Your Health

Striving for Thin

Click here to view a sample script for addressing eating disorders with your clients.

Svelte models grace magazine covers while beautiful starlets glide down the red carpet and even pop stars who appeal to young girls bare almost all to stay in the public eye and at the top of the charts. Advertisers sell products by using sexuality and physical attractiveness. The media emphasizes thinness as a standard for feminine beauty and these idealized bodies are frequently atypical of normal, healthy women. In fact, today’s fashion models weigh 23% less than the average woman and a young woman between the ages of 18-34 has a 7% chance of being as slim as a catwalk model and a 1% chance of being as thin as a supermodel.¹ This obsession with slimness can lead to eating disorders, which are severe psychological problems.

The Pressure to be Thin

According to Joan Jacobs Brumberg, author of The Body Project: An Intimate History of American Girls and Fasting Girls: The History of Anorexia Nervosa, an enormous shift has occurred in the United States from women being primarily concerned with superior achievements to now being concerned with good looks as a measure of their self-worth.² Consequently, our society is obsessed with diets. Annual diet industry revenues have grown from an estimated $100 million in the 1950s to $50 billion in the 1990s.² Teens especially are influenced by this dieting craze.

Many teens who begin dieting do not need to lose weight. Pressure to be very slim can come from friends, parents, and advertisers, and may create unrealistic expectations. Having a distorted body image is like looking into a hazy mirror and imagining yourself as heavier than you actually are.

A national survey of 11,631 high school students conducted by the National Centers for Disease Control and Prevention (CDC) found that more than one third of the girls considered themselves overweight, compared with fewer than 15% of the boys.³ More than 43% of the girls reported that they were on a diet even though a quarter of these dieters did not think they were overweight. The survey found that the most common dieting methods used were skipping meals, taking diet pills, and inducing vomiting after eating.

In the United States, conservative estimates indicate that after puberty, 5 to 10 million girls and women and 1 million boys and men are struggling with eating disorders including anorexia, bulimia, binge eating disorder, or borderline conditions.^4,5

Symptoms

The frequent vomiting and nutritional deficiencies that often accompany eating disorders can have severe consequences on oral health. Studies have found that up to 89% of bulimic clients show signs of tooth erosion.⁷ The pain and discomfort related to dental complications often prompt those with eating disorders to first seek medical care.

Following are typical signs and symptoms of eating disorders:

1. Loss of tissue and erosive lesions on the surface of teeth due to the effects of vomiting and the resulting acid. These lesions can appear as early as 6 months from the start of the problem.
2. Changes in the color, shape, and length of teeth. Teeth can become brittle, translucent, and weak.
3. Increased sensitivity to temperature. In extreme cases, the pulp can be exposed and cause infection, discoloration, or even pulp death.
4. Enlargement of the salivary glands, dry mouth, and reddened, dry, cracked lips.
5. Tooth decay, which can actually be aggravated by extensive tooth brushing or rinsing following vomiting.
6. Unprovoked, spontaneous pain within a particular tooth.

If you notice any of these symptoms, a discussion of the signs of eating disorders and their relationship to oral health care should be broached. For scripts on addressing eating disorders with clients, please visit the web version of this article at www.dimensionsofdentalhygiene.com. Table 1 lists tips for retaining a healthy body image.

Eating disorders are serious health conditions that can be both physically and emotionally destructive. People with eating disorders need to seek professional medical and psychological help. Early diagnosis and intervention may enhance recovery. Visit www.nationaleatingdisorders.org and click on “Eating Disorder Info” to find tips on getting treatment. See Table 2 for further information sources. Knowledge is power and resources are available.

References

1. Body Image and Advertising. Mediascope. Available at: www.mediascope.org/pubs/ibriefs/bia.htm. Accessed January 21, 2004.
2. Brumberg JJ. The Body Project:An Intimate History of American Girls. New York: Random House; 1998.
3. Papazian R. On the teen scene: should you go on a diet. Available at: www.fda.gov/fdac/reprints/ots_diet.html. Accessed January 21, 2004.
4. Fairburn CG, Jones R, Peveler RC, Hope RA, O’Connor M. Psychotherapy and bulimia nervosa. Longer-term effects of interpersonal psychotherapy, behavior therapy, and cognitive behavior therapy. Arch Gen Psychiatry. 1993;50(6):419-428.
5. Polivy J, Herman CP. Causes of eating disorders. Ann Rev Psychol. 2002;53:187-213.
6. Gurenlian JR. Eating disorders. J Dent Hyg. 2002;76:219-34.