Sarah Appleby* isn’t sure what the low point was.
Perhaps it was the day she woke up and, without having a wash or cleaning her teeth, drove straight to the supermarket and bought Dh300 worth of chocolates and cakes to eat alone at home that same morning.
“In the afternoon,” says the 40-year-old Abu Dhabi-based British expat, “I drove back for more.”
Or possibly it was the time, fearing what her husband would say if he knew how much junk food she’d consumed while he was at work, she took two carrier bags worth of wrappers and secreted them in her neighbour’s bin.
Or maybe it was the evening she swiped a family-sized box of biscuits from the cupboard, said she was going out, and drove to a quiet road to eat the lot.
Sarah, it was clear, was addicted to binge eating.
For more than 25 years – from childhood to becoming a mother, from schoolgirl to successful finance professional – this intelligent and articulate woman hid her disorder as it slowly started to dominate her life. On the surface, she seemed to have everything – children, career, a beautiful villa – but behind closed doors she was an out-of-control compulsive eater.
The form of bulimia she suffered from would see her crash diet, barely touching a proper meal for weeks at a time, before gorging on hundred of dirhams worth of junk over a single morning and afternoon when her family wasn’t around.
“I would stand in the queue of the supermarket mortified at the rubbish in my own basket, but I couldn’t stop,” she says. “I would get home and eat as much as I could as quickly as I could, and then I’d feel so stuffed and guilty I’d end up throwing half of it away, promising myself that was the last time I’d ever do it.
“But then by the afternoon I’d be thinking, ‘Well, I’ve already binge-eaten today so I may as well turn over a new leaf tomorrow and do it one last time this afternoon’, and so I’d go back to the supermarket to buy even more.”
At the height of her addiction – shortly after her mother passed away with cancer in 2007 – she binge-ate every day for two weeks, each morning promising herself she’d start afresh tomorrow. “But then I wouldn’t be able to sleep – because of all the sugar, probably – and I’d wake up tired and depressed, and start all over again.”
She even took to hiding credit card bills and receipts that would have shown her husband how much she was spending in the supermarket; then not using it at all.
“It was, like… cash only,” she half-jokes.
Obesity is, it is widely agreed, one of the major health issues facing the UAE. Research carried out earlier this year found some 66 per cent of males and 60 per cent of females were overweight. Officials regularly advise residents to eat better and exercise more, while parents are encouraged to ensure their children do not balloon.
Yet, behind closed doors, eating disorders such as bulimia and anorexia are also on the rise, it seems. A large and transient expat population, along with the secrecy of sufferers, means such problems are difficult to quantify, but the evidence is compelling. The American Center for Psychiatry and Neurology in Abu Dhabi admits an average of two new patients with eating disorders every week, while respected psychiatrist Dr Veena Luthra, a consultant at the center, will next month give a keynote speech warning of the dangers of such disorders for UAE teenagers.
A 2012 survey done at Al Ain University, meanwhile, found 1.8 per cent of 900 girls aged 13 to 19 were anorexic. In Britain, a corresponding figure is just 1 per cent. Perhaps more worrying was another survey carried out by Zayed University, in Dubai. Female students there were asked to pick their ideal body shape from nine silhouettes. Some 80 per cent picked the severely thin option.
The message is clear: this is a serious health issue. And if sufferers aren’t treated – and, more importantly, treated right – it is one that could lead to a whole catalogue of other problems. Major organ failures, permanent mental health problems and even suicide have, chillingly, all been directly linked to eating disorders left unchecked.
Sarah, of course, knows it all better than most. Binge eaters, like alcoholics, are never considered ‘cured’. But the mother-of-two is well on the road to recovery – thanks to specialists right here in the UAE.
And, though her story is harrowing, it is one that perhaps offers hope for others, while also showing the sheer skills of our country’s medics in dealing with the problem.
“I was 11 when I first decided to see how long I could go without eating,” she remembers. “I was a ballet dancer back then and I wasn’t remotely overweight but when you do something like that – when you’re dressed in leotard and tights – you always want to be skinnier.”
Encouraged by friends doing the same thing, she decided to test herself to see if she could go a day without food. She went two and a half. When she ended her fast, she had just a single cube of cheese and a tomato, and then started all over again.
“How did it feel?” she ponders. “Good, actually. I felt I’d achieved something, that I’d had taken control over my body. So I kept doing it.” She had no idea then that what she was actually doing had a name: anorexia. Nor did she know that by associating success with dramatic weight loss, she was setting in motion an illness that has haunted her since.
This isn’t an uncommon pattern, as it goes. Statistics compiled by the American-based National Association of Anorexia Nervosa and Associated Disorders suggest 86 per cent of all eating disorders can be traced back to teenage years. In the UAE, meanwhile, doctors have continually urged parents to look for signs their children may be suffering.
They stress that, while it is important to address the so-called obesity epidemic, children shouldn’t be made to feel so bad about their weight that they tip the other way into a disorder.
“In a country where obesity and diabetes are major issues,” Dr Osman El-Labban, of Al Zahra Hospital, Dubai, told Gulf News last year, “it is quite easy to overlook this dangerous trend in the adolescent population.”
