Kilojoules are now the killers as anorexia shuts down body

Recent speculation about the weight of stars like Ariana Grande, pictured, and Cynthia Erivo has placed eating disorders in the spotlight.

Both performers faced social media scrutiny during publicity appearances for the *Wicked *films. Grande also withdrew from a planned London musical in August, although she has not directly attributed the decision to speculation about her weight.

Anorexia not simply an obsession with being thin

Contrary to popular perception, anorexia is not simply an obsession with being thin. It is a psychiatric illness in which sufferers restrict food intake, frequently driven by an intense fear of gaining weight and a distorted perception of their bodies.

Medical doctor and psychologist Dr Jonathan Redelinghuys said prolonged malnutrition forces the body to conserve energy, slowing normal functions and breaking down muscle tissue to survive.

“The body starts shutting down functions that it can no longer afford to maintain. It is trying to survive on too little energy and eventually even the organs that keep us alive can be affected.”

The heart is particularly vulnerable, he said. Starvation can cause dangerously low blood pressure, a slower heartbeat and irregular heart rhythms.

Electrolyte imbalances, particularly involving potassium and sodium, can disrupt cardiac function and cause sudden death.

“One of the greatest dangers is that someone can look relatively healthy while their heart is under enormous strain. You cannot judge how medically unwell someone is simply by looking at their weight,” Redelinghuys said.

Damage can be permanent

Muscle deterioration causes weakness, exhaustion and dizziness, while declining bone density increases the risk of fractures and osteoporosis, even among younger sufferers.

“Damage can be permanent, particularly when anorexia develops during adolescence while bones are still developing.”

The digestive system also suffers. Constipation, bloating, abdominal discomfort and delayed stomach emptying can make eating uncomfortable. Dehydration and malnutrition can compromise kidney function.

Hormonal changes could cause menstruation to stop in women and testosterone levels to decline in men, affecting fertility, Redelinghuys said.

Hair becomes brittle, skin dries out and fine body hair may develop as the body struggles to regulate temperature. Constant coldness, fainting and extreme fatigue are further warning signs.

The brain also takes a beating. Redelinghuys said malnutrition affected concentration, memory and emotional regulation, while anxiety, depression and obsessive thinking could worsen.

Malnutrition affected concentration, memory and emotional regulation

Sufferers may lose the ability to recognise the seriousness of their condition.

“Starvation affects the very organ that a person needs to make decisions about getting better. Their thinking can become more rigid, their anxiety can increase and they may struggle to understand how serious their condition is,” he said.

This complicates treatment because the psychological illness drives food restriction, while starvation can make sufferers less receptive to medical intervention.

Treatment requires restoring nutrition alongside psychological care that addresses the fears, behaviours and distorted thinking associated with eating and body image.

“Getting someone to eat again is only one part of recovery. You also have to treat the psychological illness that caused the restriction in the first place. Otherwise, the person may regain weight without recovering from the eating disorder,” Redelinghuys said.