ARTICLE: FITNESS NUTRITION RELATIONSHIPS MIND MATTERS ALTERNATIVE HEALTH
Anorexia starves the brain
March 2, 2006
There's new hope for sufferers of the hunger-related condition, writes Paula Goodyer.
For anyone with a normal appetite, it's hard to understand how someone with anorexia can defy hunger pangs to go without food. But a better understanding of brain chemistry and eating suggests that in anorexia, avoiding food isn't just about willpower - but lack of a neurotransmitter called neuropeptide Y, or NPY for short, that stimulates appetite.
One reason why obese people find it hard to lose weight is because of an oversupply of NPY, explains Associate Professor Herbert Herzog, director of the Neuroscience Program at the Garvan Institute for Medical Research in Sydney. "But people with anorexia have less NPY - and once the NPY system is disrupted it becomes easier to starve," he says.
But what science doesn't understand is whether changed levels of NPY are a cause or a consequence of anorexia, says Herzog, who's studying the link between NPY and anorexia in the hope that it will lead to better treatment.
About 4200 people in NSW, most of them female, have anorexia. A major concern is that the disorder now appears in children as young as 10, and occasionally younger - a trend that's replicated in Canada and Britain, says Dr Michael Kohn, a staff specialist in the Adolescent Medicine Unit at the Children's Hospital in Westmead who, along with colleague Dr Sloane Madden, is studying anorexia in childhood and adolescence.
"This younger age means the physical impact of anorexia on the body is much greater," he says. "Besides affecting their growth, it affects their brain. It's at the beginning of the second decade of life that the frontal lobe is developing. This is the area of the brain that deals with judgement and organisation - anorexia delays its development and this can significantly affect the ability to function in adult life."
Thin-is-beautiful messages might contribute to anorexia, but they're not the root cause of the condition.
"What's emerging is that young people are becoming increasingly distressed at earlier ages and are using a range of different coping strategies," he says.
Some might use alcohol or drugs, while others find that restricting food helps because they get positive comments when they lose weight. And while starving might seem a way to feel bad, not better, Kohn explains that another effect of lack of food on the brain is that it blunts feelings. In other words, starving creates the emotional salve that others find in alcohol or drugs.
What makes a child or adolescent more likely to turn to food restriction, rather than alcohol, drugs or disruptive behaviour is a tendency to be anxious and more likely to internalise problems - characteristics more common in girls. Troubled boys can develop anorexia, but in general they're more likely to externalise their distress, Kohn says.
He believes eating disorders occur earlier because, compared to previous generations, today's 10-year-olds are under more pressure, yet often have less support. Because they're younger they're also less able to cope.
Helping insulate children from the kind of distress that triggers anorexia means spending quality time with them, he says.
"But this is being eroded. It's a harder, meaner society and young people are trying to find their way," Kohn says.
"Dieting is the single biggest risk factor for having an eating disorder," says Sarah Maguire, the eating disorders co-ordinator for the NSW Centre for Eating and Dieting Disorders.
"If your mother had an eating disorder and your father has depression but you don't diet, then you probably won't develop an eating disorder. But if you diet, your risk of developing one is greater."
PARENTS WALK A FINE LINE
Parents are wondering how to navigate a pathway between not encouraging eating disorders on the one hand, and concerns about childhood obesity on the other, says Dr Rick Kausman, the Australian Medical Association's spokesman on eating disorders.
Kausman, who talks to parent groups on this issue - and has two teenaged daughters - suggests these guidelines to minimise the risk of eating disorders and obesity:
* Be sure children understand you love them for the way they are. When kids feel they don't fit, you increase the risk of an eating disorder. If they feel bad about themselves they're less likely to do things that help keep them at a healthy weight, such as swimming and walking.
* Be a role model - don't be negative about your own body.
* Avoid labelling foods "good" or "bad". Normalise foods like chips by calling them foods you don't have all the time, rather than rubbish.
* Encourage kids to eat slowly - bolting food doesn't allow time to get feedback from your brain that you've had enough.
* Help them listen to their bodies and avoid non-hungry eating for reasons, such as boredom. If they're hunting for food in the cupboard, ask if they are hungry or if there's something else they would like to do.
* Sit down and eat as a family whenever you can.
DISCUSSION: For those of you who have, or have had, an eating disorder, be it anorexia, bulimia, compulsive overeating etc, do you think your parents followed the 'guidelines' at the bottom of this article?
If so, do you think it helped at all?
If not, how did they respond/react when it came to food & meals with you as a child?