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Many of us want to be slimmer, more muscular and ideally have year – round chiselled abs. We sacrifice a lot to achieve our dream figure. We eat less and less, do more sports and change our overall lifestyle almost beyond recognition. But this path to a dream body is not ideal and can bring many complications and pitfalls. It is much better to set realistic goals and choose a healthy way to achieve them without unnecessary extremes. This way, we can expect long – term results without negative effects on the body.
But what happens when the desire for a beautiful body becomes an obsession? Eating disorders may begin to show. In their case, innocent weight loss often becomes the number one priority, which can seriously compromise physical and mental health. There is not just one type of eating disorder, but several. Each one has its own specifics, which is why it is important to understand the types and causes of the most familiar ones. It is a good idea to recognise the warning signs of the disorder in its early stages and to seek professional help as soon as possible to prevent any serious problems.
What is eating disorder?
An eating disorder (ED) isn’t just a refusal to eat due to the desire for weight loss or a teenage fad that pops up from one day to the next. It can start with an innocent loss of a few extra kilos that eventually spirals out of control. It is a serious and potentially life-threatening mental illness. [1-3]
- It is characterised by behavioural disorders and an unhealthy attitude towards food and body.
- Most commonly manifested by food refusal, extremely low energy intake, alternating periods of starvation and overeating or other forms of more or less conscious manipulation of diet.
- This can be compounded by inducing vomiting, misuse of laxatives (substances with laxative effects) or diuretics (fluid expelling medications).
- In many cases, there is an attempt to maximise energy expenditure through movement throughout the day and excessive exercise.
A person with an eating disorder typically lives in their own world that revolves primarily around food, weight loss and body image. They do everything they can to work on their figure in some way, which they often associate with greater satisfaction, happiness and social status. They have huge expectations of themselves and still want to achieve their dream ideal of beauty. Instead, they often plunge into the abyss, where physical and mental health issues await them, greatly reducing the quality of life. [1-3]
What causes an eating disorder?
The beginning is usually subtle. Often it starts with a desire for a slimmer body, a sculpted stomach, better sports performance or the need to satisfy the demands placed on a person by their society or themselves. After the first success come the compliments and pleasant attention that only reassure such person that they are doing it right. And so they cut back even more on food and start exercising more. They feel that this is the only way to achieve goals. But things can get out of control and such a person can very easily and quickly fall into the ugly world of eating disorders.
The actual cause of an ED is very difficult to detect. It can’t just be weight loss, because a lot of people go through this every day and for the most part it doesn’t end up being such a problem. There are a number of factors that can be a potential trigger. Some are rooted in a person’s immediate environment and others start in their own head. [4-5]
What are the risk factors for eating disorders?
The primary cause of an ED may be a history of adherence to various diets, a desire to be the best at everything, or a desire to improve athletic performance, especially in disciplines with a strong emphasis on appearance and aesthetics. But the list is far from over. Biological, psychological and social factors can also play a role in the onset of eating disorders. [4-5]
1. Biological factors that can lead to eating disorder
- If you have a person with an ED or other mental illness in your direct surroundings: if your parent, sibling or other close relative suffers from a mental disorder, your risk of developing these illnesses, including eating disorders, increases.
- An experience with a number of diets: an ED is often found in people who have already gone through a series of diets in the past with the aim of changing their figure. This is because past failures can lead them to extreme diets and approaches.
- A constant calorie deficit: people who have a long-term energy expenditure higher than their intake are also at increased risk of developing an ED. This can also occur during periods of intense growth (puberty), other illness or excessive exercise. Food may trigger fear of unwanted weight gain in them.
2. Psychological factors that can lead to eating disorders
- Wanting to be perfect: Having exaggerated, often unrealistic demands and expectations of oneself. If you need to improve in something, trying to lose weight or otherwise changing your body shape can become a tool to achieve your goals.
- Dissatisfaction with own body shape: Dissatisfaction with your appearance can also affect your self-esteem. Damaged self-esteem can then trigger psychological problems including unhealthy relationships with food and other symptoms of an ED.
- Mental health problems: some people with an ED have symptoms of anxiety, social phobias or obsessive-compulsive disorder before they are diagnosed.
3. Social factors that can lead to eating disorders
- Cult of slimness: people with a slim figure are generally considered more successful and happy in society. This is also the reason why we try to improve our social status and prestige by losing weight. In the case of an obsession with thinness, the first kilos lost can then lead to anorexia or another eating disorder.
- Discrimination against overweight people and body-shaming: Discrimination, bullying and judging people based on their appearance also contribute to eating disorders. This can occur both in real life and on social media.
