Eating behavior disorders

Eating disorders (ED) are conditions characterized by alterations in food intake habits and misconceptions about diet, weight and body image, causing serious health consequences, such as nutrient deficiencies, body function disorders, psychosocial disturbances or a combination of these.

Eating disorders usually begin in adolescence, between 12 and 20 years of age, and about 90% of cases are female.

Risk factors of eating disorders

The causes of eating disorders are diverse, it is recognized that genetic, psychological and sociocultural factors have an influence, without being able to establish the predominant role of one or the other.

Genetic factors: in family vulnerability studies, a higher frequency of cases of eating disorders has been found in people who have relatives who have suffered or also suffer from the disorder.

Psychological factors: these disorders are more frequent in people with insecure personality traits and low self-esteem.

Sociocultural factors: there is a relationship between eating disorders and overprotective, rigid and demanding family models. The marked interest in fashions, the media and social networks also play a role.

Extraordinary events that marked their lives: they may appear in people who have been victims of physical or sexual abuse, loss of loved ones, discrimination and criticism.

Most frequent types of eating disorders

• Anorexia nervosa.

• Bulimia nervosa.

• Eating Disorder Not Otherwise Specified (EDNOS).

Anorexia nervosa: Anorexia nervosa is a group of eating disorders, characterized by poor food intake, with the aim of losing weight. Sufferers have an exaggerated desire to be thin and a distortion of body image that causes them to see themselves as fat even though they are thin, feeling panic of becoming obese. This disorder can lead them to a very serious state of malnutrition, which in extreme cases causes death; however, they are generally unaware of the risk they run for their behavior, nor do they recognize that they suffer from a dangerous disease.

To achieve their goal, they go on extremely strict diets, undergo intense physical activity sessions, induce vomiting, use drugs that reduce appetite, and abuse laxatives and diuretics.

Behaviors that may be related to the onset of anorexia nervosa:

• Decrease the amount of food served, cut it into small pieces, distribute them around the plate and chew them slowly.

• Eating alone, skipping meals, lying about what you have eaten, and throwing food away.

• Disappearing after meals and locking oneself in the bathroom.

• Obsession with continually weighing oneself and insisting on restrictive diets even though the person is very thin.

• To carry out intense physical activities immediately after eating.

• Depressed mood, irritability and anxiety.

• Preoccupation with food, body shape, and weight.

Symptoms of anorexia nervosa:

• Pallor, brittle nails, dry and cold skin, thin and sparse hair, yellowing of the palms of the hands and soles of the feet.

• Calluses on the back of the fingers, due to repeated provocation of vomiting.

• Frequent gastrointestinal problems.

• Interruption of the menstrual cycle.

• Alterations in the gums and teeth, by the repeated provocation of vomiting.

• Hemorrhages around the eyes caused by the effort to vomit.

Bulimia nervosa: Bul imia nervosa is an eating and psychological disorder characterized by repeated episodes of eating large amounts of food in a short time (binge eating), usually in secret, followed by compensatory behaviors, such as provoking vomiting, drastic fasting, excessive physical exercise and taking laxatives and diuretics. They also have a great fear of gaining weight.

Bulimia is a difficult disorder to detect because, unlike anorexia, sufferers may have a normal, healthy appearance and, in most cases, are aware of following a dangerous eating pattern that is beyond their control, so they feel guilt, shame, anguish and are often depressed.

The behaviors that may be related to the onset of bulimia nervosa are the same as those of anorexia nervosa. What differentiates bulimia are excessive food intakes, which people suffering from anorexia control.

The symptoms it causes are very similar to those of anorexia nervosa, although with less intensity, in some cases becoming barely perceptible.

Eating behavior disorder not otherwise specified (EDNOS): It is a set of eating disorders that does not meet all the symptoms to be diagnosed as anorexia nervosa, nor as bulimia nervosa. Therefore, similar severe isolated symptoms may be present, but without forming a complete picture.

Unspecified eating disorders are the most common group of eating disorders, which can interfere with interpersonal relationships, academic performance, work and seriously affect health.

The most common behaviors are chronic dieting, the use of laxatives, enemas or diuretics and intense physical exercise. Episodes of large ingestions or binge eating are infrequent.

Treatment of eating disorders: Treatment is multidisciplinary and in most cases is done on an outpatient basis, reserving day hospitalization and total hospitalization for more severe cases.

In recent years, the therapeutic approach has changed, considering it necessary to first carry out nutritional rehabilitation, and then address the reasons that conditioned the onset of the disorders.

The main objectives of the treatment are:

• Normalize the patient's nutritional status.

• Stabilize weight and treat other complications associated with the disease.

• To increase the nutritional education of the patient and family.

• To modify the psychosocial disorders that may have influenced the appearance of the disorders through psychotherapy, pharmacological treatment and family intervention.

• Avoid relapses, with appropriate medical follow-up and family collaboration.

How to prevent eating disorders in adolescence?

• Plan at least one meal a day in the family, with the participation of the little ones from the first year of life, where healthy eating habits are promoted.
• Reduce sedentary recreational activities, such as playing video games, watching television or surfing the Internet.
• Share frequent physical activities as a family, such as outdoor walks, sports, bicycle rides and trips to the countryside or the beach.
• Do not use confinement, prohibitions to play or to interact with their friends, as a punishment.
• Avoid public or private scoldings and sermons, opt for conversation and exposition of points of view, without ever reaching absolute prohibition.
• Encourage by example communication among all members of the family, listening and respecting all opinions, promoting respect for diversity.
• Avoid overprotection from an early age, in order to promote self-esteem and personal safety.

Feeding in special situations during adolescence

During adolescence there is a high growth rate and important maturational phenomena that affect body size, shape and composition, processes in which nutrition plays a decisive role. In order for these processes to be successful, situations that increase risk factors must be avoided. Among the causes that can complicate the development of adolescents are pregnancy, breastfeeding and the practice of high-performance sports.

Pregnancy: Adolescents facing pregnancy require higher nutritional intake than adult women, as they need to meet the demands of their own development and those of the fetus. This situation causes competition for nutrients from both organisms, increasing the risk of malnutrition in both mother and child. The problem can be aggravated if the mother-to-be restricts her caloric intake to avoid the usual weight gain that occurs during pregnancy.

Another factor that increases the risks of pregnancy at this stage is that most pregnancies occur suddenly, without adequate preparation of the mother and famil