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First Aid Information: Eating Disorders.
Health Implications of Disordered Eating Habits

This article is to provide information on the effects of disordered eating habits on your health. It should not be used to diagnose an eating disorder, if you believe you may have an eating disorder, or you have disordered eating habits you should speak with your doctor.


Purging is usually done via one of three ways; by making yourself vomit, by abusing medications that affect waste removal (such as laxatives or diuretics), or by overexercising. All methods will be discussed here along with the health effects of the methods.

Inducing Vomiting

This prevents the uptake of food by getting rid of it out of your stomach. However, when you purge some food will always be left there so you will still absorb some nutrients, just not as much as you need in the majority of cases. Stomach acid is meant to stay in the stomach and can cause extensive damage to anything else it comes in contact with.

-Complications of inducing vomiting
Short Term:
  • Sore throat - This may be from you scratching the inside of your throat or from irritation to the lining caused by the stomach acid being in contact with the unprotected surfaces of your throat.
  • Purging up bright red blood can also signify damage to your throat as well as changes in your voice.
  • Pulled muscles - Purging causes excessive force to be placed on the muscles in the chest and abdominal cavities, which can cause you to pull those muscles. This can cause pain in your abdomen, between your ribs, or within your rib cage which you need to get checked out as you may not be able to differentiate from other types of chest pain
  • Ruptured muscles - The excessive forces places on the muscles in your chest and abdominal cavities can also cause muscles to rupture, or break completely. Especially the muscles at the base of your esophagus. This is a medical emergency that requires urgent surgery.
  • Dizziness - Purging causes imbalances in the fluids and electrolytes in your body. This can cause dizziness, especially if you start to become dehydrated. Purging can also cause a shift in the acid levels in your body with can cause dizziness in some cases.
  • Loss of Breath - You can’t breathe and purge at the same time so purging can cause you to lose your breath. You also lose acid which affects the pH of your blood. To resolve this your body needs to increase its Carbon Dioxide level. This reduces you breathing rate so you might feel a bit breathless after.
  • Mouth Ulcers; This can be caused when stomach acid comes in contact with the lining of your mouth.
  • Halitosis (Bad breath)
Long Term
  • Dental problems - Your teeth are in contact with acid more than they should be. This wears away their enamel causing damage and making it more likely that you will need fillings or other dental work done. It also means that they will often not look as good and will appear to be thinner than they should be (sometimes leading to the top of your tooth appearing almost see-through). These problems may be worsened if your diet is low in Calcium or Vitamin D4
  • Irregular Menstrual cycles - Constant changes in your nutrient levels, and lack of nutrition because of the vomiting and lack of consistency in your electrolyte levels can affect your sex hormones, resulting in irregular periods. Because of this it may mean that you can become infertile though this is usually reversible
  • Poor skin - eg, dry skin/ acne and brittle/ dull hair; Purging causes the body to loose essential vitamins, minerals and amino acids. Without these your skin & hair may be affected due to altering your of natural oil levels.
  • Swollen Glands - Purging alters the immune response to the area as there is constant damage as well as an increased amount of saliva secreted into your mouth, damaging the entrance to your gland which can cause swelling
  • Damage to the Walls of the Esophagus & Stomach; Pressure of purging means that this can cause splits or tears in the wall. This can be VERY serious and therefore if you have any chest or upper abdominal pain or are vomiting blood (which may appear as bright red blood or resemble coffee granules) you should go to your nearest A&E/ ER IMMEDIATELY. There could also be erosion of the walls due to the lack of protection against the acid which is continuously flowing over it causing swelling and pain/ irritation and also weakness.
  • Damage/ loss of function of the muscular ring around the top of your stomach; This is due to continual purging weakening the muscle coupled with acid erosion. This muscle closes off the stomach from the oesophagus so when it is damaged acid from the stomach will rise into your oesophagus causing ‘heartburn’. Taking antacid tablets or drinking milk may help with this.
  • Heart Problems; Constant alterations in the electrolytes within your bodily fluids/ blood affects the muscles of the heart. As a result these often weaken and so more muscle has to develop around your heart to compensate. This can dramatically affect the function of your heart causing pain and a lot of heart problems eventually leading up to failure. The reduction or increased levels of some electrolytes can also cause acute changes to how the heart reacts and so you might get some problems unexpectantly. Because of this, if you have any breathlessness and/or chest pains you should seek medical assistance ASAP.
  • Electrolyte Imbalances; Vomiting causes some electrolytes to leave your body. For normal function the levels of electrolytes should be at set ratios to each other and each at a set level. If this changes problems occur with the way how your body reacts to things and how effectively it works and can cause heart, bone, muscle, and nerve disorders amongst other things as well as causing you to become dehydrated.
  • Damaged Kidneys; The change in blood properties, unbalanced electrolytes and sudden alterations in blood pressure caused by inducing vomiting can lead to kidney problems over time which often cannot be repaired and will lead on to further problems. This is often damage only in very long term cases but may appear sooner
Laxative abuse is a very serious issue that can lead to your body becoming dependant on laxatives, and can cause severe long term damage, including damage that may be permanent.