- Social isolation: limited contact with the outside world, loneliness, lack of friends and people who are interested in us can be another reason for the development of an ED. Thus, through an ED, a person can demand attention that they do not normally receive.
- Aesthetically demanding sports and activities: if you spend your time in activities where appearance or body weight plays a big role, you automatically have a higher risk of developing an ED. A slimmer figure is commonly associated with greater success in these cases. These include modelling, dancing and sports such as gymnastics, fitness, bodybuilding and cycling.
Who is most at risk of eating disorder?
It doesn’t matter if we are a child in our teens, a woman in her fifties or a grown man, any of us can be at risk.
- Eating disorders affect approximately 5% of the population and most often develop during adolescence and early adulthood.
- Globally, it is estimated that 0.5 – 3% of people suffer from anorexia nervosa or bulimia nervosa. According to experts, however, these statistics are significantly underestimated. Many cases may not even reach a doctor who will diagnose an ED. So, the overall figure will be higher.
- According to statistics, men make up as many as 25% of cases with anorexia or bulimia. In the case of binge-eating, the figure can be as high as 40%. This statistic clearly dispels the myth that these problems only affect women.
- Most of the cases recorded are young women. According to a population – based study involving over 5000 women, 15% of them had personal experience with an ED in the first half of their lives. Unfortunately, this is not an isolated disease in women. The high incidence of eating disorders in women is also supported by other data and studies. [6-8]
What are the risk groups for eating disorders?
One of the groups at higher risk is based on age and gender. Moreover, groups at risk are also linked by similar interests or occupations. [9-10]
- Adolescent men and women. During puberty, a number of physiological changes take place that affect appearance, such as breast growth or greater fat deposition in the hip area in the case of girls. Some may start to deal with these by dieting, starving or overeating, which can then develop into an eating disorder.
- Individuals going through life changes. This could be the loss of a loved one, a break-up, a change of job or residence. Some people are more sensitive to these life events than others. This can lead again to mental illnesses including an eating disorder.
- People who are into aesthetic sports. These include, for example, gymnastics, fitness, bodybuilding, dance, ballet or figure skating.
- Athletes who must meet weight categories. This applies in particular to combat sports or weightlifting.
- Athletes who must meet weight categories. This applies in particular to combat sports or weightlifting.
- People with a job that puts high value on appearance. This is especially the case for modelling, acting or presenting on television.
- Minority groups. People from the LGBTQIA community (people with different sexual or gender identities).
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What are the most common types of eating disorders?
According to the International Classification of Diseases (ICD) published by the World Health Organization (WHO), we can distinguish several types of ED. The American Psychiatric Association (APA) completes this list. The official categorisation helps with the diagnosis of eating disorders. However, there are also other unspecified problems that resemble these illnesses in many ways. And we won’t leave those out of our overview either. [11-13]
Defining eating disorders
1. Anorexia (anorexia nervosa)
Anorexia is probably the most well-known eating disorder. Anorexia is the most common disorder where people do not eat. People who suffer from this disorder manage to only eat one apple a day and some days they do not eat at all. This is compounded in many cases by a large expenditure of energy through exercise and movement. Typically, they try to stick at all costs to a very restrictive diet and exercise plan they have created. All of this then leads to a profound caloric deficit and significant weight loss. Being underweight is then one of the assessment criteria for the presence of anorexia nervosa. If it is absent in the medical history, the disease is referred to as atypical anorexia.
Fear of gaining weight, the desire to maintain a low weight and a distorted perception of one’s own body are also often added to the restriction of food intake. The people around the person may perceive them as slim enough, but the person still sees flaws in themselves. For example, they may see their thighs as too bulky, even though the opposite is objectively true. Anorexics usually do not admit that they have a problem that could harm their health. Let alone seriously harm their health. [11-13]
2. Bulimia (bulimia nervosa)
Bulimia differs from anorexia in that it is characterised by repeated episodes of binge-eating, which are accompanied by feelings of guilt and loss of control over food intake. This is often followed by compensatory behaviour in the form of starvation, excessive exercise, induced vomiting or abuse of laxatives. These strategies are used by people with bulimia to try to prevent weight gain.
If bouts of overeating in conjunction with compensatory behaviour recur at least once a week for three months, it is bulimia. If it occurs less frequently, the problem is referred to as atypical bulimia.
