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Anorexia and bulimia: early prevention and detection. (The Mortification of the Flesh).

Thirty years ago, there was no record of anorexia nervosa and bulimia anywhere in the world. Not because physicians and psychiatrists lacked the tools to detect these disorders, but because the boom of waif-like thinness had not yet invaded western women's collective imagination.

Until the 1960s when Twiggy's skeletal figure traipsed down the catwalk, fashion's spotlight illuminated voluptuous bodies, with the odd little bulge tucked away here and there. Today, however, eating disorders are appearing with an alarming and increasing frequency among adolescents who are obsessed with achieving the "physical ideal." Anorexia and bulimia are appearing at increasingly younger ages and among both sexes (young men currently account for 10% of those suffering from eating disorders).

Thinness is associated with success, power, beauty and status. No wonder "miracle" diets seem a sure way to triumph. These obsessions can lead to serious illness, such as anorexia nervosa, characterized by exaggerated weight loss, or bulimia, in which episodes of bingeing (ingesting large amounts of food) alternate with "compensatory" behavior (such as self-induced vomiting, abuse of laxatives, diuretics, anorexic agents or excessive physical activity).

According to the World Health Organization the mortality rate among those diagnosed with anorexia is 15%.

Argentina's ALUBA (Asociacion de Lucha contra Bulimia y Anorexia, Association to Fight Bulimia and Anorexia) is a non-governmental organization founded and directed by Dr. Mabel Belle. For the past fifteen years, ALUBA has been recognized as a pioneer and leader in the field of eating disorders in Argentina and abroad. Since its creation, ALUBA has handled over 9,000 consultations. Currently, the organization is treating some 2,500 patients and has a high rate of success with a variety of treatment approaches.

In addition to recovery treatments, ALUBA focuses on prevention, early detection and health education. In the schools, ALUBA's activities focus on the population at risk through consciousness-raising initiatives with teachers and parents. Special programs--group discussions, seminars and workshops--train families to prevent anorexia and bulimia and to detect symptoms of eating disorders early on, so that sufferers can receive prompt treatment.

Because teachers are key to identifying pathological behavior in the school setting, ALUBA trains teachers through a specially-designed course in early detection.

The family is the focus of "health education" programs which emphasize the importance of healthy relationships among family members. Order and mutual respect are prioritized, as are clear, well-defined roles within the family.

Many businesses dedicate time and resources to employees' family welfare, and ALUBA offers these companies prevention programs similar to those offered in the schools. Special explanatory pamphlets, videos and educational materials have been prepared for these activities.

While anorexia nervosa and bulimia are difficult to detect because those who suffer from eating disorders refuse to recognize that they are ill and hide their symptoms. The following are some danger signals:

If parents observe several of these characteristics in a child, a diagnostic consultation may be in order.

In the schools, teachers should take an interest in the issue and collaborate with the families in early detection. Their role is fundamental in the formation of young people free from addictions and prepared to face the challenges of life. For this reason, teachers must be properly informed about eating disorders. If we are able to train them, we strengthen the action of the family in the daily struggle against this scourge. We must therefore re-evaluate the role of teachers in prevention and early detection.

The following are some aspects to which teachers should be attentive:

Eating During Recess

Recess is a break to allow the students to rest and recover their energies in order to continue their activities. During this time to "recharge their batteries," students should eat appropriate food that assures their normal growth and good scholastic performance. The first red light for eating disorders among students is inappropriate eating habits during recess.

Physical Activity and Sports

Encouraging physical activity is healthy, but care should be taken: hyperactivity is one of the symptoms of an eating disorder. When exercise is practiced for the sole purpose of losing weight, in an intense and compulsive fashion and in prolonged sessions, this physical activity is not beneficial but rather activates the illness.


We pay attention to exemplary students. We admire their work, their dedication to their studies, their habits. They are an example for the rest of the class. But when perfectionism is evident at every moment, this is characteristic of individuals suffering from anorexia.

Teachers should ask themselves: Are they obsessive about their physical appearance? Do they take great pains to have a "perfect" body? What are their eating habits? What are their physical activities?

