07 December 2009

The dark side of thin

It is ironic that in an age when more than 50% of the population is burdened with overweight or obesity, the so-called "ideal woman" looks more like a skeleton, argues DietDoc.

Now that the human race has survived to the 21st Century, one would expect that they have become wiser, but when one considers the extremes of obesity and anorexia that so many people suffer from, then one wonder if this species has learnt anything since we emerged from the African plains.

Lately I have received a number of questions from my readers about eating disorders and requests for tips to lose weight from women who are already so thin that a puff of wind could blow them away. In many cases, readers ask how to help friends or family who are abusing their bodies and health with excessive dieting, purging, exercise or other potentially dangerous methods of losing weight.


Eating disorders which can be broadly classified as anorexia nervosa, bulimia nervosa, and orthorexia, tend to be much more common in females, especially teenagers and young women, but can also occur in young men.

The following symptoms and signs can alert you to the presence of an eating disorder:

  • Abnormal thinness, BMI of less than 18 and often as low as 14.
  • Starved look with protruding bones, flesh stretched over the face.
  • Excessive and abnormal dieting or eating habits.
  • Excessive or abnormal exercise.
  • Unrealistic body image - patients with eating disorders will insist that they are “fat and ugly” even when their BMI is hovering around 14.
  • Obsessive concern with being fat, labelling any foods except lettuce as “fattening, forbidden or sinful”.
  • Suspicious habits - disappearing for long periods into the bathroom after eating to purge or vomit (bulimia) or eating only those foods which the patient regards as “healthy or good or nutritious” (orthorexia).
  • Pale, clammy skin covered with a fine layer of hair (anorexia).
  • Damaged tooth enamel from contact with stomach acid due to induced vomiting (bulimia).
  • Lack of menstruation in women and loss of female characteristics (flat bony chest, loss of female curves).
  • Tiredness due to lack of food and iron and vit B12 deficiency anaemia.
  • Lack of self-worth and feelings of helplessness.
  • Suicidal ideas and attempts at suicide.


It is logical that starving the body for long periods (anorexia) or removing food by purging and vomiting after ingestion (bulimia) or only eating certain selected foods (orthorexia), will deprive the body of its required supply of macro- and micronutrients and cause serious deficiencies. These deficiencies will lead to a variety of conditions and ill health such as amenorrhoea, osteoporosis, anaemias, scurvy, dental deterioration, heart and kidney failure and pronounced psychological disturbances (anxiety, depression and suicide).

Risk of suicide and death

A recent study investigated 46 Israeli adolescent girls with anorexia or bulimia to identify risk factors associated with ideas of suicide, attempted suicide and depression. The results of this study are extremely disturbing:

  • 24% of these young girls had attempted suicide.
  • 65% reported that they often thought of suicide.
  • 58% of the subjects were moderately or severely depressed.

The following factors were linked to risk of suicide in adolescent girls with eating disorders (Fennig & Hadas, 2009):

  •  Depression.
  • A history of sexual abuse.
  • Longstanding eating aberrations.

The authors of this study emphasise how important it is to treat depression in adolescents suffering from eating disorders to prevent these young people from committing suicide.

Eating disorders were also found to increase the risk of fatalities. Researchers in the USA found that in a population of nearly 2,000 patients with eating disorders, the risk of death, particularly due to suicide, were 4% for anorexia, 3.9% of bulimia and 5.2% for eating disorders in general (Crow et al, 2009).

Causes of eating disorders

Despite the fact that eating disorders are on the rise, scientists are still not sure exactly what causes and/or triggers the reaction in healthy young people to starve themselves until they are malnourished and ill.

a) Brain physiology

Research conducted in Italy indicates that patients with anorexia nervosa overestimate their body size despite being severely underweight. Daprati and his co-workers (2009), compared body knowledge in severe anorexics, healthy volunteers and stroke patients who had suffered damage to the left or right sides of a part of the brain called the parietal lobe. The healthy volunteers and stroke patients with damage to the left side of their parietal brain lobe had normal body size concepts. The anorexics and stroke patients with damaged right parietal lobes, were not able to correctly estimate their body size. The researchers interpreted these results as an indication that right parietal lobe dysfunction may play a role in anorexia, preventing patients from judging their correct body size.

 a) Societal pressures

While defects in the nervous systems of individuals who develop eating disorders may be the underlying cause of conditions such as anorexia, certain triggers in the environment may also be responsible for this self-destructive behaviour.

A case in point, was one of my young readers, who asked how she could lose another 5kg “because my model agency says I am too fat!”. When I worked out her BMI it was already 18 and losing those extra 5kg would have reduced her BMI to less than 17. The irresponsibility of adults who pressurise young and vulnerable women to lose more and more weight so that they can act as clothes horses (they in any case don’t look human any more) for fashion shows, should be made a punishable offence. This type of coercion is as disgusting as child pornography and our law makers should act to prevent exploitation of our youth by the fashion and modelling industry, and unscrupulous parents.

It is ironic that in an age when more than 50% of the population is burdened with overweight or obesity, the so-called “ideal woman” looks more like ET than a living human being. We live in a sick society and should not be surprised when our young people react by starving themselves to death.

 Stop the exploitation, the impossible demands and the idiotic images of female skeletons on the catwalk.

 (Dr I.V. van Heerden, DietDoc, July 2009)


(Crow SJ et al (2009). Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry. [Epub ahead of print]; Daprati ND et al (2009). The role of the right parietal lobe in anorexia nervosa. Psychological Medicine. Vol 17:1-9. Fennig S, Hadas A (2009). Suicidal behavior and depression in adolescents with eating disorders. Nordic Journal of Psychiatry.[Epub ahead of print]) 


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