As obesity and the growing strain it places on health care hogs headlines, have we forgotten that many women continue to struggle with anorexia and bulimia?

Weight control is popular topic of discussion with many of my patients, but especially among adolescents. Almost universally, the first question teens ask when discussing contraceptive options is, “Will it make me fat?”

Other patients stand on the scale backwards, so they don’t have to see their weight — even during pregnancy, when a moderate amount of weight gain is acceptable and even recommended. 

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But this topic also hits closer to home. My niece, who has struggled with anorexia in the past, recently sent me a link to her new website The Starvation Army, where she is trying to “change the way the world sees beauty.” This is her way of taking a stand against eating disorders as part of her healing and recovery process. 

My niece’s email came just as I was reading an article from Johns Hopkins School of Public Health (JHSPH) about the continued presence of pro-anorexia and bulimia websites on the Internet. At first I was skeptical, so as an experiment, I did a Google search on anorexia and bulimia.

What I found was a surprisingly high number of disturbing websites on how to be a successful anorexic or bulimic. These sites offer commandments for best starvation techniques, guidance for binging and purging, and advice for how to hide anorexia and bulimia from loved ones. Despite efforts to shut websites like these down, many have survived by including information on eating disorder treatments and recovery, albeit buried in difficult to find areas.

Perhaps worse than the tips is what Jim Schnabel, the author of the JHSPH article,  dubbed “thinspiration” — the obvious social support that these websites provide to “Anas” and “Mias,” whose disease typically isolates them from friends and family. I have always joked that you can find a website to support almost any belief or behavior, but these were particularly chilling in the way they endorsed distorted thinking. 

Apparently, online pro-eating-disorder support communities are becoming more widespread and complicating treatment by keeping patients with anemia and bulimia “more enmeshed in the eating disorder.” 

This got me thinking and made me realize that  I have been remiss in discussing anorexia, bulimia and even healthy body image with my patients. Screening women for eating disorders is not something I typically do, but it is a topic I plan to discuss during routine visits going forward.

You can keep anorexia and bulimia on your radar, too, by looking for these clinical symptoms:

  • Thin appearance
  • Negative or distorted self-image
  • Reports of excessive exercise
  • Flat mood or lack of emotion
  • Social withdrawal
  • Trouble sleeping
  • Presence of soft, downy hair on the body (lanugo)
  • Amenorrhea or menstrual irregularities
  • Dry skin
  • Irregular heart beat
  • Low blood pressure
  • Dehydration

Do you have any tips for counseling patients who have anorexia and/or bulimia? Share your experiences in the comments section below and help spread awareness about these eating disorders.

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.