7 - The cost of starvation: Eating disorders

Summary

Throughout history, famine has been imposed by both natural and human causes – by drought, locusts, war, poverty, or overpopulation – and to this day undernutrition and malnutrition are the major health problems in India and Africa.

By contrast, in the western hemisphere and increasingly in Asian nations, not undernutrition but overweight is causing health problems. Overconsumption of food has led to an increase in the incidence of obesity, non-insulin-dependent diabetes mellitus, hypertension, cardiovascular diseases, and eating disorders. Easy access to too much palatable food has had the paradoxical effect of self-imposed starvation: Dieting or deliberate food restriction has reached epidemic proportions, especially among female populations, who strive for thinness as their beauty ideal. Dieting in the form of semistarvation is currently the main trigger for the development of the two eating disorders, anorexia nervosa (AN) and bulimia nervosa (BN).

Both disorders are the products of a complex interplay of psychological and physiologic processes. They both belong to a group of heterogeneous psychiatric disorders that can have their onset in childhood, but typically occur during early to middle adolescence (AN) or late adolescence and young adulthood (BN).

AN is a rare but by no means novel disorder, with an incidence rate of 0.7–1.0/10,000/year for females and 0.05/10,000/year for males. Since 1960 an increasing number of new cases, in Denmark as high as 1.9/10,000/year for females and 0.17/10,000/year for males (Nielsen, 1990), have been observed.