There are a number of different types of Laxatives that work through different methods. They are an ineffective way of ‘purging’ food from your body as they work in your large intestines and most nutrients, apart from a few vitamins and minerals, are absorbed before this and therefore it DOES NOT affect their absorption.

Lubricant Laxatives (Mineral Oil)
  • These work by coating the lining of your large intestine and it’s contents allowing them to pass through more easily.
  • Vitamin deficiencies can develop as the contents of the bowel pass through quicker and so they are not there long enough for effective absorption. Along with this, the contents are coated in the laxative which makes absorption even harder. Over time, vitamin deficiencies can lead to growth/ fertility/ sight/ hearing/ immune system/ bone as well as developmental and brain/ nerve problems especially throughout childhood and youth. They are also known to cause a lack of energy and lethargy
Bulk Forming Laxatives (Unprocessed bran flakes)
  • Work via being in the bowel and absorbing a lot of water leading to the expansion of the contents and therefore stretching the intestine wall. When this becomes stretched sets stimulates the muscles within the wall to contract. This is much greater response than what would usually happen and so in the long term your gut will not be stimulated by normal faeces production (as they would not be big enough) and therefore you’d struggle to have a bowel movement without this and you’d need to take more and more for the effect to be as noticeable.
  • They can be used for both diarrhoea and constipation.
  • They pull a lot of water from your blood and body tissues into your intestines and so they can cause severe dehydration and are definitely NOT advised when dehydration may already be present. They can also remove some electrolytes from your body which can worsen the signs of dehydration as well as causing other problems such as problems with you heart, muscular pain, slowed reflexes, etc.
Osmotic Laxatives (Lactulose)
  • These actively pump water from your body cells into your intestines causing the contents of your bowel to expand and therefore lead to the muscles within your bowel wall to contract.
  • They act very similar to Bulk-forming Laxatives and cause the same problems.
Stimulant Laxatives (Senna/ Bisacodyl)
  • Chemicals that act at your gut wall to instruct it to contract. This often is in a segmented way rather than a way where the wave of compression passes down the bowel. Because of this often faeces get trapped in an area for a bit and the wall squeezed against them which causes a lot of pain and pressure can build up because of it causing damage.
  • These have the highest rate of dependency and they can cause a lot of problems.
  • Like all laxatives, they can very easily cause dehydration.
Signs that you need to seek help
- You take laxatives regularly for longer than a few days
- You take them when you’re not constipated
- You take them at a higher than recommended dose
- You feel they don’t have the same effect as they used to
- You can no longer pass a bowel movement without them
- You start getting painful cramps
- You have symptoms of dehydration

