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Johns Hopkins Health - A Weighty Issue

Winter 2010
Issue No. 7

A Weighty Issue

Date: January 24, 2010

Knowing that you have an eating disorder is only part of the battle. Willingness to seek and engage in treatment is the tough part

a woman wearing a white towel looking down at a scale

When is an eating problem a disorder? Eating disorders include anorexia nervosa, bulimia nervosa and other problems that affect eating. Millions of people in the United States have eating disorders that impair their physical, psychological and social functioning.

When it comes to eating disorders, women own the pie, so to speak; 10 million have some type of the condition. Much of the blame is directed toward picture-perfect and unattainable images in the media, but psychiatrist Angela Guarda, M.D., says there may be another reason closer to home.

“It’s likely that there’s a physiological reason why women are more predisposed to eating disorders,” she says. “It may have more to do with hormones and heredity.”

Guarda says eating issues usually surface during puberty, when a girl’s body begins to change rapidly, including a doubling of fat mass. Plus, she says, we’ve learned that anorexia and bulimia have a large genetic component, as heritable as any other psychiatric disorder.

“Most young women will diet at some point in time,” Guarda says. “But for those who develop a severe problem, they likely have a predisposed genetic vulnerability.”

Although recognizing an eating disorder can be difficult, it’s important for families and loved ones to be aware of the warning signs. Most obvious is significant weight loss, but watch for other red flags that include excessive exercise, complaints of being fat, preoccupation with food, not eating with others, increased social isolation, evidence of binging, vomiting or abusing laxatives, and an unusual fixation on low-calorie foods.

Once an eating disorder has been identified, behavioral therapy and psychiatric counseling is the recommended treatment. But Guarda says that’s easier said than done.

“Most patients don’t seek diagnosis and treatment on their own,” she says. “Ambivalence toward treatment and denial of having the illness also are telltale signs there’s a problem.”?

Did You Know?

  • People who have eating disorders think about food and weight 70 to 90 percent of their days.
  • One in five women suffers from an eating disorder.
  • Fifteen percent of young women in the United States who are not diagnosed with an eating disorder have substantially disordered eating behaviors and attitudes.

For more information about the diagnosis and treatment of eating disorders, visit For appointments and consultations, call 877-546-1872.