Suffering in silence: Eating disorders go unnoticed in India

Disturbed eating attitudes and behaviours affect about 25 to 40 pc of adolescent girls and around 20 pc of adolescent boys. (Photo: I Yunmai/Unsplash)

In the 2015 film Dil Dhadakne Do, Shefali Shah, who played Neelam, shocked audiences with her heart-breaking scene where, overwhelmed by her husband’s disrespect and the loneliness in her life, she stuffs a chocolate cake into her mouth. Neelam, like many who have suffered from binge eating disorder (BED), incidentally the most common type of eating disorder, was attempting to fill the empty feeling inside, and substitute her deteriorating mental health with an unhealthy attitude towards food.

In a country like India, where most of society is already predisposed to dismiss any mental health issues, the prevalence of eating disorders like anorexia nervosa and bulimia, is painfully ignored. In a report published in the Pune Mirror in August 2018, Chennai-based neuro-behavioural medicine expert Dr Udipi Gauthamadas, a specialist in treating eating disorders, was quoted as saying: “Various studies of Indian school children have shown that disturbed eating attitudes and behaviours affect about 25 to 40 pc of adolescent girls and around 20 pc of adolescent boys.”

Hardly any of these studies, however, have been done by an official body and there are no nationwide surveys on the issue, with a result that any credible, comprehensive and nationwide data categorised by gender and age is also missing. A 2018 study examining the prevalence of ED in the student population of Mysore, in the southern state of Karnataka, published in the Indian J Psychiatry journal, revealed that 26.06 pc of participants were prone to ED due to their abnormal eating attitudes.

Compared to the West, where research is far more extensive, experts say the woefully inadequate information available about eating disorders may be understandable in a country like India where perhaps issues like hunger and malnutrition seem to be more of a potent problem.

“It is a fact that not much research has been done on eating disorders in India because it is actually a very, very low priority. I would say it is non-existent, whatever little is there I would not attach any significance to it; I don’t think it’s reliable. There are other things which often far outweigh eating disorders in terms of prevalence, incidence, severity of symptoms,” Delhi-based psychiatrist Dr Sanjay Chugh tells Media India Group.

The leading culprit

Yet, the societal impulse to turn a blind eye to those with EDs mean that many may be suffering in silence instead.

“While on one hand there is an increasing recognition of eating disorders in the country, there is also a persisting belief that this illness is alien to India. This prevents many sufferers from seeking professional help,” added Dr Gauthamadas.

Ria Sharma’s (*first name changed) first started purging habitually when she entered high school at the age of 14 years. The stress of moving to a new school, compounded with long-term issues at home, had caused her to deal with her anxiety by binge-eating and then forcing herself to vomit. Although Sharma knew she was exhibiting signs of bulimia and anorexia, she was reluctant to seek help for fear that her peers would judge her.

“In the beginning I passed it off as food poisoning a couple of times, or just being exhausted, which worked for a while. Although my family eventually kind of realised what was happening, there was this idea of ‘So what? Everyone has mental health issues, or everyone gets stressed,’” Sharma tells Media India Group.

Due to the the lack of awareness around the causes of ED, Sharma’s disorder was initially passed off as just a “phase” or something that she was purposely doing to cause trouble. Eventually, her condition got so bad that the doctor declared her medically underweight and had to prescribe antibiotics to heal her damaged throat, telling her parents that if she continued like this, she could collapse or even face organ failure in the future.

“My parents kept looking for the reason why I was doing it, but I couldn’t tell them anything. The more people were telling me to ‘just eat something,’ the more I refused. It was just something I could control all by myself, so I did,” she says.

“Eating disorders have what is called a biopsychosocial aetiology, so it is essentially a combination of biological, psychological and social or external environmental factors. Genetic factors could predispose you to developing a spectrum of disorder, which could be depression, anxiety, substance and alcohol abuse, and eating disorders. Then, your personality type – there is an interplay with genetics, specifically for an eating disorder: environmental factors, the effect of the media, the overemphasis on looking beautiful or perfect, play a huge role in causing such factors to manifest themselves, so the cause of the problem is not a unifactorial thing, it is not a single factor which we can put our finger on,” explains Dr Chugh.

External factors like social media however, according to Dr Chugh, are often the key reason, and explains why EDs disproportionately affect females.

“Boys are affected, but the numbers are much lesser, and I also think there is poor recognition of eating disorders in males because of the over-emphasis on body image, often equated with a size zero, is not as much in the male as it is in the female,” he says, adding, “Eating disorders involve a faulty perception of your self-image. It’s like a mirror inside the brain, which shows a complete distortion in the image produced. I’ve seen girls who weigh 22 kgs, 28 kgs, who think they are actually 50, 55 kgs, that they are overweight, constantly trying to lose more and more weight.”

Sharma also agrees that the obsession with curating a perfect image, keeping up constantly with current trends, all create a toxic environment for the young people. Easily available Instagram filters, which give users a slimmer nose or fuller lips at the touch of a button and apps like Facetune make it easy for famous influencers to fool young audiences, making them strive for an unachievable ideal. Moreover, what many young people in particular do not realise is that EDs may be more dangerous than just feeling tired or hungry, causing permanent damage long-term.

“If a person is not eating properly or eating and throwing up constantly [for a prolonged period of time], it is going to lead to a lot of nutritional deficiencies, and with the passage of time, if the problem is chronic enough, or the intensity is very severe, every organ system in the body can get affected. And once you cross a certain threshold, then those changes become irreversible and it can become a fatal disorder to have,” says Dr Chugh.

Thus, with such deep-rooted causes, simply telling a person to “just eat” is completely ineffective. With new therapies being researched such as magnetic stimulation of the brain, in which the aim is to correct this mirror, or this distorted self-image that people have, and medical as well as non-medical treatment, the path to curing an ED is incomplete without proper counselling and psychotherapy, with a need to be extended to family members as well. More significantly, comprehensive research is required, across ages and socio-economic groups in India, in order to determine the best path of treatment for patients and remove the black cloud surrounding the idea of seeking help.

“Unfortunately, in our country, there is a social stigma attached to every psychological problem. I have been associated with psychiatry for more than four decades now, and the amount of stigma I saw at that time when I set out to become a psychiatrist, the number of misconceptions that abounded, it is much, much less now compared to those times. It is still a taboo for many people, and people are still wary of seeking help. But having said that, there is much more openness, much more acceptance about the fact that mental health problems are like any other medical problems that anyone can have, and it has nothing to do with shame, if you have a problem and you are seeking help,” he says.