You can never be too rich or too thin
Mohinder Singh

What sort of a person gets the eating disorder, known as anorexia nervosa? Most of them are girls under 20, bright and energetic from well-to-do families. Good in studies and sports, the anorexic rises to competition and achieves. She is slender, usually attractive. But she worries too much about her figure. Is she getting fat? Wouldn’t she look better if she lost just a few more kilos? She is constantly dieting, becoming thinner and thinner. She talks about it all the time. She exercises hard. Active all day, she often skips meals.

Prior to 1970, anorexia nervosa was considered to be "a curiosity and a rarity". Since then, its incidence has risen in the USA and Europe to something like one in 200 among females of the 15-24 age group. By now, the phenomenon of eating disorders has assumed a global spread that includes the affluent east Asian countries of Japan, South Korea, Hong Kong, Singapore and several countries in South America, especially Argentina and Chile. It has spread to China, too, in contradiction to the traditional value the Chinese place on plumpness as a sign of health.

As late as the mid-80s, noted Indian epidemiologist Sridhar Sharma had found a very low prevalence of the disorder in India. Now, anorexia nervosa is a significant presence in the country. And then we have our unique traditions of religious fasting and protest fasting.

Although the prevalence of nervosa anorexia has increased worldwide in recent years, the numbers suffering is still not large in absolute numbers. But given the age and potential of the population which is afflicted, it represents a serious and often devastating affliction, with tragic implications for the young sufferer and her family.

Anorexics often grow in families in which there is an extraordinary emphasis on achievement, external appearance, and weight control. The mother-daughter bond in these families tends to be unusually intense, with the mother commonly seeing in her daughter access some compensation for her own disappointments in life. They are often compliant children who have a powerful need to "be good". Underneath a facade of good behaviour, they typically feel weak and unworthy. So when they encounter any serious stress such as a failure to live up to their academic expectations or rebuffs in personal relations, they try to salvage self-esteem through concentrating on the body, mostly in the shape of thinning it.

Anorexia often begins with a decision to diet, which seems innocuous enough. However, given the anorexic’s peculiar developmental vulnerabilities, dieting begins to yield a sense of control, coupled with the initial "high" of fasting. In a culture that values thinness, achieving a thin body represents a triumph. Again the anorexic derives certain satisfaction from increased attention from the family; the refusal of food always evokes a strong response from the near ones.

Once set in motion, anorexia nervosa has its own characteristic development as a disease. As dieting is transformed into fasting and finally into willful starvation, the anorexic typically withdraws from ordinary activities and relationships. She ruminates endlessly over her food intake and engages in highly ritualistic eating behaviour, such as cutting food into small bits. She starts monitoring meticulously her caloric intake. And she will typically intensify and already excessive exercise regime.

Once an anorexic has lost a significant amount of weight and the illness has progressed to a certain point, she will typically defend her lost weight by all means, such as disposing away food secretly, or hiding her emaciation under loose clothing. She not only deceives others, she deceives herself into thinking "all is well". Probably no disorder other than alcoholism is so invariably accompanied by denial.

By the time the anorexic comes to the attention of clinical professionals, the disorder has in most cases progressed considerably. In the early stages — inherently difficult to recognise — family members cling to the hope that the change that has come over their offspring is a "passing phase". And in a few cases it may turn out true; the developing anorexic is able to extricate herself from the downward course. But the same doesn’t happen in many other cases.

As the disorder advances, the anorexic starts experiencing faintness and fatigue. Menses stop and interest in sex declines. She can suffer from heart irregularities. Osteoporosis, the brittleness in bones, can set in. Over a range of studies, anorexia nervosa is known to have a fatal outcome in about 10 per cent of treated cases.

Despite the proliferation of treatment approaches in recent years, there is no universal agreement as to the optimal mode of intervention. In general, there is consensus that both the physical and psychological aspects of the disorder must be addressed through a combination of nutritional rehabilitation, weight restoration (patients tend to approach their ideal body weights much more efficiently in an in-patient setting) and psychotherapy. As anorexics commonly suffer from depression, the psychotherapy sessions can be usefully supplemented with anti-depressant drugs like prozac.

"You can never be too rich or too thin": the famous (and now notorious) dictum from Lady Diana. The thin body ideal is busily being marketed all around. Amazing why thinness in particular, and not some other body shape, has become the dominant body ideal, so intensely sought after, for women today. Our matrimonial ads, for instance, invariably ask for a "slim" bride.

With the globalisation of fashion, the norms of consumer culture have now a global impact. Well-known women’s magazines with their worldwide coverage glorify thin fashion models. Even cultures, like the African, where female plumpness was prized, are getting overwhelmed by this globalisation of fashion. The Euro-American body ideals of body image (currently a thin female body with narrow waist and hips) are penetrating various other countries and cultures, and in turn giving rise to eating disorders.

For anorexics, the fear of weight gain operates as the spectre of the ultimate catastrophe. Many make out, they would rather die than cross their magical figure of £ 90 or £100. The fear of fatness motivates them to fad diets and the punishing exercise regime so typical of anorexia nervosa. Many take to vegetarianism; meat becomes an object of particular avoidance, since animal fat is, in the mind of the anorexic, immediately and magically transformed into body fat.

Actually, a moderate degree of overweight (up to 15 per cent over the statistically normal weight for one’s height) poses no known health risks. And more so for women, whose weight accumulation is distributed subcutaneously, unlike men’s with the dangerous trunk weight. On top, for women the growth of fat tissue at puberty is critically connected with the emergence of the reproductive cycle. Yet the social bias against obese women is much greater than it is against men. In the prevailing global culture, there operates a strong prejudice against obese women.

Anorexics are particularly vulnerable to cultural messages about dieting, which offer the promise of taking control of one’s life through the alteration of body shape. For them dieting becomes the disease, with diet books a breeding ground for the same. And there is consistent evidence that dedicated dieting puts one at risk for an eating disorder.

There are male anorexics, too but they form a small minority. The politics of eating disorders primarily revolves around the politics of gender. The current epidemic of these conditions is a reflection of the ambiguities of female identity in a period of change and confusion. Perhaps as women are able to achieve real power in the world, and the size and shape of their bodies are no longer taken to be the true measure of their worth, eating disorders will sharply decline in incidence. There is even speculation that the crest of eating disorders in the western world has passed. And other countries, such as ours, should follow suit as women there make gains in empowerment.

Eat well

Diet should be regulated taking into account the desha, kala (season) and habit. Diet should be planned to include all six rasas (taste) i.e. sweet, saltish, acid, bitter, acrid and astringent. It should be balanced and the quantity should be according to one’s digestive capacity.

•  Fresh ginger with a small amount of salt should be taken 10 to 15 mintues before food.

• The food, specially hard substances, should be properly chewed.

• Wherever possible, intake of curd or butter milk should follow food.

• The food should be tasty, fresh and good in appearance.

• It should neither be very hot nor cold.

• Water should be avoided at least 15 minutes before food. The quantity of water after food should be small. Let it be drunk often.

• Heavy (guru) food should be taken in a limited quantity.

• Heavy food should not be taken at night. The proper time for night meals is two to three hours before going to bed. After night food, it is better to go for a short walk, of say a hundred steps.

• Heavy work or exercise should be avoided after food.

• After meals, heavy mental or physical work should be avoided. Some rest is advisable for proper digestion of food.

— R. K. Verma