The war on women's bodies: How dental hygienists can help patients with eating disorders

By JoAnn Gurenlian, RDH, PhD

February is an important month for health messaging. We go red for women, focus on cancer awareness, and emphasize the importance of children's dental health. All of these health topics deserve our attention. I happened to notice another awareness event during February that I don't think is getting enough consideration. February 26, 2017-March 4, 2017 is National Eating Disorders Awareness Week.

According to the National Eating Disorders Association (NEDA), the war on women's bodies is devastating and powerful. NEDA estimates that, on a daily basis, we see approximately 3,000 advertisements that promote women's dissatisfaction with their bodies. The association notes that stigmas about weight increase the prevalence of unhealthy weight control and eating behaviors. NEDA has published an infographic featuring the following statistics:

• Fashion models are thinner than 98% of American women: The average American woman is 5'4" and weighs 165 pounds, whereas the average Miss America winner is 5'7" and weighs 121 pounds.¹

• Nearly 70% of the American elementary school girls who read magazines reported that magazine pictures "influence their concept of the ideal body shape," and 47% indicated that "the pictures make them want to lose weight."¹

• More than 40% of first- through third-graders wish they were thinner, 81% of 10-year-olds are afraid of being fat, 70% of 18- to 30-year-olds dislike their bodies, and 60% of those in middle age remain unsatisfied with their bodies.¹

• 50% of girls use unhealthy weight control behaviors, which can include skipping meals, fasting, smoking, vomiting, and taking laxatives.¹

While we may think of eating disorders as "fads" or "lifestyle choices," they are serious and potentially life-threatening conditions. Eating disorders will affect almost 20 million women and 10 million men in the United States at some time during their lives.² Like all health conditions, an eating disorder cannot be wished away; it requires professional treatment. As clinicians, we can be mindful of the signs and symptoms of eating disorders while conducting health assessments and oral examinations.

There are various types of eating disorders. Anorexia nervosa involves self-starvation. This condition deprives the body of necessary nutrients and has the highest mortality rate of any mental illness.² Because bodily functions slow down to conserve energy, the patient might present with an abnormally low heart rate and blood pressure, osteoporosis, muscle loss and weakness, severe dehydration, fatigue, potential for syncope, dry hair and skin, and lanugo.² This condition typically occurs in early to mid-adolescence and primarily affects females.

Signs to look for include dramatic weight loss; a preoccupation with weight, food, calories, fat grams, and dieting; anxiety about being "fat"; an excessive exercise regimen; and withdrawal from friends and activities.³

Bulimia nervosa is another life-threatening eating disorder involving binging and self-induced vomiting. Signs include disappearance of large amounts of food in short periods of time; evidence of purging behaviors such as frequent trips to the bathroom and smells of vomiting; the presence of laxative or diuretics; excessive exercise despite weather conditions, fatigue, or illness; unusual swelling of the cheeks or jaw area; calluses on the back of the hands and knuckles from self-induced vomiting; discoloration or staining of teeth; a schedule or ritual used to make time for binging and purging; and withdrawal from friends and activities.⁴

Bulimia can damage the entire digestive system and purging can lead to electrolyte and chemical imbalances, which can lead to irregular heartbeats, heart failure, and even death.⁴ Bulimia can also cause inflammation and rupture of the esophagus, peptic ulcers, pancreatitis, caries, and enamel erosion due to stomach acid released into the mouth from frequent water brash and vomiting.⁴

Patients who present with signs of an eating disorder need to be treated with care and concern. There are effective treatments including cognitive behavioral therapy, interpersonal therapy, dialectical behavioral therapy, and pharmacotherapy. Patients with eating disorders should be referred to trained medical professionals and eating disorder specialists.

A helpline is available for immediate assistance at (800) 931-2237. For more information, visit NEDAwareness.org. Let's use this month to really see our patients and help reduce the stigma about eating disorders. RDH

References

1. The war on women's bodies. National Eating Disorders Association website. https://www.nationaleatingdisorders.org/war-womens-bodies. Published 2012.
2. Get the facts on eating disorders. National Eating Disorders Association website. http://www.nationaleatingdisorders.org/get-facts-eating-disorders.
3. Anorexia nervosa. National Eating Disorders Association website. https://www.nationaleatingdisorders.org/anorexia-nervosa.
4. Bulimia nervosa. National Eating Disorders Association website. https://www.nationaleatingdisorders.org/bulimia-nervosa.

JOANN R. GURENLIAN, RDH, PhD, is president of Gurenlian & Associates, and provides consulting services and continuing education programs to health-care providers. She is a professor and dental hygiene graduate program director at Idaho State University, and past president of the International Federation of Dental Hygienists.