FAQ

There is also a hereditary (genetic) element in eating disorders. Studies show that families in which one child suffers from eating disorders, there are greater chances that one or more of the siblings in the family will also contract an eating disorder. Among mothers and daughters, the studies show that the risk of daughters of mothers who suffer (or who suffered in the past) from eating disorders to contract eating disorders as well, is higher than that of daughters of mothers who didn't contract any eating disorders. However, the genetic aspect is compounded by many environmental factors, such as childhood obesity, peer pressure and family pressure to lose weight, weight-loss-diets, emotional distress, and other factors, which also have an impact on the development of eating disorders. There is a consensus among the researchers that genetic givens alone do not cause the emergence of eating disorders, and that the combination between heredity and environmental factors (behavioral, familial and social), is what triggers the development of eating disorders.

One may be cured of eating disorders. The earlier the treatment begins, the greater the chances of recovery. The longer a disease remains active, and if not treated properly, it becomes a chronic disease and the chances of a cure decrease. However, in chronic cases one may see that proper and prolonged treatment alleviates symptoms, and reduces the frequency of bulimic attacks and anorexic behavior patterns, and leads to enhanced quality of life of patients. There is a distinction between physical recovery, meaning returning to one's normal body weight, proper eating habits, amending nutritional deprivation, receiving regular periods, etc., and between emotional recovery from depression, anxiety, distorted body image, low self-esteem, and other disorders. Physical and emotional recovery do not always go hand in hand and sometimes full recovery from eating disorders requires long-term treatment over a span of many years.

Eating disorders are among the most prevalent psychiatric diseases among young girls and women in the Western world. Eating disorders are characterized by chronic symptoms and repeated deterioration of these symptoms. Studies show that without the proper, comprehensive and interdisciplinary treatment, eating disorders may become a prolonged chronic disease and lead to severe health problems, both physical and emotional. Eating disorders increase the risk of contracting various physical ailments such as lack of nutrients, calcium bone loss, anemia, body's electrolytes imbalance, obesity, cardiac arrest and other diseases. Eating disorders are also a primary or secondary cause of mental disorders, including depression, anxiety, addictions to laxatives and diuretics and drug and alcohol abuse or addiction. Eating disorders constitute severe health problems that can lead to long-term hospitalization in various therapeutic settings, and can also lead to attempted suicide, as well as to death.

Eating disorders usually emerge during adolescence. Anorexia nervosa emerges at younger ages than other eating disorders, with most cases of anorexia nervosa appearing between the ages of 15-17. Bulimia nervosa usually emerges towards the end of adolescence, mostly between the ages of 17-20. However, there are also cases of eating disorders emerging at younger ages or older ages. Binge eating disorder is more typical of women than young girls, and may appear at different ages in adult women. Studies have shown that over the years there has been a decrease in the age of young girls suffering from eating disorders and today this age is lower than it was a decade or two ago. In recent years, there have been more and more cases of young boys and men suffering from eating disorders, however the small number of research studies on young boys and men suffering from eating disorders makes it difficult to ascertain the morbidity rate and the age range of the emergence of the disease among this specific population.

There are many diverse risk factors for eating disorders which are a combination of genetic, biological, behavioral, familial and social risk factors. The following are several examples for each group of risk factors:

Genetic risk factors (hereditary) - in families with one sibling who has contracted an eating disorder, the rest of the siblings have a higher risk (as compared to the morbidity rate in the regular population) of contracting an eating disorder as well. The probability is even higher in the case of twin brothers.

Biological risk factors - young girls who experienced early sexual development or overweight in childhood, have a higher risk of developing eating disorders as opposed to peers their age who did not experience early sexual development or did not suffer from overweight when they were young girls.

Behavioral risk factors - various weight-loss-diets, mainly low calorie and very low calorie diets (diets bordering on self-starvation), were found to be a trigger for the emergence of eating disorders.

