Do you feel guilty for having eaten a piece of cake and then try to make up by starving for a day? Or worse, by throwing up? Dr Parul R Sheth explains eating disorders and how to deal with them

PREETI, a 21-year-old aspiring model, is always on a diet, although she has never been fat. She has cranky habits such as having a milkshake for lunch and then not eating all day. "I have to push myself to look attractive. The pressure is immense. I cannot afford to eat more," she says. Every day, the models get thinner and their clothes get smaller. It's not just Preeti - there are many like her who suffer from eating disorders (EDs) like bulimia and anorexia nervosa.

Surprisingly, about 90 per cent of people with EDs are women and 10 per cent are men. Mona, a young student, states, "I want to be happy and successful. Today, being thin is desirable. So I diet and even starve myself at times." But this trend of remaining hungry or bingeing and purging can lead to irreversible physical damage and even death. EDs can affect every cell, tissue, and organ in the body. Preeti denies that she is suffering from any ED in spite of losing 20 kg. She is excessively thin but still sees herself as overweight - a classic case of anorexia nervosa.

Are You Suffering From An ED?
Most of us today worry about our weight. And most of us have tried different diets. Indeed, it is hard to tell whether you are normal or you suffer from a problem that may escalate to threaten life and happiness. Believe it or not, EDs not only affect you, but also your relationships. They are reflective of your attitude towards food, sex and life.

Ask yourself these questions:
• Do you feel fear, anger, guilt or shame when faced with food?
• Do you feel if you lost weight, you'd be happier, more successful and accepted?
• Do you constantly check your weight? Do you have a weight you aim for but can't achieve?
• Do you feel depressed about yourself and use food to cope with these emotions?
• Do you exercise constantly to burn off calories?
• Do you think of your shape, weight and the amount you eat, 24x7?
If you say yes to any of these questions, you may have an ED and should consult a doctor.

What Causes ED?
It is suggested that the satiety centre lies in the brain and eating is regulated by a part of the brain called the hypothalamus. One theory holds that a disturbance in the hypothalamus causes EDs. Both bulimia and anorexia nervosa are psychosomatic diseases.

In anorexia nervosa, the ritual begins with normal dieting that is then carried to an extreme. As time passes, lack of food deprives the body of essentials like protein and also prevents the normal fat metabolism. Treatment involves force-feeding and giving healthy eating tips. Family counselling and psychotherapy may be needed. Some are also prescribed anti-depressants while others may need hospitalisation because of chronic fatigue and weakness.

Bulimia is three times more common than anorexia. Signs include self-vomiting, excessive usage of laxatives, cycles of bingeing and starving. Studies indicate that bulimia occurs due to an imbalance of chemicals in the brain.

For a person with an ED, it is essential to normalise the eating habits along with increased physical activity. Do not let slimming pressurise your brains.

ED Reality!
Many EDs do begin in the teenage years, but children, men, older women and just about anyone can fall victim to this.

Recovery takes a long time, but with hard work and proper treatment, you can recover fully. With all EDs, weight is the focus of life. By focusing on food, weight and calories, a person blocks out painful feelings and emotions. Eating disorders are NOT a problem with food. They are in fact only a symptom of underlying problems.

Apart from vomiting, bulimics also use laxatives, diuretics, exercising, or fasting to lose calories.
Not all anorexics look like the extreme cases shown on talk shows. Some may be anywhere from two to 10 kg underweight. Just because someone does not look emaciated, does not mean they are not anorexic.

Many anorexics avoid such foods, but some do eat them on a regular basis. If an anorexic decides to only allow him/herself 300 calories a day, they may very well choose to eat a chocolate bar, candy, etc.

Yes you can, especially if you have been purging, using laxatives and doing excessive exercise. Many bulimics have died from cardiac arrest which is usually caused by low potassium or an electrolyte imbalance. Others have died from a ruptured oesophagus.

It is in fact just as serious as anorexia and bulimia. Many have more than one ED. That just proves that the eating behaviours are only the symptoms, not the problem.

Are You Anorexic?
Symptoms of anorexia:
• Extreme weight loss
• Excessive chewing of food
• Denying hunger
• Excessive exercising
• Choosing low calorie food

Consequences of anorexia and bulimia:
• Stoppage of menstruation and infertility
• Growth of fine hair on the face and arms
• Constipation
• Muscle weakness
• Dehydration
• Osteoporosis
• Irregular pulse
• Liver and kidney damage
• Gastric dilation and rupture
• Low blood sugar, anaemia, weakness and stunted growth
• Anxiety, depression, feelings of guilt and shame, compulsive behaviour