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Eating disorder is a complex issue

Peter H. Gott, M.D., United Media

DEAR DR. GOTT: Last year, I found out that my sister-in-law had an eating disorder. At first I thought she was making herself throw up, but during a recent visit, I accidentally found a bag of Epsom salt with a cup and spoon in it she had put in my guest bathroom.

She is 29 years old, 5 feet 8 inches and now weighs 110 pounds. She lost more than 150 pounds in the last 18 months but hasn’t changed her eating habits. I have seen her eat a 3-pound hamburger with everything on it and then rush into the bathroom.

No one knows that I know about this, but I am very worried about her. She spent most of her visit here in the bathroom. Can you tell me how dangerous this is?

DEAR READER: This is a very complicated issue.

At 5 feet 8 inches and 110 pounds, her body mass index (BMI) is 16.7, which categorizes her as underweight; however, this is not the best judge of a healthful weight. If she has a very narrow/slender frame, this weight may be appropriate.

Another issue is that losing 150 pounds in 18 months is not unhealthful, depending on the methods used. At that rate, your sister-in-law lost an average of just under 2 pounds a week, which is not harmful.

The final issue is that while you have suspicious behavior on your sister-in-law’s part, you do not have proof that she is using the Epsom salt inappropriatly. The product is widely used in soaking baths to ease sore muscles, as an exfoliant and as a laxative for occasional constipation.

I think the main issue here is that you are worried your sister-in-law is overusing the Epsom salt as a laxative for weight loss. This may certainly be the case. Some people who try the product to relieve constipation find that it causes severe diarrhea, cramps and even vomiting. Everyday use can be associated with complications such as chronic diarrhea and allergic reactions such as hives, difficulty breathing and swelling of the lips or face. It is also possible to overdose, which may lead to vomiting, nausea, low blood pressure, drowsiness, decreased heart rate, coma and even death.

If you are truly worried, express your concerns and let her know that you love and worry about her and only wish her to be happy and healthy. Perhaps knowing someone cares for her will be enough to get her to realize that she needs help. An eating disorder is like any addiction: The person will not seek out help until he or she is ready to admit there is a problem, but sometimes it only takes one person with a kind concern to be the catalyst.

To give you related information, I am sending you a copy of my Health Report “Eating Disorders.” Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and a check or money order for $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

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