Eating Disorders

June 14, 2019

Dr. Shannon Albert

Eating disorders (ED), as the name suggests, are characterized by a difficult relationship with food and feeding behaviors. The most commonly known eating disorders are Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. However, eating disorders span the wide range of weight- and eating-related disorders. This includes: compulsive overeating, avoidant/restrictive food intake, orthorexia, and laxative abuse. When distressing or health impacting symptoms are present but do not quite fit diagnosis criteria for other EDs, health care providers might consider a diagnosis of other specified feeding or eating disorder or unspecified feeding/eating disorder.

In the USA, over 30 million people live with an eating disorder (The Emily Program, 2019); these disorders have one of the highest mortality rates amongst mental illness. Warning signs to be aware of include:

Preoccupation with weight, food, calories, nutrition labels, dieting
Increasing restrictions on what foods are okay to eat, or cutting out entire food groups
Discomfort or avoidance of eating around others
Skipping meals altogether
Food and eating rituals that cause distress when interrupted

Who is affected?

Eating disorders do not discriminate. People of all ages, sizes, shapes, genders, and race/ethnic backgrounds can experience eating disorders. Eating disorders affect male-identified and gender non-conforming people with the same degree of severity as they do women.

Eating disorders can begin at any age, though prevalence rates are higher among youth under 18 years of age, and some people experience disordered eating for the first time in their 40’s, 50’s, and beyond. Some estimates place the average age of onset for anorexia, bulimia, and binge eating between 18 and 21 years, though symptoms are seen in much younger children as well.

No single thing leads to developing an eating disorder. Genetics, environment, social, culture and personality all factor into individual risks for eating disorders. EDs often occur in conjunction with other issues, such as sexual abuse, post-traumatic stress, substance use, depression, and/or anxiety. EDs can impact every organ system in the body and can lead to other health concerns such as obesity, type II diabetes, osteoporosis, heart failure, and high or low blood pressure. Other risk factors include:

Having a family member with an eating disorder or other mental health concern (e.g. parent, sibling)
History of dieting or use of fad diets
Tendency for perfectionism
Body image concerns or dissatisfaction
Anxiety disorders
Bullying, especially around weight
Exposure to weight discrimination (e.g. media)
Trauma history
Lack of social support

Prevention

Some ways to support teens and people of all ages in being more resilient to eating disorders include (Mayo Clinic, 2018):

Set a positive example of a healthy and balanced relationship with food. Don’t treat food as a reward or punishment; such behaviors set food up as a potential weapon for control. Discourage the idea that a particular diet or body size will lead to happiness and fulfillment. Encourage eating in response to body hunger and allow all foods in your home.
Maintain open, non-judgment communication. Discuss media images and how they might be setting unrealistic expectations of “healthy” bodies or ideal body shapes.
Promote a positive body image: have conversations about self-image, give reassurance that healthy bodies come in various shapes and sizes, do not use hurtful nicknames or negative jokes that target physical characteristics and avoid commenting on a person based on their weight or shape. Rather, demonstrate appreciation for diversity and all that the body can do.
Foster self-esteem: respect your loved one’s accomplishments, support their goals, listen when they speak and give them the time to share, be curious about their day, look and point out the positive qualities they have that you appreciate.
Remind the person that your love is unconditional, that you accept them as they are.
Encourage the person to share their feelings with others, and to seek out counselling if needed.

How are eating disorders diagnosed?

If you are worried that your loved one might be struggling with an eating disorder, the first step is to talk with them. Share your observations and concerns, and listen to what they have to say in response. If possible, schedule (or encourage them to schedule) a checkup appointment with their primary care provider. Their primary care provider can assess for general risks and order lab testing to identify any other health complications. They will likely also make a same-day referral to Swedish Primary Care Behavioral Health. In consultation with a PCP, the Behavioral Health can support the patient to come up with health goals and a treatment plan that includes connecting the patient to outside eating disorder specialists and resources.

Treatment

Treating an eating disorder ideally involves a multidisciplinary approach, with a combination of psychological and nutritional counseling, along with medical and psychiatric monitoring. Treatment must address the eating disorder symptoms and medical consequences, as well as psychological, biological, interpersonal, and cultural forces that contribute to or maintain the eating disorder. There are different levels and combinations of treatment plans, ranging from outpatient therapy to intensive inpatient hospitalization. The level of care needed is determined by the severity of the eating disorder and health risks present.

There are now a variety of therapeutic modalities that are supported by research to be effective in reducing eating disorder symptoms. These evidence-based approaches include: Family-Based Treatment (FBT), Acceptance and Commitment therapy (ACT), Cognitive Behavior Therapy (CBT), Cognitive Remediation Therapy (CRT), Dialectical Behavior Therapy (DBT), and Interpersonal Psychotherapy.

How you can help a loved one

The first way you can help is educate yourself on eating disorders through reading books, articles, and other materials published by reputable sources. A selection of resources is listed at the end of this article to help you get started.

Before having a conversation with your loved one consider these tips:

Rehearse what you will say. It may help to write out all the points you want to make.
Set a time and private place to talk without interruption
Be honest and open about your concerns
Use “I” statements that focus on behaviors you see. This helps you avoid accusatory language.
Stick to facts, and stay calm. Try not to let emotions and concern overwhelm you.
Express your care but be firm about your boundaries. Avoid making promises that you cannot follow through with
Remove shame from the conversation, let them know you do not think of them as weak and that many people are diagnosed with an eating disorder each year
Avoid telling your loved one to “just stop” or “just eat more”, simplistic solutions like these are unhelpful
Be prepared for strong negative reactions
Encourage your loved one to make an appointment with a health professional themselves
Be prepared to tell someone else about your concerns if your loved one is in danger of hurting themselves