Familial risk factors - daughters of mothers who are excessively preoccupied with their body weight and weight-loss-diets, and daughters of mothers who suffered from different levels of eating disorders, were found to have a greater risk of developing eating disorders, as compared to girls and adolescents of mothers whose body image is normal and do not suffer nor suffered in the past from eating disorders.

Social risk factors - cultural and social pressure on women to be thin, exposure to models of extreme thinness through the various media channels, such as successful models and actresses, were found to have a significant impact on the development of eating disorders among female adolescents.

Risk factors that were investigated and which were found to have a significant statistical association with eating disorders include: obesity, cultural and social pressure to lose weight (exerted by family members, friends and the media), dissatisfaction with body shape or weight, internalization of the ideal of thinness, dieting, the aspiration toward perfection and early sexual development. There is a consensus among researchers that an isolated risk factor usually cannot trigger the development of an eating disorder and that the combination of several risk factors along the lifespan is what actually leads to the development of eating disorders.

There are differences of opinion among health professionals and researchers regarding the question of whether obesity (which does not derive from binge eating disorder) is also an eating disorder. Most of the health professionals and researchers still consider eating disorders and obesity to be two separate phenomena, however there are those who consider obesity to be an eating disorder for all intents and purposes. Those who support the approach that obesity is also a form of eating disorder, rely on the fact that there are many people who have suffered from certain eating disorders in the past (anorexia nervosa or bulimia nervosa), who were treated and the symptoms of the eating disorder disappeared, however over time, symptoms of obesity began to emerge in these patients. In addition, overweight and obese people often have other symptoms of eating disorders such as binge eating disorder, night eating syndrome, and emotional eating.  

An additional aspect which reinforces the connection between obesity and eating disorders may be found in recent research studies which demonstrate that obesity and eating disorders share common risk factors such as weight-loss-diets, dissatisfaction with one's body weight and shape, and comments of friends and family members regarding one's body appearance and weight. Additionally, studies have shown that an obesity prevention program among junior high school students that was implemented in Boston, U.S., succeeded in hindering the development of eating disorders among girls who were enrolled in the program. These results reinforce the assumption that eating disorders and obesity have a lot in common, and that they may both belong to one spectrum of health problems related to weight disorders, eating disorders and distorted body image.

Binge eating disorder is characterized by bingeing attacks (similar to those in bulimia nervosa) and by the consumption of very large amounts of food in a relatively short amount of time. The food may be sweet or salty, in liquid form or solid, hot, cold or frozen, usually in no particular order or organization in its consumption. The bingeing attacks are accompanied by loss of control and onerous feelings of guilt. As opposed to bulimia nervosa, patients who suffer from binge eating disorder do not purge - they do not carry out activities that compensate for the attacks, such as self induced vomiting or intense physical activity. As a result, most of those who have binge eating disorder suffer from different levels of overweight and are exposed to the dangers of obesity such as diabetes, high blood pressure, hyperlipidemia (high blood cholesterol and triglyceride levels), cardiovascular disease, diseases of the joints, and more. Patients who suffer from binge eating disorder may also suffer from related mental disorders such as depression and anxiety.

Bulimia nervosa is an eating disorder that manifests itself in uncontrolled bingeing attacks. A bingeing attack is defined as the consumption of very large amounts of food in a relatively short amount of time, and the foods may be sweet, salty, liquids, solids, hot, cold or frozen, in no particular order, usually without any planning or organization of consumption.

The bingeing attacks are accompanied by a sense of loss of self-control during the attack and onerous feelings of guilt which lead the patient to compensate for the bingeing (an act which is called 'purging'). Compensating activities can be self induced vomiting (which is the most common act among those with bulimia nervosa), prolonged fasting, obsessive physical activity and excessive use of enemas, diuretics or laxatives. The frequency of bingeing and purging can vary from occasional episodes to many times a day and last for months and even years. It is important to note that bulimia nervosa doesn't necessarily manifest itself in significant overweight, and those who suffer from the disease usually have a normal body weight or are slightly overweight.

