Dying to lose weight

It's in the news everyday:  the obesity plague is pushing up death statistics wordlwide.  But the other extremes - eating disorders like bulimia and anorexia - are even more dangerous.  The Eating Disorder expert tackles a couple of questions on the subject.


Q:  Bulimia
I am 16 and I have a huge problem. I am a normal weight of 51 kg, but used to be quite a bit skinnier than that, so I have gained weight. I used to be overweight at a young age so I have always felt insecure about my body and gaining weight terrifies me. Lately almost everything I eat I feel the need to purge.  Sometimes I lose control and eat anything I can find and then vomit. It's making my throat really sore and I sometimes feel weak and I come last in all my races at school. This is starting to control my life and I don't know what to do?! Even though I am vomiting up a lot of my food I still seem to be gaining weight on top of it.

Expert:  Not only are you very brave to have reached out here, but you now need to try and be open with a parent or close family member in order to seek out some professional care. Your behaviour is very dangerous, and not just for your throat.

I suggest that you speak to your mum if you have one, and share with her how you are feeling and what you have stumbled into. You could start by seeing your GP to get a thorough physical examination, but your GP should then direct you to a psychologist and/or dietician who specialized in eating disorder treatment. If you email me, I might be able to give you some names of clinicians in your area.

Please respond quickly, as you are doing enormous damage to yourself in every way possible. Your behavior is not going to help you have a healthy weight or body, so you need to get some help to find ways of eating that will make you healthy in a sensible way.  Your eating disorder is not so much about food, but rather a reflection of your emotional difficulties. However, the first thing that needs to be attended to is helping you see that eating in a healthy and proper way is the priority. Once that is achieved, then you can explore the underlying difficulties. But first, you need to start treating yourself in a more gentle and healthy way.


Q: BMI and menstruation

Would a BMI  of 17,9 affect my menstrual cycle? Is this too underweight for a normal cycle, and is there medication that can restore it?

Expert:  There is a possibility that a BMI (Body Mass Index) just under 18 can lend to either a cessation of menses (called amenorrhoea) or an interruption of regular menses (called oligomenorrhoea). Excessive exercise or fluctuating weight will also contribute to a disturbance of menses. Once a BMI for an adult or late adolescent female drops below 18.5, she is deemed underweight, and once she is 10 to 15% underweight, her levels of oestrogen will likely be significantly depleted to cease all menstruation.

The biggest danger of amenorrhoea is that bone density immediately falls as bone tissue is not regenerated in order to maintain complete bone density. This will eventually result in osteoporosis, leaving the bones fragile and extremely prone to stress fractures or breakage. Once amenorrhoeic, going onto the contraceptive pill (oestrogen therapy) will not simply resolve the problem. The body needs to produce natural oestrogen. I suggest that if you are enquiring about a particular individual, that she immediately consult with her gynecologist, who might bring a dietician into the mix.

More information:

Telltale signs of anorexia

Post a question to DietDoc
Post a question to Cybershrink

(Joanne Hart, Health24, November 2011)

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