Physical Effects of Anorexia
What is Anorexia?
Anorexia nervosa is an eating disorder characterized most notably by weight loss and nutrient deficiency. Those with anorexia have difficulty maintaining an appropriate weight for their size and shape. They may restrict their calorie intake, exercise compulsively, use laxatives, and/or purge in order to keep their weight low. Anorexia affects people of all genders, ages, or any other demographic categorizations. Anorexia cannot be diagnosed by simply looking at a person, because people can suffer from anorexia without looking like the stereotypical thin image. Those who live in larger bodies can be underweight and suffer from anorexia that is equally serious and severe.
According to the DSM-5, the following criteria must be met for an individual to be diagnosed with anorexia (please note that if all of the following are not met, an individual may still have a serious eating disorder that requires treatment):
1. Restriction of energy intake relative to requirements for the person’s specific body leading to a significantly low body weight in context to the person’s age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
Warning Signs and Symptoms
Warning signs of anorexia may include:
- Dramatic weight loss
- Obsession with weight, food, calories, fat, and/or dieting
- Feeling “fat” despite weight loss
- Denial of hunger, lack of appetite
- Refusal to eat in public and avoidance of situations involving food
- Excessive exercise in an attempt to burn calories
- Gastrointestinal problems
- Loss of menstruation
- Body dysmorphia
Physical Effects of Anorexia
Individuals affected by anorexia have a severely distorted body image and an obsession with thinness that results in a conscious refusal to maintain an appropriate body weight. When an individual’s body is consistently starved, a myriad of health problems occur due to malnutrition, including effects on the person’s skin, respiratory system, and cardiovascular system. These effects vary depending on the severity of the individual’s eating disorder, but the severity increases with the amount of time the disordered behaviors are present. If treated promptly and safely, some, but not all, of these effects may be reversible. However, without professional treatment some effects may be fatal.
With weight loss, those with anorexia experience nutritional deprivation, resulting in physical changes in their hair, skin and nails. As starvation occurs, blood flow slows, resulting in intolerance to cold temperatures and a bluish tint in the tips of fingers and ears (Brown & Mehler, 2017). In an effort to retain body heat, the body beings to produce lanugo hair, which is fine hair that grows excessively on the upper lip, chin, arms, and spine. In contrast, scalp hair begins to thin or fall out due to a lack of adequate nutrients needed for it to properly grow.
Once individuals begin to restrict food to a point where their body weight is 15-20% below ideal, gastroparesis, the delayed emptying of the stomach, occurs. The small amount of food individuals eat passes slowly through the digestive system, causing bloating and upper stomach pain, along with constipation and infrequent bowel movements. This is due to the hypofunctioning of the colon following starvation, where food is not promptly processed and digested (Brown & Mehler, 2017).
Endocrine System Effects
Food restriction and excessive exercise enacted during anorexia leads to the depletion of glycogen (a form of energy storage), resulting in abnormal glucose metabolism and hypoglycemia (very low levels of blood sugar) (Mayo Clinic, 2018). Hypoglycemia can cause headaches, slow thinking, mood changes, seizures, and poor balance (Falck, 2018). Severe hypoglycemia may even lead to death, as it “indicates liver failure and a depletion of substrate to maintain safe blood glucose levels” (Brown & Mehler, 2017).
Sex hormones are also affected in all genders of individuals with anorexia. Typically, people will have low levels of estrogen and testosterone, which may affect potency and fertility. Women experiencing anorexia frequently stop menstruating, thus often resulting in a failure to ovulate. However, it is possible that a woman continues to ovulate without monthly menstruation, which may cause to unplanned pregnancy or pregnancy that goes unnoticed. If unnoticed, this may lead to pregnancy complications.
Nervous System Effects
In addition to complications anorexia places on the endocrine system, it also may have significant effects on the brain. A study conducted by Roberto and colleagues in 2010 noted that underweight individuals have significant deficits in brain gray matter volume.. Recent studies have also demonstrated that “Anorexia nervosa is associated with variable, but usually significant, brain atrophy” and that “severe cases may appear, on an MRI, to be indistinguishable from the brain of a person with Alzheimer’s disease” (Brown & Mehler, 2017). This lowered gray matter along with atrophy may lead individuals to slower functioning, memory loss, seizures, and other difficulties.
These negative effects of anorexia on the brain also have negative effects on individuals’ day-to-day functioning. Often, people struggling with anorexia place a high degree of importance on school or work. However, the physical effects of anorexia often result in underperformance in classroom and workplace settings. Due to starvation’s effect on the brain, people often find themselves unable to concentrate, reason appropriately, or process efficiently. While anorexia’s effects on the brain are severe, they are reversible. Studies have shown that these brain deficits will no longer be present after weight restoration and long-term recovery (Roberto et al., 2010).
