In order to live a healthy life, we must maintain a healthy body weight. Excessive gain or loss in weight changes the body composition, resulting in decreased physical ability of the body such as a loss of desire, weakened immunity and physical retardation. This results in a decreased quality of life.

The development of the food industry and the mass media has led to a culture where one can easily access tasty, fatty foods. At the same time, society demands an excessively slim figure, resulting in a mix of overweight and underweight people.

Anorexia nervosa is a psychiatric condition causing abnormal eating patterns. This starts off initially as a diet to lose weight, as well as a distorted body image, leading to abnormal eating behavior. Anorexia nervosa is more common in the later years of adolescence, but there have been cases where children under age 9 have refused to eat for fear of becoming obese. These problems arise from the distorted expectations of the body and a belief that obese people are disadvantaged in areas such as admission to schools or finding employment. 

The symptoms of anorexia nervosa can become severe from strict limitation of food intake. This can lead to a state of starvation, which not only affects growth and development, but also sexual development. In addition, it is known that 3-8 percent of anorexic patients commit suicide, or die from heart disease and infections.

If the body weight is more than 15 percent below the normal weight or if the Body Mass Index (divide the body weight in kilograms by the square of the height in meters) is below 16 kilogram per meter squared, the risk of having anorexia nervosa increases and a more accurate diagnosis is required.

Diagnostic criteria (American Psychiatric Association 2000)

● Refusal to maintain body weight even to the minimum 85 percent of the ideal weight for the patient’s age and height.

● Intense worry about gaining weight, even though underweight.

● Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

● In women, the absence of at least three consecutive menstrual cycles.

Clinical signs

● Hypothermia from the loss of body fat.

● Decreased basal metabolic rate due to decreased thyroid hormone production.

● Reduced heart rate, fatigue, syncope, increased sleep.

● Iron-deficiency anemia from poor nutrition.

● The skin lacks elasticity, feels rough, dry, and is pale.

● Reduced number of white blood cells and an increased risk of infections.

● Hair loss, fine soft hair covering all the body to maintain a normal body temperature.

● Constipation.

● Arrhythmia due to hypokalemia (one of the main causes for death with anorexic people).

● Increased risk of osteoporosis and interruption with menstruation.

● Dental caries from frequent vomiting.

● Bone fracture and rupture of the muscular fiber from reduced bone and muscle mass.

Nutrition treatment

● A healthy diet must be established to recover the body weight to its normal level, with the parallel treatment of nutrition recovery and psychotherapy. A sense of emotional stability is needed along with a reduced obsession about weight. A team approach consisting of an internal medicine doctor, nutritionist and psychiatrist is recommended for treatment.

● The first aim of the nutrition treatment is to correct the habit of skipping meals and to recover physiological balance, and the second aim is to increase the weight by changing eating habits and eating regular meals. Nutrition treatment consists of the educational stage and the treatment stage. At the educational stage, assess the patient’s dietary history and educate them on the role of nutrients, the need to control weight and correct information about food. At the treatment stage, the body weight should be increased steadily and slowly based on compliance.

● An investigation and assessment of the dietary history: meal types, current intake of calories and protein, number of meals and snacks taken, eating area, who has meals together with this person, favorite food, foods disliked and food consumed frequently needs to be investigated.

● Making the decision on nutritional requirements should be based on the basal energy needs and the current intake; however, it is not advisable to set the intake significantly higher than the current level of intake. It is recommended to consume a minimum of 1,200 kcal a day, and a calorie increase of 200 kcal/week is ideal.

● Food plan: It is recommended that the nutrient composition of calories is made up of 50 percent carbohydrates, 25 percent protein and 25 percent fat. Not only is a balanced intake of food important, but it is also important that the plan is individualized with consideration of the patient’s past eating habits.

Things to consider while eating

● Consume low-fat food.

● Instead of eating meals three times a day, eat small portions six times a day.

● Don’t consume a lot in one meal.

● Eat foods that are high in nutrients.

● Limit excessive use of artificial sweeteners or salt.

● Limit excessive consumption of caffeine.

● Consume enough fiber for a normal bowel movement.

Increasing body weight and maintaining it

In general, when there is a stop in weight loss, it is said that the treatment meal is successful. To achieve a body weight of 80-90 percent of pre-anorexic weight, it is important to increase weight slowly by 0.5-2 kilograms each week. In addition, during the recovery, symptoms such as an increased body temperature and bloating can occur, so careful observation is required.

Prevention

● Avoid fasting, skipping a meal, or diets that limit caloric intake.

● Inform youths that the change in their bodies during puberty (ephebogenesis) is normal.

● Correct misunderstandings about nutrition, normal weight and weight control.

● Give careful advice to the anorexic person regarding weight, and don’t overestimate the numerical figures of the scales.

● Encourage the patient to eat only when feeling hungry.

● Implement a basic education on nutrition and exercise at home and at school.

● Create a sense of responsibility, choice and a spirit of independence with the teen.

By Cho Young-yun

The author is director of Dietetics at Samsung Medical Center and a professor of Sungkyunkwan University Medical School. ― Ed.