Why do you eat?

CHENNAI: In many social circles, especially within the Indian familial set-up, you’d always have someone say: ‘You are what you eat’. As much as it’s an acceptable phrase that signifies a holistic perspective, it’s a horrible reality for someone struggling with an eating disorder. There has been a lot of buzz on Meta’s recent announcement to regulate content on self-harm and eating disorders due to its influence on the people. But in India, there is not much awareness on eating disorders. There is hardly any chatter about psychological factors influencing eating habits, which eventually leads to a disorder.

This needs attention as it can also cause serious physical ailments and lifestyle-related issues, especially among youngsters.

Lack of resources

Eating disorders can have adverse consequences on your body, affecting your heart, digestive system, bones, teeth and mouth. It can lead to long-term complications and other diseases. They’re also linked with depression, anxiety, self-harm, and suicidal thoughts and disturbing behaviours.

Since eating disorders remain under-diagnosed in India, resources to identify, diagnose and treat are limited. That’s why it’s important to have a strong support system in the form of family and friends, as it’s difficult to manage the symptoms by yourself.

“Eating disorders are becoming common among the younger generation, especially in women. There are various types of eating disorders – anorexia, bulimia, binge eating and obesity. People with anorexia may eat a lot but they throw up immediately after, so that their body does not consume the carbs,” explained consultant clinical psychologist at V-Cope Vadhana.

Symptoms can be acidity, ulcers, dehydration, abdominal pain and others, all of which can be related to psychological trauma. Seeking psychological support is very important for those with anorexia nervosa.

“Recent studies have suggested neuropsychological aspects responsible for eating habits, food choices and selection of food. The ‘brain gym’ concept along with cognitive behaviour therapy is being used to enhance brain function and take control of their food habits,” added Vandhana.

How you relate to food

If you’re eating to fill a vacuum, then your relationship with food is unhealthy. It could quickly become a habit you cannot control and leads to an eating disorder. Overeating or under-eating could be a symptom of an underlying mental health problem.

“We get many patients with an eating disorder. They have other symptoms that represent depression but we still conduct evaluations to be thorough. Cases of eating disorders are rarely diagnosed in India, mainly because of lack of awareness,” opined Dr M Malaiappan, director, Institute of Mental Health.

People get so used to these eating habits that it seems normal to them. Very rarely do patients identify it as a problem. It takes time to reflect on food habits as other psychological concerns take precedence in diagnosis and treatment.

“Such patterns are diagnosed 10-15 years after an onset of a physical illness, or it’s pointed out by others to patients. It’s important for parents to notice these signs in their children in adolescence or teenage years as bullying, childhood trauma or even social media influence can also impact eating habits. Though people of any age group can suffer from an eating disorder, it’s particularly difficult for youngsters due to the peer pressure they feel on social media,” says a psychotherapist at IMH.

As a contrary to over-eating, there are people who have a fear of eating and would rather starve. They avoid food, or eat very little because they are afraid of gaining weight. “Anorexia nervosa is an eating disorder in which the person eats less because of the fear of putting on weight. There is also a strong association between perfectionism as a personality trait and eating disorders, where an individual’s definition of perfection stems from the society’s standard of the ‘ideal body type’. This causes a lot of distress,” described C Akshaya, a city-based consultant psychologist.

There are also other factors that are responsible for eating disorders, such as family dynamics. If someone is raised in a rigid family system, where food is used as a punishment or a deterrent from becoming ‘perfect’ and ‘successful’, their relationship with food is not one of pleasure but of pain.

“For instance, when someone with anorexia looks in the mirror, they only see ‘the ugly fat’ though they are extremely malnourished,” she added. “On the other hand, it’s common for people to crave more calorific foods when stressed, and start eating as a coping mechanism. This leads to binge-eating.”

Exercise can become an excellent coping mechanism, as releasing pain-killing hormones could make them feel better. “We encourage them to eat only when they are hungry and not when they are bored and stressed,” pointed out Akshaya.

