What amounts to eating disorder

Qn: I once read in this column that eating disorder may be linked to mental stress. Tell me the early signs of this. I am poor eater lately.

The UK marked the first week of March 2020 as the National Eating Disorders Awareness week (Neda). It is estimated that 1.25 million people in the UK are living with an eating disorder. The reality is that eating disorder is a complex mental condition that sadly leads to the deaths of many people in Europe and America.

The three main types recognised are anorexia nervosa, bulimia and binge eating.

In this regard, it is important to point out that occasional poor appetite or eating a great deal at say a wedding, do not amount to an eating disorder.

The subject of our discussion today relates to an actual clinical entity that is diagnosed by a qualified doctor.

In anorexia nervosa, the patient has an intense fear of gaining weight and, therefore, restricts eating, leading to life-threatening loss of weight. This is beyond “slimming” because it is associated with a distortion of one’s perception of body weight and shape.

A girl whose weight is less than 35kg would, if shown her skinny shape, say that she is fat and ugly. If asked to draw a picture of herself, she would a picture of a fat person. This, therefore, is an abnormal state that satisfies the definition of a mental disorder.

Bulimia nervosa is recognised by the fact that the patient eats large amounts of food in a short period of time. After this episode of binge eating, the person feels a sense of lack of control over their eating. So, the person knows they are eating too much but they have lost of the ability to stop.

After a binge eating session, the patient will take measures to “get rid of the food” by either inducing vomiting or using large amounts of laxatives to induce diarrhoea. Some exercise vigorously.

Binge eating is similar to large amounts of food being eaten in a short period of time, but such patients often tend to eat alone, very rapidly and even when they are not hungry. Such patients express disgust about themselves for eating. Many people with these conditions have low self-esteem and hate themselves.

In the late seventies, when we went to the UK for further studies, we came across many girls, who to us were “refusing” to eat food. We found it difficult to understand that “refusing” to eat food could be a disease. We had come from Africa where many people did not have enough to eat. When we noticed that the patient (mostly girls) were dying (25percent of all patients), we took the matter seriously and in time sought to find out why Kenyan girls did not seem to have the same or similar problem

We postulated at the time that British girls developed anorexia nervosa because of social pressure to be fashionably thin to conform to the western model of beauty as thin.

It was, therefore, suggested that with time, as more Kenyan girls were influenced by western media, the disease could become manifest in Kenya.

Two studies suggest that this has not happened, and that pressure to be thin amongKenyan girls has not led to anorexia nervosa.

The first involved a questionnaire among many senior psychiatrists.

Asked to state the number of patients they had seen in a combined period of study the equivalent of 320 years, only five doubtful cases were reported.

In another study comprising high performance long distance athletes from Kenya and a similar number from the UK, 25 percent of the British girls had anorexia nervosa.

None of the Kenyan girls had the problem.

The seeming absence of the condition in Kenya (and Africa in general) has led to much speculation as to what would be the reason. The jury is out on this matter.

A group of psychiatrists is now looking for persons with the Prader — Willi syndrome.

In this condition, the opposite of anorexia nervosa occurs. The patient literally eats themselves to death. They are unable to stop.

As you can see, eating disorders are complex, interesting and are the subject of much scientific enquiry.

Remember, however, that we are here concerned about a disease, not a condition that normal people feel from time to time.