Changes in Personality

Individuals with eating disorders display aggressive behavior, rage, crying jags, mood swings and withdrawal. If we notice these changes, we should look for other symptoms.

"Ugly Duckling" Syndrome

Low self-esteem and lack of faith in one's ability to succeed lead adolescents to see themselves as "losers." This "ugly duckling syndrome" is characteristic of both anorexia nervosa and bulimia.

Let's prevent the appearance of eating disorders. Let's encourage students to believe in themselves. Let's teach them to trust in their own abilities.


Our culture admires power, money and the body beautiful above other values that are gradually being lost. If we stop to listen to students' conversations, we hear talk of "miracle diets" or" a great way to lose weight." We should encourage them to focus on other interests, providing an incentive to change and to abandon the fight for the "physical ideal."

Lack of Concentration

Occasionally the performance of a good student may waver; they can't seem to concentrate; and sometimes appear to drift off. Anorexia nervosa and bulimia lock their victims into a minute world in which the only things that matter are weight, calories, the scale and the diet; there is no room for other projects and interests.

Feeling Ashamed of Their Bodies

Because of their distorted body image, students who suffer eating disorders see themselves as "fat" even though they may be a normal weight or even under-weight. They generally try to hide their bodies, to escape the observation of others. They hide in oversized clothes; they refuse to use bathing suits; and they avoid any situations that would force them to show themselves.

Bathroom Use

Among the various methods for eliminating food, self-induced vomiting is one of the most frequent. Special attention should be paid to this behavior, especially after students eat during recess.

Teachers should observe this sort of behavior very carefully because the consequences of self-induced vomiting are very serious. Vomiting can cause decreased levels of potassium in the blood, which can cause heart attacks.

Teachers who become aware of this issue, understand it and collaborate in prevention and early detection of anorexia nervosa and bulimia in the schools are our strongest allies in the struggle against these terrible disorders.

Profile of the Anorexic Patient

* Lack of awareness of the illness

* Intense fear of obesity

* Distorted self-image (they see themselves as fat even though they are under-weight)

* Refusal to maintain normal weight

* Hair loss

* Amenorrhea (lack of menstruation)

* Dry skin

* Hypertension

* Hypothermia

* Habit of cutting food in small bites

* Tendency to eat slowly

* Tendency to chew for a long time

* Preference for small portions

* Habit of spitting out, throwing away or hiding food

* Use of anorexic agents, laxatives and/or diuretics

* Habitual calorie counting

* Rituals revolving around food

* Hyper-activity to loose weight

* Social isolation

* Irritability

* Depression (present in 40-45% of all cases)

* Obsessive behavior

* High demand placed on self

* Rejection of sexuality

* Bingeing

* Use of loose clothing (which hides body)

Profile of the Bulimic Patient

* Recurrent episodes of bingeing

* Awareness that their eating habits are not normal

* Feelings of not being able to stop eating

* Significant fluctuations in weight

* Deterioration of teeth or loss of teeth, if the patient purges by vomiting

* Periods of bingeing alternating with purging

* Use of "compensatory" behavior, such as chewing the food and spitting it out, abuse of laxatives, drinking large amounts of liquid to feel full or to provoke vomiting

* Fasting

* Hyperactivity

* Tendency to cut food in large pieces

* Tendency to eat quickly

* Barely chew or swallow instead of chewing

* Preference for large portions

* Lack of will power or energy

* Swelling of the parotid glands, as the result of induced vomiting

* Irritability

* Feelings of guilt

* Hiding when they eat

* Stealing to buy food

* Obsession about their shape and weight

* Oscillation between strictly disciplining and indulging themselves

* Bouncing between depression and euphoria

* Tendency to abandon projects midway

The authors are members of the Argentine Asociacion de Lucha contra Bulimia y Anorexia (ALUBA, Association to Fight Bulimia and Anorexia).
COPYRIGHT 2001 Latin American and Caribbean Women's Health Network
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2001, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
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Author:Bello, Alicia
Publication:Women's Health Collection
Geographic Code:3ARGE
Date:Jan 1, 2001
Previous Article:Addictions to psychoactive substances and eating disorders. (The Mortification of the Flesh).
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