For an appointment with one of our physicians, please call the physician's clinic

Dr. Elizabeth Londino practices at Northside Medical Clinic with family practitioner Dr. Tim Hayden.

Warning signs of an eating disorder

Anorexia nervosa, bulimia and binge eating are serious and potentially life-threatening eating disorders. Those who have the disorder are often good at hiding it from others. Still, there are warning signs that concerned parents and friends can watch out for.

Anorexia nervosa is characterized by self starvation. Warning signs include…
• Dramatic weight loss.
• Refusing to eat certain foods, progressing to restrictions against entire categories of food, such as eating no carbs.
• Frequent comments about feeling ‘fat’ or overweight despite weight loss.
• Anxiety about gaining weight or being ‘fat.’
• Denial of hunger.
• Development of food rituals, such as eating foods in certain orders, excessive chewing, rearranging food on a plate.
• Consistent excuses to avoid mealtimes or situations that involve food.
• Loss of menstrual periods in girls and women post-puberty.

Bulimia nervosa is characterized by a cycle of binge eating and self-induced behaviors to undo the effects of binge eating. Warning signs include…
• Evidence of binge-eating, including disappearance of large amounts of food in short periods of time or the existence of wrappers and containers indicating the consumption of large amounts of food.
• Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
• Unusual swelling of cheeks or jaw area.
• Calluses on the back of hands and knuckles from self-induced vomiting.
• Discoloration of the teeth.
• Creation of complex lifestyle schedules or rituals to make time for binge-and-purge sessions.

Signs of either or both anorexia and bulimia include…
• Extreme concern with body weight and shape.
• Preoccupation with dieting, food, calories and fat grams.
• Excessive rigid exercise regimen, in spite of weather, fatigue, illness, or injury; the need to “burn off” calories taken in.
• Withdrawal from usual friends and activities.
• Behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.

Binge eating is characterized by frequent episodes of eating large quantities of food in short periods of time. Warning signs include…
• Feeling out of control over eating behavior.
• Feeling ashamed or disgusted by the behavior.
• Eating when not hungry.
• Eating in secret.

The information on these warning signs was found at www.nationaleatingdisorders.org, the website of the National Eating Disorders Association.
Another recommended source of information and support is www.edct.net, the website of the Eating Disorders Coalition of Tennessee.




Other stories with our doctors

Eating disorders a serious health issue

Charlie is a 12-year-old boy who lost 30 pounds in a short period of time. A friend had teased him about being chubby.

Amy is a 17-year-old college student. Though it doesn’t look like she’s losing weight, she’s beginning to look sick and weak. Her friends don’t know it, but she’s forcing herself to throw up after every meal.

Emily is a 13-year-old honor student. She’s cutting back on what she eats, and is starting to look too thin.

Frank is in his 30s and under a lot of stress. When he sits down to a meal, he often will eat the equivalent of two to three meals in an hour’s time.

Charlie, Amy, Emily and Frank all have eating disorders, a growing problem in our society with serious and even fatal side effects, says Dr. Elizabeth Londino, a board-certified family practice physician at Northside Medical Clinic.

There are three main types of eating disorders…
• Anorexia nervosa occurs when an individual eats so little he or she starves themselves and has excessive weight loss. When the body is denied essential nutrients, it slows down its processes to conserve energy. It weakens muscles, such as the heart.
• Bulimia occurs when the person practices binge eating and then purges food after eating, by throwing up or using laxatives, for example.
• Binge eating is eating excessively, much more than a normal person would eat during a short time. People can binge on any type of food, not just sweets. Unlike bulimia, it does not include purging afterwards.

Some people have more than one form of the disorder, Dr. Londino said. Most are good at hiding the eating disorder from others. “They are a very resourceful group,” she says. For example, the bulimic may throw up in the shower or throw up in a bag and hide it in the closet until it’s time to take out the trash.

Anorexics are usually easier to spot because you can see the visual change to their bodies. A binge eater or bulimic may not be losing weight, or could even gain a few pounds.

Though both men and women can have an eating disorder, it occurs most often with women. Anorexia, for example, usually first appears when a young girl is in her early to mid-adolescence.

Eating disorders have no one cause, Dr. Londino said. “It’s a multi-faceted problem.”

You could blame our society’s obsession with looking thin. Magazines, television shows and other media are filled with skinny people. Young people, and girls in particular, are given a false impression of what is normal. Even Barbie dolls are a problem, she says. “If you had a woman with Barbie’s proportions, she’d be seven feet tall.”

People with an eating disorder may be under stress or have an unrealistic idea of what is healthy. A huge part of the disorder is a false feeling of control, says Dr. Londino. “The person is deluded by this sense that they are in charge.” Anorexia may even have a genetic component: Either through genes or learned behavior, it can run in families. Some bulimics have a history of past sexual abuse: by throwing up their food, they are controlling what’s coming into their bodies.

Eating disorders can cause death
All three of the eating disorders cause health problems, and 20 percent of those with anorexia will die because of it, Dr. Londino said. One third will die from a heart-related complication, such as a weakened heart muscle that can no longer pump for the whole body, electrolyte imbalance or arrhythmia.

One third will die with kidney-related complications, such as dehydration or acidosis. And one third will die from miscellaneous causes, including suicide. “Anorexia is a leading cause of suicide,” she says.

“This is what is so frightening about eating disorders,” Dr. Londino says. “Even when the disorder is under control, the person is at risk of dying because of damage done to the heart or another part of the body.”

Treatment in the early stages of the disorder is important, she said. The longer a person starves herself or throws up after eating, the more long-term the damage that is done to the body.

Know warning signs
She encourages parents, family members and others in a person’s life to know the signs of an eating disorder and to take action and encourage treatment if they suspect a problem. (See related story.)
Dr. Londino’s interest in eating disorders began when she was in high school. Karen Carpenter of the popular Carpenters singing group died of anorexia nervosa in 1983, becoming the first major celebrity to die of the disease and draw attention to it. “I was fascinated and saddened that the disorder existed and that someone could die from it,” said Dr. Londino.

The truth was that thousands, girls in particular, were starving themselves, but most people didn’t know how widespread the disorder had become. The subject wasn’t discussed in medical school, she said. Later, as a physician in Jackson, the daughter of one of her patients asked her if she would have an interest in treating people with eating disorders.

Dr. Londino did more research on the problem. One of her biggest surprises, she said, was the medical complications of the disorder. By the time she sees a patient with an eating disorder, someone else in the patient’s life usually suspects a problem and is encouraging the patient to get treatment.

“There is hope”
Dr. Londino ends her discussion of her concern about eating disorders with a note of hope. “There is hope,” she says, “hope for recovery, hope for people with an eating disorder to get relief from the illness. You can get better.”

Treatment, she says, is “a marathon, not a sprint” and it requires that the person commit to getting better. A team approach of counseling, nutrition consulting and medical treatment is key, she says.

She tells her patients: “You are worth more than this illness. The consequences of this illness are far worse than the perceived benefits. You are okay just being you.”