When Food Is Your EnemyAwake!—1999 | January 22
When Food Is Your Enemy
Reflecting on her teen years, Jean vividly recalls being a target of teasing and ridicule. The reason? She was the tallest and largest girl in her class at school. But that was not all. “Even worse than being big, I was shy and socially awkward,” says Jean. “I was often lonely, wanting to fit in somewhere, but most of the time I felt like an outsider.”
Jean was convinced that her size was the cause of all her problems and that a lean, trim figure would fix everything. Not that Jean was obese. On the contrary, at six feet [183 cm] tall and 145 pounds [66 kg], she wasn’t overweight. Nevertheless, Jean felt fat, and at age 23 she decided to lose weight. ‘When I’m thin,’ she reasoned, ‘other people will want me around. At last, I will feel accepted and special.’
“That kind of foolish logic led to a twelve-year trap named anorexia nervosa and bulimia,” Jean explains. “I got thin all right, so thin I almost died, but instead of building a happy life, I ruined my health and created more than a decade of depression and misery.”
JEAN is not alone. According to one estimate, up to 1 out of 100 American females develops anorexia nervosa as a teenager or young adult, and perhaps three times that number are bulimic. “I’ve been working on schools and college campuses for years,” says Dr. Mary Pipher, “and I see firsthand that eating disorders are just as rampant as ever.”
They are also diverse. Once thought to be a problem of the wealthy, eating disorders are now considered to be common in all racial, social, and economic levels. Even the number of men being diagnosed is increasing, causing Newsweek magazine to call eating disorders “equal-opportunity plunderers.”
What is especially alarming, though, is that the average age of those being treated for eating disorders appears to be getting lower. “There are girls younger than 10, even as young as 6, being admitted to hospital programs,” says Margaret Beck, acting director of an eating disorder center in Toronto. “It is still a small number,” she adds, “but it is growing.”
All told, eating disorders affect millions—primarily girls and young women.a “They don’t think about food or use food the way the majority of people do,” notes social worker Nancy Kolodny. “Instead of eating when they’re hungry, eating for nutrition and good health, eating for pleasure, or eating to share good times with others, they get into bizarre relationships with food and do things that aren’t considered ‘normal’—such as developing odd rituals before they allow themselves to eat, or needing to immediately rid their bodies of the food they’ve eaten.”
Let us take a close look at two common eating disorders: anorexia nervosa and bulimia nervosa.
Anorexia and Bulimia—The Facts, the DangersAwake!—1999 | January 22
Anorexia and Bulimia—The Facts, the Dangers
“Food carries an emotional weight far heavier than anything that can be measured in calories or grams.”—Janet Greeson, author.
ANOREXIA and bulimia are the two most common eating disorders. Each has its unique characteristics. Yet, as we shall see, both can be dangerous—even deadly.
Anorexia sufferers, anorexics, either refuse to eat or eat in such small amounts that they become malnourished. Consider 17-year-old Antoinette, who says that at one point her weight may have dropped to 82 pounds [37 kg]—very low for a teenager five feet seven inches [170 cm] tall. “I ate no more than 250 calories a day and kept a notebook about what I ate,” she says.
Anorexics are obsessed with food, and they will go to extreme lengths to avoid gaining weight. “I started to spit my food out in a napkin pretending I was wiping my mouth,” says Heather. Susan strenuously exercised to keep her weight down. “Virtually every day,” she says, “I ran eight miles [12 km], or swam for an hour, or felt terribly anxious and guilty. And every morning I got my greatest pleasure, usually my only real pleasure, by getting on the scale to confirm that my weight was well under 100 pounds [45 kg].”
Ironically, some anorexics become excellent cooks and will serve exquisite dinners that they themselves refuse to touch. “When I was at my very worst,” says Antoinette, “I prepared every single dinner at home and made all the brown-bag lunches for my little brother and sister. I wouldn’t let them near the refrigerator. I felt like the kitchen was all mine.”