Dangers of abusing laxatives long term

  • Your intestines can no longer contract in a co-ordinated way without them and therefore you need them to pass a bowel movement. This may cause a lot of pain as he contractions will become very strong and not in any particular direction so you will get little relief.
  • The strength of the contractions can severely damage your guts by causing ulcers, haemorrhage, reduced contraction/ weakness, or even causing so much damage to their structure that they become torn which can lead to serious damage, infection and death.
  • Dehydration can become serious enough to initiate medical shock requiring hospital treatment. If this isn’t sought it may be life-threatening.
  • Electrolyte imbalances can occur such as low Potassium (hypokalaemia). This can cause problems with your heart and nerves so you should be vigilant for any signs of chest pain.
  • Irritable Bowel Syndrome (IBS); your bowels no longer cope with food in the normal way and so when you eat something it can cause severe pain, constipation/ diarrhoea, intestinal spasms, flatulence

Due to the nature of laxative abuse when you think about recovering you should always consult an appropriate medical professional first. They can devise an individual plan to help wean you off them healthily and therefore reduce the risks/ severity of any long-term damage

Diet Pills

  • There are many different types of these but in general they should not be used unless under the guidance of a doctor.
  • They are often either a stimulant (so increase the speed of your metabolism), appetite suppressant, a drug which reduces absorption of food indiscriminately (therefore you don’t absorb any vitamins/ minerals/ protein that you need causing deficiencies and they can damage the wall of the gut). Some are also marketed as this but are mild diuretics.
  • Many are not classed as medications and therefore have not gone under the stringent testing that medications have to and so they can cause a lot of damage if you are not careful.
  • A lot of them have no proof whether or not they work and in most cases they cause a lot more damage then the positive effect the may have on some obese people that need to take them.


  • A group of medications designed to allow your body to remove excess water.
  • Often used as a weight loss aid.
  • Don’t cause reduction in fat, they cause weight-loss only by getting rid of water such as water retention. Therefore, they do not truly aid diets and make no difference to your body’s fat
- Examples
o Furosemide
- Action
o They act on different parts of the kidney to decrease the amount of water that re-enters the blood and therefore causes it to leave the body through urination
o The part of the kidney they act on depends on the drug
- Interactions with other drugs
o Dependent on the specific Diuretic but commonly;
- Some anti-biotics (Aminoglycosides being a common group)
- Aspirin
- Lithium

-  Side effects

  • Dehydration
  • Thirstiness
  • Kidney Damage
  • Reduce Electrolytes
  • Low Potassium
  • Heart problems (of varying causes depending on the Diuretic)
  • Low BP
  • High heart rate
  • Vomiting and/or diarrhoea

These can cause a lot of problems with certain conditions, especially those affecting the circulation, heart and kidneys depending on the type of drug.


- Exercising excessively to a point where it is more than you need and can cause damage
- On it’s own this can cause;

  • Increased risk of injury as exercise is often taken past the point where it can cause damage
  • Fainting/ dizziness
  • Heat stroke
  • Exhaustion
  • Dehydration
If you experience these the best thing to do is stop what you’re doing and try to reduce the amount of exercise you do. If your problems are severe or you are worried you should see a doctor.
It becomes even more of a problem when coupled with restriction as the person in question isn’t receiving enough nutrients to allow them to do this exercise. In these cases it increases the risk of falling victim to the problems listed above and the exercise can also lead to an increased amount of stress on the heart and therefore cause damage to this.


- Purposely eating fewer calories than what is necessary to maintain weight when at a normal/ low weight
- Normal Daily Calorific Needs
o Adult Female
o Adult Male

- This can be anything from eating foods with lower calories/ less fat than you require but otherwise eating normally, through to skipping the odd meal, and then on to starving yourself
- Starving is classified as eating less that 1200kcals per day. This is less than the body needs to survive so it does cause a lot of health problems
- Problems associated with restriction

