating disorders. Researches are still uncertain why eating disorders have this effect. Some researchers speculate that it might be due to structural changes in the brain, but this still needs more research to be confirmed. 

In bulimia nervosa, people might be showing tooth decay and calluses/scars on their knuckles. While those with anorexia nervosa could have dry skin and the growth of lanugo-like body hair. Lanugo body hair is very fine, fuzzy body hair that we often associate with infants. 

Some other not so obvious signs to look for are irritability, social isolation, perfectionist or obsessive personality types, and participation in athletic activities.

A set of questions called the SCOFF Questions has been developed to help identify those with eating disorders. Ask yourself or someone you might be concerned about the following questions:

  1. Do you make yourself SICK because you feel uncomfortably full?
  2. Do you worry you have lost CONTROL over how much you eat?
  3. Have you recently lost more than ONE stone (14 pounds) in a 3 month period?
  4. Do you believe yourself to be FAT when others say you are too thin?
  5. Would you say that FOOD dominates your life?

One point is assigned per yes and a score of two or more indicates the possibility of an eating disorder.

Eating disorders are serious conditions that affect a wide array of people, but most predominantly affect women, and rates of eating disorders are only increasing. A study conducted in 2013 found that lifelong Anorexia Nervosa affected 4% of women, and Bulimia nervosa and Binge Eating Disorder were both at 2% that’s 1 in 25 women and 1 in 50 women respectively. All eating disorders are treated differently, yet share the same negative nutritional and overall health outcomes. Anorexia Nervosa especially carries the risk for hospitalization and death. Longtime eating disorders also impact women gynecologically and may interfere with women’s ability to become pregnant and if they do become pregnant, has serious risks for their babies. Among some of the greater risks of eating disorders is the decrease in BMD which can lead to permanent bone disease, a serious and life threatening condition. 

The road to recovery for all those with eating disorders, first begins with a diagnosis. If all of us become more aware of the signs and symptoms, then we can all help to play a role in looking out for ourselves and our loved ones. A strong network of support in combination with help from medical professionals is essential for sufferers of eating disorders. The more we know, the more we save.

Resources
https://www.nhs.uk/conditions/malnutrition/
https://bodymatters.com.au/wp-content/uploads/2015/01/DSM_V_Diagnostic_Critera_for_Eating_Disorders.pdf
https://www.msdmanuals.com/
https://www.nof.org/patients/diagnosis-information/bone-density-examtesting/low-bone-density/

Author
Renee Cotter, MD

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