Health Resource Center

Eating Disorders

In the United States, as many as 10 million females and 1 million males are fighting a life and death battle with an eating disorder such as anorexia or bulimia. Approximately 25 million more are struggling with binge eating disorder. Because of the secrecy and shame associated with eating disorders, it is very likely that many more cases are not reported. While eating disorders may begin with a preoccupation with food or weight, according to the National Eating Disorders Association, eating disorders are complex conditions that arise from a combination of long-standing behavioral, emotional, psychological, interpersonal, biological and social factors, all of which need to be addressed for effective prevention and treatment.

In recognition of this serious problem and National Eating Disorders Awareness Week (Feb. 24 – March 3), Health Politics, the National Eating Disorders Association (NEDA), the National Women’s Health Resource Center, and the New York University Health Center have partnered to bring you the following information. You can also view a video about eating disorders by Mike Magee, M.D., host of Health Politics, at our Web site.

Health Politics Interview: NYU’s Allison Topilow Dr. Magee sits down with Allison Topilow, a nutritionist and adjunct professor at New York University. In the interview, Dr. Magee and Ms. Topilow discuss eating disorders on college campuses and ways to help students develop a healthy lifestyle and body image. View 15-minute interview View 23-minute interview

What is An Eating Disorder?

According to the NEDA, eating disorders such as anorexia, bulimia, and binge eating disorder include extreme emotions, attitudes, and behaviors surrounding weight and food issues. They are serious emotional and physical problems that can have life-threatening consequences. Below are descriptions of the different types of eating disorders, from NEDA’s Web site :
Anorexia Nervosa is characterized by self-starvation and excessive weight loss.

Symptoms include:

• Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level
• Intense fear of weight gain or being “fat”
• Feeling “fat” or overweight despite dramatic weight loss
• Loss of menstrual periods
• Extreme concern with body weight and shape

Bulimia Nervosa is characterized by a secretive cycle of binge eating followed by purging. Bulimia includes eating large amounts of food--more than most people would eat in one meal--in short periods of time, then getting rid of the food and calories through vomiting, laxative abuse, or over-exercising.

Symptoms include:

• Repeated episodes of bingeing and purging
• Feeling out of control during a binge and eating beyond the point of comfortable fullness
• Purging after a binge, (typically by self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, or fasting)
• Frequent dieting
• Extreme concern with body weight and shape

Binge Eating Disorder (also known as Compulsive Overeating) is characterized primarily by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full. While there is no purging, there may be sporadic fasts or repetitive diets and often feelings of shame or self-hatred after a binge. People who overeat compulsively may struggle with anxiety, depression, and loneliness, which can contribute to their unhealthy episodes of binge eating. Body weight may vary from normal to mild, moderate, or severe obesity.

Other eating disorders can include some combination of the signs and symptoms of anorexia, bulimia, and/or binge eating disorder. While these behaviors may not be clinically considered a full syndrome eating disorder, they can still be physically dangerous and emotionally draining. All eating disorders require professional help.

What Causes Eating Disorders?

• Evidence suggesting a genetic predisposition shows that anorexia may be more common between sisters and in identical twins.
• It is estimated that one has a five-to-six greater chance of developing an eating disorder if an immediate relative has one.
• Other research points to hormonal disturbances and to an imbalance of neurotransmitters, which are chemicals in the brain that, among other things, regulate mood and appetite.

In most women, an event or series of events triggers the eating disorder and allows it to take root and thrive. Triggers can be as subtle as a degrading comment or as devastating as rape or incest. Times of transition, such as puberty, divorce, marriage or starting college can also provoke eating problems. Parents who are preoccupied with eating and overly concerned about or critical of a daughter’s weight, and coaches who relentlessly insist on weigh-ins or a certain body image from their athletes, especially in weight-conscious sports including ballet, cheerleading, diving, wrestling, and gymnastics, may also encourage an eating disorder.

According to NEDA, people with eating disorders often use food and the control of food in an attempt to compensate for feelings and emotions that may otherwise seem over-whelming. For some, dieting, bingeing, and purging may begin as a way to cope with painful emotions and to feel in control of one’s life, but ultimately, these behaviors will damage a person’s physical and emotional health, self-esteem, and sense of competence and control. For a more detailed description of the general issues that can contribute to the development of eating disorders, visit NEDA’s “Causes of Eating Disorders” page.

Addressing Symptoms and Preventing Them

When confronting a person with an eating disorder, it's important to have a plan, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD).  A confrontation can be difficult because those suffering from eating disorders are often in denial and the topic is very sensitive.  However, even if a person does deny the problem, the initial seed has been planted, and hopefully at some point in the future, the problem will be recognized and admitted.  The following scheme, from ANAD’s Web site, is when confronting someone:

The Plan: “CONFRONT'”

C- Concern.  The reason you are doing the confronting is because you care about the mental, physical, and nutritional needs of the person.
O- Organize.  Decide in advance who will be involved, where to confront, why the concern, how to talk, and when is a convenient time.
N- Needs.  What will be needed after the confrontation?  Professional help and/or support groups are options to consider.
F- Face the actual confrontation.  Be empathetic, but direct.  Do not back down if the problem is initially denied. 
R- Respond by listening carefully.
O- Offer help and suggestions.  You may want to encourage the person to contact you when there is the need to talk to someone.
N- Negotiate another time to talk and a time span to seek professional help.
T- Time.  Remember to stress that recovery takes time and patience.  However, there is a lot to gain by the process and a lot to lose if the choice is made to continue existing habits.

