Anorexia nervosa, often called anorexia, is a treatable eating disorder. People with anorexia have a low body weight based on personal weight history. While many with anorexia appear very thin, some may not, and others may seem overweight. Individuals with anorexia often have a strong fear of gaining weight and may perceive themselves as overweight, even when thin. To prevent weight gain or lose weight, they often restrict the amount or type of food they eat.
Overview of Anorexia Nervosa
Anorexia can cause changes in the brain due to malnutrition, where the body doesn't receive the necessary nutrients. Untreated weight loss can lead to serious physical harm or death. Anorexia has the second-highest death rate of any mental illness, surpassed only by opioid overdoses.
Anorexia, like other eating disorders, can dominate a person's life and be difficult to overcome. Because it's related to changes in the brain, anorexia behaviors are not choices, and the illness is not really about food or looking a certain way.
Symptoms of Anorexia Nervosa
The physical and behavioral symptoms of anorexia nervosa relate to how starvation affects the brain. It may be hard to notice symptoms because what is seen as a low body weight differs for each person. Some people with anorexia may not look very thin.
Physical Symptoms
Physical symptoms of anorexia nervosa may include:
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- Irregular heart rhythms
- Low blood pressure
- Dehydration, which occurs when the body lacks sufficient water and fluids to function properly
- Blue-looking fingers
- Dry skin
- Changes in skin color, such as yellowing
- Hair that thins, breaks, or falls out
Emotional and Behavioral Symptoms
Emotional and behavioral symptoms may include:
- Extreme focus on food, sometimes including cooking for others but not eating those meals
- Skipping meals or refusing to eat
- Eating only a few certain "safe" foods, often low in fat and calories
- Excessive focus on eating "clean" or healthy, stopping specific food types without professional advice
- Rigid meal or eating habits, such as spitting out food after chewing
- Not wanting to eat in public
- Bingeing and purging, similar to bulimia. Binges involve feeling unable to control what or how much you eat, sometimes in large amounts. Purges involve self-induced vomiting or misusing enemas, laxatives, diuretics, diet aids, or herbal products to eliminate consumed food.
- Too much exercise
- Fear of weight gain
- Focus on appearance
- Concern about being overweight
- Emotional changes, such as lacking emotion or feeling emotionally flat
- Social withdrawal
- Irritability
- Trouble sleeping
- Self-harm
When to Seek Medical Advice
Due to how malnutrition affects the brain, someone with anorexia may not want to be treated. A core feature of anorexia is that people with the eating disorder usually don't see how serious their symptoms are. If someone in your life has anorexia, it's better to take action - even if you think it could be an overreaction - rather than let symptoms continue. If you're worried about a loved one, urge your loved one to talk to a healthcare professional. If you think you have an eating disorder, get help. If you're thinking about suicide, contact a suicide hotline.
Causes and Risk Factors of Anorexia Nervosa
The causes of anorexia nervosa aren't fully understood. However, several factors may contribute to its development:
- Genetics: Genetic changes may increase the likelihood of developing anorexia.
- Mental Health: People with eating disorders sometimes have obsessive-compulsive personality traits that make it easier to stick to strict diets and not eat, even though they're hungry.
- Environmental Factors: Modern Western culture emphasizes thinness. Social media plays a big role. Peer pressure may cause you to want to be thin, lean or muscular. A constant push to eat a healthy diet could lead to very strict eating habits. Anorexia is more common among teenagers due to the changes their bodies go through during puberty.
- Family History: Weight bullying. People who have been teased or bullied about their weight are more likely to develop eating disorders.
- History of Dieting: Dieting behaviors raise the risk of an eating disorder.
- Transitions: Major changes can bring emotional stress and raise the risk of anorexia.
Complications of Anorexia Nervosa
Anorexia nervosa can lead to severe complications, including:
- Heart Problems: Irregular heart rhythms (arrhythmias) and other heart conditions, such as mitral valve prolapse or heart failure, can occur.
- Menstrual Irregularities: In females, anorexia can lead to having no period.
- Organ Damage: Severe malnutrition can damage every organ system in the body.
- Death: At its most severe, it can be fatal. Death may happen suddenly - even if you aren't visibly underweight.
Prevention Strategies
There's no guaranteed way to prevent anorexia nervosa. However, primary healthcare professionals, including pediatricians, family medicine professionals and internal medicine professionals, may be in a good position to see early signs that could lead to anorexia. For instance, they can ask questions about eating habits and satisfaction with appearance during routine medical appointments. If you notice that people have dieting habits that seem too rigid, or they're unhappy with their appearance, think about talking to them about these issues.
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The Pro-Ana Movement: A Dangerous Trend
For decades, people living with eating disorders including anorexia nervosa have taken to the internet for empathy and support. Harmful hashtags are hard to manage and regulate, especially as they can be changed rapidly or use words with multiple meanings. The pro-ana movement refers to online and offline communities that promote and support anorexia nervosa as a lifestyle choice rather than recognizing it as a dangerous mental illness. These communities often share tips, encouragement, and "thinspiration" to help members achieve and maintain dangerously low body weights.
Dangers of the Pro-Ana Movement
The pro-ana movement is dangerous for several reasons:
- Normalizing Disordered Behavior: It implies that disordered thoughts and behaviors associated with anorexia nervosa are lifestyle choices as opposed to the symptoms of a serious illness. Pro-ana communities tend to normalize and support the unhealthy behaviors characteristics of anorexia nervosa and other eating disorders, such as the extreme restriction of calories, excessive exercise, and the use of laxatives and diuretics, to achieve or maintain low body weight.
