Bharat Thakur Artistic Yoga

Eating disorders create unhealthy attitudes and habits to food

Understanding Eating disorders

Eating disorders are mental health conditions with unhealthy attitudes and habits to food with the obsession to monitor and control one's weight and perceived body image. It involves behaviour of restricted eating, purging, and over-eating, and carries the risk of high mortality if left untreated.

While it is considered to be a mental illness, recent research has found biological underpinnings governing some of its mechanisms. This involves the gut-brain connection in the form of neuronal and chemical pathways that regulate hunger and satiety.

Types of Eating Disorders

The most prevalent eating disorders are -

Anorexia Nervosa - This eating disorder is characterised by a misperception of one's body weight and shape. The person considers themself to be overweight even when in reality they are very thin, malnourished, and dangerously underweight. The person tends to obsessively check their weight, and control what they eat and the portion size. There are two types of Anorexia Nervosa -
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1-The restricting type of Anorexia wherein the person controls their weight by restricting calories, fasting, and excessive exercising.
2-The purging type of Anorexia wherein the person aims to keep their weight in check through purging behaviours such as induced vomiting, misuse of laxatives, diuretics, and enemas. A person with purging Anorexia may also indulge in binge eating followed by compensating behaviour of extreme dieting and exercise and purging by means of vomiting, laxatives, diuretics, or enemas.

Bulimia Nervosa - A person with this disorder tends to maintain normal weight with some being slightly overweight but they are obsessed with losing weight and being thin. Their eating behaviour, mindset, and physical exercises are driven by the pursuit of perfect body size and shape. A bulimic person goes through periods of binge eating in which they consume large amounts of food to the point where they experience gut discomfort. This is followed by purging behaviours of forced vomiting, laxatives, diuretics, or enemas to relieve gut discomfort and maybe the guilt or shame associated with over-eating with the goal of controlling their weight and body shape.

Bulimia can cause severe tooth and enamel decay, digestive issues, hormonal problems, and in severe cases lead to stroke or heart attacks triggered by electrolyte imbalance of sodium, potassium, and calcium ions.

Binge Eating Disorder (BED) - BED is a condition wherein the person consumes large amounts of food without any inhibition and lacks control over how much they are eating even when they are not hungry. There is no compensatory behaviour of calorie restriction, excess exercise, or purging following the binging episode. This can lead to weight gain and obesity and makes the person vulnerable to heart disease, stroke, and type 2 diabetes.

Eating disorders can distort the relationship with the self, and body weight and body image

Possible causes of eating disorders

Eating disorders may be caused by a combination of psychological, environmental, social, and biological factors.

Biological factors - Feeding behaviour is regulated by two groups of neurons in the hypothalamic arcuate nucleus that governs our food intake in response to the internal energy status. This helps maintain energy homeostasis through the regulation of food intake versus energy expenditure.
These two groups of neurons that regulate our feelings of hunger and satiety. are pro-opiomelanocortin (POMC) and AgRP neurons in the hypothalamus. The POMC acts as a brake on appetite by way of another hormone called melanocyte-stimulating hormone (MSH) and when we get or see a lot of sunlight our appetite goes down as happens during summer for instance. When specific genes in the central nervous system (CNS) 'melanocortin system' are found mutated in either humans or rodents, this results in an obese phenotype. AgRP neurons stimulate feeding and fuel positive or negative anxiety or excitement `about food depending on the context. Studies have shown that people with a lesion or damage to AgRP neurons from toxicity have very reduced or no appetite at all. In contrast, people with elevated levels of AgRP over-ride gut-brain signals that indicate fullness and satiety, and become anxious, hyperphagic, and overeat to the point of discomfort.
Another hormone Leptin communicates to the brain how much fat/ energy reserves the body has. The more body fat we have the more leptin is secreted. Leptin travels to the brain and suppresses appetite. It has been observed that leptin signaling is disrupted in people with bulimia, obesity, and some form of binge eating disorder, resulting in the person not being able to exercise control over how many calories they consume.

Psychological factors -
Poor handling of situations that cause stress and anxiety can affect appetite and trigger unhealthy eating behaviour in a person leading them to undereat or overeat.
Studies have shown a bidirectional relationship between stress and appetite. Chronic stress results in the activation of orexigenic pathways resulting in increased food intake if high-calorie palatable food is available. Also, eating palatable food is known to reduce feelings of stress and improve mood which prompts the person to overeat leading to obesity.
On the other hand, in the absence of high-calorie palatable foods, acute or repeated restraint stress activates anorexigenic pathways leading to decreased food intake and stress-induced anorexia.

