A bulimic is a mixed bag of diametrically opposite and frenetic emotions and feelings. People with this eating disorder of bingeing and then purging their bodies of the food, particularly when stressed, experience extreme fear of weight gain on the one hand; on the other, they are incorrigible bingers, food addicts, indulging in frequent episodes of frenzied eating of high-calorie, fattening foods in response to anxiety or stress.

Bingeing is about consuming large volumes of prohibitive, high-calorie, junk food, which is easy to swallow and sweet, in a very short span. It is not uncommon for a bulimic to gorge maniacally on several bars of chocolate, 50-odd sweets or marshmallows, and guzzle a couple of cans of Coke, all within minutes, sometimes even after a full meal, especially when stressed and worried.

Eating disorder: Bulimics binge on high-calorie food and then purge it.

Most bulimics are female, within a normal weight range in accordance to their height, or weigh 5-10kg more than their ideal body weight. They tend to struggle with weight fluctuation. An estimated 1-1.8% of college women met all the criteria for bulimia, and 2.6-3.3% had sub-clinical levels, according to a study by J.H. Crowther and others published in the International Journal of Eating Disorders in 2008.

Unlike anorexics, bulimics have a fairly accurate perception of their body weight.

But an obsession with body weight, coupled with the fear of gaining weight, and falling prey to media that persists in idolizing frail size zero bodies, promotes bulimic behaviour. Bulimia Nervosa is confirmed when a person has two or more binge episodes a week for three months.

Serious complications may include a cessation of the menstrual cycle, digestive disturbances, hair fall, muscle cramps, fatigue—severe electrolyte imbalances and self- induced vomiting can even lead to heart failure. Self-induced vomiting also leads to other problems: the enlargement of the parotid (salivary) glands that can lead to a dry mouth, pain or difficulty in swallowing, drooling, permanent erosion of tooth enamel, halitosis (bad breath) and lacerations of the food pipe (oesophagus).

As in Anorexia Nervosa, the bulimic needs to participate in one or more therapy programmes, including nutrition therapy, cognitive behaviour therapy and regular counselling. Family members must refrain from jeering or resorting to emotional blackmail to force a change in habits. In case the bulimic is a teenager, the parents must try and understand the child and work to win his/her confidence.

A few tips on helping bulimics:

• Try using the small-steps, big-rewards approach. A layered approach is more rewarding than doing too much too soon. Say, in the first days your bulimic child agrees to cut her intake of Coke by half and sticks to the plan, then that is better than forcing her to give up Coke altogether. The big reward is the self-belief when the chosen task actually gets done. This can then be used to work on the more difficult mental blocks.

• A first goal is to fix mealtimes and not resort to comfort eating as a response to an anxious moment. This way one can also begin to build a behaviour pattern of eating according to hunger patterns. Start with regular meal- times to restore the feeling of eating when hungry, more than anxious, as a first goal of what the person would like to eat

• Gradually decide together to make two of the four meals healthier, then three, and so on.

• Add multigrains, green leafy vegetables, seafood, and lots of fresh lime water, coconut water and buttermilk to restore electrolyte balance.

• At first use foods that are mild, not spicy, and at room temperature to avoid irritating the swollen salivary glands and the sore food pipe.

• Be empathetic, not judgemental, when you sense the patient is tense.

Madhuri Ruia is a nutritionist and Pilates expert. She runs InteGym in Mumbai, which advocates workouts with healthy diets.

Write to Madhuri at dietdesk@livemint.com

Also Read |Madhuri Ruia’s earlier articles