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