[이데일리 이정민 인턴기자] From Netflix entertainment to filming ‘Body Profile’, completing today’s workout, and an endorsement from ‘Woon-Wan Oh’. More than ever, the atmosphere is enthusiastic about a ‘healthy body’. But on the other hand, the other world is developing. To become ‘bone thin (a body so thin that the bones are visible)’, repeat ‘Mujjol (starve yourself ignorantly)’ and ‘Mukto (eat and vomit)’. The aim of ‘pro-anorexia’ in favor of anorexia is to be 125 height minus weight in the ‘height body’. If you are an adult woman with a height of 160 cm, you must weigh 35 kg to become proana.
On the 22nd, singer Barbara appeared on CBS’s ‘Kim Hyun-jung’s News Show’ and warned about the danger, saying, “Anorexia is the number one death rate among psychiatric diseases.” Many articles on anorexia also add that “the mortality rate of anorexia is high”, but the source is unclear. Last month, Korea’s first ‘Eating Disorder Awareness Week’ was held, and interest in anorexia increased compared to the past. Yet many people are still unaware that anorexia is a mental illness. I drew attention to the seriousness of anorexia as a psychiatric disease and drew attention to the role of the social institution.
Is Anorexia a Mental Illness?
The full name of anorexia is anorexia nervosa. According to the Center for Classification and Information of Diseases (KOICD), the disease code for anorexia is F50.0. The F code is a mental illness code. Treating anorexia as a simple extension of diet prevents you from getting the right treatment at the right time. Anorexia is one of the psychiatric disorders that requires formal treatment.
Anorexia is one of the representative eating disorders, and is a disease in which people refuse to eat food due to an endless desire to be thin or an extreme fear of gaining weight. The Center for Disease Classification Information explains that anorexia “is associated with a particular psychopathological aspect, and is caused by setting the threshold for one’s weight too low because one is so overwhelmed by concerns about obesity and serious concerns for a saggy body shape.” Severity is judged on the basis of body mass index (BMI). A body mass index of less than 17 is classified as anorexia.
One of the reasons the Academy for Eating Disorders (AED) considers anorexia a mental illness is as follows: “Anorexia causes emotional and cognitive problems that interfere with the ability to complete daily tasks. ” Just as depression leads to social isolation, anorexia affects a person’s life holistically.
How many anorexia patients are there in Korea? According to the open healthcare big data system provided by the Health Insurance Review and Assessment Service (HIRA), the number of anorexia patients has been on the rise over the past five years. As of 2021, the number of anorexia patients is 4,881. There are 1,227 men and 3,654 women, almost three times as many women. In particular, among young women, ‘Bone Dry’ and ‘Proana’ were spreading like fashion, with 888 female patients (24%) in their teens and 20s.
The problem is that there are more patients outside the statistics. Inje University Seoul Paik Hospital Psychiatry Professor Kim Yul-ri said, “The prevalence of anorexia is considered to be 0.6% of the total population.” Based on a population of 50 million, 300,000 suffer from anorexia. Professor Kim pointed out that the reason for the large gap between reality and statistics is that “most of the cases do not come to hospital for treatment because they do not recognize that they are are patients.” Even if you go to a hospital for diarrhea, you go to internal medicine, pediatrics, or obstetrics and gynecology because of anemia, hypothyroidism, or infertility, so they are omitted from anorexia statistics . According to Professor Kim’s dissertation ‘Physical abnormalities and the treatment of eating disorders’, eating disorders are recognized in less than 50% of cases, and as a result, treatment is delayed.
Another point to note in the HIRA statistics is the proportion of elderly patients with anorexia. The age group that accounts for the largest proportion of anorexia patients are women over 80 (1,352 people). Professor Kim said, “Anorexia occurs not only in women in their 10s and 20s, but also in men and the elderly, in any gender and age group. Even loss of appetite due to aging is said to be misdiagnosed as anorexia.
◇ Anorexia is the leading cause of death among mentally ill?
Proving a direct causal relationship between anorexia and mortality is not easy. This is because there are many causes of death, such as various physical complications caused by anorexia and extreme choices. In fact, deaths due to eating disorders such as anorexia were not included separately in Statistics Korea’s “Statistics on Causes of Death in 2021”. There was no investigation related to anorexia in the ‘Mental Health Investigation Report 2021’ published by the National Center for Mental Health under the Ministry of Health and Welfare.
However, anorexia is clearly a fatal disease. The Institute of Eating Disorders and Mental Health said, “Data are hard to come by because domestic studies still focus on prevalence,” and provided the research paper “Death in anorexia nervosa” referenced by the organization . This paper, published in the American Journal of Psychiatry, is a meta-analysis of 42 studies of anorexia patients followed for 10 years.
According to the thesis, the death rate due to anorexia was 5.9%, and 178 died out of 3,006 patients. Deaths due to complications accounted for 89 cases (54%), and extreme options accounted for 44 cases (27%). The paper concluded that “mortality rates among patients with anorexia are significantly higher compared to female psychiatric inpatients and the general population.” The organization said, “Although the study was conducted in 1995, it is still valid considering the current trend of anorexia patients continuously increasing.” In addition, he added, “In the case of anorexia, it is more likely to lead to physical complications than other mental disorders, and it is also open to the risk of trying extreme choices.” Professor Kim also explained, “Anorexia is accompanied by complications due to malnutrition. Not only does it lose the ability to solve problems in everyday life, but it also increases the risk of falling into depression and having a heart attack. It can put you at ‘double risk’, both physically and mentally, than other mental illnesses.
The American Anorexia Disorder Association (ANAD) warns that “at least 9% of the world’s population is affected by an eating disorder” and that “eating disorders are one of the deadliest mental illnesses after opioid abuse.” Eating disorders kill 1 person each. 52 minutes.. The British Guardian also published an article called ‘The most deadly mental illness, anorexia… why doesn’t the NHS (British National Health Service) take it seriously?’ One of the main problems was that eating disorders were not taken seriously enough, the article said, “a complex mental illness with extremely damaging potential” and “without adequate support, people with eating disorders are isolated from the school and work.” he warned.
The problem is that it is not easy to apply the ‘brake’ on your own even if you feel physically and mentally abnormal. Professor Kim explained, “If you are in a state of malnutrition at the level of anorexia, it is normal to take a break or eat to protect your body.
◇ Mental illness with the highest recovery rate Early treatment is important
‘Mental illness with the highest cure rate compared to treatment.’ Anorexia is a fatal disease, but hopefully it can be cured. The key is to treat it early. A third of people with anorexia suffer from chronic anorexia.
The problem is cost. In the case of anorexia, as non-pharmacological treatment is required, the cost of the treatment is not small. Since 2016, mental illnesses such as depression and ADHD have been included in the indemnity insurance through standard terms and conditions. However, anorexia was excluded. Professor Kim encouraged insurance coverage for eating disorders, including anorexia, and argued that “early treatment of anorexia can reduce overall medical costs.” Early treatment can reduce individual loss of life and reduce national medical costs due to physical complications. If the underlying cause of anorexia is not treated, a vicious cycle repeats itself, such as a chain of secondary complications and the cost of treating them.
In 2017, the National Institute for Health and Clinical Research (NICE) published guidelines for eating disorders. for the early detection and treatment of anorexia. Specific criteria for diagnosing and treating anorexia are presented, and physical and mental checks are included from time to time, such as measuring bone density. Regarding this, Professor Kim emphasized, “It is because of the social perception that anorexia must be treated early,” and “that society should take an interest in anorexia.”
