When ‘Being Thin’ Is Not Beautiful!
Anorexia nervosa is a psychological disorder with misconceptions regarding body image and shape that may have resulted from the stereotype of ‘being thin’ is beautiful
Eating disorders are a group of mental ailments categorized into anorexia nervosa, bulimia nervosa and eating disorders otherwise not specified (EDNOS). Anorexia nervosa is a psychological disorder with misconceptions regarding body image and shape that may have resulted from the stereotype of ‘being thin’ is beautiful. It also features extreme fear from gaining weight? becoming fat in spite of being grossly underweight and is the complete refusal to maintain normal body weight resulting in drastic weight loss.
Symptoms And Complications
Dehydration. lowered heart beats, fatigue,muscle weakness, diarrhoea/constipation, bloating, amenorrhea (cessation of menstrualcycle) and extreme weight loss are the most striking symptoms. Untreated Anorexia can further lead to serious complications such as extreme loss of hair, dry skin, proximal myopathy (difficulty in standing from a seated position or lifting arms up in the air), respiratory function may be altered because of loss of inter-costal muscle strength, reduced bone mineral density that can lead to osteoporosis, loss of cognition and memory, poor circulation and hypotension, loss of fertility and reproductive function etc.
Plan of Action: Behavioural Cognitive Therapy
A recovery meal plan for anorexia nervosa starts with behavioural cognitive therapy in which the nutrition counsellor initiates proper reasoning for the patient’s perception/ mindset regarding food and body image. Usually, those suffering from anorexia nervosa have very high, deliberate energy expenditure through extensive physical exertion.
“A major step towards a change in the mindset and prevention of relapse is counselling to explore one’s body image and to love oneself the way one is”
Gradual Increase To A 1000 Kcals A Day
They have long gaps between meals and consume not more than 500-700 kcals a day. It is hence important to start slow with a gradual increase to a l000 kcals a day for week one, 1500 kcals a day for week two – until 2000 kcals a day throughout week three. However, the duration differs, depending on the patients coping abilities and current status.
Here are a few important nutritional and medical guidelines to combat the effects of under-nutrition, regain normal weight and restore normal physiological functioning:
- The individual may or may not need hospitalization, but it needed, nutrition via naso-gastric tube teed is considered, This kind of feeding often helps in combating the malabsorption that has developed due to a comprised gastrointestinal tract.
- The rate of weight gain could be estimated to be O.9 -1.4kilo/week for in-patients due to better monitoring and O.5 kilos/week for out-patients.
- Body fat mass especially over abdomen is usually gained over f at- tree mass and this could create more concern for the patient. Educating the patient regarding the physiology of weight gain, again through proper reasoning eventually helps.
- Sometimes, patients use water loading? excessive use of clothing as methods to manipulate their weight gain. Clinicians need to be aware of these deceptive protocols.
- Menstrual cycle may not regularize immediately, post the inception of weight gain because recovery therapy requires time to restore the functions of all systems including the reproductive system.
- Bone health needs to be restored, Estrogen replacement therapy and adequate consumption of calcium and vitamin D rich foods is equally essential in the form of paneer/cheese cubes, baked broccoli, milkshakes, and egg toast etc. and adequate sunlight exposure.
- Other medications like anti depressants, anti-psychotics, anti anxiety etc. may be used too.
- Family members need to be educated about the condition and made aware of their role of supervision for daily meal and snack intake.
- Adequate carbohydrates in the form of rice, pasta, spaghetti preparations are considered. Fried rice, khichdi, dal rice, pulav, upma, poha etc. could also be considered. Finger foods rich in carbohydrates such as potato tikkis, bread rolls, cut sandwich pieces are easily accepted over chapattis and parathas.
- Adequate protein is essential to prevent any further muscle wasting. This again in the forms of paneer tikka, cheese cubes, soy cutlets, chicken nuggets, pattice, muthiyas, dal dhokli, sprouts tikkis etc. could be consumed.
- Essential fatty acids, through the consumption of nuts and oilseeds in the form of chikki, laddoos, nutty bars or handful of nut varieties are essential. Fat intake requires being high enough to facilitate the absorption of tat soluble vitamins A, D E and K.
- Iron rich foods such as red meat, dates, beet root, leafy vegetables etc. need to be consumed to restore haemoglobin levels.
- Specific vitamin and mineral supplements may be required depending on the condition.
- Consumption of more frequent and regular meals is required to balance the abnormal blood sugar levels and restore normal gastrointestinal functioning.