  • Fatigue; not taking in enough energy to function well
  • Poor hair/ skin; low vitamin and mineral intake altering the levels of oils you naturally secrete
  • Feeling achy
  • Unable to get comfortable
  • Low blood pressure/ orthostatic hypotension; your heart may not contract with the same pressure and the recoil of your artieries may not be as strong and therefore your blood pressure is worsened. This is seen more when you first stand up, especially out of a hot bath, as your blood will sink to your feet and must be correct. If you feel dizziness when this happens it is because it happens too slowly and the condition is called Orthostatic Hypotension.
  • Dizziness/ Fainting; your body cannot cope with your food/ energy intake being so low and so the only way for it to deal with it is to force you to stop whatever you are doing so it can give itself a break. To do this it causes you to faint.
  • Abdominal pains; due to contraction of the muscles within your stomach wall contracting against an empty stomach
  • Amenorrhoea
- The loss of 3+ consecutive menstrual periods
- Seen commonly in anorexics or people of very low weight/ BMI
- This can be caused for a number of reasons
  • Low BMI (less than 19)
  • Low percentage body fat (<10% in men & <20% in women)
  • Stress
  • Anxiety
  • Change in lifestyle
  • Hormonal/ Ovarian conditions
  • Polycystic Ovary Syndrome (PCOS); a condition causing weight gain, a deepened voice, excessive hair growth (including facial hair), infertility & is a condition commonly associated with long term Thyroid Gland problems
  • Excessive exercise
  • (Pregnancy)
- Your menstrual cycle is based around the percentage of body fat in your body. When this drops below a certain level your periods stop. If this happens it is a sign of you being very underweight or that your weight has dropped too quickly.When this happens your body isn’t able to cope with the stresses of pregnancy, and thus your periods stop.
ü It can also happen due to Anorexia/ when restricting because your body needs the energy it has for more important functions so shunts it away from reproductive activity to energy for your heart/lungs/brain to function as well as to allow you to move around
- Implications
- When you have it you are infertile. Often your fertility will return when your Menstrual cycles return to normal though the lack of your hormones cycling can cause reproductive damage and therefore there is the potential for long term reduction in your fertility
- As your hormones stop cycling it can be one of the contributing factors of Osteoporosis (when your bones become less dense and appear to have holes within them) which leads to someone easily breaking bones from just a small fall.
Decreased bone density; bones appear to have ‘pores’ within them and are not solid. This causes them to become weakened and therefore increases the risk of bony damage at the joints as well as increasing the incidence of fractures even from a minor injury
ü The main symptoms are pain, increased bending of the bones and fractures from just simple falls. If you are at all worried about this you need to get assessed by a doctor so that they can do the necessary blood tests and scans for this and start you on an effective treatment plan if necessary
The effects of Osteoporosis can be permanent, and even after resuming a normal diet the damage may not be able to be reversed. This can lead to serious issues later in life when bone density begins to naturally decrease.
- Causes
  • Amenorrhoea
  • Low Calcium
    - Calcium is needed in bones and is what gives them (along with the structure) their strength. With less Calcium, holes develop within the bones which reduces their strength.
    - Seen when the diet is low in Dairy products or alongside some drugs which reduce the absorption of Calcium (eg. Carbamazepine)
  • Reduction in movement/ stress on the bones
- If you do not exercise your bones start to lose some of their strength as it is exercise which stimulates them to repair/ strength
- Ways to improve it:
  • Have a more varied, healthy diet containing dairy produce
  • Take Calcium supplements
  • Raise your BMI to the normal level
  • Use Hormone Replacement Therapy (HRT); something which you should see a doctor about
  • Ensure that you do an adequate daily amount of exercise eg. A brisk mile-long walk as well as regular movement as part of a healthy lifestyle.
  • More easily injured and if injured recover tends to be slower; as bones protrude from the fat more they will be more vulnerable and less nutrition means your body is not as strong as it could be. Because of this you are more easily succumb to injury. This is something you won’t recover from as fast as most people as you don’t have enough nutrients to use to repair the damage.
  •  Loss of muscle mass and therefore muscular weakness; your body will need protein which you aren’t giving it. It gets this from your own muscle which it effectively ‘eats away’ and so your muscle mass will drop
  • Heart Problems
- A process by which you eat a lot of food over a small period of time.
