For many individuals, the fight against fat begins as an eating disorder. In fact, many weight loss surgery (WLS) patients have eating disorders that, if not addressed, will hinder weight loss and lessen satisfaction with life after surgery--or even threaten their lives. But what exactly are eating disorders, and how difficult is it to treat them? What follows is Eating Disorders 101, a kind of mini-course on some much-misunderstood ailments that affect millions of people nationwide. Eating disorders can be challenging and sometimes discouraging, but have hope. They are highly treatable. Anorexia Nervosa Anorexia nervosa is much more than a refusal to eat. It is often a symptom of low self-esteem and an inordinate desire to control one's surroundings. Anorexia is an unhealthy coping mechanism for those dealing with stress, anxiety, or depression. People dealing with anorexia might have an irrational fear of becoming fat, or at least of being perceived as overweight. They embrace dieting and starvation in order to control not only their weight, but their feelings as well. They may also wish to deprive themselves of pleasure by denying themselves certain foods. While some WLS patients have a history of anorexia, a small number become anorexic following surgery. It is important to seek help immediately if you suspect you may be developing anorexia. Warning signs for anorexia can include:

• constant concern with body image,
• obsessive calorie counting,
• extreme exercise,
• use of diet pills or laxatives, and
• self-induced vomiting.

There are many other symptoms, as well. A woman suffering from anorexia after WLS might experience dramatic weight loss over a relatively short period of time, even after reaching her goal weight. (While we refer here to women, men can be afflicted with anorexia, too.). She may also wear baggy clothes in order to disguise her additional weight loss. She may flush food down the toilet rather than eat it; she may also have a fear of eating around others. Anorexia patients may also develop unusual food rituals such as chewing food without swallowing it, dividing food into tiny pieces, or moving food around a plate to make it appear as if portions of it have been eaten. The anorexic might experience hair loss, headaches, frequent sore throats, low blood pressure, and a loss of her menstrual cycle. She might also suffer from insomnia, depression, or fatigue. She may also complain constantly of feeling cold. Bulimia The recent autobiography of actress Jane Fonda has focused new attention on the problem of bulimia. In her book, the award-winning actress tells how she struggled for years with bulimia nervosa. Those who suffer from bulimia make a concerted effort to binge and purge--they gorge on food, then engage in self-induced vomiting or taking laxatives. The ritual seems to be an effort for sufferers to punish themselves, either because of self-hatred or negative emotions regarding a specific event in their lives. In a number of cases, bulimics might be avoiding emotions such as anger or anxiety. Ironically, bulimics might also have a fascination with food, going so far as to buy cookbooks compulsively or share exhaustive dieting tips with other people. Warning signs for bulimia can include:

• ritualistic gorging followed by purging,
• an overemphasis on exercise,
• a misuse of diet pills, and
• almost constant worry about body image.

If binging and purging occur twice a week over a period of three months, the individual is classified as bulimic. It should be noted that there are a number of similarities between anorexia and bulimia. Such disorders are often linked with sexual and/or physical and emotional abuse, and have also been connected with clinical depression. In some cases, the eating disorder may result in depression; in other cases, depression can trigger an eating disorder. In order to effectively treat such disorders, deeper emotional conflicts often have to be dealt with. Binge Eating Those suffering from a binge eating disorder often have a combination of symptoms similar to those suffering from bulimia. Binge eaters tend to consume an incredibly large amount of food in less than two hours. They don't just eat until they're full--they eat until they are uncomfortably full. Binge eaters also tend to be overweight and have a difficult time maintaining their weight. Unlike those who suffer from bulimia, binge eaters do not purge after eating. There appears to be an emotional underpinning to binge eating. Bingers are often trying to hide from their emotions or to keep other people at bay. They may feel undeserving of love, and so they use binging in order to self-punish. Ironically, the more they binge, the worse they feel about themselves. To be diagnosed with binge eating disorder, an individual must engage in binge eating episodes at least twice a week for six months. A binge eater often eats alone out of embarrassment, and may feel guilty after overeating. He or she also tends to eat large quantities of food, even when not hungry. Treatment Treatment does not simply mean stopping potentially dangerous or even life-threatening behavior. The path to recovery can be difficult and sometimes painful. However, in the end, it's well worth the effort. After recognizing the problem, an individual with an eating disorder needs to reach out to a friend, parent, spouse, or doctor. The idea is to develop a support system that can help you through your recovery. The next step is to find the right professional help. You might ask your doctor if he or she can refer you to a therapist who can help you work through your feelings. A psychiatrist or professional counselor will also work with you in helping you to develop healthy coping mechanisms. Another good resource is a support group such as Overeaters' Anonymous. Such a group puts you in touch with other people who are struggling with the same emotional issues and physical problems. It has been said that therapy and support groups are essential for permanent recovery from eating disorders. It is vitally important to keep an open mind during the recovery process. Your therapist may recommend that you explore avenues you haven't thought of. If you're open to suggestion, you may find that your recovery time is faster than it would be otherwise. Resources A number of good books are on the market to help you learn about eating disorders. The Eating Disorder Sourcebook by Carolyn Costin is an excellent resource. Written by a recovering anorexic, the book explores the nutritional, psychological, and biochemical aspects of eating disorders. Surviving an Eating Disorder by Michelle Siegel was among the first books on the subject to emerge in the 1980s. Written by an expert on bulimia, the book is a survival guide for those who believe their eating and/or dieting is now out of control. An important resource for parents is When Your Child Has an Eating Disorder: A Step-By-Step Workbook for Parents and Other Caregivers. In this book, Abigail Natenshon provides hope as well as guidance for helping children change disturbing behavioral patterns involving eating. An inspiring look at conquering eating disorders can be found in Life Without Ed: How One Woman Declared Independence from Her Eating Disorder and How You Can Too by Jenni Schaefer. Schaefer, a singer and songwriter, is also a recovering bulimic. Ed, in this case, is the personification of her eating disorder, a character who follows her wherever she goes. Through Schaefer's story, readers can gain the encouragement and inspiration to battle their own eating disorders. Eating disorders are complicated afflictions that have both emotional and physical aspects. But the more information you have about anorexia, bulimia, and binge eating, the more likely you are to be able to recover. An important thing to keep in mind is that eating disorders can be treated; the lonely suffering can come to an end.