Dieticians, Dentists and Eating Disorders

As a dietitian, my role is to re-educate people on the key aspects of healthy eating and how it affects their physical health, through nutrition counselling. This is often done face-to-face in clinic, but can also be in larger group sessions.

Did you know that over 1.6 million people in the UK are affected by eating disorders? These are mainly 14-25 year olds females; however, the incidence is definitely rising in men. 'Eating disorder' is an umbrella term used to describe Anorexia, Bulimia Nervosa and other non-specific eating behaviours. Whilst the levels of Anorexia Nervosa have remained steady over the past decade, we have seen an increase in binge eating and eating disorder not otherwise specified (EDNOS). Younger people in particular may be diagnosed with EDNOS when they show some, but not all, of the typical signs of an eating disorder. Shockingly, approximately 40% of people affected by an eating disorder are bulimic, with this statistic rising by 18 per 100,000 people, every year.

What is Bulimia?

People with Bulimia experience periods of binge eating, followed by deliberate purging or laxative use to control their weight. It is often very difficult to recognise the signs, as people with Bulimia can appear 'healthy' with a 'healthy weight'. However, there are telling signs if you look hard enough. People often have very short nails to ensure they don't scratch the back of their throat, red marks or cuts are found around their knuckles from teeth grazes, and redness around the eyes are common from burst blood vessels. Bulimia also causes significant damage to the teeth due to stomach acid. It mostly affects the backs of the teeth facing the palate and at the gum line around the incisors. I have always been told that dentists can be the first to identify Bulimia so, with this in mind, I asked leading Dentist Dr. Krupal Shah (Founder of Wimpole Street Cosmetic Dentist Sensu London) a few questions....

1) Is it true, can dentists be the first to identify Bulimia due to tooth damage?

Many of the symptoms of bulimia can be concealed from friends and loved ones, but there are tell-tale signs that cannot be so easily hidden from a dentist. For example, loss of enamel from behind the upper front teeth can provide a strong indication of purging, particularly if a patient has a history of good oral health. Other warning signs can include a dry mouth, cavities, sensitive teeth and sore, inflamed gums; and, in severe cases, the nerves of the teeth can become exposed causing extreme pain and even tooth loss. These symptoms can sometimes be exacerbated by high-sugar binging as, not only does a high-sugar diet create the perfect conditions for decay, but it will also intensify the impact of gastric acid.

2) How long does it take for this to happen?

There are different factors that can influence the onset of these symptoms. The frequency of purging will have a big impact, and it can be months of even years before the physical symptoms of Bulimia materialise.

3) Is it reversible?

Some symptoms such as sensitivity and inflammation can be reversed to some degree, but only once the underlying cause - in this instance the Bulimia - has been treated. Only then can we look to restore a patient's oral health through a combination of preventative and restorative dental treatments. These treatments typically include fillings and crowns to repair and protect the teeth. In some cases a patient may need to be referred to a periodontist - a dentist who specialises in treating gums - or an oral surgeon if there are missing teeth that need replacing.

4) What is the best thing to do if people have damaged their teeth?

If an individual has damaged their teeth through purging, they should seek advice from a dentist straight away. Providing the Bulimia has been treated we will look to repair any damage promptly and prevent any further deterioration to the patient's health or appearance. If a patient is not ready to seek treatment for their condition, then we can advise them how to minimise any future damage to their oral health.

5) What's the best advice for people who suffer from Bulimia?

As dentists we are concerned not only for our patients' oral health but for their overall health. We are in a unique position where we have a responsibility to highlight damaging behaviours, but we are not equipped to offer treatment for mental illnesses such as bulimia.

We can provide non-judgemental advice on the impact of bulimia on an individual's oral health. However, providing the patient is an adult ultimately the onus will be on them to seek the help they need. We can instigate or facilitate this process by advising them to seek help. In most cases this would involve encouraging the patient to speak to someone they trust such as their GP, a friend or family member.

Personally, I'm seeing more and more people with disordered eating habits and I am often asked about the best forms of treatment. Firstly, having involvement from more than one professional is essential in my opinion, as no one can be solely equipped to handle the challenging aspects that an eating disorder encompasses. The first and most important thing is recognising there is a problem. Once people do, seeking help for their physical and psychological health is next.

As a dietitian, my role is to re-educate people on the key aspects of healthy eating and how it affects their physical health, through nutrition counselling. This is often done face-to-face in clinic, but can also be in larger group sessions. Designing tailored, balanced, nutrition plans is a fundamental part of treatment and these are amended in line with weight management. Input from a trained therapist is another fundamental part of treatment and they will help with any underlying psychological causes. Cognitive behavioural therapy (CBT) or cognitive analytic therapy (CAT) are commonly used therapies. CBT focuses on changing how someone thinks about a situation which in turn, affects how they act, whereas CAT focuses on personality and life experiences. CAT looks at how these factors influence an individual's current thoughts, relationships, feelings and behaviours. Regardless of the chosen therapy, one should definitely play a part in treating eating disorders in line with specialist input from a dietitian.

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