Addressing and Preventing Eating Disorders
Eating disorders are mental health issues characterized by severe disturbances in eating behaviors. Disordered eating may involve eating too little or too much, rigidly restricting food portions or types, eating compulsively or purging eaten food. Some changes in eating patterns may originally come out of a desire to be healthier and more physically fit, but disordered eating can spiral out of control with life-threatening side effects.
“Eating disorders don't discriminate,” says Suzanne Straebler, PhD., PMH-BC, director of Clinical Care for the Eating Disorder Partial Hospital Program and Outpatient Eating Disorder Specialty Clinic at Weill Cornell Medicine. “Eating disorders affect people of all genders, races, ethnicities, socioeconomic status and sizes.”
“We're seeing [eating disorders] start at a younger age. We have been accepting patients as young as 11 in our unit,” says Melissa Klein, PhD., assistant professor of Clinical Psychology in Psychiatry at Weill Cornell Medicine and an assistant attending psychologist at New York Presbyterian Westchester Division. “We also see it go up into much older ages: 50s, 60s. I think we're seeing a lot more disordered eating overall.”
Recognizing the Different Eating Disorders
Since eating disorders are as varied as the people they affect. Recognizing the different disorders can help you or your loved ones identify their presence much faster. The most common eating disorders include:
- Anorexia nervosa. People with anorexia often have a distorted sense of their body size and shape, known as body dysmorphia, and believe they are much heavier or bigger than they really are. This distorted body image occurs together with an overpowering fear of gaining weight. In an attempt to control weight, people with anorexia will extremely restrict their food intake, exercise excessively or both.
- Avoidant/restrictive food intake disorder (ARFID). People with ARFID are extremely selective eaters with an intense aversion to certain tastes or textures, a fear of vomiting, choking, or not being interested in eating. Their diets are so restricted that it may lead to medical problems such as poor growth or nutritional deficiencies.
- Binge eating disorder (BED). People with BED consume large amounts of food even when not hungry, and are unable to stop eating until uncomfortably full. They often feel disgust or guilt and may conceal their eating habits out of embarrassment.
- Bulimia nervosa. This disorder combines uncontrollable binge eating with an overwhelming urge to control weight. After overeating, a person with bulimia will purge the food by various methods such as vomiting, taking laxatives or using enemas. They may also engage in excessive exercise or periods of fasting.
Also, be watchful for changes in eating patterns. Being underweight is not the only indication of disordered eating—people with eating disorders can be normal weight or overweight. Depending on the specific illness, signs of disordered eating may include:
- Preoccupation with appearance and perceived physical flaws, especially weight and body shape.
- Anxiety around food-related social situations such as eating at restaurants, on vacations or holidays.
- Food rules and rituals such as inflexible ideas about acceptable foods, keeping detailed records of weight, body measurements, calories or exercise, or dividing one bite of food into several tiny pieces.
- Secrecy around eating by hoarding food, hiding empty food packages, going into the bathroom after every meal to purge, reluctance to eat in front of others or lying about how much they have eaten.
Eating Disorders Prevention
The exact causes of eating disorders are not well understood, but likely are due to a combination of genetic, psychological and social influences. For many young people, mixed messages about weight and attractiveness from peers, mainstream media and social media can be particularly powerful. Parents can counter some of these influences by modeling healthy behaviors and attitudes around eating and exercise at home.
Dr. Straebler and Dr. Klein advise that instead of labeling foods as good or bad, demonstrate that all foods can be enjoyed in moderation. Provide a wide variety of foods at mealtimes, and emphasize that food is a source of energy the body needs. It’s also important to not talk negatively about your own body size and shape, and to avoid commenting on your child's weight.
Eating Disorder Treatment
Eating disorders are complicated, and often occur together with other mental health issues such as depression, anxiety, obsessive-compulsive disorder or substance use disorders. Fortunately, effective treatments are available. Early detection and swiftly seeking help are key to helping someone achieve lasting recovery from an eating disorder.
“Eating disorders are very difficult illnesses to treat,” Dr. Klein says. “What we do see is that patients can be very responsive to treatment. With adolescents, when this disorder is caught early and they're given the help that they need, we do see a high rate of recovery.”
Treatment plans are tailored to the affected person’s needs. Plans typically focus on ensuring adequate nutrition, restoring weight, stopping cycles of binging and purging, and curtailing extreme exercise routines. These goals are usually achieved through a combination of approaches, which may include:
- Psychotherapy. Therapeutic approaches include cognitive behavioral therapy (CBT) and family-based treatment (FBT), also known as the Maudsley method. CBT focuses on developing greater awareness of the emotions and thoughts that lead to disordered eating, and it generally works best for adults. For children and adolescents, FBT treatment gets adults in the household involved to restore the child’s weight and reestablish healthy eating patterns with the entire family’s awareness and support.
- Nutritional counseling. Working with a registered dietitian helps people with eating disorders gain insight into their attitudes toward food and better understand how to make long-term changes to their eating habits.
- Medications. While there are currently no medications to cure eating disorders, prescription drugs help reduce symptoms of co-occurring conditions such as depression or anxiety.
- Medical care and monitoring. Some people may need medically supervised care to ensure they eat enough, get binging or purging under control, and address health problems related to malnutrition. Following inpatient treatment, people with eating disorders may continue to need therapy to address ongoing psychological issues.
“For most people, eating disorders are treatable,” Dr. Straebler says. “One of the most rewarding aspects of working with individuals and families is that moment where either the parent comes in and says, ‘My child is back to who they used to be,’ or the adolescent even says, ‘I feel like my old self.’”
Concerned about your eating habits or those of a loved one? Talk to your provider about eating disorders. Find a doctor today.