For decades, bulimia was nearly exclusively a "white women's disease". However, statistics now show that more and more bulimics are black teenagers.
Recent South African findings suggest that schoolgirls between the ages of 15 and 18 years have a similar predisposition to abnormal eating attitudes and body-image concerns, regardless of ethnicity. About 19% of girls in this age group are affected.
Many black teenagers are caught between their traditional culture, which accepts womanly, rounded bodies as attractive, and western pop culture, which hails extreme thinness, or even emaciation, as "beautiful".
What is bulimia?
Bulimia nervosa is characterised by repeated episodes of binge eating followed by inappropriate compensatory methods such as purging (self-induced vomiting or misuse of laxatives, diuretics or enemas) or non-purging (fasting or engaging in excessive exercise).
Thus, a person with bulimia will alternate between bouts of excessive eating and episodes of ridding the body of this mountain of food by using laxatives, or diuretics, or vomiting. Some bulimics resort to periods of fasting or exercise to the point of exhaustion to counteract the vast amounts of food they eat.
In most cases, the act of gorging arouses extreme feelings of guilt in bulimics, who punish themselves by using self-degrading methods to "cleanse themselves of their sin" (in other words, overeating).
The hidden scourge
Although bulimia and anorexia nervosa often overlap, bulimia can be much more difficult to detect than anorexia.
Bulimics are usually masters at concealing their disorder, going to extreme lengths to cover up their binges and subsequent purging. In many cases, bulimics are also not as thin and emaciated as anorexics, so that most observers, including parents and loved ones, are unaware of the situation.
The best example of this hidden scourge was Diana, Princess of Wales, who dazzled the world with her beauty and charm while suffering the secret agonies of bulimia.
How to detect bulimia
Many parents worry about their children’s diets and eating habits, but tend to rationalise their fears: "Oh, Sarah has always been thin, but she has such a wonderful appetite. You know how these girls are always fussing about their figures. And they won’t listen to any advice. But she assures me that she is fine. So what can I do?"
You should start worrying if:
- You suspect that your child is binging (in other words, eating an abnormal amount of food in a short period such as two hours) and she doesn't really gain weight or starts losing weight.
- Your child is continually using laxatives or disappearing into the bathroom for hours after meals.
- Her teeth show signs of erosion caused by repeated exposure to stomach acid during bouts of self-induced vomiting.
- Her behaviour is anxious or out of control.
- She exercises to exhaustion or fasts in between bouts of gorging.
- You feel she's trying to cover up something.
Bulimics are excellent at duping both themselves and loved ones about the severity of their illness. You may find that any overtures you make, any attempt to even suggest that your child has an eating disorder, is met with denial, anger and evasion.
But if you, as a parent, feel that there is something seriously wrong with your child, you need to take drastic steps to bring this hidden scourge out into the open.
Bulimia and anorexia are serious psychological illnesses, and you and your child are going to need expert help to win the battle against the disease. Since eating disorders have a large psychological component, your first step should be to get the assistance of a clinical psychologist or psychiatrist.
Ask your family doctor to refer you, or contact Tara Hospital in Johannesburg (Phone: 011 783 2010) or the Kenilworth Clinic in Cape Town (Phone: 021 797 1400).
To address the eating component of bulimia, it's also important to consult a clinical dietician. Visit ADSA's website to locate a dietician in your area.
People with bulimia need to be guided and counselled by a professional to correct their disordered eating patterns. In addition, bulimics may have a variety of nutrient deficiencies due to long periods of vomiting or abuse of laxatives and/or diuretics. These deficiencies need to be eliminated by implementing balanced eating habits and supplements.
(Dr I.V. van Heerden, DietDoc, updated April 2010)