Anorexia patients with normal body weight can be just as sick as patients with severe underweight, doctors have warned.
Although they have a relatively healthy weight on the outside, such patients may have a dangerously low heart rate and blood pressure.
Researchers have now said that the rate at which anorexia patients lose weight is much more dangerous than how much they lose.
They warned that such patients may not be noticed because their condition is masked by their body weight, meaning that they are not receiving crucial treatment.
And experts also said that overweight patients can be praised for losing weight without anyone knowing that they are sick.
Anorexia patients with normal body weight can be just as sick as patients with severe underweight, doctors have warned. They have drastic and sudden weight loss and limit food, but are not dangerously low in weight (stock image)
The study, led by Stanford University School of Medicine, is the largest study among adolescents with normal weight and anorexia.
It compared 50 patients with atypical anorexia nervosa with 66 people who met traditional diagnostic criteria.
Atypical anorexia nervosa was formally recognized in 2013 and is diagnosed in patients who do not have the usual low body weight that is synonymous with the condition.
The participants were between 12 and 24 years old and almost all of them were female. They all received treatment for their eating disorder during the examination.
Patients in both groups lost the same amount of weight – 30 pounds (13.6 kg) – for one year and four months.
HOW CAN YOU HAVE A NORMAL WEIGHT AND ANOREXIA?
When people think of anorexia, they usually think of a person with an extremely low weight.
However, a person with atypical anorexia nervosa does not have this symptom of the disease.
In 2013, the American Psychiatric Association added atypical anorexia nervosa to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The DSM is used worldwide and contains sets of diagnostic criteria to help clinicians diagnose psychological problems.
Atypical anorexia has met all the criteria of anorexia, except that despite the significant weight loss, the person's weight is within or above the normal range.
According to the DSM-5 criteria, they must be diagnosed with atypical anorexia or tradition anorexia in order to be diagnosed:
- Continued limitation of energy intake (in the case of anorexia, leading to a considerably low body weight)
- Either an intense fear of gaining weight or becoming fat or persistent behavior that hinders weight gain (even if it is a considerably low weight)
- Disruption of the way the body weight or body shape is experienced, improper influence of body shape and weight on self-evaluation, or persistent lack of recognition of the severity of the potentially low body weight
Sometimes atypical anorexia is considered to be a & # 39; other specified nutritional or eating disorder & # 39; (OSFED).
Like any other eating disorder, OSFED is a very serious mental illness that is not only about how the person deals with food, but also about underlying thoughts and feelings, says Beaty, the eating disorder charity.
Dr. Andrea Garber, lead author of the University of California-San Francisco, said more research is needed to find a healthy weight for those patients recovering from atypical anorexia nervosa.
She said: & # 39; If a patient was obese, it is not intended that they recover all the lost weight.
& # 39; Someone gaining weight, getting menses back, and doing social, emotional, and cognitive well may indicate that they are in a recovery site. & # 39;
However, those with atypical anorexia were still within normal weight for their height.
The researchers discovered that both groups had equally poor vital functions, including a low heart rate. A slow heartbeat can often cause fainting, heart failure and sudden cardiac arrest or death.
They also had low electrolytes, chemicals in the blood that could fall due to a poor diet.
An imbalance causes weakness and, if not treated, can lead to seizures and possibly fatal heart rhythm disturbances.
Equal numbers of patients in the two groups no longer had menstruation, indicating a failure of normal hormonal functions that also caused fragile bones.
Dr. Neville Golden, senior author's study, said: & Our study showed that they (patients with atypical anorexia) can be as medically and psychologically ill as patients with anorexia nervosa who are underweight.
& # 39; This group of patients is recognized and under-treated. & # 39;
Some members of both groups also had very low blood pressure, although this is more common in patients with typical anorexia.
Atypical patients also had, on average, worse psychological symptoms, such as low self-esteem and OCD.
The researchers determined which factors best predicted the severity of the disease using a statistical model.
The amount, speed, and duration of weight loss were linked to worse disease, while body weight was not at the time of diagnosis, they found.
Based on the findings, experts said GPs may not be able to identify symptoms such as dizziness and absence as an eating disorder in patients who are not underweight.
Arti Dhokia, from Priory's Woodbourne Hospital in Birmingham, told MailOnline: & although doctors' awareness of eating disorders is increasing, the "markings" and "red flags" used are often associated with low weight.
& # 39; When anorexia nervosa is mentioned, images of emaciated bodies, protruding bones and wasted muscles come to mind.
& # 39; Atypical presentations are varied and are not that easy to recognize. Patients who were previously overweight or obese may have experienced extreme weight loss, but for example still have a healthy BMI. & # 39;
Leading British charity Beat said: “We welcome these findings because it supports a growing body of evidence that weight, or BMI, cannot dictate how ill someone is considered to be.
"You cannot tell if someone is feeling unwell by looking at them, and it is crucial to break the stigma that only people with very underweight can have anorexia.
& # 39; Healthcare providers sometimes see no eating disorders and this is often exacerbated in patients who are not underweight. & # 39;
Dr. Andrea Garber, the lead author of the University of California-San Francisco study, implied that overweight or obese teenagers are vulnerable to adopting unhealthy ways to lose weight.
She added: & # 39; Teens are told to lose weight without tools to do it in a healthy way.
& # 39; By the time they see us, they have lost a lot of weight, their vital functions are unstable and need to be hospitalized. & # 39;
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