Survival of the fittest
Body weight brings pressure on
anorexic patients and bulimics

By Adelaide Lau

A norexia nervosa and bulimia nervosa are eating disorders that are found mostly among young women. Fairly common in the West, the disorders have only recently shown up in significant numbers in Hong Kong.

Anorexia is a condition in which a person refuses to eat anything except minimal amounts of food and eventually loses weight steadily to a dangerously low level.

Dr. Lee Sing, a senior lecturer in the Department of Psychiatry at The Chinese University of Hong Kong, said, “Bulimia is an attempt to first restrict food intake and then results in out-of-control eating binges due to the prolonged starvation.

“Bulimics feel guilty afterwards. They compensate by self-induced vomiting, using laxatives, drinking water exclusively for the next few days or doing excessive exercises.”

If a person conducts such compensatory behaviour about twice a week, then one is regarded as a bulimic.

The most famous victim of bulimia is Diana, the Princess of Wales, who has publicly admitted her affliction with the disease.

Dr. Freedom Leung Yiu Kin, a lecturer in the Department of Psychology at The Chinese University of Hong Kong, said, “Eating disorders are mostly due to psychological problems.

“Whether these illnesses will be genetically transmitted cannot be sure.”

Dr. Leung added, “Through abnormal eating habits, people with either anorexia or bulimia reveal a lack of confidence in their body shape and self-image.

“They may want to lose weight in order to get rid of the sense of incompetence and uselessness.”

Dr. Leung stated that some anorexic patients and bulimics are perfectionists. They want their body shapes and their working abilities to be perfect.

It has also been suggested that physiological factors are responsible.

Said Dr. Lee: “Some investigations has revealed that the secretion of neuro-transmitters from the brains of patients may differ from that of normal people. This explains why bulimics get excited easily.

“There may also be something wrong with the hormone secretion of these patients.”

Said Dr. Leung: “Anorexic patients are easily spotted because they are extremely thin. Amenorrhea, the cessation of menstruation persisting more than three months, is another syndrome of an anorexic patients.

“Since the weight of bulimics is about the same as that of normal people, they are harder to identify. Sometimes, even their parents and their close friends do not know about their secrets.”

Dr. Lee added, “Repeated vomiting of bulimics causes the enamel of teeth to be eroded by gastric acid. Inflammation will occur, as the vomit may pass through the noses and around the cheeks.

“Besides, bulimia will lead to hypokalemia, the imbalance of the body’s electrolytes, which causes non-rhythmic cardiac beats. This can be very dangerous.”

Some bulimics develop marked calluses on their fingers or hands because of friction. These are caused by repeatedly sticking their hands down their throats to stimulate self-vomiting.

Many bulimics have been anorexic patients as well.

Above: Ideal body weight, in kilograms, for young adult Chinese females, according to the Chinese University's Dr.Lee Sing.

“About 20 to 30 percent of anorexic patients will become bulimics after a prolonged starvation. About one-third of them suffer a fluctuation between anorexia and bulimia. The rest of them will die of either exhaustion or suicide,” said Dr. Lee.

Anorexia was not found in Hong Kong until the late ’80s.

“These illnesses are mainly found among females and largely confined to ages between 10 to 19,” Dr. Leung said.

To date, three deaths have been reported in Hong Kong. One was due to exhaustion, and two patients committed suicide because they were lonely and bored.

Body mass index, which consists weight in kilograms divided by the square of a person’s height in meters, has been widely adopted as an objective indicator of body fat. It can determine whether a person is underweight.

Said Dr. Leung: “In Hong Kong, an adult’s body mass index should be 19 to 24 for females and 20 to 25 for males.

“Usually, the body mass index of a bulimic is about the same as that of a normal person, but a female anorexic’s body mass index is mostly below 16.

“The nutritional level of an anorexic patient is so low that they will die from starvation naturally.

“It is difficult to tell the weight at which a patient will probably die, because it depends on the biological tolerance of different individuals.”

Although psychotherapy and a new drug can help cure the illnesses, a trusting relationship between doctors and patients is very important.

“Anorexic patients have great satisfaction as long as they can control the amount they eat. Thus, they will probably not cooperate with psychologists,” said Dr. Lee.

During treatment, the psychologists try to assure patients that to be a contributing and valued person is not determined by one’s the weight.

Dr. Leung stated that bulimia is easier to cure than anorexia. As the weight of anorexic patients is about 30 percent less than the weight they should be, nutrition counselling is given first so as to raise their weight.

Said Dr. Leung: “A long psychological counselling programme should follow. Whether a patient can fully recover depends on one’s personality.

“The support of friends and family is also important.”

February 1996