Page last updated at 09:41 GMT, Tuesday, 1 April 2008 10:41 UK

Is size 0 really to blame?

By Clare Murphy
Health reporter, BBC News website

Skinny models may be our favourite culprits when it comes to explaining the exponential rise in eating disorders of recent decades. But research increasingly suggests not everything can be laid at the door of Kate Moss and colleagues.

Lily Cole's legs
Do legs like these really carry the burden of responsibility?

Anorexia and bulimia are not modern phenomenon: examples of women refusing to eat can be found as far back as the 14th Century, with Catherine of Siena an early pioneer of holy starvation.

But since the 1950s, the number of people - primarily women - suffering a troubled relationship with food has risen dramatically - with a threefold increase in the last decade alone.

Bulimia - a condition which involves periods of fasting followed by binge eating and then vomiting - is now one of the most commonly documented eating disorders.

The figures can in part be explained away by growing awareness - both among those who diagnose and care for someone with a problem, and the young women themselves who are increasingly aware of what can be an effective, if dangerous, form of dieting.

'Size 0 culture' plays a key role, but it may not be the whole story, according to Professor Janet Treasure, a psychiatrist at King's College, London and a specialist in eating disorders.

"We are learning all the time about what the mechanisms are - and increasingly that genetics may play a role in this as well as the environment."

Autistic connections

Adolescents and people in certain professions appear to be particularly prone: models may be at an obvious risk, but so are those in other jobs where appearance is important, such as flight attendants.

Paradoxically, eating disorders also feature more commonly among some of the people who know most about the consequences of failing to eat properly, including medical students and dieticians, as well as those who work with food in the catering industries.

And when specialists talk about 'environment', they don't just mean the immediate perceived pressure to look good.

Often you see when they are little children they don't like change, they don't like going to new schools, they like things planned out and they don't like uncertainty
Professor Janet Treasure

Eating habits have also changed down the decades, with the apparent decline of the sit-down family meal in favour of an abundance of tasty snacks.

This, according to some, means that an erratic relationship with food can start at a young age.

The desire to stay slim combined with the temptation of accessible snacks like crisps and chocolate can mean people restrict themselves before giving in - starting an unhealthy pattern of binging.

"There's a tendency to break the diet when you see these highly palatable foods," says Professor Treasure.

"That sets it up so you get into a cycle of intermittent naughtiness. It gets you into a momentum - hooked on that sort of cycle."

But in recent years, researchers have also started to focus on the idea that anorexia - and possibly other eating disorders - may have as much to do with hardwired personality traits as environment.

Professor Christopher Gillberg of the University of Strathclyde was among the first to suggest that anorexia may be a sign of an Autism Spectrum Disorder.

Studies have found that some of those with eating disorders focus intently on detail, rather than seeing the bigger picture. They may find it hard to change rules they have set themselves and learnt behaviours once they become fixed in the brain.

Obsessive calorie counting and restricting intake to very specific items of food could be one of the ways in which autism is expressed in girls, who tend to be diagnosed with the condition less frequently than boys.

Understanding some cases of anorexia as a form of autism, Professor Gillberg argues, may cast light on why some patients do not respond to traditional treatments and why there is often a low rate of full recovery.

So what

It is this low recovery rate which campaigners argue means society needs to sit up and take notice of eating disorders as a key problem.

Pouring wine
Those who binge eat may also be more likely to binge drink

They affect around 4% of the female population - although not all of these may suffer seriously.

But while the death rate may be falling, the long term prognosis can be bleak.

Swedish research shows 20% are still on benefits ten years after being treated for the illness - making them a burden on the state.

They are also likely to have problems falling pregnant, and there may be implications for their children when they do.

In addition, experiments on animals show those made to starve and then binge-eat are also more likely to show addictive tendencies when offered alcohol and cocaine, apparently as a result of chemical imbalances in the brain brought about by such eating habits.

One of the most comprehensive surveys of the relationship between substance abuse and eating disorders, carried out at Columbia University in 2001, highlighted the extent of "cross-addiction".

It suggested people with eating disorders were five times more likely to abuse substances, while substance abusers are 11 times more likely to have eating disorders.

The concept "drunkorexia" - started perhaps in jest to describe those women who save up their calories to splurge on wine - is yet to go down in the lexicon as an official medical term.

But the evidence may be stacking up in its favour.

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