Those who suffer from bulimia nervosa are exposed to many health risks such as tooth decay, sore throat and bad breath, vomiting, dizziness, headaches and fatigue, dehydration and body's electrolytes imbalance, ruptures of the esophagus, cardiac arrest and possible death.

There is evidence of co-morbidity of physical disorders and mental disorders, and as a result bulimia nervosa patients may suffer from depression, anxiety and other mental health problems. Bulimia nervosa usually emerges towards the end of adolescence (age 18-20 on average), however there are numerous adults who suffer from this disease. The prevalence of bulimia nervosa among young girls and women is much higher than that of young boys and men.

Anorexia nervosa is an acute eating disorder which is mainly contracted by adolescent and young adult girls. The girl suffers from a distorted body image, which manifests itself in the fact that she feels that she is overweight, despite the fact that her weight is normal or even low, relative to her height. The young girl gradually cuts down on the amounts of food that she consumes, until reaching starvation, and a significant loss in body weight. From a medical perspective, a young girl who has lost more than 15% of her normal body weight, respective of her age and height, may be defined as suffering from anorexia nervosa. (Anorexia nervosa diagnosis is given following a psychiatric diagnosis according to a list of criteria defined in the Diagnostic and Statistical Manual of Mental Disorders DSM-IV, 1994).

Patients suffering from anorexia nervosa sometimes use additional means to increase the rate of weight loss, such as intense and obsessive physical activity, forced vomiting, and use of laxatives and diuretics. All these increase the health risks of severe malnutrition, and may lead to dangerously low heart beat and low blood pressure, hair loss, changes in the body's electrolytes balance, progressive loss of bone density (osteoporosis), cardiac arrest, and even death. There is evidence of co-morbidity of physical disorders and mental disorders and as a result, anorexia nervosa patients may suffer from depression, anxiety and other mental health problems. The radical gauntness may cause amenorrhea (cessation of the menstrual cycle) and stunt growth in young girls.

Anorexia nervosa usually emerges during adolescence (at the age of 14-15 on average), however there are women who contract anorexia nervosa later in life as well. The number of young boys who contract the disease is low as compared to young girls. It is estimated that for every 10 girls who contract anorexia nervosa, only one boy contracts the disease.

The answer is yes.

Childhood and adolescence constitute periods of accelerated growth and development. Uncontrolled low-calorie diets may impair their development, may stunt their growth, impair the functioning of their immune system, their capacity for learning, and may trigger the development of eating disorders such as anorexia nervosa and bulimia nervosa.

Treatment for children and adolescents suffering from overweight should be provided by skilled professionals who specialize in the treatment of this specific population. These professionals are responsible for a controlled weight loss process that does not impair the children's development, their physical growth, and the fulfillment of their genetic potential. Hence, weight loss in children must be extremely moderate!

Oftentimes, there is no need for weight loss, but rather, maintenance of stable weight while the child grows in stature, thus achieving the desired outcome - controlled and healthy weight loss.

Professional caregivers ascertain that the long-drawn-out, and often exhausting process of shedding excess body fat is implemented, such that the children's and adolescents' health is safeguarded.

Research studies indicate that the treatment of obesity among young children (under the age of 10) is effective only if the entire family undergoes changes in its lifestyle, adopts proper and balanced eating habits, and physical activity. The parents serve as a model for their children to emulate, hence the chances of changing children's lifestyle increases when parents are also part of these changes. In most cases, children who do not eat fruits and vegetables come from homes where parents don't eat fruits and vegetables. Children who drink only sweetened, carbonated beverages (soft drinks), usually come from homes where parents don't drink water and mainly drink sweetened or carbonated beverages. The success of the treatment of obesity in children (and among youth and adults as well) lies in the capacity to maintain lifestyle changes in the long-term. Proper lifestyle habits must be internalized, and adopted for good, and they must not be discarded even after anticipated weight loss is achieved.

