Does bulemia work?

From having lurked in eating disorder communities where people share photos, I can anecdotally tell you that self-professed bulimics tend on the whole to appear to have substantially more body fat (often even obesity) compared to self-professed anorexics. This could be in part due to the comorbidity of bulimia and binge eating without purging, in people for whom it's predominantly a mental health issue. Of course there's also some sampling bias with who shares their images and measurements, but from what's available, there does seem to be a trend.

If satiety is the primary goal, you can get the same effects with less of the permanent destruction of the oropharynx by consuming high-fiber, low-caloric-density foods. /r/volumeeating on Reddit has plenty of recipes in that vein.

I'm a doctor, though I haven't had the ?good fortune to treat many bulemics. It's thankfully rarer here in India than in the West, even if I agree with Scott's theory that it's largely social contagion, it's only slowly taking root.

To put it as succinctly as possible, yes, though that's orthogonal to whether or not it's a good idea.

I can't see where the question even arises really, if you're eating a relatively normal amount of food yet vomiting it back up, you're clearly not getting most of the calories, especially since bulemics try and purge themselves as soon as they can instead of timing things.

Weight loss is obviously a sign of bulemia in clinical practise, most of them have a distorted self image/dysmorphia where despite being quite slim or even thin compared to their peers, they perceive themselves as overweight or at least desire further weight loss.

Regular self-induced vomiting has plenty of downsides, including the erosion of teeth enamel from repeated exposure to stomach acids, dyselectrolytemias from both loss of gastric fluids as well as an improper diet, and finally the cardiac strain from a grossly insufficient intake of calories.

If they're within a normal-ish weight range, we usually refer them for therapy or other psychiatric services, but if they drop down to a very low BMI they often need to be admitted for supervised care.

CICO (accounting for absorption) is trivially true, even if our biology makes adhering to it difficult, and I for one am very glad that Ozempic and other GLP-1 agonists are on the market for obesity, not that the typical bulemic should take them for the purposes of losing weight.

TLDR: Yes, and it works too well, hence the associated health risks.

Short answer: No, and trying this does significant damage to people's health.

The prototypical bulimic goes through a cycle where they severely undereat overall, then occasionally experience (what feels from the inside like) a willpower failure which causes them to "binge", eating an enormous amount in a short time. They're then in a state where, if they let digestion run its course, they'd be sick from the excess; so they make themselves vomit, to prevent that.

I believe the "binge" state is actually hypoglycemia (aka low blood sugar), because (as a T1 diabetic), I've experienced it. Most people who talk about blood sugar in relation to appetite have never experienced blood sugar low enough to be actually dangerous; it's very distinctive, and it includes an overpowering compulsion to eat. It also can't be resolved faster than 15 minutes, because eating doesn't raise blood sugar, digesting raises blood sugar; that can lead to consuming thousands of calories of carbs at once (which would be fine if spaced out a little, but is harmful if concentrated into such a narrow time window).

The other important thing about hypoglycemia is that being hypoglycemic is proof that someone's fat cells aren't providing enough energy withdrawals to survive. The binge-eating behavior is a biological safeguard that prevents people from starving themself so much that they literally die.

Technically yes, but in practice-probably not. 

It is often said that purging 'doesn't work' in the sense that it doesn't "get rid of the calories" and create a deficit. This doesn't seem necessarily true. 

The logical answer seems to be that if the food isn't fully digested before being purged, the calories aren't retained. This seems to be supported by this University of Pittsburgh study:

https://www.researchgate.net/publication/14705396_Amount_of_calories_retained_after_binge_eating_and_vomiting  

-"In 17 normal weight bulimic patients, there appeared to be a ceiling on the number of calories retained after vomiting. That is, whether or not bulimic patients had small (mean = 1,549 kcal, SD = 505) or large (mean = 3,530 kcal, SD = 438) binges, they retained similar amounts of kilocalories (mean = 1,128, SD = 497, versus mean = 1,209, SD = 574, respectively) after vomiting."

It is suggested that bulimics cannot completely empty their stomachs of the food, so some of it is absorbed, but it is true that some (perhaps most) of it is lost by the act of vomiting. 

Whether this actually satiates you long enough to create a calorie deficit is a different question. Dehydration from vomiting and saliva overproduction as well as a suddenly empty stomach may mean you are hungry again unexpectedly quickly, and any calories lost by the act of purging would just be negated by the urge to replace those calories. Even if binging and purging was done repeatedly in a day, some calories are retained through each cycle so the TDEE could easily be met or surpassed. 

Obviously the negative health effects of self inducing vomiting (markedly heart damage and raised cancer risk, lack of nutrient/vitamin absorption) far outweigh any possible benefit. 


 

Probably much better for health overall to have a bowl of veg and fruit at your table for easy healthy snacking (carrots, cucumber, etc)