by Giulia Chiuso
MONACO. Eating disturbances may include inadequate or excessive food intake which can ultimately damage an individual’s well-being. The most common forms of eating disorders include Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Especially teenagers can be affected by eating disorders.
They are associated with important physical health and psychosocial morbidity, and carry increased risk of death. Their cause is not yet completely understood and their management is complex, with some patients resisting all available treatments. We are not talking about the positive habit to get a fit or a bikini body as the beach season is approaching! We are talking about adolescents and young adults hiding the pain from family, friends and even doctors. Those suffering from an eating disorder such as anorexia nervosa, already described since the end of the nineteenth century, usually decrease food intake to reach levels of extreme thinness; while in bulimia nervosa, described for the first time in 1979 by a London psychiatrist, the patient ingests large quantities of food and then fasts, or rejects it, freeing himself from an unbearable weight. Although the scientific interest in eating disorders as a psychosomatic drawback spread only in the second half of the 20th century, the complications related to the nutritional act were mentioned in the treatises of doctors in much more remote times and were also referable to the male gender. In the richest societies, food has slowly become the vehicle of an ocean of emotions. In the world of globalization, starting from the nineties, a different vision of the relationship with food has also spread, which has caused the appearance of new disorders: orthorexia, for example, or the obsession with healthy foods and “Pure”, usually raw vegetables and, in general, foods free of artificial substances; or bigorexia, that is the obsession with the perfect body, which seems to be spreading more and more among male individuals.
The data we possess are impressive: according to the Ministry of Health, there are now three million people suffering from eating disorders and the age of onset of these disorders is decreasing, to the point that we can see children aged 10-11 suffering from it. In 2016, only anorexia caused 3240 victims: the most affected are the most industrialized civilizations, perhaps due to greater social pressure towards an ideal of feminine thinness that is rooted in modern Western culture. There is something very profound that leads to such self-destruction, to an annihilation that makes even the simplest and most everyday actions impossible (yes, because those who suffer from anorexia nervosa, for example, cannot tolerate sitting for more than a few minute, due to the pain caused by a very low percentage of body fat, in contact with rigid surfaces). The causes are always difficult to identify and admit, but usually it is emotional retention, a traumatic event that has never been overcome, low self-esteem, a wound that does not heal, an attempt to self-compensate for serious shortcomings.
Those who suffer from anorexia nervosa, bulimia nervosa or BED (binge eating disorder, which can be translated as “eating disorderly and without inhibitors”) or more “classic” discomforts, very rarely ask for help: let your body speak for itself self, as if to say: “Hey, look at me! I need care, love, attention! Why did you let me reduce myself to notice? ” Suffering from eating disorders disrupts the lives of those affected, and even a simple dinner at a restaurant can become a source of anxiety: “how many calories will this dish have?”, “I could not resist that temptation!”, “If I don’t eat, everyone will ask me what I have … What shall I say? ” Now, here it is where a happy convivial occasion turns into a nightmare: the exits, then, are rare, while the social and working life is negatively affected and one remains more and more alone. In most cases, an eating disorder begins with a common desire for weight loss that, however, gets out of hand and triggers a series of very complex mental mechanisms.
The problem is especially common among, though not limited to, gymnasts, dancers, models, wrestlers and other athletes, who often struggle to maintain ultra-slim bodies or maintain restrictive weight limits. In the Principality, we asked Federica Nardoni-Spinetta, president of the Chamber of Fashion of Monaco, what she thought of the now sadly known relationship between catwalk models and eating disorders, of which many of these girls suffer: “Strict aesthetic standards are required to access the High Fashion catwalks but, compared to the past the situation fortunately has changed, – said the tireless organizer of the prestigious Monte-Carlo Fashion Week since 2013 – we try to reward the uniqueness beyond the size! Today we are far from established rules.” –
In the last 30 years a substantial improvement has been achieved both in the understanding and management of eating disorders, but many problems still need to be resolved. Three principal priorities should be addressed. First, the actual classification of eating disorders should be revised, since about half the cases seen in clinical practice receive a diagnosis of eating disorder not otherwise specified, and it is common to observe a migration between eating disorder diagnoses. Second, the research on pathogenesis should better clarify the exact role of genetic and environmental risk factors, and how they interact and vary across the development and maintenance of eating disorders. Third, there is an urgent need both to disseminate the few evidence-based treatments available, and to develop more potent treatments for all the eating disorder diagnostic categories. It is also very important for family members, partners, friends, classmates, colleagues, teachers and doctors to seize the problems as soon as possible.