Eating disorders don’t always look the way people expect them to. And that’s exactly what actor Sana Saeed discovered after spending years unknowingly living with bulimia. The Kuch Kuch Hota Hai and Student of the Year star recently revealed that she struggled silently for a long time, unaware that her complicated relationship with food was actually a recognised eating disorder and that effective treatment was available.
What is bulimia?
Bulimia nervosa is a serious eating disorder characterised by repeated episodes of binge eating, where a person consumes unusually large quantities of food within a short period. These habits are typically followed by attempts to prevent weight gain through self-induced vomiting, excessive exercise, prolonged fasting or the misuse of laxatives and other medications.
According to Dr Sujit Nair, Consultant – Medical Gastroenterology, Hepatology and Endoscopy, KIMS Hospitals, Thane, bulimia is equally a mental health condition, although its impact extends far beyond emotional wellbeing.
“It is primarily a mental health condition,” Dr Nair adds, explaining, “However, repeated purging can cause significant damage to the digestive system. Many people maintain a normal body weight, making the condition difficult to identify in its early stages.
Why does bulimia develop?
There isn’t one single reason behind bulimia. Instead, experts say it usually develops through a combination of emotional, biological and environmental influences.
Dr Honey Savla, Consultant Internal Medicine, Wockhardt Hospitals, Mumbai Central, explains that multiple factors often contribute to the disorder.
“There is no diagnosis and cause of this condition. It usually develops due to a combination of psychological, biological and social factors. A family history of eating disorders. Low self-esteem and anxiety. Depression, perfectionism, body image and the pressure to meet unrealistic beauty standards; all of these silently play a role in this condition. Restrictive dieting is another common trigger, as it may set off a cycle of binge eating followed by guilt and compensatory behaviours,” she says.
Common signs and symptoms
Bulimia doesn’t always leave visible physical signs, making awareness even more important. Some of the most common symptoms include:
Repeated binge eating episodes
Self-induced vomiting after meals
Constant worry about weight or physical appearance
Strict dieting or fasting between binge episodes
Frequently rushing to the bathroom after eating
Swollen cheeks or jaw caused by repeated vomiting
Increased tooth sensitivity or dental erosion
Feelings of guilt, anxiety or emotional distress after eating
Noticeable mood changes
How bulimia affects physical health
Although bulimia begins as an eating disorder, it can eventually affect nearly every part of the body, especially the digestive system.
Dr Nair warns, “Frequent vomiting exposes the food pipe, stomach and mouth to stomach acid. This causes acid reflux, inflammation of the food pipe, gastritis and, in some cases, tears in the oesophagus that may cause bleeding. Dental enamel erosion is also common due to repeated acid exposure. It can also result in dehydration and electrolyte imbalances which affect heart function and become life-threatening if left untreated.”
The emotional burden of bulimia
Beyond its physical impact, bulimia can deeply affect mental health. Many individuals experience persistent shame, guilt and anxiety around food while constantly worrying about body image.
Dr Savla says emotional struggles are often at the centre of the disorder, adding, “People struggle with intense guilt, shame and anxiety around eating, along with a constant preoccupation with weight and appearance. It often coexists with depression, anxiety disorders and obsessive thought patterns, making it difficult to break the binge-purge cycle without professional support.”
“Early recognition and timely treatment are important, as recovery is possible with a combination of medical care, psychological therapy and nutritional guidance,” the expert explains.
Why many cases go unnoticed
One of the biggest challenges with bulimia is that people often hide their symptoms due to embarrassment or fear of being judged.
Dr Saiprasad Girish Lad, Consultant Gastroenterology, says the disorder frequently remains undiagnosed because of this silence.
“Bulimia is a common condition which often goes undiagnosed because individuals may hide their symptoms out of shame or fear of being judged. Increasing awareness and reducing stigma can encourage people to seek help before serious complications develop,” he says.
Can bulimia be treated?
The good news is that bulimia is highly treatable, particularly when recognised early.
Treatment generally combines psychotherapy, especially Cognitive Behavioural Therapy (CBT), with nutritional counselling and, when necessary, medication to manage anxiety or depression.
Dr Lad emphasises that recovery requires a collaborative approach. “Treatment involves addressing the eating disorder and its physical effects. As gastroenterologists, we manage complications affecting the digestive tract, while long-term recovery requires care from a multidisciplinary team that includes a psychiatrist or psychologist, a physician and a dietitian.”