MHM Magazine

Issue 2 | 2021 | MENTALHEALTHMATTERS | 37 MHM often present in transitional periods (puberty, pregnancy etc.,) it can present at any stage of life. It’s especially likely if vulnerabilities were present in early life such as disordered eating, morality and rigidity around food in family members and genetic predisposition to eating disorders. • Eating disorders have the highest mortality rate of all mental illnesses. Death rates are high as a result of medical complications as well as suicidality in individuals who don’t receive appropriate support or become hopeless over the long-term nature of the illness. Eating disorders are serious and can be life threatening so early intervention as well as long term supportive therapy and family support is paramount. • You can tell very little about a person’s health, or whether they have an eating disorder by simply looking at body size or calculating BMI . Two people who eat exactly the same number of calories and food types, with the same amount of movement are likely to have vastly differently sized and/or shaped bodies. Body size is a lot more complex than the sum of energy in and energy out. Variation in body type is most directly related to genetics, despite the myth that we’re in control of our size and shape. BMI was introduced by a mathematician, not a physician, in the early 19 th century. It was designed as a research tool and not as a measure of health. Taking only BMI into consideration can lead to stigmatisation or missing clients with eating disorders completely. • Eating disorders can present in a person with any body size . Though BMI might be helpful in calculating risk on the lower side of the spectrum, this is often the main reason why an eating disorder in a person with a “normal-looking body” is missed. When diagnosing an eating disorder we need to take into consideration eating habits, weight fluctuations, restrictive, obsessive thoughts, obsessive exercise, body image concerns, body dysmorphia and emotional triggers around food and a lot more. The DSM 5 now includes Eating Disorders Not Otherwise Specified, including Atypical Anorexia to account for the large number of people who have lost a significant amount of weight but remain in the “healthy range” according to BMI. Without this category, many individuals don’t receive the critical care they need for the health risks of sudden dramatic weight loss. It also accounts for those who restrict their food intake, posing health risks while appearing not to look ill. This category includes Rumination Disorder, Purging Disorder and Night Eating Syndrome where suffering is experienced and has previously been overlooked. Many people within a normal weight category aren’t acknowledged for the significant hopelessness and suicidality experienced by weight dissatisfaction and low self-esteem. We always need to recognise suffering without looking for quantifiable measures.