Extreme dieting or slow suicide? Why eating disorders kill more than they cure

Anorexia nervosa remains one of the deadliest psychiatric disorders, yet public awareness and early intervention remain alarmingly low. From the psychological triggers of perfectionism and low self-esteem to the physiological impacts of genetic predisposition and hormonal imbalances, anorexia is a complex condition that demands urgent attention.

Recently, in a tragic incident, a 19-year-old woman from Meruvambayi in Kerala’s Kannur lost her life after months of extreme “water fasting,” a regimen she adopted based on online recommendations. Surviving almost entirely on water for nearly a year, her death was attributed to complications arising from anorexia nervosa, a severe eating disorder characterised by an intense fear of gaining weight and distorted body image.

In an exclusive interview with Dr. Shambhavi Jaiman, Consultant Psychiatrist at Fortis Memorial Research Institute (Gurugram), she discusses the psychological and physiological factors behind the disorder, the dangers of unverified weight-loss trends, and the urgent need for medical and societal interventions.

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Psychological and physiological factors

Anorexia nervosa is influenced by a complex interplay of psychological and physiological factors. Psychological triggers include perfectionism, obsessive-compulsive traits, low self-esteem and an intense need for control. Physically, genetic predisposition, imbalances in neurotransmitters like serotonin and dopamine and hormonal dysregulation affecting appetite and metabolism play significant roles.

Mortality rate comparison

Anorexia nervosa has the highest mortality rate among psychiatric disorders, estimated at 5-10%. Deaths often result from severe medical complications such as cardiac arrhythmias, organ failure, or suicide. The lethal combination of extreme malnutrition and psychological distress makes it a life-threatening condition.

Risks of unverified weight loss advice

Following extreme dieting or unauthorised weight-loss methods can lead to severe health risks, including malnutrition, electrolyte imbalances, heart complications, gastrointestinal damage and psychological issues like anxiety and depression. Alarmingly, these practices can also increase the risk of developing eating disorders.

Identifying credible vs. non-credible weight loss sources

Credible sources for weight loss advice include government health agencies like the WHO and CDC, certified dietitians, and peer-reviewed studies. On the other hand, non-credible sources often raise red flags with miracle claims, lack of scientific evidence, and endorsements from influencers without medical expertise.

Role of healthcare professionals

A multidisciplinary team of psychiatrists, physicians, gynecologists, dietitians, and therapists plays a vital role in the early detection, diagnosis, and treatment of anorexia nervosa. They provide medical stabilisation, nutritional rehabilitation, cognitive-behavioral therapy and long-term monitoring to prevent relapse.

Supporting someone with eating disorder

Supporting a loved one with an eating disorder requires non-judgmental encouragement, urging them to seek professional help, and avoiding comments on weight or food choices. Educating yourself about eating disorders and offering consistent emotional support are crucial steps in their recovery journey.

Warning signs of an unhealthy relationship with food

Warning signs include drastic weight changes, obsessive calorie counting, meal avoidance, excessive exercise, distress over body image, and social withdrawal. Psychological indicators may include guilt after eating and an extreme fear of weight gain.

Societal-level interventions

Societal efforts to prevent eating disorders include promoting body diversity in media, regulating misleading diet industry claims, incorporating eating disorder education in schools, and reducing weight stigma in healthcare settings. These interventions can help curb disordered eating behaviors.

Social media trends and eating disorders

Social media trends promoting unrealistic body standards and excessive exercise often fuel body dissatisfaction, disordered eating, and eating disorders. The pressure to conform to curated online images can have devastating psychological effects.

Stigma and barriers to treatment

Misconceptions that anorexia is a choice or a vanity issue create stigma, discouraging individuals from seeking help. Additional barriers include fear of judgment, lack of awareness, limited access to specialized care, and delay in timely intervention.

Long-term recovery and relapse prevention

Long-term recovery from anorexia nervosa requires ongoing therapy, nutritional guidance, and relapse prevention strategies such as stress management and body acceptance. Support groups and regular follow-ups with healthcare professionals are essential for sustained progress.

Legal/policy actions against unregulated weight-loss content

Governments must enforce stricter regulations on misleading weight-loss claims, ban harmful dieting products, and require social media platforms to monitor and flag dangerous content related to disordered eating. These measures can help protect vulnerable individuals.