For two years after that first fast, Sarah tested herself, celebrating the times she survived on just water, chastising herself when she had to have a carrot or piece of bread.
And although it petered out for a short period during her mid-teens, it came back with a vengeance when she was 17.
This time, worried about her appearance and what young men may think of her, she would go days without food in a bid to lose weight, before binge eating to combat the depression such an action brought on. And this time she would not get well for 20 years.
“It affected my life, there’s no doubt about that, but I always thought I had it under control,” says Sarah, who was living in London at the time.
“I’d cancel going out for dinner at the last minute because I was having a day when I wasn’t eating or, conversely, I was having a day when I’d binged. But it still felt manageable. I would actually tell friends that I was one of those people who could eat whatever they liked and never get fat.”
That is until 2007.
That year her mother died – she’d been diagnosed with cancer the day after Sarah’s first child was born in 2002 – and the loss sent the new mother’s eating problems surging back to the surface. Her weight bounced from 40kg to 66kg – and back again – all in less than a year, as she fluctuated between complete fasting and periods of bingeing. To put that in context, as Sarah stands at 165cm, her ideal weight would have been about 55kg.
“My one blessing might have been that I could never make myself throw up,” she recalls. “Otherwise I’m certain I would have started doing that as well.
“But my husband had obviously noticed things weren’t right before and we’d discussed them and I’d been to a doctor, but that’s when he realised how serious it was, I think,” she says. “We went to a GP and they basically talked about me like I wasn’t there. It was decided I had to go to a hospital.”
Yet, even at that point, she refused to acknowledge the seriousness of the problem. “Everyone else in hospital looked so bad,” she says. “They were half my weight. I just thought ‘What am I even doing here?’”
After three weeks she was checked out. The binge eating, followed by periods of fasting, continued. And whatever solutions were tried thereafter, she would ultimately go back to that same pattern. “I’d sort of accepted that’s who I was,” she says. That is until the day her husband came home and announced he had been offered a job in the UAE. “I’ve not had a real relapse since I got on the plane,” she says. A variety of factors, it seems, helped her…
Dr Luthra has a saying: an eating disorder is not about eating. “It’s about underlying psychological problems that manifest themselves in this form of compulsive disorder,” she tells Friday. “There are a range of issues that need to be addressed.” But doing that is easier said than done. The average time it takes someone with anorexia to completely recover is seven years; with bulimia it’s 14. As many as five specialists – a psychiatrist, psychoanalyst, psychotherapist, dietician and GP – can be needed to help an average case. And if it’s recognised too late, sufferers will almost certainly already have done lasting damage to their organs and mental health.
But it’s not all bad news: while the number of sufferers in the UAE may be silently growing, those who do come forward for help get what is thought to be among the best treatment anywhere in the world.
“We had a teenager brought to us a little while ago,” recalls Dr Luthra, who has 25 years’ experience. “She was an Indian girl born in the UAE, but when she was 13 her parents moved back to India. She started losing weight and suffering from various illnesses, and her parents took her to several doctors over there but none could diagnose what was wrong with her. They were all looking for a physical disorder.
“It was only when they moved back here that we saw what the issue was: she was anorexic. She’s 14 now and is coming on well. Hopefully we’ve caught it before it does any damage to her major organs.”
Sarah, too, is proof of the care provided. In the three years since she sought treatment here, she has been seen by five separate specialists, including Dr Luthra. And while that may sound expensive, the results pay off. The more effectively a sufferer is dealt with initially, the less likely they are to need more costly treatments – for illnesses such as major organ failure – later in life. It is joined-up thinking that simply never happened for her in the UK.
“When I got on that plane I decided I’d be a new person – a fresh start,” she says. “But it doesn’t just work like that. You can’t run away from your problems. I quickly realised I’d need professional support. But the help I’ve received has just been beyond anything.
“The good weather and the living standards – and I think my own determination – have played their part, but without the treatment I’ve received I would have relapsed, I’m sure.”
The treatment has included regular counselling, full medical checks to address the minor physical damage to some organs including the liver, and sessions with dieticians for advice on better eating.
In her case, she was also placed on anti-depressants, which she continues to take to help combat the clinical depression she was diagnosed with.
“There’s no one rule for making someone better,” says Dr Luthra. “But as a professional you take a role that family or friends can’t.
You need to support the patient and listen without judging; recognise that there’s a battle inside them between the healthy person and, in Sarah’s case, the compulsive eater. It’s your job to form an alliance with the healthy side, to help make it stronger, to defeat the negative side.”
Exactly how to do that is different for every patient, of course. Eating disorders may largely fall under the two headings of bulimia and anorexia but, in many ways, it’s a different disease in every person – which is perhaps what makes it so difficult to spot and then treat.
Yet, for Sarah, things are looking up. Her treatment here continues to work. And that’s perhaps good news for others too. For while the secret extent of these illnesses continues to be unknown in the region, as in much of the world, one thing at least is certain: help is on hand for those who seek it.