According to the book A Parent’s Guide to Anorexia and Bulimia, some anorexics “become obsessively neat and may demand that the entire family meet their unrealistically fastidious standards. No magazine or pair of slippers or coffee cup may be left out of place for a moment. They may become equally, or even more, obsessed with personal hygiene and appearance, spending hours in the bathroom with the door locked and refusing to allow others to come in to get ready for school or work.”
How does this unusual disorder called anorexia develop? Typically, a teenager or young adult—most often a female—sets out to lose a certain number of pounds. When she reaches her goal, however, she is not satisfied. Looking in the mirror, she still sees herself as fat, and so she decides that shedding a few more pounds would be even better. This cycle continues until the dieter’s weight falls to 15 percent or more below what is normal for her height.
At this point friends and family members begin to express their concern that the dieter looks extremely thin, even emaciated. But the anorexic sees things differently. “I didn’t think I looked skinny,” says Alan, a five-foot-nine-inch [175 cm] male anorexic whose weight at one point dwindled to 72 pounds [33 kg]. “The more weight you lose,” he says, “the more your mind becomes distorted and you can’t see yourself clearly.”a
Over time, anorexia can lead to serious health problems, including osteoporosis and kidney damage. It can even be fatal. “My doctor told me that I had deprived my body of so many nutrients that two more months of my eating habits, and I would have died of malnutrition,” says Heather. The Harvard Mental Health Letter reports that over a ten-year period, about 5 percent of women diagnosed as anorexic die.
Bulimia—Bingeing and Purging
The eating disorder known as bulimia nervosa is characterized by bingeing (rapidly consuming large amounts of food, perhaps up to 5,000 calories or more) and then purging (emptying the stomach, often by vomiting or using laxatives).b
In contrast with anorexia, bulimia is not easily recognized. The sufferer may not be unusually thin, and her eating habits may seem quite normal—at least to others. But for the bulimic, life is anything but normal. Indeed, she is so obsessed with food that everything else is unimportant. “The more I binged and threw up, the less I cared about other things or people,” says 16-year-old Melinda. “I actually forgot how to have fun with friends.”
Geneen Roth, a writer and teacher in the field of eating disorders, describes a binge as “a thirty-minute frenzy, a dive into hell.” She says that during a binge “nothing matters—not friends, not family . . . Nothing matters but food.” A 17-year-old sufferer named Lydia describes her condition with a vivid analogy. “I feel like a trash compactor,” she says. “Shovel it in, smash it, throw it out. Over and over, the same thing.”
The bulimic is desperate to prevent the weight gain that would normally result from her uncontrolled eating. Immediately after the binge, therefore, she either induces vomiting or takes laxatives to eliminate the food before it can be turned into body fat.c While the very idea of this might seem repulsive, the experienced bulimic does not view it that way. “The more you binge and purge, the easier it becomes for you,” explains social worker Nancy Kolodny. “Your early feelings of revulsion or even fear are quickly replaced by the compulsion to repeat these bulimic patterns.”
Bulimia is extremely dangerous. For example, repeated purging by vomiting exposes the mouth to corrosive stomach acids, which can wear away the enamel of the bulimic’s teeth. The practice can also damage the sufferer’s esophagus, liver, lungs, and heart. In extreme cases, vomiting can cause stomach rupture and even death. Excessive laxative use can also be hazardous. It can destroy bowel function and can also lead to ongoing diarrhea and rectal bleeding. As with repeated vomiting, abuse of laxatives can, in extreme instances, lead to death.
According to the National Institute of Mental Health, the incidence of eating disorders is consistently rising. What moves one young woman to flirt with death by starving herself? Why does another become so obsessed with food that she binges and then becomes so obsessed with her weight that she feels compelled to purge what she has eaten? These questions will be explored in the following article.
a Some experts claim that a 20- to 25-percent loss of a person’s total weight can induce chemical changes in the brain that may alter his perception, causing him to see fat where there is none.
b Compulsive overeating without purging is also considered by some to be an eating disorder.
c To keep from gaining weight, many bulimics exercise strenuously every day. Some of these are so successful with weight loss that in time they become anorexic, and thereafter they might alternate between anorexic and bulimic behavior.
