The dangers of losing weight

Figure skating happiness: lose weight or get sick
ABC MagazineAuthor: gutta-honey, psychiatrist.

What is happiness for women? To be beautiful, desirable and forever young. To say, as in an advertisement: "I'm 50, and young men look after me with admiration, or my daughter and I are mistaken for sisters."

And what kind of happiness is there, when there is a lot there, and it sticks out here? And the advertisement seems to mock: are you as fit and shapely in your 15-20-25-30 as this successful woman in her 50s?

The unfortunate woman approaches the mirror and realizes that her figure is far from "glossy". This means that she is significantly removed from happiness. With a thick booty, they are not allowed into a convertible, and a small evening dress on a belly will look, at least, not sexy. At the same time, the question of what a woman considers a "fat booty" or a "belly" is a very extensible concept. It's not so much the standards of height and weight that play a role here, as the self-perception of one's body. If a woman is dissatisfied with herself in principle and has a reduced self-esteem, she will definitely find fat. That's where you want to feel, even in the perinephrine space, and it will be useless to convince her that fat should be located there normally.

TWO EXTREMES OF ONE WEIGHT LOSSHealthy self-criticism, in general, is useful.

If you don't like something, go on a low-calorie diet and go to the gym. The secret of losing weight is simple to tears: spend more energy than you consume, and develop muscles so as not to look like a deflated balloon. But that's where different dangers lie in wait for us.

The first danger: the desire to reduce calories consumed to almost a minimum: "The less I eat, the faster I will lose weight." If a diet of 1100 kcal is considered critically small and, according to the mind, it can be practiced only in short courses, then some ladies reach as much as 500 kcal, 200 kcal daily and, indeed, become "income earners". Moreover, their willpower can be envied. As they said: "I won't eat!", and they don't eat almost to the grave. This disorder – anorexia – is considered especially life-threatening.

The second danger: the desire to get rid of the eaten as quickly as possible.

These people are eating. They can eat constantly or break down to gluttony after some short time of abstinence. Moreover, "abstinence" can be just speculative. Yesterday I made a vow not to eat cakes, and the next day at a friend's tea party I ate almost half of the cake. What to do? Urgently two fingers in the mouth, so that it does not have time to suck. And to enhance the effect, there is also a laxative (suddenly tricky pieces of cake are already in the intestines), and a diuretic (so that what has been absorbed into the blood does not get into the adipose tissue). And for what got into the adipose tissue, there are "wonderful" pills – fat burners. This is how bulimic patients behave.

Now there is another disorder that is associated only with the fact that people with normal body weight use cleansing procedures (vomiting, diuretics, laxatives, fat burners), even if they eat normal and reduced amounts of food.

If anorexia is immediately visible by thinness, then these experimenters on themselves in search of happiness are not so noticeable. They skillfully hide not only from doctors, but also from their relatives, who often do not even suspect that their daughter (spouse, sister) maintains a "normal" weight in such an extravagant way.

BURN CALORIES WITH HEALTHOf course, bulimia is not as dangerous as anorexia (it is clear that starving yourself is like booking a place in a churchyard).

 But even here there are a lot of somatic problems:

• dehydration (dehydration due to excessive fluid excretion);
• anemia (reduced hemoglobin);
• electrolyte imbalance (excessive excretion of trace elements and minerals);
• reduced blood pressure;
• arrhythmia (heart rhythm disturbance due to potassium loss);
• reduction of myocardial contractile function;
• kidney damage (prolonged use of laxatives and diuretics can irreversibly damage the kidneys);
• intestinal dysfunction;
• stomach and esophageal ulcers
• weakness and fatigue;
• conjunctival hemorrhages (with repeated vomiting).

By the way, by these signs you can guess that the disorder is taking place. The patients themselves are extremely ashamed of their behavior and admit it not too willingly.

In addition to all this parade-alley, they have a number of concomitant mental disorders.  These are anxiety-depressive states, states of obsession, various addictions. Coupled with somatic problems, they excessively "decorate" the life of a person suffering from bulimia.

WILL WE BE TREATED?Bulimia patients are much more willing to go for treatment than anorexics.

