This ‘halfway’ eating disorder may be more serious than you realise

Oh, these carbs are gonna be the death of me,” groaned my friend when she saw the platter of garlic bread that was in front of us...I nodded in agreement. But at the same time, I also thought: so many of my conversations with friends tend to be about how someone has gone vegan, someone else has started a new diet, or a third friend “simply can’t eat dessert without feeling guilty.” None of these women would identify themselves as suffering from an eating disorder, but the signs are slowly showing.

In our world, eating disorders are mostly limited to Anorexia Nervosa (AN), which causes an obsession with weight and food, and Bulimia Nervosa (BN), marked by bingeing followed by throwing up to avoid gaining weight. But between these two serious disorders lies another one that might still be too nascent to demand medical intervention, but is certainly a cause for concern. Call it a ‘Quiet Eating Disorder’, if you will.

What we are looking at is a ‘halfway’ disorder, which is a lot more common than reported. It surfaces when we spend our days counting calories, or feeling guilty when we eat a slice of pizza, or when we obsessively check the weighing scale. And when our relationship with food is laced with anxiety. 

Social media only amplifies these feelings. According to a study in Science Direct, the use of social media is strongly linked to disordered eating among adolescent and young adult women, in part because it promotes engagement in social comparison. So even if you started off feeling comfortable in your skin, a ‘wellness influencer’ might convince you that your breakfast is no good. Or a friend’s photos at the beach might make you feel inadequate about your own body (and that chocolate cake you just ate).

And I understand! My own feed is plagued with ‘before and after’ photos, skinny pills, and weight-loss candies. And it doesn’t help that many of these diet-and-body-related trends on Instagram aren’t even made by accredited health professionals. This is a toxic trap that can hurt our self-esteem and association with food.

If you don’t realise what’s going on—and end the negative pattern—things can get serious very quickly. This ‘Quiet Eating Disorder’ can escalate quickly to an eating disorder, which is a serious mental health condition that can lead to health-related challenges.

“The prominent EDs in India include AN, BN, and Binge Eating Disorder (BED)—out of which anorexia is the most common,” informs Dr Samir Parikh, who is the Director of Mental Health and Behavioural Sciences at Fortis Hospital, Delhi. Differentiating between these three disorders, he clarifies that AN typically involves having a very low body weight, coupled with the fear of gaining fat and employing extreme measures to control it; BN involves bingeing, which is commonly followed by purging; and BED, on the other hand, involves episodes of bingeing on food until uncomfortably full. Dr Parikh says, “Both BN and BED can involve people experiencing guilt, shame, and disgust with their bodies and eating patterns.”

The public perception of EDs in India is vague—one would think that they are uncommon across the country. But Dr Sanjay Chugh, who is a senior consultant psychiatrist with decades of experience in treating eating disorders, suggests otherwise. “EDs in the metropolitan cities of India are as prevalent as in any other part of the world—especially the western world,” he says, presenting compelling statistics. “The lifetime prevalence rate of AN is 0.6 per cent, BED is 2.8 per cent, and BN is 1.0 per cent—but in India, estimated lifetime prevalence of any eating disorder is 1.01 per cent, and those of AN, BN, and BED are 0.21 per cent, 0.81 per cent, and 2.22 per cent respectively.”

Largely shaped by our exposure to popular culture and social media, our perception of EDs is that of extreme thinness. This erroneously makes us think that we’d be able to ‘identify’ if someone was sick, but the reality is that someone who is suffering from an eating disorder may not share their misery.“The biggest challenge in the treatment of a person who is affected by an eating disorder is them denying that a problem exists, and as a result, a lot of people tend to drop out of treatment,” says Dr Chugh, adding worryingly that, “what they fail to understand is that their negligence can have severe consequences.”

When only a specific body type is admired, it is easy to feel insecure, Dr Chugh explains, “When your obsession with how you look, eat, and exercise crosses a rational limit and starts affecting your personal and social functioning, then we are definitely looking at the development of an eating disorder.” 