- Discouraging Treatment: By labeling it as a lifestyle choice, pro-ana sites discourage entering treatment, which can have serious implications on a person’s mental and physical wellbeing. The longer a person suffers from anorexia nervosa, the worse the effects become, which can include severe malnutrition, organ failure, and even death.
- Glorifying Emaciation: The pro-ana movement can have an almost cult-like appeal for those who engage with it, which can be especially dangerous to vulnerable young people. Pro-ana content is usually created by people who are living with an eating disorder themselves, who have complicated feelings about their illness and the idea of recovery.
- Creating Isolation: Eating disorders can be very isolating and pro-ana sites offer people a way to connect with like-minded individuals. However, these sites can also encourage increasingly disordered activities and push people toward unhealthy goals and behaviors, instead of towards recovery.
Online Behaviors and Trends in Pro-ED Communities
Pro-ED communities are a controversial subculture that promotes positive attitudes toward EDs, namely AN (pro-anorexia/proana) and bulimia nervosa (pro-bulimia/promia). These communities share content to promote thinness, provide advice to other members, and glorify low body weight as ideal. A shared group identity is formed through interactions between community members and can involve the exchange of “tips,” restrictive dieting plans, extreme exercise plans, and motivating imagery of thin bodies, also known as “thinspiration” or “thinspo”.
Hashtags can connect users and be used to form communities around common interest topics. In the online Pro-ED community, #proana signifies a post supporting pro-ED attitudes and behaviors and is considered to be the established term to describe the Pro-ED movement’s consistent referencing of EDs (eg, explicit mentions of bulimia and AN) within these accounts. Most of these accounts have acquired followers who themselves posted about EDs. Other research has focused on #thinspiration (“motivating” imagery of thin bodies) and #fitspiration (“motivating” imagery of “fit” bodies) and their use within a variety of social media formats. Across social media platforms, typically #thinspiration encourages more weight loss behaviors with a stronger connected community than that of #fitspiration. However, both have been found to essentially share the same themes of encouraging guilt, dieting, and restraint.
Identifying and Addressing Pro-Ana Content Online
Recent research suggests identifying terms, themes, and a common lexicon used within the Pro-ED online community as beneficial in understanding a Pro-ED identity. Communication patterns and network structures of online ED communities are differentiated by their intentional online behavior. Members of pro-recovery communities who view EDs as an illness and are actively working towards recovery generate more original content and actively seek out new profiles to follow when compared to Pro-ED communities.
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Rapid Weight Loss Diets: An Overview
Rapid weight loss diets involve losing more than 2 pounds (lb) or 1 kilogram (kg) a week over several weeks. These diets require very few calories and are most often chosen by people with obesity who want to lose weight quickly. These diets are less commonly recommended by health care providers. People on these diets should be followed closely by their provider. Rapid weight loss may not be safe for some people to do on their own.
Types of Rapid Weight Loss Diets
- Very-Low-Calorie Diets (VLCDs): Most VLCDs use meal replacements, such as formulas, soups, shakes, and bars instead of regular meals. This helps ensure that you get all of the nutrients you need each day. A VLCD is only recommended for adults who have obesity and need to lose weight for health reasons. These diets are often used before weight-loss surgery. You should only use a VLCD with the help of your provider. Most experts do not recommend using a VLCD for more than 12 weeks.
- Low-Calorie Diets (LCDs): These diets usually allow about 1,200 to 1,500 calories a day for women and 1,500 to 1,800 calories a day for men. An LCD is a better choice than a VLCD for most people who want to lose weight quickly. But you should still be supervised by your provider. You will not lose weight as fast with an LCD, but you can lose just as much weight with a VLCD. An LCD may use a mix of meal replacements and regular food. This makes it easier to follow than a VLCD.
- Time-Restricted Eating: Time-restricted eating limits the number of hours per day that you can eat. A popular strategy is the 16:8. For this diet, you have to eat all of your meals during an 8 hour period, for example, 10 am to 6 pm. The rest of the time you cannot eat anything. There are some studies that this method can cause rapid weight loss, but there is little information so far about whether the weight loss is sustained.
- Fasting: Fasting is an ancient form of caloric restriction. It has become more popular recently. This is partly because some animal and human studies have shown benefits to fasting for people with diabetes and obesity. There are many different fasting regimens and it is unclear which may be the best. One of the most popular is the 5:2 system. This involves 2 days a week of fasting or VLCD and 5 days a week of eating your normal diet. Diets that incorporate fasting can cause rapid weight loss.
- Fad Diets: Some fad diets also severely limit calories to achieve rapid weight loss. In some cases, these diets are not safe. In most cases, these diets are not sustainable for long enough to cause long-term weight loss. Once you stop the diet, you are at risk for regaining the weight if you return to your old eating habits.
Considerations for Rapid Weight Loss
Rapid weight loss is more about cutting calories than exercising. Talk with your provider about what type of exercise you should do while you are on this type of diet. Your provider may suggest waiting until you are on a more long-term diet to start exercising.
Who Might Benefit from Rapid Weight Loss Diets?
Rapid weight loss diet is usually for people who have health problems because of obesity. For these people, losing a lot of weight quickly can help improve:
- Diabetes
- High cholesterol
- High blood pressure
Risks and Side Effects
You should only follow one of these diets with the help of your provider. Losing more than 1 or 2 lb (0.5 to 1 kg) a week is not safe for most people. It can cause you to lose muscle, water, and bone density. Rapid weight loss can also cause some side effects including:
- Gallstones
- Gout
- Fatigue
- Constipation
- Diarrhea
- Nausea
People who lose weight quickly are also more likely to gain back the weight quickly. This can lead to other health problems.
In general, a rapid weight loss diet is not safe for children. It may also not be safe for teens, pregnant women or older adults unless a provider recommends it.
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