The most important thing here is for the bulimic to admit that he has periods of gluttony and then "vomiting procedures". But it is extremely difficult for him to admit this, he considers it really shameful and disgusting and would be glad to get rid of it, but he can't. Well, if he confessed, you can offer him treatment, which consists of a combination of drug and psychotherapy.

Medications are a bulimic's dream, as they remove his main problem – appetite, which is difficult for him to cope with. Psychotherapy is also mandatory, because a person needs to be able to cope with their problems not only with the help of food manipulations. If he cannot do this, then the resumption of the disorder at the first stress is almost guaranteed.

It is necessary to be treated for the disorder for at least a year. Relapses account for about 20%, but it is quite difficult to check this. Some patients take up the old, but they don't tell the doctor. Having broken down, patients go into a deaf "unconsciousness", because they are ashamed again, and it seems to them that they will be hated for weakness.

How is bulimia treated? Antidepressants are the main and rather highly effective means.Serotonin reuptake inhibitors have proved to be the most successful in this regard.

The mechanism of their action is, apparently, that they remove anxiety and low mood, as well as help to control their impulses more easily. After all, it is these manifestations that mainly trigger the disorder. There is a leader in this group (these drugs are prescription, and therefore we cannot give their trade names here and further – ed.). This is the most popular and frequently prescribed drug. But the effect it gives only in large doses (but not excessive), and large doses are not all tolerated well in terms of side effects. I personally saw two "slimming women" with a good clinical mania, which they created for themselves while sitting on a drug of this group.

Tricyclic antidepressants have also shown a good effect on all symptoms of bulimia, but their side effects in patients with this disorder outweigh the potential benefits.

Serotonin and norepinephrine reuptake inhibitors. The situation here is also not simple. There is practically no data on the effect of third-party drugs. Another drug has shown itself positively in some resistant to other therapy cases. But another one for some reason caused some patients to develop convulsive seizures. The causes of seizures could not be established even with a detailed examination, so the appointment of this drug for bulimia is avoided.

Anticonvulsant drugs with the active substance topiramate, when taking which there is a decrease in appetite and weight. With these qualities, they attracted attention for the treatment of bulimia. In practice, they gave good results and a fairly low number of side effects. In terms of their effectiveness, they are not inferior to antidepressants. Considering that they are more expensive, and yet their side effects are heavier than, say, a serotonin reuptake inhibitor, topiramate, apparently, should just be kept in mind as an option if antidepressants are ineffective for some reason.

Antiemetic drugs with the active substance ondansetron, developed for the treatment of nausea and vomiting in cancer patients receiving chemotherapy or radiation therapy. Ondansetron prevents the release of serotonin from cells in the intestine, which in turn leads to excitation of the vagus nerve and vomiting. Hypersensitivity of the vagus nerve, according to one theory, often leads to the fact that vomiting in such patients occurs easily and actually becomes a reflex to the introduction of food into the stomach and intestines. I.e. the drug does not allow the vagus nerve to engage the vomiting center.

Naltrexone blocks endogenous opiate receptors and suppresses appetite, and also possibly prevents the urge to overeat and vomit again. According to one theory, after a person has eaten to the brim (as well as after vomiting with a complete cleansing of the stomach), he releases endogenous opiates (drugs). And the patient resorts to such a procedure again and again, because at the moment of saturation and cleansing of the stomach, he feels completely happy. The drug does not allow opiates to join their receptors and does not allow a sense of satisfaction to develop. Actually, there is no need for a person to overeat and cause vomiting, since there is no pleasure anymore. Everything looks very logical and beautiful, and even studies have confirmed the effectiveness of the drug, if not for its high toxicity to the liver.

Lithium turned out to be no better than a placebo (dummy). Moreover, its already decent toxicity increases significantly in conditions of dehydration of the body, which bulimics always have.

Atypical neuroleptics have performed well in relation to the treatment of anorexia, but there are few studies of their action in bulimia. The University of California Center for Research and Treatment of Eating Disorders in San Diego has shown that low doses of these drugs are effective in severe and resistant to other therapy cases of bulimia. Other researchers show that atypical neuroleptics can, on the contrary, enhance the phenomena of impulsive overeating due to their activating effect. However, the idea of using drugs of this group for this disorder is only an experimental idea, there is no data yet on how useful and safe such an application can be.

Based on Psychiatric times, May 2008 Vol. XXV №3

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30.09.2009