Environmental factors -
Challenging family dynamics - Growing up in a negative household environment with either unhealthy attitudes to food or on the other hand too much emphasis on eating healthy and established rules about how one should conduct oneself in all matters concerning food may create food perversion.
Also, if the child suffers from any form of physical, mental, or sexual abuse then they may manifest their anger, resentment, or sense of guilt and shame by controlling what and how they eat.

Learn more

Yoga: Self Acceptance, Listening, Loving, Trusting Your Body

Yoga for Eating Disorders

Can yoga contribute to the management of eating disorders? Yoga is commonly integrated into eating disorder treatment protocols as a complementary practice. For instance, The Emily Programme, a prominent facility in the Minneapolis/St Paul region, offers around 30 weekly yoga classes tailored to clients at various treatment stages (Diers, personal communication, 15 May 2013). In the Monte Nido Residential treatment program, yoga is a regular element of the treatment plan (Wyer, Citation 2001). Therefore, a crucial consideration is whether incorporating yoga enhances the effectiveness of the treatment program.

Several studies conducted involving randomised control trials (Carei, Fyfe-Johnson, Breuner, & Brown, Citation 2010; McIver et al., Citation 2009) and some less rigorous ones (Cook-Cottone, Beck, & Kane, Citation 2008; Dale et al., Citation 2009) provide preliminary evidence supporting the potential utility of yoga in the treatment of eating disorders. It's important to note that yoga should not replace conventional medical and psychological interventions. Eating disorders are complex mental health conditions, and a multidisciplinary approach involving medical professionals, therapists, and nutritionists is typically necessary. That said, here are ways in which yoga can contribute to the overall treatment plan:

Mind-Body Connection(The Gut-Brain Axis):Yoga emphasizes the connection between the mind and body. Practicing yoga can help individuals become more aware of their bodies and develop a healthier relationship with them. This increased awareness may contribute to a more positive body image.

Stress Reduction:Yoga is known for its stress-reducing benefits. Engaging in regular yoga practice can help manage stress, anxiety, and depression, which are often linked to eating disorders. The relaxation response triggered by yoga may alleviate some of the emotional triggers associated with disordered eating.

Mindfulness and Presence: Yoga encourages mindfulness, focusing on the present moment. Mindful eating, a concept derived from mindfulness practices, involves paying full attention to the sensory experience of eating. This can be beneficial for individuals with eating disorders by promoting awareness of hunger and fullness cues.

Self-Compassion:Yoga philosophy often emphasizes self-compassion and self-acceptance. Learning to approach oneself with kindness and understanding can be particularly valuable for individuals struggling with body image issues and perfectionism, common factors in eating disorders.

Improved Body Awareness: Through the various poses and movements, yoga helps individuals develop a greater sense of body awareness. This can be particularly helpful for those with eating disorders who may be disconnected from their bodies or experiencing distorted body image.

Physical Activity in a Supportive Environment: Yoga provides a form of physical activity that is generally low-impact and can be adapted to various fitness levels. Engaging in physical activity within a supportive and non-competitive environment can be a positive experience for those with eating disorders.

Signs and Symptoms

Depending on the type of eating disorder a person can exhibit different signs and symptoms.
In the case of anorexia nervosa, one of the visible signs is restricted eating with limited calorie eating. The person may appear visibly emaciated with the appearance of yellow and dry skin.

In bulimia nervosa, the person may show visible signs of tooth and enamel decay resulting from the reflux acid of frequent self-induced vomiting.
Another symptom that is common to both anorexic and bulimic people is their obsession with their body weight and wanting to become or appear thin.
Lack of menstruation in anorexic girls and women (although this doesn't apply to all anorexic girls and women)

A person with Binge Eating Disorder will exhibit high obesity with a predisposition to heart disease and type 2 diabetes.