Khushi Jain was plagued by similar symptoms when she was 19. Now 22, she describes her struggle with AN. “It began gradually, as I developed an unhealthy relationship with food and my body image.” She began skipping meals to maintain a certain weight believing that being thin was the only way to flourish in her modelling career. Her symptoms included severe restriction of consumption of food, excessive exercise, and an intense fear of gaining weight. 

As we talk, she recollects counting calories and monitoring her weight. On being asked what triggered her eating disorder, she blames “the pressure to conform to society’s beauty standards, the highly competitive nature of the modelling industry, body-shaming incidents, and personal insecurities.” 

Jain also holds the social media responsible, as she was exposed to images and messages that glorified thinness and promoted unrealistic body ideals. Repeated exposure to idealised body images and the pressure to compare herself with others created a toxic environment that fuelled her insecurities. Dr Parikh adds, “Women are seen to be more vulnerable; continual exposure to information that propagates specific body types or an ‘acceptable’ body weight can make one more susceptible to developing an eating disorder.”

Eventually, she realised that she required professional intervention, when her physical and mental health began to deteriorate rapidly. “I felt fatigued, experienced frequent dizziness spells, and my hair started falling out. I was emotionally drained and trapped in a cycle of self-destructive thoughts.” The real breakthrough came when she was referred to a specialised eating disorder clinic where therapists, dieticians, and psychiatrists provided comprehensive care.

She underwent various forms of therapy, including cognitive behavioural therapy (CBT) that helped clear the distorted thoughts she had about food, body image, and self worth. “Nutritional counselling played a crucial role in helping me establish a healthier relationship with food,” she adds.  Jain has now recovered and prioritises her overall well-being, self-compassion, and mental health, above all else.

I next spoke with Kabir Mehra (a pseudonym used to protect his privacy). His case sheds light on the fact that eating disorders encompass a wide range of behaviours and are not confined to those who might appear reluctant to eat in social settings. Kabir, for instance, would participate in meals but would then engage in purging afterward. Recognising the complexity of his condition, a gastroenterologist referred him for specialised intervention and support.

Now 25, he experienced multiple episodes of bingeing and purging ever since he was 21. He had been seeking help from multiple doctors for issues pertaining to his gastric and medical functioning, but despite their interventions, there were no significant changes. Consequently, he was referred to a psychologist for further evaluation. “I have always been someone who internalises their problems. I was bullied back in school, and it was a tense environment at home due to certain familial disputes that prevented me from sharing my experience with any adult,” the 25-year-old tells Bazaar India. 

He fell back into the vicious cycle of counting calories when he found comfort in eating food. “Initially, after bingeing a few times, I would purge as I would be overcome with guilt, and over time, it became an unavoidable habit.” During binges, Mehra would be in a frenzy—he would start his day by purging, and would binge multiple times thereafter.“The aim for someone with BED is to ensure that the calories they spend are more than what they consume. Hence, a pattern is established: you eat a lot and indulge in purging behaviours, take laxatives and diuretics, or have binge-eating episodes where you continue to eat even after you’re completely full,” explains Dr Chugh.

Thankfully, Mehra underwent timely therapy and medical treatment, which helped him cope with his experiences. Medical professionals helped him develop his coping skills, which consequently cultivated a healthy mechanism for him to manage his emotional experiences.

The aim of this article is not to make someone conscious about their calorie tracking or eating habits, but instead making enough noise around the ‘Quiet Eating Disorder’ so that we are able to keep ourselves in check. My time spent speaking with medical professionals and ED survivors is proof enough that there isn’t any single symptom that can determine the prognosis of an ED but being aware and seeking help can make a significant difference.

Image credits: Illustrations by Sumedha Abhyankar

Lead image credit: Pexels 

This article first appeared in Harper's Bazaar India, August print issue. 

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