Fat And Eww!

Where ever we go there are images splashed all over – in media, on hoardings, in magazines. They are also glaring back at us 24/7 on our phone screens. We are constantly confronted with impossible beauty ideals in advertising, branding and beyond. In addition to this bombardment, disturbing pop culture trends promoting ‘thigh gaps’ and challenges like the ‘belly button challenge’ on social media, are setting unreal ideals for the youth and even those older, prompting men and women to scrimp on their eating and exercise far more than they should.

The body positivity movement began as a powerful antidote to the media’s obsession with reel-like models and airbrushed glamour dolls and is steadily growing. Yet body shaming continues. The pressure is insurmountable, lead­ing to eating disorders in many cases.

Eating disorders 

Bulimia nervosa is an eating disorder. Senior psychiatrist, Dr Sanjay Chugh says, “it is characterised by frequent binge eating, which is followed by compensatory behav­iour, which could include throwing up, inducing vomiting and, or excessive exercise in a bid to burn off the calories that have been consumed. Patients sometimes take laxatives to forcibly induce loose motions in the hope that the food will not be absorbed. The patient could be using diuretics to increase urination, which leads to water loss, thereby leading to weight decrease. The patients feel a lack of control over these episodes.”

Most people with anorexia nervosa, which is another eating disorder, see themselves as overweight, even when they are clearly underweight. Eating food and weight control become obsessions for them. They usually stand on the weighing scales frequently, focus on portion food and eat very little amounts of only certain foods. Some common signs of anorexia nervosa include extremely low body weight, severe food restriction, overwhelming fear of gaining weight and lack of menstruation in girls and women. If the disorder persists, other symptoms and medi­cal complications may emerge, including thinning of bones, brittle hair, mild anaemia, muscle wasting, weakness, severe constipation, lethargy, infertility etc.

People with bulimia nervosa, unlike anorexia nervosa, usually maintain, what is considered a healthy or normal weight, while some are slightly overweight. But like people with anorexia nervosa, they want to desperately lose weight and are intensely unhappy with their body size and shape. Bulimic behaviour usually remains a secret, as it is accompanied by feelings of disgust or shame. Other symp­toms of bulimia nervosa include electrolyte imbalance, sore throat, severe dehydration etc.

Fat – and eww! 

Eating disorders can start at any age and be triggered by a variety of reasons. While a host of reasons can precipi­tate eating disorders, aetiological, biological or hormonal factors are common. Societal and environmental factors too have a very significant role to play. Says Dr Chugh, “The way society or the people around you, your family or peer group looks at you, creates what is called, your body image or self-image. If the image that has been created is nega­tive, repeated shaming or ridicule, either real or perceived, leads to problems with self-identification, self-identity and self-esteem and some linkages take place inside the electric circuitry of the brain, which start to associate positive self- image with loss of weight, or looking good – which may, or may not have been the original content of the sarcasm that the person was subjected to, but this becomes the endpoint.” 

He explains that such people see losing weight as a means of attaining acceptability in society and of gaining social approval. They believe that their needs for attention would be met if they manage to lose weight. Chugh says children brought up in families with dysfunctionality in their dynamics usually grow up with some eating disorder or the other – because eating is the one thing they can control, ir­respective of what is happening to them and around them. 

Adults who have been victims of social abuse or physical abuse in their childhood, are also likely to be bulimic or have some eating disorder. In professions like modelling or acting, where looking thin is the norm, incidents of eating disorders, especially bulimia, is very high. Some sports too, like horse riding, rowing and cycling, demand lower the body weight, where athletes may develop eating disorders because of the pressures imposed on them, says Dr Chugh. 

Eating disorders among 25% of teenage Indian girls

With the concept that ‘thin is beautiful’ being ham­mered into young minds, eating disorders such as anorexia nervosa and bulimia nervosa – virtually unheard of only a decade or so ago in India – are becoming serious issues of concern. The two conditions can, and often do, co-exist. What’s worrisome is that both these disorders often go unrecognised and therefore, undiagnosed.

In many ways, the reason they remain invisible is because they fit perfectly with disturbing stereotypes and distorted facts around body shape and beauty. That is, until they manifest into mental disorders that can have morbid physical implications.

According to the US-based National Eating Disorders Association, anorexia and bulimia, among the worst mental disorders characterised by an extreme fear of gaining weight, take more lives than any other psychological ail­ment. According to the National Association of Anorexia Nervosa and Associated Disorders, over 600 million Americans are affected by anorexia.

In India, however, the prevalence of eating disorders is largely unrecognised because of a lack of quantitative research and ignorance around mental health.  What is of concern is that these disorders often go unrecognised and therefore, undiagnosed, till they metamorphose into men­tal disorders that can have morbid physical implications. Various treatments are available, but in Chugh’s opinion, the best results come from a combination of psycho­therapy, medication and repetitive transcranial magnetic stimulation (RTMS). The best results are obtained with a combination of all three.

With such a ghost-like presence it, therefore, imperative that we be cognisant of the words we use when talking about food in front of children and be kind when speaking to others about their appear­ance. We should use our words carefully.