Anorexia Nervosa – is ‘Skinny’ really beautiful?

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Once a lady came to me with her grand daughters. She had been an old patient of mine but her twin grand-daughters were first timers. While one was a typical ‘Parley G’ girl, her twin was visibly petite and scrawny. Upon inquiring if she suffered from any illness, the grand mother disclosed proudly, “Oh she is very conscious about her looks. She doesn’t eat much. You know, she hates potatoes as they can make one grow fat! She even tells her sister to rather go for a glass of water instead of eating potatoes, if she felt hungry!”

IT WILL FILL THE STOMACH AND WON’T BE FATTENING AT ALL, believed the nine year old gorgeous lil girl…

As general practitioners we come across so many very young, young and not so young adults who are extremely conscious of their bodies. The very first thing they mention while presenting their complaints is, “Oh Doc, I’ve started eating so much. I have become so fat! Do you have any medicine so that I can shed these extra kilos!!” 

In fact, this “thin is beautiful” syndrome has permeated so deeply into the modern psyche that thinness is equated with success. Many of us think that people who are thin have not only greater control over their eating regimen but also have a greater command over other aspects of life. Even the business world seems to be attaching preference to people who look slender and sleek in business suits, since they are expected to be agile, aggressive and quick on their feet.


Unfortunately, the trend has gripped the taste and imagination of our teenage population too. Their fixation with a thin figure compels them into self-starvation and a consequent lack of appetite. Youngsters today are conditioned into believing that having a model-like physique is one of the prerequisites of beauty and success. More and more young people are following punishing exercise regimes and lean diets. Anorexia is on the rise.

Though the disease was mainly encountered in the western world, more so among women in certain professions, such as models and ballet dancers, current statistics reveal that more than 1 million cases of anorexia per year are reported in India alone.

Distorted body image perception - Distorted body image perception – “I am too fat.”

The cause of anorexia nervosa is unknown, although both inherent biological factors and social environment play a significant role. Puberty, mishaps in the family and other life stresses could to be the potential triggers.

Anorexia Nervosa is a very serious, potentially life-threatening, eating disorder characterized by a physiological aversion to food. It usually occurs in adolescent boys and girls who have an intense fear of becoming fat and hold a distorted perception of their own body image (“I am too fat”).

They place a high value on controlling their weight and shape, using extreme efforts to the point that it significantly interferes with day-to-day activities in their lives. They have an abnormally low body weight. To prevent weight gain or to continue losing still, they usually –

  • bulimia-nervosaSeverely restrict the amount of food they eat – restrictive anorexia nervosa.
  • May control the calorie intake by inducing vomiting after eating or misusing laxatives, diet aids, diuretics or enemas – anorexia nervosa binge/purge.
  • They may also try to lose weight by exercising excessively.

Anorexia nervosa is characterized by self-starvation and excessive weight loss. Ironically, the sufferer is unable to appreciate the severity of the situation.

 What ‘Warning Signs’ should you look for?

It is important to be aware of the warning signs of anorexia nervosa as prompt intensive treatment can significantly improve the chances of recovery.

  • Dramatic weight loss of at least 25% of body weight without any physical illness.
  • Preoccupation with weight, food, calories, fat grams, and dieting.
  • Refusal to eat certain foods, progressing to restrictions against whole categories of food (carbohydrates or fats).
  • Frequent comments about feeling “fat or overweight” despite weight loss.
  • Anxiety about gaining weight or being “fat”.
  • Hunger denial.
  • Development of food rituals (e.g. eating foods in certain orders, excessive chewing, rearranging food on a plate).
  • Consistent excuses to avoid mealtimes or situations involving food.
  • Formation of calluses on the back of the hands/knuckles or discoloration/staining of the teeth from self-induced vomiting in binge/purge type.
  • Excessive, rigid exercise regimen–despite weather, fatigue, illness or injury, with a need to “burn off” calories taken in.
  • Withdrawal from usual friends and activities.

A general behavior and attitude indicating that weight loss, dieting, and control of food are becoming primary concerns for you, coupled with an abnormal weight loss is a sure shot indication that you are heading towards anorexia nervosa.

What are the Health Consequences of anorexia nervosa?

Anorexia nervosa involves self-starvation. The body is denied the essential nutrients it needs to function normally, so it is forced to slow down all of its processes to conserve energy. This “slowing down” can have serious medical consequences:

  • Abnormally slow heart rate and low blood pressure, which means that the heart muscle is changing. The risk of heart failure rises as heart rate and blood pressure levels sink lower and lower.
  • Reduction of bone density (osteoporosis), which results in dry, brittle bones.
  • Muscle loss and weakness.
  • Severe dehydration, which can result in kidney failure.
  • Problems relating to brain and nerves including fits (seizures) and difficulties with concentration and memory.
  • In severe cases there can be shrinking of brain tissue.
  • Anemia, fainting, fatigue, and overall weakness.
  • Cessation of menstrual periods or delayed development of puberty in girls consequent upon hormonal imbalance.
  • Dry hair and skin, hair loss is common.
  • Growth of a downy layer of hair called lanugo all over the body, including the face, in an effort to keep the body warm.

Anorexia nervosa typically appears in early to mid-adolescence. It is one of the most common psychiatric disorder. Approximately 90-95% of it’s sufferers are girls and women. Anorexia has one of the highest death rates by any mental health condition, the probability rising with the length of the condition.


Anorexia isn’t really about food. It’s an unhealthy way to try to cope with emotional problems. When you have anorexia, you often equate thinness with self-worth.

Anorexia can be very difficult to overcome. But with treatment, you can gain a better sense of who you are, return to healthier eating habits and reverse some of it’s serious complications. This new year take a vow not to be too hard on yourself. It’s perfectly alright to go out with your family or friends, binge upon a piece of cake or indulge in a few scrumptious delicacies.


For tips on a gentle and lasting cure of this self-starving psychiatric eating disorder — wait for the next post.