- It can lead to;
  • Weight gain if it occurs often
  • Heart burn; due to weakening of the muscular ring at the top of your stomach
  • Inability to feel when you’re full if it is done regularly over a long period; your stomach becomes bigger due to the wall being continuously stretched and your brain doesn’t pick up signals from the nerves within the wall as much to say it is being stretched.
  • Heart problems; A sudden change in what you are eating and huge amounts at once can put your heart under stress as it has to cope with a lot of blood needing to be diverted to your digestive system along with the absorption of a large amount of unbalanced nutrients at once.
  • Vomiting
  • Reduced absorption of nutrients; due to food being fed through your digestive system faster some of the vitamins and minerals may not have chance to be absorbed in the large intestine
  • Diarrhoea; as large amounts of food are passing through quicker than normal there will be less chance for water to be absorbed.
- Eating over the amount of food that your body needs and therefore putting on weight as a result
- Over a short time period this isn’t too bad, everyone goes through stages of this but it becomes a problem when overeating becomes a habit that you do all the time.
- This can lead to problems such as;
  • BMI in the overweight/ obese/ morbidly obese rangeo High BP; this can lead to damage in number of your organs especially your brain, kidneys and eyes so if you are worried about it then you should see a doctor.
  • Gall bladder stones; these can cause a lot of pain and often need to be removed by surgery. They can be associated with a high fat diet.
  • Increased stress on the heart putting you more at risk of heart attacks; due to a high BP/ blockage or narrowing of the arteries supplying blood to your heart muscle due to cholesterol in your blood.
  • Osteoarthritis/ joint problems; due to more weight being carried on your joints than what they are designed for causing damage to the cartilage and soft tissue structures.
  • Skin problems; sweat getting trapped in folds of fat causing irritation.
  • Breathlessness; This can be due to weight pressing down on the chest, heart problems meaning you need to breathe faster to supply your body with sufficient oxygen, or due to exercise putting too much strain on your body due to the extra weight you have to carry.
  • Reduced fertility.
  • Increased chances of developing Type 2Diabetes; Due to the amount of sugar and fat that someone who is overweight has ingested and due to the fat in their system their body may become resistant to their insulin to some degree so their blood sugar rises.
BMI stands for Body Mass Index. It is a ratio of your height compared to your mass and is used by health professionals and dieticians as a guide whether your weight is healthy and so that they can set up a healthy eating plan and target weights for people who either need to lose or gain weight or those that just need alterations to their diet and they are monitored throughout recovery.
- It is not totally accurate as many factors such as Age, Gender, Activity levels, Muscle mass (high muscle mass increases your BMI as this is heavier than fat), health conditions & body shape alter it
- A person’s BMI is calculated by their weight in kilograms divided by their height in metres squared.
- The number that comes out is then used against a range to assess whether it is right for the person. The categories alter depending on different sources but generally they are;
o Less than 15= Emaciation
o 15-17.5= Anorexia
o 17.5-18.5= Underweight
o 18.5-25= Normal (sometimes seen as 20-25)
o 25-30= Overweight
o 30-40= Obese
o 40+= Morbidly Obese
- More accurate measures of healthy weights
o Waist measurements are now being used to sense if someone is overweight. These are considered overweight if they are higher than;
§ 35” in women
§ 40” in men
o Body Fat Percentage is also a better indicator of health levels though this cannot be tested as easily. The healthy level for this is;
§ 8-22% in young- middle aged males (increasing with age)
o 21-33% in young- middle aged females (increasing with age).
- Complications with a low BMI (/ being underweight)
o Low blood pressure
o Amenorrhoea
o Fainting/ Dizziness
o Osteoporosis
o Lack of Growth (if still a child/ teenager)
o Heart problems
o Lack of energy (due to low fat stores)
o Feeling cold (due to low fat stores)
o Circulation problems
- Complications with a high BMI
o High BP
o Heart problems
o Osteoarthritis Arthritis
o Difficulty with exercise
o Type 2 Diabetes
o Skin Problems (if BMI is very high due to sweat getting trapped within folds of fat)
o Circulation problems
If you are worried about your BMI you should discuss this with a doctor. They can then refer you to a dietician if they feel it is due to your diet and try get it back into the healthy range. If they don't think it is dietary then they can use it as a guide to see if you may be suffering from other health problems.

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