Social media, a trigger

Social media plays a mitigating role in how youngsters see themselves, physically, emotionally and intellectually. It plays havoc on their raging hormones and insecurities by glorifying impossible beauty standards of body weight, skin tone and figure.

Focus on body-size and shape rather than holistic fitness has an adverse impact on the younger generation. This leads to unhealthy diets and exercise regimens that could lead to a clinical presentation of eating disorders or disordered eating behaviours.

“Disordered eating behaviours aren’t frequent or severe enough to be diagnosed as eating disorders,” said G Swarnameenaa, a city-based clinical psychologist, trainee, Central Institute of Psychiatry. “For example, extreme starvation could be followed by episodes of uncontrolled eating (cheat meals), purging behaviours like induced vomiting or diarrhoea to compensate for the calorie intake. These could co-occur with extreme distress around body weight, and aversion of their body structure.”

People identify with certain food items and eat them to boost their happy hormones when they’re stressed. Besides psychological care, they need help with diet patterns because it becomes addictive. “We need to educate adolescents more, as they are vulnerable to trends. Awareness of fitness on every level – physical, emotional and mental health – must be discussed and encouraged at home. The importance of nutrition and its relation to fitness must also be emphasised,” said Dr R Vasanth, consultant psychiatrist, Fortis Malar Hospital.

A different presentation of an eating disorder could be decreased interest and motivation to eat, which could restrict their diet while also affecting their lifestyle at large. Social withdrawal may also be seen in this population which could prevent them from stepping out for meals, leading to decreased food intake.

“They need to slowly be introduced to healthy diet patterns. They have to consume the right nutrients and essentials like proteins to avoid deficiency of certain micro-nutrients. Constant monitoring is required to ensure that they stick to the right diet and in a right manner, while they also battle against the mental health issues,” says Vijayshree N, head and chief dietician, MGM Healthcare.

It’s important to ensure that people with eating disorders adapt to the right diet patterns and have a restricted food regimen they can follow.

However, forcing anyone with an eating disorder to change their food habits can backfire. Dieticians point out that it’s not possible for them to switch to a different diet pattern suddenly.

“It’s also important to create the right environment. For example, stocking unhealthy items at home should be avoided. Involve them in cooking, purchasing or even prepping. This brings a sense of responsibility to them. Though it’s very difficult to handle a person with eating disorders, the food choices should not be forced. Take small steps to gain their trust and cooperation,” she adds.

A multi-modal approach

People with eating disorders rarely disclose the information even to their loved ones, as they are often shamed for it. It’s important to give them a safe space for them to share their struggle.

“Don’t generalise or undermine their stressors. It usually arises from distorted cognitions and stressors, trigger-eating disorders. This is why professional help is required,” said Dr Vasanth.

If there is a psychological or psychiatric ailment, it can be recognised and treated. There can be coexisting mental health concerns and it needs to be treated accordingly. “Medical intervention could be both therapy-based and medications for alleviating the symptoms. It’s a complex process and there are social, psychological, and biological factors, which is why a multi-modal intervention is required,” he added.

While it’s either bulimia or anorexia, people tend to avoid all kinds of food items and become extremely thin. They would not even drink adequate water, though it takes a toll on their physical and health. So treatment needs to be multifaceted to focus on nutrition and psychological wellness.

“People also use laxatives to vomit immediately after they eat to not gain weight. All this impacts the physical health extensively as it affects blood parameters, menstrual cycles and other hormones. Early identification of symptoms always help in any medical condition, and that’s how it must be treated — a disorder that requires medical intervention. So, it’s important to be sensitive and not to ridicule someone with an eating disorder,” says Dr Vasanth.

The mental health link

Mood disorders like depression, and other severe mental disorders like schizophrenia can also present with eating disorders. “Some may tend to be emotional-eating where they eat in excess to alleviate negative emotional states like sadness, anxiety, and loneliness. This could lead to metabolic syndromes like diabetes and cardiovascular disorders apart from obesity,” pointed out Swarnameena.