What Causes Eating Disorders?Awake!—1999 | January 22
What Causes Eating Disorders?
“An eating disorder doesn’t just pop up out of nowhere. It’s a symptom, a signal that something is wrong in a person’s life.”—Nancy Kolodny, social worker.
EATING disorders are not new. Anorexia nervosa was first formally diagnosed in 1873, and the symptoms have reportedly been observed as far back as 300 years ago. Since World War II, however, the number of anorexics appears to have increased dramatically. The situation is similar with bulimia. The condition has been known for centuries, but in recent decades it has, as one book on the subject puts it, “exploded onto center stage.”
What is behind eating disorders? Are they inherited, or are they an unusual reaction to a culture that glorifies thinness? What part does family environment play? These questions are not easily answered. As social worker Nancy Kolodny says, defining an eating disorder “isn’t as straightforward as diagnosing a medical condition like measles or chicken pox, where a doctor knows exactly what the cause is, how you catch it, how long the illness will last, and what the best course of treatment is.”
Nevertheless, researchers point to a number of factors that may contribute to the development of eating disorders. Let us consider a few of them.
The Culture of Thinness
In affluent lands the fashion industry parades stick-thin models before young and impressionable onlookers, indoctrinating them with the notion that a girl is only as beautiful as she is thin. This distorted message compels many women to strive for a body weight that is both unhealthy and unrealistic. Dr. Christine Davies observes: “The average woman is five feet, five inches [165 cm] and 145 lb [66 kg]. The average model is five feet, 11 inches [180 cm] and 110 lb [50 kg]. Ninety-five percent of us don’t match up and never will.”
Despite this fact, some women will go to extremes to acquire what they perceive to be the ideal body. For example, in a 1997 survey of 3,452 women, 24 percent said that they would be willing to give up three years of their life to attain their weight goal. For a significant minority, the survey said, “life is worth living only if you are thin.” Since 22 percent of those surveyed said that fashion magazine models influenced their body image when they were young, the report concluded: “It’s no longer possible to deny the fact that images of models in the media have a terrible effect on the way women see themselves.”
Of course, those who are most likely to fall prey to the media’s artificial ideal are those who do not feel good about themselves to begin with. As clinical social worker Ilene Fishman says, “the bottom line is self-esteem.” It has been noted that people who accept the way they look rarely develop obsessions with food.
Eating and Emotions
Many experts say that there is more involved in an eating disorder than food. “An eating disorder is a red flag,” says social worker Nancy Kolodny, “telling you that you need to pay attention to some situation in your life that you’re ignoring or avoiding. An eating disorder is a reminder that you aren’t giving voice to whatever stresses and frustrations you may be experiencing.”
What type of stresses and frustrations? For some it might involve trouble on the home front. For example, Geneen Roth recalls that during her childhood, food—in particular, sweets—became her “defense against slammed doors and raised voices.” She says: “When I sensed a parental fight brewing, I would switch my awareness, as easily as you switch a TV channel, from feeling at the mercy of my mother and father to a world in which nothing existed but me and the sweetness on the roof of my mouth.”
Sometimes an eating disorder has even deeper roots. For example, The New Teenage Body Book notes: “Studies show that those who have sexual trauma (abuse or molestation) may unconsciously try to protect themselves by making their bodies sexually unattractive and by focusing their attention on something safe like food.” Of course, people should not jump to the conclusion that one suffering from an eating disorder has been sexually molested.