Skeletal System Effects
Due to a lack of nutrients and calcium, individuals commonly have impaired bone structure and a reduction in medically expected bone density and strength. Studies show that 85% of women and 26-36% of men with anorexia have either osteoporosis (loss of bone density) or osteopenia (loss of bone calcium), and are at a significant risk of bone fractures (Brown & Mehler, 2017). It is advised that individuals struggling with severe anorexia avoid strenuous exercise or challenging activities as they are at an increased risk for bone-related injuries.
These low levels of bone density may be due to the fact that the body decreases energy expenditure during times of starvation, thus decreasing the energy needed to maintain bone mass. With an inability to retain bone integrity, bones become more fragile. One study notes that another potential cause of low bone density may be the reduction in estrogen in women and testosterone in men (Brown & Mehler, 2017).
The most common physical effect of anorexia is bradycardia, a slower than normal heart rate. Where a typical adult’s heart beats between 60-100 times per minute, those with anorexia are unable to reach 60 bpm. With this drop in heartrate and blood pressure, the heart becomes weaker and can shrink in size (Dying to be Thin, 2018). This weakening has been seen to result in a lack of oxygen to the brain and other organs causing syncope, dizziness, fatigue, shortness of breath, chest pain, and confusion (Mayo, 2018). These symptoms can become serious or even fatal should an individual have a dangerous fainting spell or be unable to catch their breath.
As previously stated, when the heartbeat is abnormally slow, the heart loses muscle mass, and the walls thin and become weaker. This can lead to congestive heart failure, which is the main cause of death in patients with anorexia and has been reported both during starvation and the refeeding process (Schoken et al., 1989). Congestive heart failure occurs when the heart cannot pump blood throughout the body effectively. This causes a weakening of the heart, which results in blood staying in the heart ventricle, as opposed to being pushed out and circulating through the body (Mayo 2017). With this accumulation of blood in the heart and the inability for the heart to pump at the necessary rate, sudden death can occur, which is frequently seen in people suffering from severe, lifelong anorexia.
With any eating disorder, it is recommended that individuals immediately seek professional treatment. This process may involve hospitalization or inpatient treatment depending on the severity of the illness. Typically, individuals can expect to meet with a doctor, therapist, and dietitian during the course of their recovery. Individuals will work through disordered eating and negative thought patterns to regain weight and find a new stability in life. Through recovery, individuals are able to reverse some, if not all, of the negative effects anorexia has on the body. The sooner an individual receives treatment, the easier it will be for them to fully recover from an eating disorder.
Recovery is Possible
Eating disorders don’t have to be permanent. With the proper treatment, full recovery from anorexia is possible. If you or a loved one are struggling, reach out to The Emily Program at 1-888-364-5977.
Brown, C., & Mehler, P.S. (2017). Medical Complications of Anorexia Nervosa and Bulimia Nervosa. Journal of Eating Disorders. doi:10.1093/oxfordhb/9780190620998.013.29
Falck, S. (2018, June 11). The Effects of Low Blood Sugar on Your Body. Retrieved from https://www.healthline.com/health/low-blood-sugar-effects-on-body#1
Holloway, D., Schocken, D., & Powers, P. (1989). Weight Loss and the Heart: Effects of Anorexia Nervosa and Starvation. Jama Internal Medicine. doi:1989.00390040085017
Roberto, C. A., Mayer, L. E., Brickman, A. M., Barnes, A., Muraskin, J., Yeung, L., Walsh, B. T. (2010). Brain tissue volume changes following weight gain in adults with anorexia nervosa. International Journal of Eating Disorders,44(5), 406-411. doi:10.1002/eat.20840
Anorexia nervosa. (2018, February 20). Retrieved from https://www.mayoclinic.org/diseases-conditions/anorexia/symptoms-causes/syc-20353591
Bradycardia. (2017, August 23). Retrieved from https://www.mayoclinic.org/diseases-conditions/bradycardia/symptoms-causes/syc-20355474
Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. (American Psychiatric Association, 2013).
Dying to Be Thin: The Long Term Health Risks of Anorexia. (2018, May 07). Retrieved from http://centerfordiscovery.com/blog/dying-thin-long-term-health-risks-anorexia/
Hypoglycemia. (2018, February 16). Retrieved from https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685
Warning Signs and Symptoms. (2017, February 26). Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia/warning-signs-symptoms