People with bulimia are able to eat a large volume of any food in a short time. They may also experience extreme changes in their diet. Some days they eat only low -calorie foods such as fruit, vegetables, lean meat or low-fat dairy products, which are then replaced by large portions of ‘forbidden’ foods such as sweets or fast food. This transition is then perceived as a failure, followed by guilt. [2, 11-13]
3. Binge-eating disorder
As with bulimia, binge-eating is characterised by episodes of large food intake over a short period of time. This behaviour is then accompanied by feelings of guilt, failure, disappointment and loss of control. However, compensatory behaviours are often absent. If this is repeated at least once a week for three months, it is binge-eating. If it occurs less frequently, the problem is referred to as atypical binge-eating.
It is characteristic of people who suffer from binge-eating that they eat faster and larger portions than normal. They then continue eating until they reach an unpleasant, even painful feeling of overeating. It is also typical for them to start eating even when they do not feel hungry. They are often ashamed of their behaviour and prefer to eat alone. [11-13]
4. Pica
This eating disorder is characterised by the consumption of inedible items with no caloric value. This can be for example cotton wool, hair, paper or soap. For a clinical diagnosis of this disorder, such behaviour must have been ongoing for at least one month. However, people with this condition do not avoid common foods and so may not show signs of malnutrition. [11,14]
This problem is often diagnosed only when consumption of an item causes health problems and people seek medical attention. Otherwise, it can be hidden to all but the affected person. But the bigger problem arises when the disease is part of another ED. People with other mental illnesses or intellectual disabilities are especially at risk. [11,14]
Rumination syndrome or disorder
This is a disease characterised by the return of stomach contents back into the mouth and their repeated chewing, swallowing or spitting out. This often happens involuntarily and without effort. It happens without pain or nausea and is not related to gastrointestinal disease or other eating disorders. To be diagnosed, this behaviour needs to be repeated for at least a month. [11,14]
6. Non-specific eating disorders
These conditions do not meet the necessary criteria for a diagnosis of the above. However, this certainly does not diminish their severity. In addition to atypical anorexia nervosa, bulimia and binge-eating, this also includes purgative disorder. The latter is characterised by the repeated use of laxatives, diuretics and induced vomiting in order to influence body weight. In contrast to bulimia, it lacks a previous history of excessive food intake.
This group also includes night eating syndrome, which involves overeating after dinner or eating in the middle of the night. This can then disrupt sleep and lead to weight gain, even obesity. It is also typical for people who experience this to have their first meal of the day later in the day. [11,12,15]
7. Avoidant restrictive food intake disorder (ARFID)
A person with this disorder is not concerned with body image or weight loss. Instead, they avoid certain foods or entire food groups because of their taste, consistency, appearance or temperature. It may occur as a result of some negative experience in the past (choking on a certain food or indigestion after eating).
Fear of certain foods may cause them feelings of anxiety and fear. Because of this, a person can often have a very limited diet, which they are unable to expand due to the present feelings of fear. [11,14]
Non-specific food-related conditions
Although these disorders are not officially eating disorders, they are very close in nature. They are associated with a number of health risks and should therefore not be forgotten about.
1. Bigorexia (muscular dysmorphia)
Bigorexia is also known as Adonis Complex and is considered the opposite of anorexia. It is a psychological disorder that occurs more often in men. Like anorexia, it is characterised by a distorted perception of one’s own body. The difference, however, is that individuals with bigorexia perceive themselves as too small, weak and have inadequate muscle mass. They try to compensate for this with hours of exercise in the gym and increased energy intake. They simply do everything they can to put on muscle. And even though they succeed, they are still not happy with their appearance, which can trigger depressive thoughts.
It probably comes as no surprise that this problem occurs mainly among bodybuilders. According to studies, more than 50% of individuals (both men and women) who compete in amateur and professional bodybuilding suffer from bigorexia. In these cases, unfortunately, the use of anabolic steroids to grow muscle mass is not exceptional. This issue can then lead to serious steroid-related health problems. [16-17]
2. Orthorexia (orthorexia nervosa)
Orthorexia is a mental illness that, although it doesn’t meet the criteria for an official eating disorder, definitely falls under this umbrella. It is also sometimes referred to as an obsession with healthy eating. It is characterised by a compulsive need to eat only ‘healthy’ or ‘clean’ foods, which gives a person with this condition a sense of control over their health. After eating any ‘forbidden’ foods, guilt and anxiety set in.
A person with orthorexia eats only what they consider appropriate and may therefore have a very limited choice of food. They often eliminate entire food groups from their diet that they perceive as unhealthy or harmful. These may include sugar, bread or other cereal products, fat, meat or dairy products. The more serious the situation, the fewer foods that are considered good and healthy enough to eat are left.
