By Dr. Kevin Wang
Bulimia
Before beginning this week's topic, I'd like to remind everyone of a survey I'm conducting. The survey is for a research project in my program to increase awareness of the LGBT community in the medical community, and asks what you would like your primary care physician to know about our community. (For more information about the survey see "Ask Dr. Wang: Looking for research subjects" online at www.pridesource.com)
Please e-mail me at [email protected] and I'll send out the materials. I'd like to thank those of you who have already responded. Your help is much appreciated. Now on to this month's column!
To rehash a bit of what we've been talking about, last month's article discussed the dangers of anorexia. We're bombarded by messages, advertisements, Hollywood glitz and glamour to let us know what they consider beautiful and attractive. With these influences, some people look towards anorexia (see "Looking good for you" online at www.pridesource.com) and this week's topic, bulimia, to try to fit that image.
Bulimia isn't an idea that just randomly pops into one's head. You can find all sorts of information on the web on, "better techniques for binging and purging" as well as support forums! To be diagnosed with bulimia nervosa one must meet the following criteria: 1) Episodes of binge eating with a sense of loss of control, 2) Binge eating is followed by purging behavior (self-induced vomiting, laxative use) or nonpurging type (fasting or strict diets), 3) Binges and the resulting purging behavior must occur a minimum of two times per week for at least three months and 4) Dissatisfaction with body shape and weight.
Even with the excessive purging behavior after a binge eating episode, people who are diagnosed with bulimia usually have a normal weight, or may even be slightly overweight. So when a patient comes in with any other problems, it's very difficult to make a diagnosis just based on weight compared with height. In fact, even if I were to ask my patient directly about body image issues and any problems with weight, he or she might completely deny any problems. However, these patients usually have an uncontrollable behavior of attempts to control weight by purging after binging. These patients may even use other substances (drugs).
The physical signs that pop up in bulimia patients are similar to the ones seen in patients with anorexia. In addition, patients with bulimia also have something called parotid gland hypertrophy, an enlargement of the salivary glands, from the vomiting. The enamel of their teeth may be eroded from constant vomiting and they may have scratches along the back of their hands, made by their teeth when they stick their fingers down their throats to force vomiting.
As with anorexia, the cycle of binge eating and purging can result in many medical complications similar to those of anorexia. Some examples include osteopenia/osteoporosis (weakening of the bone due to low calcium), heart problems (rhythm issues), gastrointestinal issues including slowed movement of bowels, electrolyte imbalances and some endocrine problems.
I think I'm going to end the column here for this month. In next month's column we'll talk about treatment of eating disorders and what we can do to help out any family members or friends who may be suffering from anorexia or bulimia. As always, please see your primary care physician for any of your health concerns and to discuss ways to improve your health. And remember, I'm available for any questions you might have – just e-mail me at the address listed below. I hope this column finds all of you in good health and spirits. See you next month!