Persons with schizophrenia could present with disordered eating behaviour, which could be secondary to their symptoms. Some of them have false fixed beliefs that they are persecuted or someone is poisoning their food and may starve themselves. In some, this has been reported secondary to commanding voices they may hear that instruct them to not eat.

Studies reveal...

A study from Yale School of Medicine reports that almost 3% of American women aged 50-64 years, and almost 2% of women 65 and older, have an eating disorder. Another study published in the Journal of Eating Disorders found that roughly 26% of older female participants reported binge-eating one or more times a week. The study’s authors report that menopause can leave a woman more vulnerable to developing an eating disorder. Some women start dieting to stop hormonal weight gain, for example, and develop a distorted body image.

When eating becomes a coping mechanism

Emotional baggage from childhood trauma

For Shruti (30), her life has been a monotonous circle of a 9-to-5 IT job, brief periods of break on the weekends which would be all about household chores and back to work on Mondays.

She would not visit her family because of the childhood trauma related to her father’s drinking habits and violent behaviour. And when her mother fell sick, it would stress her out but she would not go home, though she was constantly worried about her health.

This led to a lot of emotional baggage that built up as depression but Shruti did not acknowledge it until her eating habits took a downward turn.

Growing up, Shruti loved to cook but as an adult, she would not even go to the kitchen to even boil some water for herself. Despite facing a financial crunch due to her mother’s treatment, she would spend on buying junk food at least 2-3 times/day.

Battling depression, she struggled to get out of her bed on many days. Soon, her home had become popular with food delivery agents.

This has led to a lot of health issues including obesity, irregular periods, PCOD, thyroid, and ulcers. Her sleeplessness would only trigger her to eat junk food, even in the middle of the night and would also cause indigestion very frequently.

When she was hospitalised for uncontrolled vomiting, her younger brother found out about her eating habits. Overcoming his shock of seeing his otherwise-responsible sister in a hospital bed, he urged her to seek professional help.

In therapy, Shruti realised that she was suppressing her emotions and eating her feelings to overcome them.

She was also diagnosed with depression and is currently being treated.

However, there is still a long way to go because when living alone, coping with triggers becomes a challenge.

Grief over death of spouse

Jaya (55) was diagnosed with an eating disorder around 4 years ago. Though Jaya had a good social life, she had been feeling lonely after the death of her husband. Her friends observed that she had gained weight but she initially attributed it to menopause. What she was doing was eating away her loneliness, or at least trying to. Jaya had always been very health-conscious, and always making healthy choices in what she consumed.

Which is why her friends were shocked to see that her refrigerator filled with junk food and aerated soft drinks. That’s when she was alarmed of her own eating habits and began reading about it online, and ended up on a page on eating disorders, which mentioned the correlation between how you feel and what you eat. Since she was also physically fit with a strict exercise regimen — a mix of cardio, Pilates and weight training — she was also embarrassed to talk about it to anyone. Jaya sought professional support in the form of therapy and counselling, which took her to many experts in New Delhi, Mumbai, Chennai and Hyderabad on eating disorders.

But she didn’t find any of them helpful. The problem? All of them specialised in treating young people. Finding a geriatric counsellor was a huge challenge. After changing therapists a few times, a counsellor in Hyderabad diagnosed her with an eating disorder. It also enabled her to link the psychological impact of losing her husband. Because of her busy social life, Jaya never really took time to grieve; She kept herself busy instead of mourning over the loss of a loved one. But subconsciously, without her realising it, food became a coping mechanism, which led to over-eating and weight gain. It was also connected to menopause because of all the changes her body was going through.

The urge to continue living without taking the time to grieve from losing her husband was taking a toll. She was also hesitant to seek support from the family members, as she did not want to be seen as a burden. Despite being in therapy, Jaya was struggling with her relationship with food. When her counsellor insisted that she cannot overcome this alone, she opened up to her sons about her issues. Much to her surprise, they were very supportive and began taking turns to keep a regular check on her.

She too began following a specific schedule with the help of mobile-based applications and others.