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The severe nutritional deficiency seen in those with anorexia nervosa (AN) can lead to edema, which is a form of swelling caused by excess fluid trapped in body tissues. (1) Edema can affect any part of the body, including your arms, hands, feet, ankles, and legs, and in some cases, anorexia can cause facial swelling.
Proteins draw water into blood vessels, but when a person is malnourished there are reduced blood protein levels. This can cause water to leak from blood vessels and collect in the surrounding tissues, causing anorexia face swelling.11
The purging behaviors common in those with eating disorder AN, including self-induced vomiting and/or laxative and diuretic misuse, can also contribute to edema development. This is because purging causes water loss, which triggers the release of antidiuretic hormones, signaling the body to retain water and minerals. This leads to edema, typically in the extremities, and is known as peripheral edema.11
Additionally, during the refeeding phase of anorexia recovery, which is a process that helps restore body weight, it’s not uncommon for a person to experience edema. During recovery, someone with AN will stop engaging in purging behaviors, including withdrawing the use of laxatives and/or diuretics and no longer self-inducing vomiting. This sudden cessation of purging behaviors can lead to edema via a condition known as pseudo-bartter syndrome.2
Pseudo-bartter syndrome can occur when there is an increase in an adrenal hormone responsible for retaining salt and water to prevent fainting from low blood pressure. As more salt and water are absorbed without the elimination of fluids through purging, severe edema occurs.2
Weight restoration, also known as refeeding, is a key component of treating and recovering from anorexia nervosa. Studies indicate that anorexia cannot be treated effectively without first restoring body weight. Furthermore, without refeeding, a person with a severe eating disorder may face serious and potentially life-threatening complications of severe starvation.3
Refeeding syndrome is a term used to describe one of the serious complications during the treatment of anorexia. It describes the hormonal and metabolic changes that can occur during the refeeding process of a seriously malnourished patient when improper and excessive nutrition is introduced. (4) It’s caused by a sudden shift in the electrolytes that help your body metabolize food.5
When a person in anorexia recovery starts to consume more carbohydrates, the human body produces more insulin which triggers the flow of electrolytes into cells to energize them. This can result in dangerously low levels of phosphorus that can lead to muscle weakness and the breakdown of blood vessels. This results in a dangerous form of edema.5
Additionally, the increase in insulin levels signals the kidneys to hold onto salt and water, and therefore swelling can occur, including an.6 Other metabolic changes that can occur in refeeding syndrome include:5
Edema in anorexia varies in terms of severity. For some, the edema may be uncomfortable, but in some instances, it can be dangerous. Symptoms of edema include:1
There are several types of edema or swelling that may occur as a result of refeeding syndrome.
Pulmonary edema occurs when excess fluid collects in the lungs, which can make breathing difficult. It is a serious form of edema that should be treated immediately, that can lead to respiratory failure and death.
Also known as peripheral edema, lower extremity edema typically affects the feet, ankles, and legs, but it can also affect the hands and arms. Symptoms include puffiness, swelling, and difficulty moving affected body parts.
Also known as cerebral edema, this form of edema occurs in the brain and causes numerous symptoms, including:
While more research is needed to determine the best way to treat refeeding syndrome, typically, treatment involves replacing essential electrolytes to slow down the refeeding process. (8) The introduction of calories should be slow and is typically about 20 calories per kilo of body weight, or around 1,000 calories initially.9
Frequent blood tests to monitor electrolyte levels can help identify imbalances, which can be addressed with intravenous infusions. Furthermore, fluids are reintroduced at a slower rate, and salt replacement is carefully monitored during the refeeding process.
While more research is needed, studies have shown an estimated 20% of adolescent patients experience edema.10 Although it typically only lasts a few weeks, it can have a significant effect on a person in recovery.
Sudden swelling in the ankles, legs, stomach, and sometimes face can make a person feel like they are rapidly gaining weight, which can be very distressing for someone with anorexia.
Gaining weight, especially around the face, during treatment for anorexia nervosa can be a daunting part of the process. However, there are ways to cope with negative body image issues during treatment and recovery. Here are some tips to remember when recovering from AN.
Your body is going through so much right now, yet it is still supporting you. Practice gratitude for what your body can do instead of focusing on what it looks like. As you eat more, your energy levels are likely to improve, enabling you to do more.
Distraction can be a useful coping skill when used temporarily. Distraction is not meant to suppress your feelings, but you get your mind off a situation that may tempt you into disordered eating behaviors. If you’re feeling upset about the changes happening to your body during recovery, distract yourself by doing something you enjoy, whether it’s binge-watching your favorite show or playing video games.
Reach out to someone you trust about the discomfort you feel. Talking to a friend, family member, or support group can help you to process how you feel and let you know that you're not alone.
While relatively uncommon, swelling of the face, or any other part of the body, during anorexia recovery is uncomfortable, it is only temporary. Support from medical professionals during this phase of anorexia recovery can help ensure that nutritional rehabilitation is done as safely and as comfortably as possible.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