Treatment of obesity is systemic and involves significant changes in lifestyle, meaning increasing physical activity on the one hand and adopting proper eating habits and a balanced diet on the other hand. In morbid obesity, there is sometimes a need to administer the proper medication. Similarly, it is important to examine the emotional state of the patient, provide the proper treatment, and above all, offer emotional support throughout the difficult and long-drawn-out weight loss process.

In the case of morbid and life-threatening obesity, surgical intervention, such as bariatric surgery (stomach stapling), should be considered. However it should be noted that following recovery from these surgeries, the patient must adopt new life habits which include proper nutrition and a balanced diet as well as physical activity in order to prevent positive energy balance which in turn will lead to repeated weight gain.

Effective treatment of obesity requires a comprehensive perspective of the problem, the assistance of highly skilled therapists specializing in the treatment of obesity, and complete cooperation between the various care givers: physicians, dieticians, psychologists and fitness trainers.

Obesity, mainly morbid obesity, is a very significant risk factor for the development of many chronic diseases, such as high blood pressure, high blood fat levels, also known as hyperlipidamia (high blood levels of cholesterol and triglycerides), diabetes, cardio-vascular diseases, fatty liver disease, cancer, various orthopedic problems, joint diseases, back pains, respiratory problems, sleeping disorders, and other ailments. People suffering from obesity may also suffer from various emotional problems such as depression, anxiety and binge eating disorder. The greater the excess weight, the greater the risk of contracting these chronic disorders!

The dispersion of fat in the body plays a very significant role. When the fat accumulates mainly in the stomach area, it is called apple-shaped obesity (similar to an apple). When it concentrates in the hip area it is called pear-shaped obesity (similar to a pear). Apple-shaped obesity is more dangerous because most of the accumulated fat is in proximity to the heart, and hence there is a greater risk of contracting heart diseases.

There are many reasons for obesity. Some are genetic or hereditary, and some are environmental. Studies show that the hereditary factor in obesity is very significant. Parents who are overweight have a higher risk of having children with a genetic tendency to be overweight.

However, seeing as genetic changes are long-term processes in human evolution, and the phenomenon of obesity among the Western population has become aggravated in just the past three decades, it may be assumed that environmental factors have had a significant impact on the sharp rise in obesity among this specific population.

The environmental factors include many changes in modern lifestyle.

From one aspect, there has been a very large increase in production and distribution of processed food products that contain large quantities of fat, sugar and salt. These processed foods are high in energy and their consumption increases the amounts of energy ingested.

Conversely, the far-reaching technological developments have caused most of us to be much less active than our antecedents. The extensive use of cars, clerical work that doesn't require any physical activity, sitting for long hours in front of the TV and computer, use of elevators, and many other factors, have significantly changed the physical activity levels of the average person in modern society. As a result of these changes in lifestyle, we have a greater risk of developing a positive energy balance, which in turn increases obesity.

Obesity develops when there is an imbalance between the amount of energy consumed as food and the amount of energy that is expended by our body in the following activities:

• a) Body metabolism, in other words, muscle, heart, liver, brain, and blood flow activity, breathing, thought and learning processes, and more. All these require energy in order to be sustained.
• b) Physical activity in which we partake, such as walking, swimming, running, bike riding, climbing stairs, diverse activity at the gym, and more.

A positive energy balance is produced when the amount of energy ingested exceeds the amount of energy expended (higher calorie intake than the body requires), whereby storage fat accumulates. The excess fat accumulates mainly subcutaneously, however it also accumulates in other organs such as in the liver. When the positive energy balance continues for weeks, months and even years, there is a consistent and continuous increase in the percentage of body fat. This leads to morbid obesity, which constitutes a significant health risk for various chronic diseases such as: diabetes, high blood pressure, high blood cholesterol, cardio-vascular diseases, diseases of the joints, back pains, gall bladder diseases, and cancer.