“Oh, these carbs are going to be my death sentence,” my friend groaned when she saw the plate of garlic bread in front of us… I nodded in agreement. But at the same time, I also thought: So many of my conversations with friends revolve around someone going vegan, someone else starting a new diet, or a third friend “just can’t eat dessert without feeling guilty.” None of these women would describe themselves as having an eating disorder, but the signs are starting to show.
In our world, eating disorders are mostly limited to anorexia nervosa (AN), which causes an obsession with weight and food, and bulimia nervosa (BN), which is characterized by binge eating and subsequent vomiting to avoid gaining weight. But between these two serious disorders lies another that may be too early to require medical intervention, but is certainly a cause for concern. Call it a “silent eating disorder,” if you will.
We are dealing with a “half” disorder that is much more common than is reported. It comes to the fore when we count calories all day, when we feel guilty when we eat a slice of pizza, or when we compulsively look at the scales. And when our relationship with food is characterized by fear.
Social media only reinforces these feelings. According to a study in Science directlysocial media use is strongly linked to eating disorders in adolescent and young adult women, in part because it encourages confrontation with others. So even if you initially feel good about yourself, a “wellness influencer” can convince you that your breakfast isn’t good. Or a friend’s photos at the beach can make you feel like you’re not good enough about your own body (and the chocolate cake you just ate).
And I get it! My own feed is full of “before and after” photos, slimming pills, and weight-loss sweets. And it doesn’t help that many of these diet and body trends on Instagram aren’t even created by recognized health experts. It’s a toxic trap that can damage our self-esteem and our connection to food.
If you don’t recognize what’s going on – and stop the negative behavior pattern – the situation can get serious very quickly. This “silent eating disorder” can quickly develop into an eating disorder, a serious mental illness that can lead to health problems.
“Eating disorders prevalent in India include AN, BN and binge eating disorder (BED) – of which anorexia is the most common,” informs Dr Samir Parikh, Director of Mental Health and Behavioural Sciences at Fortis Hospital, Delhi. Differentiating between these three disorders, he clarifies that AN is typically associated with very low body weight, coupled with a fear of gaining fat and taking extreme measures to control it; BN involves binge eating, usually followed by vomiting; and BED involves episodes of binge eating to the point of uncomfortable fullness. Dr Parikh says, “Both BN and BED can cause people to feel guilt, shame and disgust towards their bodies and eating habits.”
The public perception of eating disorders in India is vague – one might think they are rare across the country. But Dr Sanjay Chugh, a senior psychiatrist with decades of experience in treating eating disorders, suggests otherwise. “Eating disorders are as prevalent in major cities in India as in any other part of the world – especially in the Western world,” he says, presenting compelling statistics. “The lifetime prevalence of AN is 0.6%, BED 2.8% and BN 1.0% – yet in India, the estimated lifetime prevalence of all eating disorders is 1.01%, and those of AN, BN and BED are 0.21%, 0.81% and 2.22% respectively.”
Our perception of eating disorders is largely shaped by our exposure to pop culture and social media and is one of extreme thinness. This falsely leads us to believe we can “know” when someone is sick, but the reality is that someone suffering from an eating disorder may not share their suffering. “The biggest challenge in treating a person suffering from an eating disorder is that they deny there is a problem. As a result, many people tend to abandon treatment,” says Dr. Chugh, adding worryingly, “They don’t understand that their negligence can have serious consequences.”
When only a certain body type is admired, one quickly feels insecure, explains Dr. Chugh: “When your obsession with your appearance, diet and exercise exceeds rational limits and begins to interfere with your personal and social functioning, then we are definitely dealing with the development of an eating disorder.”
Khushi Jain suffered similar symptoms at age 19. Now 22, she describes her struggle with AN. “It started gradually, as I developed an unhealthy relationship with food and body image.” She skipped meals to maintain a certain weight, believing that only by being thin would she be successful in her modeling career. Her symptoms included severe restriction of food intake, excessive exercise, and a great fear of gaining weight.
As we talk, she recalls counting calories and monitoring her weight. When asked what triggered her eating disorder, she cites “the pressure to conform to society’s beauty ideals, the high level of competition in the modeling industry, body shaming incidents and personal insecurities.”
Jain also blames social media, as she was exposed to images and messages that glorified thinness and promoted unrealistic body ideals. The repeated exposure to idealized body images and the pressure to compare herself to others created a toxic environment that exacerbated her insecurities. Dr. Parikh adds, “Women are viewed as more vulnerable; constant exposure to information that promotes certain body types or ‘acceptable’ body weight can make them more susceptible to developing an eating disorder.”
As her physical and mental health rapidly deteriorated, she finally realized she needed professional help. “I felt exhausted, had frequent dizzy spells, and my hair started falling out. I was emotionally drained and caught in a vicious cycle of self-destructive thoughts.” The real breakthrough came when she was referred to a specialist eating disorder clinic, where therapists, nutritionists, and psychiatrists offered her comprehensive care.
She underwent various forms of therapy, including cognitive behavioral therapy (CBT), which helped her clear her distorted thoughts about food, body image and self-esteem. “The nutritional counseling was instrumental in helping me develop a healthier relationship with food,” she adds. Jain has since recovered and prioritizes her overall well-being, self-compassion and mental health above all else.
Next, I spoke to Kabir Mehra (a pseudonym he uses to protect his privacy). His case sheds light on the fact that eating disorders encompass a wide range of behaviors and are not limited to people who seem reluctant to eat in social situations. Kabir, for example, would participate in meals but would vomit afterward. A gastroenterologist recognized the complexity of his condition and referred him to a specialized treatment and care center.
The 25-year-old has suffered from binge eating and vomiting since he was 21. He consulted several doctors to treat his gastrointestinal problems and other medical issues, but despite their interventions, no significant changes occurred. He was therefore referred to a psychologist for further evaluation. “I have always been someone who internalizes his problems. I was bullied at school and there was a tense atmosphere at home due to certain family disputes that prevented me from sharing my experiences with an adult,” says the 25-year-old. Bazaar India.
He fell back into the cycle of calorie counting when he found comfort in food. “Initially, after a few binges, I would vomit because I felt guilty, and over time it became an unavoidable habit.” During binge eating, Mehra would be in a frenzy – he would start his day vomiting and then have multiple binge eating episodes. “The goal for someone with BED is to make sure they expend more calories than they take in, so a pattern is established: you eat a lot and indulge in vomiting, take laxatives and diuretics, or have binge eating episodes where you keep eating even when you are completely full,” explains Dr. Chugh.
Fortunately, Mehra underwent therapy and medical treatment in time to help him cope with his experiences. Medical professionals helped him develop his coping skills, which subsequently developed a healthy mechanism for him to deal with his emotional experiences.
The goal of this article is not to make anyone aware of their calorie counting or eating habits, but rather to raise enough awareness about the “silent eating disorder” so that we can keep ourselves under control. My time spent with medical professionals and ED survivors is proof enough that there is no single symptom that can determine the prognosis of ED, but being aware of it and seeking help can make a significant difference.
Photo credit: Illustrations by Sumedha Abhyankar
Image credit: Pexels
This article first appeared in the August print issue of Harper’s Bazaar India.
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