Global Health Asia-Pacific July 2020 July 2020 | Page 16

You Ask, They Answer Q : What part can diet play in treating anorexia? A : What happens in most eating disorders is that food becomes the manifestation of what is a complex psychological and social problem. I would say that a patient seeking treatment for a condition like anorexia should do so through the combination of a GP, psychotherapist or psychologist, and a dietitian. You need to have people with experience in each of these areas because the treatments for an eating disorder can be very far reaching. If I’m working with someone with a disorder of eating — perhaps they restrict some of the time or they binge some of the time — I would ask them what they hope this will manage and what distress has been triggering it, and work with them from this perspective. Most anorexics know the calorie value of the food better than dietitians. But calories are not the only thing food gives you since there are nutrients and also the social aspect of people eating together, both of which are beneficial. Only when a holistic approach is taken, incorporating treatment across various disciplines including nutrition, will a patient get better. Q : What long-term harm can anorexia do to the body? A : Patients who’ve had anorexia for many years will have done severe damage to their bodies. They may have had it for years and not sought treatment because they’ve been in denial. Others might have realised they have a problem but may not be brave enough to confront it. I had a client who had been anorexic for 25 years. She was Most anorexics know the calorie value of the food better than dietitians 34 and had the bones of an 80-year-old. They were so brittle that she might have fractured a rib doing something as easy as catching a tennis ball. She had managed to maintain her fertility, but this was the exception rather than the rule. With fasting, you can lose heart muscle, so anorexics can end up with heart problems. They could also suffer from digestive problems. When you’re on a starvation diet, your body will take protein from body tissue, even if that tissue is central to the system. People don’t realise how serious the condition is. The reality is that some of the harm may never be reversed if it’s chronic. Q : When should treatment begin? A : After encountering an eating disorder, treatment should begin very soon. A big part of the problem is that conditions like anorexia are not picked up early enough. And even if it is, the resources are often not available to treat it, particularly in public health systems. The ideal situation for a younger person with an active eating disorder would be to have treatment within 3-6 months of their condition emerging. If the patient has been purging or binging, they may already have done permanent damage to their bodies if they’ve been doing so for longer than 2-3 years. Helen Gibbs Helen Gibbs is a primary care clinical dietitian in Dunedin, New Zealand. 14 JULY 2020 GlobalHealthAndTravel.com