The seeds of an eating disorder can be sown in what may appear to be tranquil soil. Indeed, a prime candidate for anorexia may be a girl who lives in an environment in which she is not free to make any of her own decisions or to express her negative feelings. Outwardly, she complies; but inwardly, she is in turmoil and feels that she has no control over her life. Not daring to rebel openly, she focuses on the one part of her life that she can control—her body.
It should be noted, however, that eating disorders are not always the result of family turmoil or sexual trauma. For some, eating disorders develop simply because weight is a dominant issue in the family. Perhaps a parent is overweight or is constantly dieting and engenders an overly cautious—or even a fearful—attitude toward food. For others, the onset of puberty is in itself a factor. The bodily changes that are part and parcel of the transition to adulthood can make a girl feel that she is fat—especially if she matures more quickly than her peers. She may take extreme measures to stave off the curves of womanhood if she finds this transition to be frightening.
In addition to citing emotional factors, some researchers say that there may be a physical factor involved. For example, they point out that bulimia may be rooted in the sufferer’s brain chemistry. They claim that the part of the brain that controls moods and appetite is involved and that this may explain why antidepressants are at times effective in alleviating the bulimic’s symptoms.
In any event, it is difficult for researchers to isolate a single factor that causes anorexia or bulimia. But what can be done to help those who are struggling with these eating disorders?
[Picture on page 7]
Anorexics often have a distorted view of their appearance
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The media promote the idea that thin is beautiful
Eating Disorders—What Can Help?Awake!—1999 | January 22
Eating Disorders—What Can Help?
IF YOUR daughter has an eating disorder, she needs to get help. Do not postpone matters under the assumption that the problem will go away on its own. An eating disorder is a complex illness, with physical and emotional components.
Of course, experts have put forth a confusing array of treatments for eating disorders. Some recommend medication. Others endorse psychotherapy. Many say that a combination of both is most effective. Then there is family counseling, which some say is especially vital if the sufferer is still living at home.a
Although experts may differ in their approach, most agree on at least one point: Eating disorders are not just about food. Let us examine some of the deeper issues that typically need to be addressed when someone is being helped to recover from anorexia or bulimia.
A Balanced View of Body Image
“I stopped buying fashion magazines completely when I was about 24,” says one woman. “Comparing myself to the models had a very strong and negative impact.” As already discussed, the media can distort a girl’s concept of beauty. Indeed, one mother of a girl with an eating disorder speaks of “the unrelenting publicity in our newspapers and magazines and television advertising to be thin, thin, thin.” She says: “Both my daughter and I like being slender, but we feel the constant barrage turns it into being the most important thing in life, ahead of everything.” Clearly, recovering from an eating disorder may require adopting new beliefs about what constitutes genuine beauty.
The Bible can help in this regard. The Christian apostle Peter wrote: “Do not let your adornment be that of the external braiding of the hair and of the putting on of gold ornaments or the wearing of outer garments, but let it be the secret person of the heart in the incorruptible apparel of the quiet and mild spirit, which is of great value in the eyes of God.”—1 Peter 3:3, 4.
Peter is saying that we should be more concerned about inner qualities than outer form. Indeed, the Bible assures us: “Not the way man sees is the way God sees, because mere man sees what appears to the eyes; but as for Jehovah, he sees what the heart is.” (1 Samuel 16:7) This is comforting, for while we cannot change certain aspects of our physique, we can always improve the kind of person we are.—Ephesians 4:22-24.
Since eating disorders can thrive in a climate of low self-worth, you may need to reevaluate yourself as a person. True, the Bible tells us not to think more of ourselves than is necessary. (Romans 12:3) But it also tells us that even a single sparrow has value in God’s eyes, adding: “You are worth more than many sparrows.” (Luke 12:6, 7) So the Bible can help you to develop healthy self-respect. Appreciate your body, and you will take care of it.—Compare Ephesians 5:29.
