It appears that almost everybody in America—regardless of race, ethnic background, class, or income—wants to be slim. When this desire becomes an overriding obsession with achieving bone thinness, it can translate into the distorted eating patterns of anorexia or bulimia. Estimates of the scope of these disorders necessarily involve guesswork, but some say that more than 35 percent of American women and over 75 percent of American teenage girls have at least flirted with either bulimia or anorexia. The incidence among males has not been adequately studied, but it appears to be rising.Anorexia nervosa is a condition of self-induced starvation tied in to a fear of becoming fat, poor body image, mental stress, and biochemical imbalances. A person loses a minimum of 20 percent of her or his body weight and still perceives her- or himself as fat. Every pound lost is seen as a victory and gives the person a feeling of greater control over his or her life.The effects of anorexia go far beyond a person’s looking emaciated. Starvation, whether involuntary or self-inflicted, affects mental function, so what the person can no longer think clearly. This does not help the person deal with or comprehend the seriousness of the physical problems that develop. These include fatigue, loss of menstruation, constipation, and hormonal changes, including increased levels of cortisol, the stress hormone. One of the many problems of this progressive condition is that when the person’s electrolyte balance, particularly in relation to sodium and potassium, becomes disturbed, it can lead to life-threatening complications, including kidney failure, heart rhythm abnormalities, and cardiac arrest.Bulimia nervosa, which describes a binge-purge cycle, is not as obvious a disorder as anorexia. Here a person eats uncontrollably and then purges the food in one of several ways. She or he may vomit; take laxatives, purgatives, diuretics, or enemas; sit in a sauna; or even cover her-or himself in plastic wrap. Whatever the method, the goal is the same: to avoid the consequence of eating too many calories. After a person takes several laxatives a day—and in rare instances as many as 100—over a period of time, the body loses its ability to eliminate on its own. Other serious medical consequences of bulimia include loss of tooth enamel and tooth decay, rupturing of the esophagus and stomach, throat muscle enlargement, dehydration, low blood sugar, and personality changes. As with anorexia, bulimia can result in severe chemical imbalances, leading to abnormal heart rhythms and even death.*60\233\8*

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