Blog

• 

Jumping onto the weight loss and fitness bandwagon is a trend now that it is almost strange if one is not concerned about body image or weight. There is even a subtle negative connotation underlying the contentment of one’s body image, such as being lazy or not health conscious enough. However, the constant pursuit of the “perfect” body/ weight comes at a high cost and especially risky for those with an eating problem. Losing weight is appropriate if one is medically overweight and follows modest weight loss goals and flexible guidelines for eating. It is advisable to lose 0.5 to 1 kilogram a week. Many trendy diets with restrictive dietary rules can be detrimental to your physical and your mental health. By sustaining a markedly under-eating diet or a low body weight, one can suffer from dangerous psychological, social, and physical effects. 

Psychological

Firstly, under-eating can affect our thinking, feelings, and behaviours. Our brain consumes roughly 300 calories daily to function properly and with a restrictive diet, you may notice a decline in your  concentration, reaction time, and decision making ability. Having a restrictive diet also increases the thoughts of food, which interfere with the ability to focus on other things, and further exacerbates the symptoms of low mood and irritability. Another common feeling experienced is “feeling fat” despite of a low body weight. In hope to cope, behavioural changes, such as heightened obsessiveness with food, a rigid routine or a ritualized eating habit are developed overtime. As time passes, people are susceptible to think that this is their new identity whereas their true personality is being masked by the effects of under-eating or being underweight.

Social

The above-mentioned psychological effects also have profound impact on social functioning. The heightened concern about body image and weight also exaggerated the need for routine and predictability. As a result, many have difficulty being spontaneous, fear to eat in public, and tend to withdraw from social event and interaction to maintain their inflexible lifestyle. The loss of sexual desire due to hormonal change and low mood also reinforces their socially withdrawn behaviours. Prolonged social withdrawal could aggravate low mood by limiting social support and pleasurable activities, which further reinforces the vicious cycle.

Physical

Lastly, under-eating and being underweight have a marked impact on one’s physical health with cooccurring medical complications such as electrolyte abnormalities, respiratory failure, and cardiovascular and kidney problems (Mehler & Brown, 2015). The physical effects significantly elevated mortality rate among individuals with an eating disorder.

By losing fat and muscles from a restrictive diet, many experience weakness when walking up stairs or trying to stand up from a sitting/squatting position. The body’s natural temperature regulation is altered, resulting in a lower body temperature and feeling profoundly cold. The heart and circulation is also affected by deterioration of the heart muscle. Many experience a drop in heart rate and blood pressure. There is a heightened risk of heart beat irregularities (arrhythmias) and sudden death amongst these individuals. 

Another harmful effect is the deterioration of one’s bone strength. This amplifies the risk of osteoporosis and bone fractures, even from minor accident. Likewise, under-eating and being underweight have profound effect on one’s hormonal functions and fertility. Some individuals experience loss of interest in sex, a decline in sexual responsiveness, and amenorrhea (absence of  menstruation). There may also be hair loss and dry skin (e.g. skin pilling on palms and lips), which can develop an orange tinge. In some cases, a downy hair called lanugo may start to grow on body especially face, abdomen, back, and arms. Some of the effects above are direct effects of sustained under-eating despite a healthy body weight. The exact physical effects, though, vary depending upon the extend and nature of one’s dietary deprivation.

Conclusion

It is certainly concerning and frustrating when you see someone engaging in a restrictive diet while damaging their body. We are often tempted to confront and say “why can’t you just eat?!”. However, it is always a tough fight with a demon when one has an eating problem. The fear of weight gain and food intake that consumes them often surpass the dangerous effects that dieting does to their physical and mental health. This is also the reason why ED is difficult to treat and require collective professional help from doctors, psychologist, dietician and etc. Many people often do expect all the detrimental effects when they embarked on a restrictive weight loss journey and when all these effects emerge, they are already too deep into this self-maintaining vicious cycle. Having said that, it is never too late to visit an ED professional to understand more about your condition and discover if you suffer from an eating disorder. While the effects of having too low a body weight are dangerous and can cause long-term damage to your body, most of these effects would go away if you regain to a low but healthy body weight, with or without professional help. 

This article was published on ‘Singapore Psychologist’, a quarterly flagship magazine by the Singapore Psychological Society. For the full magazine, visit https://singaporepsychologicalsociety.org/singapore-psychologist/ .

Dear Psychologist,

In June, I came to this clinic with difficulties adjusting to the stressful situations in my life. I discovered that I suffer from depression. I was dealing with academic stress and could not fit into the environment. I did not have much social support and even when I do, people may still not understand. They often say “What is there to worry about?” or “Get yourself together. Find something to do!”

These words never help. Sometimes they even kill.

I realise people like to point fingers at others and tell them what they should do, with no understanding of the matters the victims are really going through. Many of them do not have bad intentions for doing this. They believe wholeheartedly that their ways will help those suffering from depression. But this is sometimes not the case.

What I really found out after this long journey is acceptance. When you feel depressed, do not deny it. Embrace the fact that you may be more vulnerable to depression because of your DNA, family history, or how your brain is wired. It is important to accept and embrace it before you can start the so-called ‘self-redemption’. It is okay to feel distressed as we have many thoughts going through our brain every second. They might come, stay for a while, and go. We cannot decide our DNA but we can decide how to re-wire our thinking. When something bad or something you think is bad happens, you can alter your thinking to lead to a more positive outcome. Think about the positive consequences that may happen and you will usually feel differently. I want to thank the psychologist who really helped me to recover. Yet, the recovery process never ends.

Battling depression and other mental health issues is a long battle. Emotions come back, so depression will too. In the next phase of my life, I foresee new obstacles, nasty things, and challenges. However, I think I can continue to learn how best to overcome them. I may have other mental health issues too, but as long as I know how to help myself, I am confident it will be fine and I will recover.

Sincerely,

Your Patient

Disclaimer:
This letter has been edited to protect the patient’s identity but it maintains the patient’s originality.

From the Psychologist’s Desk

As clinical psychologists, we would have worked with many patients on a similar recovery journey like the one described in this letter. Even with the same diagnosis, patients often present with a different set of symptoms and life stories. With this patient’s consent, we wish to share his insight to the public in hope that we can raise awareness and, ultimately, instill hope. This was a letter that was shared with me during our final session. In the beginning, he was struggling to manage academic stress and started to develop depressive symptoms and suicidal thoughts that manifested as mental images of his own death. He felt both helpless and hopeless in a rat race where he thought he could never accomplish his goals.

Nevertheless, he took a leap of faith and came for regular therapy with great compliance and motivation. In the course of six months, he has gained deep insight and ample coping skills to manage his depression. More importantly, he adopted an open attitude and embraced depression as it is. During our sessions, he never thought of merely battling depression but aimed to understand what it is and learn how to manage it. I will always remember the quote he shared, “There isn’t always a solution to everything”. Is that not a perfect depiction of true acceptance?

This article was published on 'Singapore Psychologist', a quarterly flagship magazine by the Singapore Psychological Society. For the full magazine, visit https://singaporepsychologicalsociety.org/singapore-psychologist/ .