Eating disorders are on the rise, particularly among young women and teenagers, and parents must keep an eye out for the warning signs before it is too late, UAE doctors have warned.

"There are mainly two types of eating disorders: anorexia nervosa and bulimia nervosa. If a patient has either of the two for three months, then we diagnose it as an eating disorder," Dr Khizara Amin, specialist in psychiatry, Universal Hospital, told Khaleej Times.

Dr Amin said in anorexia the patient has a fear of gaining weight. "It is an obsessive fear of gaining weight - the appetite is usually there in anorexia, but they restrict the food by excessive fasting, excessive exercising, or excessive dieting."

She said in bulimia nervosa, binge eating, purging by induced vomiting, or misuse of laxatives, are common. "One in four women is at risk of battling eating disorders. It can be biological or psychodynamic factors that can affect the person, such as severe anxiety."

In anorexia nervosa, a dynamic family history is common, where the patient often has a difficult relationship with the parents. "Usually, in anorexia, the patient has a difficult relationship with the mother, or has a controlling mother."

Dr Amin said a recent case she had was a 19-year-old female patient who had a rough relationship with her mother. "The patient had all the characteristics of both anorexia and bulimia, and she also had a poor relationship with her mother."

The patient was suffering from eating disorders for a long time until she felt she finally had to seek help. Dr Amin said there are also signs other than severe weight loss, to diagnose the patient; for instance, if a woman misses three menstrual cycles.
Look for warning signs

Dr Amin said parents must look out for red flags in their children, including refusal to eat, severe weight loss, emotional instability, menstrual irregularity, gland swelling and marks on the knuckles from inducing vomit.

"These signs don't go on for one or two days, but for months or years. Warning signs of anorexia include rapid weight loss, which can be noticed, whereas in bulimia, the weight often stays the same, which is why it is harder to spot."

She said the child must be referred to a doctor and a psychiatrist for immediate help. "If a parent feels something odd is going on, then it probably is."

She also warned parents to notice if their child goes to the restroom right after eating or spends a long time in the washroom. "The child with bulimia might eat a lot in front of the parents, and make sure the parents see, then they go to the toilet and purge, use enema or laxatives." Dr Amin stressed that doctors today are receiving cases with patients battling both anorexia and bulimia. She said parents have an imperative role in detecting the illness and must also notice dangerous signs, including marks on the child's hands or body from self-harm, functional decline or sudden low grades in school, as well as isolation and mood swings.

"Parents must not ignore it because it can lead to emotional and psychological disturbances. Eating disorder is a psychiatric illness."

Inducing vomit may even trigger cancer over time, she warned. She noted that social media and peer pressure also have a lot to do with the rise in cases. "The fashion industry and social media, where airbrushed images of what a woman's body should ideally look like, is affecting our children."

She stressed that there are countless hidden cases of teenagers and young adults suffering from eating disorders but, "have not come out yet - sometimes it can take years to seek help". "They might only seek help when the body weight is dangerously low, because they end up admitted to ER and require hospitalisation for days." Eating disorders can be fatal, particularly in anorexia, if the body weight is 80-85 per cent less than expected or if the BMI is less than or equal to 15 - which is severe to extreme.

"This is when the patient must be hospitalised and doctors must re-feed the patient. The patient will also require behavioural therapy, psychotherapy and medication to control the eating disorder.

Dr Anita Das Gupta, clinical dietitian at Burjeel Hospital, said those suffering from eating disorders could face life-long complications. "The patient might have several vitamin and nutritional deficiencies, as well as psychological effects and these can lead to heart failure and neurological issues."

She said people are advised to eat nutritious meals from all the food groups, maintain a healthy body weight, not under-eat or over-eat, nor over exercise. "We have even seen patients as young as 10 seeking advice on weight loss and it is worrying."

She stressed bulimia, which causes acidic stomach content to come out, will not only inflame the esophagus but can also cause gastreosophageal reflux disease.

"I notice young women outside the hospital looking dangerously underweight and frail, and it is worrying because they are most likely suffering from an eating disorder, but are afraid to seek help."
'Eating disorder took over my life'

A 28-year-old Abu Dhabi resident told Khaleej Times that she has been battling an eating disorder throughout her life. "I have been fighting this disease for as long as I can remember. It took over my life, not just physically, but mentally as well," said the public relations officer.

She recalled the moment when it "hit" her that she was suffering from the illness. "I was 18 years old and remember that I felt guilty about the amount of junk food I had just eaten, so I went to the bathroom and threw it all up."

"It was a horrible feeling, but it unfortunately become a habit for a long time. I began to over exercise on an empty stomach, to the point where I would just faint."

She said she had always had a close relationship with her parents and siblings, yet "no one under that roof even noticed." Her struggles continued for more than five years, until she finally called out for help.

She advises anyone who has the symptoms to immediately speak to a doctor.  Although she has changed her life and has become a healthy woman, the reminder of the illness is still there, she pointed out. "Living with an eating disorder is not a joke that anyone can just brush under the rug and ignore. It is life-threatening. I still remember all my struggles and pain every day."
What are eating disorders?

> Two main types of disorders - anorexia nervosa and bulimia nervosa

> Takes upto three months to diagnose symptoms

> Most common age group is 15-20 years

> More common in women

> May take up to 10 years to heal from the disorder

> Family dynamics: Anorexia is  linked to tough relationship between mother and child
Warning signs of eating disorders

> Refusal to eat

> Change in attitude towards family and friends

> Mood swings

> Anger / anxiety / depression

> Substance abuse / drugs / alcohol

> Excessive smoking and caffeine intake

> Isolation

> Excessive dieting

> Excessive exercise

> Functional decline

> OCD

> Sanity issues

> Binge eating

> Chewing food then spitting it out

> Marks on the hand or body from self-harm

> Marks on the knuckles from inducing vomit

> Swollen glands in the mouth from vomiting

> Going straight to the restroom after eating

> Spending a long time in the toilet

Source: Khaleej Times