Eating disorder

Loneliness, a need for approval and manipulated media images have triggered a sharp rise in eating disorders in Pakistan. Nabeel Khan shares the ways this epidemic can be curbed

Eating disorder
“Eyeing the debris of food that lay before me, I could not believe I had done it again. It had already happened thrice in a week. I cursed myself for feeding my feelings and not being man enough to control my emotions. My weight was ballooning uncontrollably and consuming so much food was affecting my digestion. I promised myself that I wouldn’t binge eat from now on, but my promises to myself rung hollow as I knew my issues lay deeper. I felt lonely and suicidal and hoped for a miracle to break out of this vicious cycle.”

What you just read is a mental script commonplace for individuals who suffer from a binge eating disorder. When does simple overeating cross over to becoming an actual disorder? The latter is very different from junk food consumption and has a much deeper psycho-social context.

An eating disorder (ED) is an individual’s unhealthy relationship with food causing detriment to his/her health. Clinically speaking, three types of eating disorders exist – anorexia nervosa, bulimia and binge eating. Anorexia involves unusual eating habits and a distorted self image. Binge eating and Bulimia both involve consuming large quantity of food in a short interval. However, in the latter affected individuals try to rid themselves of the consumed food through vomiting or laxatives.

So what causes these disorders to develop and who does it impact most?  The Journal of Pakistan Medical Association (JPMA), states that 85% of eating disorders (ED) have their onset during the adolescent years. 90% of those who have EDs are women between the ages of 12-35 years. However as body image dissatisfaction in midlife has increased dramatically, doubling from 25% in 1972 to 56% in 1997, increasing numbers of older women are also having these disorders.

A study in The European Journal of Scientific Research (“Does Media Develop Eating Disorders: A Study with Reference to Young Women of Pakistan”) suggests that psychological, biological and interpersonal reasons result in an unfriendly relationship with food.

Adolescent boys and girls go through an identity crisis (and identity formation) phase during teen-age with significant changes to their bodies. In this age of flux, kids are impressionable and overly concerned about the perceptions of their peers, elders and their environment. During this socialization period, they often come in conflict with a society’s perceived ideals and their own reality.

Such situations create havoc for individuals who don’t fit into a narrowly defined ideal of beauty. Heavy or plus sized people are often liable to being bullied and fat shamed in school and college. Sometimes, they also receive subtle (or not so subtle) “guidance” from their parents on the criteria of being marriage-worthy. In an era of media revival and unprecedented consumption of both local and foreign media channels in Pakistan, teenagers are bombarded with a lot of messages regarding a society’s perceived ideals regarding skin tone, body types and shapes. Thin or under-weight women are overly represented in the media (compared to the average demographic). Additionally, women strutting in a size zero jeans are seen gnawing down junk foods and sipping colas like no tomorrow, depicting that a girl can “have it all”.

Huma, a business woman recounts her experience, “Growing up, girls as well as boys aim to look attractive. A few years ago, being overweight (74kgs at a height of 5 ft), I was the object of ridicule and was called names like double roti and roly poly, and was laughed at and insulted. While angry at this mockery, I was a confident kid and didn’t shy away from eating everyone’s lunch at school and emptying my sister’s plate. However, switching from an all-girls school to a coeducational environment changed my worldview. Call it vanity, want for broader acceptability or the need to upgrade my tomboy image, I took negative comments regarding my weight from the opposite sex to heart. Sick of being bullied and held to “acceptable beauty standards”, I decided to give dieting and workout a try.

Consequently, in order to improve their body and self image, individuals resort to strict dieting. Eating disorders thus arise, where an individual tries to cut down on food to fill the perception gap or feed their feelings by consuming a lot of food.

I did all the crash diets on the planet from Kellogg’s Special K, Atkins, South Beach, All Soup, the 7 day Banana Diet, the Roti Daal diet. I would live off Chai and wheat biscuits and would skip meals. Petrified that my stomach would become full I would even avoid drinking water as that made my stomach feel heavier. I worked out like a crazy dog, nearly 3 times a day and dropped a lot of weight. Slimming down felt great and I received numerous compliments for a toned body. However, the feeling of fullness/satiation would irritate me and this is when I realized I had developed an anorexic eating disorder”, laments Huma.

[quote]Whenever anxiety strikes, a person binges on an insane amount of food within a short time to fill the "emotional void"[/quote]

Emotional turmoil such as failed relationships, troubled childhood and other such interpersonal factors are also fertile ground for developing eating disorders. Individuals with certain personality traits such as low self esteem, depression, anxiety and approval-seeking behaviour are more prone to these disorders.  Without any emotional back-up and a battered self-image, an individual seeks solace in food. Consequently, whenever anxiety strikes, a person binges on an insane amount of food within a short time to fill the “emotional void”. However, a binge eating session in most cases is followed by extreme guilt. This guilt results in either the individual removing the ingested food (known as purging) due to concern for weight gain, or a cyclical path of weight gain leading to guilt-triggering a binge.

“Within a span of 30 minutes, I consume half kg Karahi, A box of Pringles, and few pastries. There comes a point where the food stops tasting good but you still keep on filling yourself to fill that “emotional gap”. I have health problems now and I experience weight gain and loss. I have tried managing stress through meditation, yoga etc and it helps but then I get lazy and the unhealthy pattern manifests itself again”, says Hassan, a college student.

The role of biological/genetic factors in eating disorders cannot be denied. Children of individuals with eating disorders are also at risk of developing them.

Lack of knowledge, perceived high costs of treatment and the social stigma associated with seeking help from a psychologist results in individuals suffering this trauma silently. If left undiagnosed or untreated they result in a person’s inability to perform daily tasks, maintain relationships and quality of life. Additionally, for policy makers, the scale of the problem is unknown due to dearth of data.

So what can be done at an individual level to lessen the problem? On a personal level, we need to better educate ourselves regarding the symptoms manifested by individuals affected by eating disorders. Parents need to have discussion with teenage boys and girls around an investment into a healthier lifestyle. Crash dieting or “drop 10-15 pounds in two weeks” are unsustainable methods, leading the weight to yo-yo and causing significant health problems in middle age.

“Building a support system is so essential. When I was fat, my elders told me that if I did not lose weight, I would not be marriage-worthy. When I was pushing unhealthy diets on myself, nobody really pushed me to stop. Had there been better guidance, perhaps I could have made more well-informed choices”, states Huma

Knowledge of local organizations (such as Rainbow Obesity and Eating Disorder Center) that specialize in eating disorders allows the affected to seek professional help where unqualified help may not remedy the situation. But simply reaching out can also make a huge difference. With platforms like Facebook, Pakistanis are waking up to the possibilities of community support groups. These can help sufferers get through various everyday challenges through online support and sharing.

Lastly but more importantly, an empathy needs to be cultivated for individuals who may be different. Pressurizing individuals or judging them based on their appearance can trigger eating disorders. Additionally, the collective consumer power rallying against misleading campaigns that create unreachable ideal body-images can make brands more accountable for their behavior.