Water loading refers to drinking excessive amounts of water in a short-period of time. There are several possible reasons for water loading in the disordered eating population. Firstly, large amounts of fluids may be consumed to ward off hunger. Secondly, water loading may be used to aid purging.1 Thirdly, excessive amounts of water may be consumed right before being weighed by a health professional in an attempt to alter the reading on the scale. A possible reason for attempting to falsify weight during a clinic visit is to disguise the weight loss effects of an eating disorder.2 Another possible reason for falsifying weight is to deceive health professionals about complying with a refeeding treatment.3 This can occur because individuals with eating disorders may experience a fear of restoring weight during the early stages of treatment. Since water is an essential nutrient, water loading may seem harmless for the body, however, having too much of anything can harmful. Drinking excessive amounts of water is a dangerous behaviour as it can severely dilute electrolytes and lead to serious medical complications.
Drinking too much water too fast can lead to water intoxication. This occurs when the body takes in more fluids than the kidneys can handle.4 As a result, excess water collects in the blood and dilutes electrolytes, which are responsible for proper nerve and muscle function. When electrolytes are diluted, symptoms such as muscle weakness, muscle spasms, and muscle cramps may occur.5 The heart is an important muscle that pumps blood throughout the body. When electrolytes levels are brought out of balance, the heart can begin to ineffectively pump blood, resulting in cardiac arrest, which occurs when the heart stops functioning properly.2 Moreover, excess fluids can begin to enter the brain cells, causing changes in mental state such as mild confusion and disorientation, and can further progress to hallucinations, delusions, or inappropriate behaviour.6 If left untreated, water intoxication can also lead to seizures, unconsciousness, coma, and even death.6 Early treatment is crucial to prevent fatal complications, thus emergency help should be obtained if any of these symptoms develop.6
Water intoxication requires drinking extremely large amounts of water. The amount of water that will cause intoxication will very between different individuals. Before water intoxication occurs, your body may show more mild signs that you may be drinking too much water. Signs of over-hydration include nausea, vomiting, headaches, fatigue, drowsiness, restlessness, or irritability.4 In addition, very frequent urination may be a sign of over-hydration.
Water intoxication is a medical emergency. It can be treated using an intravenous electrolyte solution or using medication that will replenish electrolytes.4 Medical professionals are becoming increasingly aware that some patients may attempt to falsify their weight readings. As a result, patients may be weighed in a hospital gown with little to no clothing underneath, or unscheduled weight checks may be performed to reduce temptations of weight manipulation.3 In addition, periodic urine tests may also be utilized to either detect or prevent water loading.2 Most attempts to falsify weight are ineffective, not only because medical professional are becoming increasingly aware about it, but also because they pay attention to weight trends; thus, severe weight loss will still reveal a downward trend, even if water loading is used. Therefore, water loading can be a dangerous and ineffective way to manage weight readings. Even though water is necessary for life, our bodies need to receive everything in moderation to stay in balance.
- Marino, J. M., Ertelt, T. E., Wonderlich, S. A., Crosby, R. D., Lancaster, K., Mitchell, J. E., Fischer, S., Doyle, P., Grange, D., Peterson, C. B., & Crow, S. (2009). Caffeine, artificial sweetener, and fluid intake in anorexia nervosa. The International Journal of Eating Disorders. 42(6), 540-545. doi: 10.1002/eat.20633.
- Fluid Loading/Water Loading. InEating Disorders Glossary. Retrieved from http://glossary.feast-ed.org/3-treatment-medical-management/fluid-loadingwater-loadingweight-manipulation.
- Weight Manipulation. In Eating Disorders Glossary. Retrieved from http://glossary.feast-ed.org/3-treatment-medical-management/weight-manipulation.
- Mayo Clinic Staff. (2018). Hyponatremia. In Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/hyponatremia/symptoms-causes/syc-20373711.
- Radcliffe, S., & Watson, S. (2017) Overhydration. In Healthline. Retrieved from https://www.healthline.com/health/overhydration.
- Farrell, D. J., & Bower, L. (2003). Fatal water intoxication. The Journal of Clinical Pathology. 56(10), 803-804. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1770067/.