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SCMP Reporter

NEW studies suggest that anorexia and bulimia are twice as common as shown in earlier studies and that the incidence is increasing steadily.

  The single most likely culprit for the increasing incidence of these eating disorders is the spread of dieting.

  People with bulimia go on eating binges, followed by a 'purge'.

  This can include forcing themselves to vomit to keep their weight down.

  Those with anorexia, on the other hand, have such a strong fear of gaining weight that they starve themselves, despite becoming skeletally thin.

   'The increase [in eating disorders] is directly proportional to the numbers of people going on diets,' said Dr George Hsu, director of the Eating Disorders Programme at Tufts University School of Medicine in the United States.

  'For example, in developing countries like Taiwan, Singapore and China, dieting is becoming a fad.

  'Eating disorders, once little known, are now becoming more common.'   Eating disorders are about 10 times as common in women as in men.

  This reflects the greater prevalence of dieting among women, Dr Hsu said.

  'The desire to fit the cultural ideal of thinness drives many women to diet severely,' said Dr Terence Wilson, a psychologistin the United States.

  'In some vulnerable young women, this leads to bingeing and purging, or to self-starvation.'   Previous estimates had put the rate of anorexia at one to five cases each year per 100,000 people.

  For bulimia, the rate had been pegged at 5.5 cases each year per 100,000 women up to the age of 24.

  But a new, more careful epidemiological study in the Netherlands, published in a recent issue of the American Journal of Psychiatry, found higher rates.

  They recorded 8.1 for anorexia and 11.5 for bulimia.

  The rate of bulimia in urban areas seems to be higher, according to the Dutch study.

  In rural areas it was just 6.6 per 100,000 women, climbing to 19.9 in small towns and 37.9 in cities.

  At the same time, a study in Scotland found that from 1965 to 1991, the number of patients being treated for anorexia increased by about five per cent each year.

  That study notes that it is not clear how much of the increase is due to an actual jump in the number of cases and how much is due to better diagnosis or increased public awareness.

  A study of more than 2,000 female twins, published in the January issue of the American Journal of Psychiatry, found a significant hereditary component to eating disorders.

  Anorexia, in which, most commonly it is a young woman who starves herself to keep her weight down, is life-threatening.

  rate among women in whom the disorder is diagnosed is five to eight per cent over the course of 10 years.

  This is mainly from suicide or effects of severe weight loss.

  The outlook is better for bulimia than for anorexia, particularly with newer treatments.

  'There's lots of relapse with anorexia,' said Dr James Mitchell, a specialist in eating disorders at the University of Minnesota's medical school.

  'But with bulimia, there's a better picture.

  'When patients get good treatment, 60 to 70 per cent get much better.'   Several controlled studies have found that cognitive-behavioural therapy is the most effective treatment for bulimia.

  It fares better than other kinds of psychotherapy or drugs.

  Treatment for eating disorders increasingly includes antidepressants because depression commonly accompanies the affliction.

  'One theory is that depression triggers anorexia and bulimia,' Dr Hsu said.

  'If you go on a diet and there's a history of depression or alcoholism in your family, there's a much higher risk of your developing an eating disorder.'   One of the first goals of treatment for bulimia is to help patients establish regular eating habits with good nutrition.

  'We explain why eating a balanced diet is unlikely to lead to weight gain, while bingeing clearly does,' Dr Wilson said.

  'Bulimics are living off the calories they don't expel through purging.

  'Vomiting reduces calories by about 50 per cent and laxative misuse is fairly ineffective at reducing calories.

  'But if they stop bingeing and purging, and eat well, they won't take in any more total calories.'   Another key element in the cognitive-behavioural treatment is 'self-monitoring'. This is getting the patient to pay close attention to the physical signals of the emotional triggers that lead to bingeing.

  One of the most common triggers of binge eating is a bad mood.

  'Say a patient has a fight with her boyfriend or a bad day at work,' Dr Wilson said. Any such incident that makes her feel bad, out of control or helpless can lead her to binge for a feeling of short-term relief.

  'We might help her find ways to become more effective at managing her feelings of anxiety or deprivation, or be more assertive with her boyfriend. We also help them plan ahead for high-temptation situations, like going to a wedding where there will be lots of food.' The New York Times Health is edited by Mariana Wan; tel: 2565-2275; fax:2562-2485 



Falling foul of the eating fads