Feelings someone with an eating disorder may experience

Eating disorders are most likely to create negative feelings in the person and can give them a false sense of being in control. They feel by controlling; their weight they are able to exercise their will or compensate for lack of it in other aspects of their life.
They feel anxious regarding their weight and shape along with guilt and shame about their portion sizes, hiding their issues from family and friends, and avoiding social situations concerning food.
Despite their efforts to attain and maintain an ideal shape and size, they are never happy with how they look and seem to disapprove and un-accepting of themselves in the mirror of their eyes. This can make them feel worthless, low self-esteem, and even if they do realise that their eating behaviour is putting them at risk and can even be fatal, they feel helpless to do anything about it (unless helped by someone or professionally).

How eating disorder can affect the person and their life?

Eating disorders can affect the individual physically, psychologically, and socially. Depending on the type of eating disorder different effects may be experienced.
In an anorexic person, some of the physical effects are a weakness of muscles and bones leading to osteoporosis, severe constipation, very low metabolism, infertility, anaemia, and damage to vital body organs.
A bulimic person can experience poor dental and digestive health among other problems and a person with a binge eating disorder develops obesity with a predisposition to heart attacks and type 2 diabetes.
Psychologically the person suffers from a lack of self-worth, a lack of motivation in life with no interest in planning for the future, and is at risk of developing other mental health conditions such as depression, anxiety, and stress.
Socially individual tends to become isolated as they avoid situations that can expose their condition, or they are unable to participate in exercise and sport events for lack of physical fitness and mobility.
Also, the person may find it difficult to maintain significant relationships and or be able to have a great equation with family and friends at large

Effects of eating disorder on family and friends

An individual's eating disorder is bound to cause a sense of shock and alarm among family members and friends when they first come to realise that their loved one has such a disorder. They may feel confused, or experience a sense of guilt and pain as they explore why this might have happened to their loved one. They will certainly feel concerned for the well-being of the person and will look into ways they can help the person among themselves and seek professional help for the person to break free from their disorder.
In helping the person to recover, family and friends may experience an uphill battle as the person affected may not cooperate well in their efforts to help the person. This can create frustration, worries, the need to monitor the person, and loss of trust or feeling helpless when the person doesn't stay on track with treatment. In rare cases, it can become an emotional ordeal for family and friends as they realise that despite their best efforts they are not able to help the person to recover and sadly may lose them.

Different approaches to the treatment of eating disorders

Eating disorders have the highest prevalent mortality rates of all psychiatric illnesses and treatment should be sought soon once the problem is identified. Several treatment approaches are available and the best results are seen when a multipronged approach is applied to heal the person physically, psychologically, medically, and through the reintroduction of healthy eating behaviour. Also, on the part of the family and the professionals involved in the treatment, it will require a lot of patience and compassion to help the person as the person may not perceive the situation with the seriousness it deserves and rather may rebel as they fear losing control over that aspect of life that they assumed to have had charge of.

Depending on the severity of the disorder the person may be treated at an outpatient clinic, or a patient in a day clinic, or in case of high risk at a specialist centre or a hospital. Treatment is provided under the guidance of a person's GP and a care team comprising a specialist counsellor, psychiatrist, psychologist, nurse, nutritionist, and paediatrician if a child or a young person is affected.
Psychological treatments include Cognitive analytic therapy (CAT), Cognitive behavioural therapy (CBT), Interpersonal therapy (IPT), Focal psychodynamic therapy (FPT), and Dialectical behavioural therapy (DBT) and each may be best suited to the person depending on their temperament.

CBT may help the person to identify unhealthy thoughts, emotions, and behaviours relevant to their eating disorder and encourage them to transform their thought patterns to develop healthy attitudes to food and gradually resume eating well to maintain normal body weight and function.

DBT brings in the element of mindfulness to increase awareness of the thoughts, sensations, and emotions as experienced by the person. For instance, if the person has a compulsive urge to purge, mindfulness will help the person to dissociate their thought and emotions from the desired action and choose to respond in a way that will serve them best rather than acting out their instincts.
Advice about eating and nutrition is a vital component of a person's recovery irrespective of which eating disorder they have to help them attain a healthy weight remedying problems occurring from malnutrition or obesity. The plan involves making small changes to enable better adaptation and aims to develop an intentional relationship with food to fine-tune a person's natural cues of hunger and satiety so they eat in accordance with their physical needs instead of emotional triggers.

Medication can be used in combination with other approaches to manage any accompanying mental health conditionas such as depression, anxiety, or OCD-obsessive compulsive disorder.

Transforming the Relationship with the Self