NEDA points out that you cannot force someone to seek help, change their habits, or adjust their attitudes. You will make important progress in honestly sharing your concerns, providing support, and knowing where to go for more information. Below are NEDA’s tips for doing that:

• Learn as much as you can about eating disorders. Read books, articles, and brochures.
• Know the differences between facts and myths about weight, nutrition, and exercise. Knowing the facts will help you reason against any inaccurate ideas that your friend may be using as excuses to maintain their disordered eating patterns.
• Be honest. Talk openly and honestly about your concerns with the person who is struggling with eating or body image problems. Avoiding it or ignoring it won’t help!
• Be caring, but be firm. Caring about your friend does not mean being manipulated by them. Your friend must be responsible for their actions and the consequences of those actions. Avoid making rules, promises, or expectations that you cannot or will not uphold. For example, “I promise not to tell anyone.” Or, “If you do this one more time I’ll never talk to you again.”
• Compliment your friend’s wonderful personality, successes, or accomplishments. Remind your friend that “true beauty” is not simply skin deep.
• Be a good role model in regard to sensible eating, exercise, and self-acceptance.
• Tell someone. It may seem difficult to know when, if at all, to tell someone else about your concerns. Addressing body image or eating problems in their beginning stages offers your friend the best chance for working through these issues and becoming healthy again. Don't wait until the situation is so severe that your friend's life is in danger.

Your friend needs as much support and understanding as possible.

The National Women’s Health Resource Center has specific suggestions for parents who might be able to stop an eating disorder in their child before it happens. According to the NWHRC Web site, how we perceive our bodies is only one component of a complete self-image, but too often it becomes the sole factor in determining self-esteem. When "how-I-look" becomes more important than "who-I-am," the groundwork is laid for crippling and life-threatening eating disorders. Parents can do a lot to prevent that from happening, beginning with examining attitudes about their own bodies and by fostering a healthy, positive body image in their children. Below are some steps to help discourage unhealthy behaviors. Other steps can be found on the NWHRC site at http://www.healthywomen.org/content.cfm?L1=3&L2=23&L3=3.0

• Accept that puberty will influence girls’ perception of their bodies, but be prepared to step in if certain behaviors become unhealthy
• Don’t reinforce the message that women have to look a certain way
• Talk about images of women in the media and how they are unrealistic for most, if not all, women
• Encourage children to be active as a way to have fun and to enjoy what their bodies can do
• Model healthy attitudes about your own body. Girls need to see women who are satisfied with their bodies and appearance or who take positive and healthy steps toward making changes. Girls who see their mothers worrying about their own appearance and weight are more likely to believe that being thin will make them happy.
• Don’t nag about eating or focus on eating habits, which could make a child more self-conscious and secretive about her relationship with food
• Don’t compare her to others and don’t be judgmental about other people’s weight
• Most important, don’t ignore an eating disorder. It is a devastating and potentially fatal disease. But people can and do recover from this illness, once it is correctly diagnosed and treated. If you are a mature woman with an eating disorder, talk to a health care provider for guidance. Support groups may also be helpful.

What Some Colleges Are Doing About the Problem

Health Politics has identified five colleges with outstanding eating disorders programs for their students. Click here to view information about these programs.

What About Treatment?

Eating disorders are most successfully treated when diagnosed early. The longer abnormal eating behaviors persist, the more difficult it is to overcome the disorder and its effects on the body.

Once the eating disorder is diagnosed, a health care professional can assess whether hospitalization is necessary or if the person can be treated as an outpatient. The information below is from the Harvard Eating Disorders Center:

• Conditions warranting hospitalization include the following:
• excessive and rapid weight loss
• serious metabolic disturbances
• clinical depression
• risk of suicide
• severe binge eating and purging
• psychosis
• Many treatment plans are comprehensive due to the complex interaction of emotional and psychological problems in eating disorders.
• Treatment often involves a combination of interventions including
• individual, group, and/or family psychotherapy
• nutritional counseling
• cognitive therapy
• behavioral therapy
• antidepressant medication

Ongoing emotional support is necessary for the individual, as recovery is a long process and relapse is common.

Resources for Help

National Eating Disorders Association
            Web site: www.nationaleatingdisorders.org
            Information and Referral Helpline: 800-931-2237

National Eating Disorder Information Center (Canada)
            Web site: http://www.nedic.ca/
            Helpline: 866-NEDIC-20

Helping End Eating Disorders (HEED)
            Web site: www.heed.org
            Helpline: 516-695-1054

American Dietetic Association
            Web site: http://www.eatright.org/Public/