But what if you truly do need to lose weight? Perhaps a healthy diet and a program of exercise will help. The Bible does state that “bodily training is beneficial,” even if only to a limited degree. (1 Timothy 4:8) But never should you become obsessed with your weight. “Perhaps the wisest course,” concluded a survey on body image, “is to get plenty of exercise—and accept yourself the way you are rather than try to mold yourself into a narrowly defined and arbitrary ideal.” A 33-year-old woman in the United States found this approach to be helpful. “I’ve had one simple rule,” she says. “Work on improving what you can realistically change, and don’t spend time worrying about the rest.”
If you take a positive view of life and supplement this with a healthful diet and a reasonable exercise program, likely any pounds that need to come off will.
Finding “a True Companion”
After studying a number of bulimics, Professor James Pennebaker concluded that to a large degree, their cycle of eating and purging was forcing these women to adopt secret lives. He says: “Virtually every one spontaneously noted the inordinate amount of time and effort required to conceal her eating habits from her close friends and family. They all were living a lie and hated it.”
A major step to recovery, therefore, is to break the silence. Both anorexics and bulimics need to talk about the problem. But to whom? A Bible proverb states: “A true companion is loving all the time, and is a brother that is born for when there is distress.” (Proverbs 17:17) That “true companion” may be a parent or another mature adult. Some have also found it necessary to confide in someone who is experienced in treating eating disorders.
Jehovah’s Witnesses have an additional resource—congregation elders. These men can be “like a hiding place from the wind and a place of concealment from the rainstorm, like streams of water in a waterless country, like the shadow of a heavy crag in an exhausted land.” (Isaiah 32:2) Of course, elders are not doctors, so in addition to their helpful counsel, you may still need medical treatment. Nevertheless, these spiritually qualified men can be a wonderful support to you in your recovery.b—James 5:14, 15.
Your greatest confidant, however, can be your Creator. The psalmist wrote: “Throw your burden upon Jehovah himself, and he himself will sustain you. Never will he allow the righteous one to totter.” (Psalm 55:22) Yes, Jehovah God has an interest in his earthly children. So never neglect praying to him about your deepest anxieties. Peter admonishes us: “Throw all your anxiety upon him, because he cares for you.”—1 Peter 5:7.
When Hospitalization Is Necessary
Hospitalization is not a cure in itself. However, if a girl has become malnourished from severe anorexia, it may be necessary for her to receive specialized care. Admittedly, it is not easy for a parent to take this step. Consider Emily, whose daughter had to be hospitalized after life became, as Emily puts it, “intolerable for her and for us.” She adds: “Putting her, crying, into the hospital was the hardest thing I have ever gone through, the worst day I have ever had.” It was similar with Elaine, who also had to hospitalize a daughter. “I think the worst moment that I can remember,” she says, “is when she was in the hospital and refused to eat and they had to tube-feed her. I felt that they had broken her will.”
Hospitalization may not be a pleasant thought, but in some cases it may be necessary. For a number of those with eating disorders, it paves the way for recovery. Emily says of her daughter: “She did need to be hospitalized. It was the hospitalization that did help her to start to get better.”
Living Without Eating Disorders
As part of recovery, the anorexic or bulimic needs to learn to live without an eating disorder. This can be difficult. Kim, for example, estimates that in her anorexic phase, she lost 40 pounds [18 kg] in ten months. Yet, regaining 35  of those pounds [kg] took her nine years! “With great difficulty,” Kim says, “I slowly learned to eat normally again, without counting every calorie, measuring my food, eating only ‘safe’ foods, panicking if I did not know the ingredients in a casserole or dessert, or dining only at restaurants with salad bars.”
But recovery for Kim entailed something more. “I learned to recognize and express my feelings with words rather than through actions or food behaviors,” she says. “Becoming aware of new ways to face and resolve conflicts with others opened doors to closer relationships with friends and family.”
Clearly, recovering from an eating disorder is challenging, but ultimately it is worth the effort. That is what Jean, quoted in the first article in this series, believes. “Returning to disordered eating,” she says, “would be like going back into a padded cell after living free for a while.”