Eating Disorders on a Global Scale

April 20th, 2019 Eating Disorders on a Global Scale Food is a dire necessity fundamental in facilitating living. Food is the source of all energy and strength, in order to complete tasks required of daily life. In society, food is the centerpiece of socialization in a lot of respects such as celebration, conversation and joy. While this may represent the quintessential representation of relationship to food, many people are suffering, have suffered and will suffer with a staggeringly difficult fight against food. In a world filled with very clear dichotomies, eating disorders fall in a “no man’s land” that is open to interpretation attached with a very negative stigma. This paper will cover the definition and background, this history, who is affected, why those affected, are affected with eating disorders. Following, I will touch on the influence of media, the rise of eating disorders in different countries, signs and symptoms of eating disorders, the mortality, current/failed initiatives, and suggested initiatives for the future. Types of Eating Disorders Eating disorders are extremely real, fatal diseases that involve extreme emotions, behavior, and attitudes that hone-in-on weight, body shape, and food consumption. The umbrella term of eating disorders covers a wide array of diagnoses. This paper will focus on the eating disorders that fall under the DSM-5 Diagnoses: Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), Avoidant-Restrictive Food Intake Disorder (ARFID), and Other Specified Feeding or Eating Disorder (OSFED). When researchers followed a group of 496 adolescent girls for eight years until they were twenty years old, they found that 5.2% of the girls met criteria for DSM5 anorexia, bulimia, or binge eating disorders. When the researchers included non-specific eating disorder symptoms, a total of 13.2% of the girls had suffered from a DSM-5 eating disorder by age 20. (Stice, Marti, Shaw, Jaconis, 5). This is an alarmingly high number for something so stigmatized and not well-informed on a global platform. Anorexia Nervosa, often known as simply, anorexia, is more than likely the most known eating disorder. Anorexia is characterized by actively starving oneself and extreme weight loss. During the process of self-starvation, this denies the body of the substance to properly function and does not provide the nutrients to create energy or strengths vital to properly function. Therefore, the body has absolutely no choice but to slow down all systems in order to conserve whatever energy it obtains, which in turn, leads to medical conditions. At any given point in time between 0.3-0.4% of young women and 0.1% of men will suffer from anorexia nervosa (Keski-Rahkonen, 1). Young people between the ages of fifteen years old and twenty years old with anorexia have ten times the risk of dying compared to their same-aged peers (Smink, 2). Having ten times the risk of something as serious as death due to eating disorder is not something that should be taken lightly. Bulimia Nervosa, also known, bulimia, is when an individual will have an episode of binge eating copious amounts of food and feelings of remorse will follow shortly after leading to compensatory behaviors such as self-induced vomiting, misuse of laxatives, or excessive exercise, with the intention of reversing the effects of overeating. During these binging episode, it is not uncommon for the individual partaking to have extremely fogged judgement concerning weight and body shape as well as a lack of self-control. The health consequences of bulimia can affect the entirety of the digestive system and lead to serious imbalances within the body that affect the heart and other functionalities. Electrolyte imbalance occurs due to the recurrent bingeand-purging which can lead to irregular heartbeat and potential heart failure leading to death. The imbalances are caused by a dehydration and loss of important nutritional value such as sodium, potassium, and chloride. Similarly, this presents the act of gastric rupture during the purging period, inflammation and possible esophagus ruptures from the frequency of upchucking, stained and rotten teeth from the stomach acids regularly passing through, chronically irregular excretion and constipation from laxative abuse, and calluses on hands and knuckles from the act of making oneself throw up. Between 1.1% and 4.6% of females and 0.5% of males will develop bulimia. Subthreshold bulimia occurs in 2.0% and 5.4% of adolescent females (Favaro, Caregaro, Tenconi, Bosello, Santonastaso, 6). Binge Eating Disorder is when someone engages in regular sessions of binge eating. While people suffering with bulimia also binge, the difference between the two is that participants of binge eating disorder do not capitalize on the use of compensatory measures to contour their influx of eating. A main component of binge eating disorder is that during the binging episode, the individual feels completely out of control during the episode followed by feelings of extreme distress due to the intake. This is the most common form of eating disorders in the United States of America and can be very easily mistaken as just over eating. It is important to shed light on this disorder and understand that this is not a conscious choice, and causes a great deal of distress and psychological impact on the person that is suffering. The person that is suffering does not have a cookie cutter shape and can be essentially any size, shape or weight. This makes it impossible to know that someone is going through this just by the way that they look on the outside. With that being said, there is certainly a correlation between binge eating disorder and weight gain, which can magnify characteristics of obesity. A 2007 study asked 9,282 English-speaking Amercans about a variety of mental health conditions, including eating disorders. The results, published in Biological Psychiatry, found that 3.5% of women and 2.0% of men had binge eating disorder during their life (Hudson, Hiripi, Pope, Kessler, 4). This is a startlingly high percentage seeing as this is a disorder that is not talked about very often. Ultimately, this claims that binge eating disorder is three times more common than anorexia or bulimia. This disease is also more common than HIV, breast cancer, and schizophrenia. Research does estimate that 28.4% of people that are suffering with binge eating disorder currently are receiving treatment for their disorder. 