This typically results in a deficiency of certain nutrients (proteins, carbohydrates, fats, vitamins, minerals), which can lead to health problems. They are usually firmly convinced of the correctness of their diet and often do not admit that their behaviour could be a problem. [14]
Symptoms and consequences of eating disorders
If someone regularly eats only a piece of fruit instead of a full meal, tries to fill an empty stomach with water or alternates between overeating and starving, it can be expected that this behaviour will have a negative effect on their health in the long run.
All of the above disorders have one thing in common – a disturbed relationship with food. This can have serious consequences for mental and physical health. But that’s not all, because these problems then carry over in various ways into the functioning of interpersonal relationships and sporting performance. Overall, quality of life is reduced.
1. What are the consequences of eating disorders for your physical health?
Food provides not only energy but also important micronutrients such as vitamins, minerals and other biologically active ingredients with a positive effect on the body. If the body lacks any of these for a prolonged period of time, it cannot function properly.
These consequences and impacts may vary from one ED to another. In the case of insufficient energy intake, adaptation mechanisms occur in the body to help it save as much energy as possible. Logically, the body takes drastic reductions in energy intake as a life-threatening condition, so it conserves wherever it can. Energy is then used mainly for essential functions such as heart function or breathing. Some of the body’s processes are severely restricted, with serious consequences. [18-19]
The effects of eating disorders on the body
- chronic fatigue and irritability
- loss of muscle mass and general weakness
- concentration and attention problems
- digestive disorders (constipation, diarrhoea), abdominal pain
- hair loss and deterioration of skin quality
- frequent vomiting causes damage to the oesophagus and teeth
- bone thinning (osteoporosis)
- sleep problems
- negative effect on oestrogen and testosterone levels, sexual health and fertility
- irregular menstruation or complete absence of menstruation (amenorrhea)
- anaemia due to iron deficiency
- in severe cases, the heart rate and blood pressure may slow down, which can compromise normal heart function
2. What are the mental health implications of eating disorders?
A person with an eating disorder may already have psychological problems before the outbreak of the disease. Likewise, an ED can later take a toll on their mental health and interpersonal relationships. They often stop attending social and family events that could jeopardise their adherence to their carefully set schedule. The extrovert then suddenly becomes an introvert. [19-20]
When suffering from an eating disorder, it is common to constantly overthink food and obsess over weight and appearance. Flexibility and adaptability in daily life is reduced, as the person needs to stick to their plan and set regime.
Mental health and the impact of eating disorders
- depression, anxiety and feelings of inferiority
- self-pity and self-doubt
- feelings of guilt, disappointment and shame
- feelings of loneliness
- fear of new things
- rituals and compulsive behaviour (repetitive behaviour)
- obsessive or intrusive thoughts that you can’t get rid of
- deteriorated family relationships
- damaged or destroyed partner and friend relationships
3. Effect of eating disorders on sporting performance
While some athletes are able to train normally for quite a long time due to their body’s adaptation to low energy intake, over time they may begin to see a decline in performance and other negative consequences of the ED. [21]
Sporting performance and the impact of eating disorders
- feelings of fatigue and exhaustion
- reduced training performance
- loss of muscle mass and strength
- impaired muscle function due to lack of energy from food, protein and electrolytes (potassium, magnesium, calcium), which are important for their proper functioning
- muscle cramps due to deficiencies in electrolytes
- difficulty concentrating on performance
- more frequent fractures and injuries
- impaired recovery and healing of injuries
- lower glycogen stores in the body – a stored carbohydrate
If you’re wondering what else low energy intake combined with excessive exercise can do to an athlete’s body, read our article How to Combat Menstrual Loss and Other Symptoms of the Female Athlete Triad?
How to address eating disorders?
One should definitely not be left on their own when it comes to eating disorders. In this case, the expert help of a doctor and other members of a multidisciplinary team is necessary to ensure comprehensive care. A doctor, a psychologist and a nutritionist are usually involved in the therapy of a person with an ED. Equally important is support from family and close friends. [13]
Listen to the Healthy Measures podcast on the topic of a healthy relationship with food
What should you remember?
People with eating disorders often manipulate food for more than just the reason of losing weight or gaining muscle. In many cases, they believe it will help them achieve a better physique, improved athletic performance as well as greater self-confidence, life satisfaction and success. They live in their own world, which is full of calorie counting and regrets after eating a certain food. Their own perfectionism, peer pressure or psychological problems may lead them to this. In this case, early help from professionals is essential to help prevent the negative health effects of an ED.
If you’ve taken something away from today’s article and feel that someone else should read it too, feel free to share it with your friends. You will be helping to raise awareness and spread the word about eating disorders.
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