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Life expectancy much shorter for anorexics [Article in National Post]

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Life expectancy much shorter for anorexics
Women die 25 years earlier on average

Tom Blackwell, National Post
Published: Friday, July 18, 2008

Anxious to highlight the gravity of an often-overlooked disorder, Canadian doctors have calculated that women with anorexia die on average about a quarter of a century earlier than other women.

The B. C. specialists who published the research this month say they hope their dramatic life-expectancy statistics will both motivate anorexia patients to get better, and spur governments to more generously fund work on the condition.

Their number-crunching revealed, for instance, that a woman who develops the disorder at age 15 will live on average to age 56 -- 25 years less than the average Canadian female.

"Anorexia nervosa is basically not recognized as a serious disease by society and government, in my opinion, certainly not compared to heart disease and cancer," said Dr. Laird Birmingham, the University of British Columbia psychiatry professor who led the research.

"Most people have a picture of supermodels who lose too much weight because of dieting and think 'How pathetic is that?' "

The findings might also counter a stigma that has turned the disease into a "modern-day leprosy," he said.

Anorexia nervosa is an eating disorder whose sufferers typically refuse to keep their body weight within 15% of normal, have an intense fear of gaining weight and a distorted body image, and have missed at least three consecutive menstrual cycles because of their weight loss.

About half of those who die commit suicide, while the rest succumb to medical problems, often out-of-control heart rhythms related to their weight loss.

The mortality rate has been pegged previously at about 5%, but no one had worked out the actual life expectancy of anorexics, says the article in the journal Eating and Weight Disorders.

The researchers analyzed mortality statistics for 954 anorexia patients in B. C. over a 20-year period ending in July, 2000, using "decision analysis" software that compares such outcomes as death or illness in different groups.

Depending on the age -- from 10 to 40 -- when the women developed anorexia, their life expectancy was reduced on average by 22 to 25 years, the study concludes.

The numbers are averages, meaning that many patients who make full recoveries in treatment can expect a normal life span, Dr. Birmingham said.

Dr. Leora Pinhas, psychiatric director of the eating-disorders clinic at Toronto's Hospital for Sick Children, said she was not surprised by the statistics, and agreed it could help draw much-needed attention to the seriousness of the disorder.

"It's a psychiatric disorder that cuts years off people's lives, that kills people," she said. "That's not how people usually see mental-health disorders. It's a really acute, serious illness and it's interesting to me how calm people are about that."

A shortage of money and personnel in the field means specialists are "constantly reeling under the workload" and patients can wait as long as eight months to get treatment, Dr. Pinhas said.

The disease is sometimes given short shrift because of a misconception that it results simply from personal lifestyle choices or the influence of family, Dr. Birmingham said.

There is mounting evidence, though, that patients have a genetic predisposition to the condition, and that their brains act abnormally, he said.

Imaging has shown, for instance, that fear centres in the brains of anorexics "light up" when they are asked to eat food, the psychiatrist said.

Dr. Pinhas said she sees the disease as caused by a combination of biological factors and psycho-social influences, such as a culture that encourages people to lose weight.

Meanwhile, Dr. Birmingham has started telling patients about the life-expectancy figures to drive home the gravity of their problem.

"What this says is 'I have to get better or my life is going to be a lot shorter.' "

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