43.6% of people suffering will receive treatment during some point of their life (Westerberg, D.P., Waitz, 5). While binge eating disorder has been reported in young people before, it is likely that this is a struggle encompassed by someone in their late teens or early twenties most commonly. Three out of ten individuals looking for weight loss treatments show signs of binge eating disorder and close to half of them are men (Westerberg, D.P., Waitz, 5). Avoidant-Restrictive Food Intake Disorder is an eating disorder that is characterized by someone that can come across as an extremely picky eater, who shows a lack of interest in food entirely or fear of negative consequences of food intake. People struggling may experience an unexplained bodily discomfort. As this disorder progresses, the range limited in the “acceptable foods” category narrows down. This lack of food acceptance can lead to severe nutritional deficiencies. Some of the potential health consequences include the potential to grow as a person physically, meaning you may lose your hair, dries out hair, anemia, brittle nails, osteoporosis or osteopenia (reduction in bone density), and difficulty concentrating or focusing. In a group of adolescents with eating disorders receiving treatment at a specialist clinic, 14% met criteria for avoidant-restrictive food intake disorder (Fisher, Rosen, Ornstein, Mammel, Katzman, Rome, Walsh, 3). The people that are most likely to suffer from avoidant-restrictive food intake disorder are generally male and on the younger side. Nearly half of children with avoidant-restrictive food intake disorder report fear of vomiting and/or choking, and one-fifth say that they avoid certain food because of sensory issues. The same study found that one-third of children with avoidant-restrictive food intake disorder have a mood disorder, three-quarters have an anxiety disorder, and nearly twenty percent have an autism spectrum condition (Nicely, Lane-Loney, Masciulli, Hollenbeak, C.S., Ornstein, 3). The link between avoidant-restrictive food intake disorder is staggering and intimidating. This should be a main focus in terms of solving this health crisis globally because it is not touched on nearly enough during the standard education of eating disorders. The last category of eating disorders that will be touched on is other specified feeding or eating disorders. This is a broader category that includes conditions that do not meet the criteria for the feeding or eating disorders listed before, but still cause extreme distress or impairment. Atypical Anorexia Nervosa meets the criteria for anorexia nervosa but weight is not below normal. Subthreshold Bulimia Nervosa meets the criteria for bulimia nervosa but is met with much less frequently occurrences. Subthreshold Binge Eating Disorder meets the criteria for binge eating disorder but is also at a lower frequency. Purging disorder is the purging without the binge eating. Lastly, night eating syndrome consists of excessive nighttime food consumption (NEDA, 16). This is clearly a broader spectrum of eating disorders but should be taken just as seriously as the other eating disorders with more concrete diagnoses. Who/Why? There are many misconceptions about eating disorders as a whole, and who suffers from eating disorders. When thinking about the stereotypical eating disorder, the first group that comes to mind would be affluent white women between the ages of fifteen to twenty-five years old, that eat salads for both lunch and dinner, and are “suffering” from an eating disorder for reasons involving vanity or attention seeking. While some individuals in that demographic are affected, this could not be further from the truth. Eating disorders do not discriminate. Eating disorders affect men, transgender people, athletes, people at any age, people of any race, people from different religions, people with disabilities, and people from literally every walk of life, all over the globe. When stereotyping the group of people suffering with eating disorders, this perpetuates a stigma and does an extreme disservice to those affected. For whatever reason, eating disorders are seen to be reserved for white, upper-middle class girls. This obviously could not be further from the truth. Older women have gone to their physicians just to hear that they cannot have an eating disorder because they are past the “age limit.” Similarly, courageous men that are willing to seek help against societal “norms,” are then put through an abundance of intense testing, because they cannot have a “teenage girl’s illness.” Males represent 25% of individuals with anorexia nervosa, and they are at a higher risk of dying (Mond, Mitchison, Hay, 2). The heightened risk of death is due to a later diagnosis since it is assumed that males cannot have an eating disorder. Subclinical eating disordered behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss purposes) are nearly as common among males as they are among females (Mond, Mitchison, Hay, 2). When thinking about such behaviors, it is hard to imagine males doing these things based on the stigma attached to such struggle. If the stigma is to persist, this will make things even worse for men and the consequences will continue. An overlooked group of people that are affected are athletes. In a study of division 1 athletes, over one-third of female athletes reported attitudes and symptoms of anorexia nervosa (Johnson, Powers, Dick, 3). Athletes are often overlooked because they are regularly engaging at a high level in a competition that requires the exertion of ample energy. Though most athletes with eating disorders are female, male athletes are also at risk – especially those competing in sports that tend to emphasize diet, appearance, size and weight. In weight-class sports (wrestling, rowing, horseracing) and aesthetic sports (bodybuilding, gymnastics, swimming, diving) about 33% of male athletes are affected. In female athletes n weight class and aesthetic sports, disordered eating occurs at estimates of up to 62% (Bonci, 3). It is interesting to think of the practice of weight-in’s for sporting events. During a time when body positivity is a main focal point, it does not seem appropriate to have expectations and requirements that will enforce such behavior that mirrors those of someone battling an eating disorder. Eating Disorders on a Global Scale 20% of the world’s population suffers with the umbrella topic of a mental disorder. People globally look at eating disorders as their own entities and have a unique relationship with countries separately and different on a case-by-case basis. With that being said, it is not super surprising that eating disorder is rapidly rising worldwide due to global westernization, extreme advances in technology, and cultural shifts collectively. According to the National Eating Disorder Association, seventy million people (both female and male) suffer from eating disorders. The very first culture that was examined was the prevalence of eating disorders in Asia. 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