What you need to know about disordered eating
If your child has an unhealthy relationship with food, then you need to pay attention
Meghan says she is a vegetarian because she loves animals. But as far as you can tell all she eats are salads. She’s always freezing cold, and has she grown taller or is she just skinnier?
Matthew’s going out for track and runs miles a day but he’s sworn off carbohydrates and fights fatigue every day.
Are these teens dealing with normal angst and insecurities or is there a larger issue at work?
There are several types of eating disorders, and some are combinations of disorders. What they all have in common is an unnatural relationship to food. People without this condition eat at regular times, when they’re hungry, and usually a range of foods in appropriate proportions.
Someone with an eating disorder may refuse or pretend to eat despite being hungry. Or they may seem to eat normally with others, while hiding food and gorging themselves on thousands of calories a day in secret.
Some binge eaters then “purge” or throw up what they’ve eaten, also in secret, to avoid gaining weight. Some become hooked on laxatives while others exercise compulsively trying to burn off what few calories they did eat.
The eating disorders most are familiar with are anorexia nervosa, where someone eats very little or restricts most foods, or bulimia nervosa, where someone throws up to avoid gaining weight.
How can you tell the difference between a typical teenage preoccupation with appearance — frequent mirror checks, lengthy bathroom grooming rituals — and mood swings, and a child with an eating disorder? The difference is the extreme.
Hope Damon, a registered dietician in New London who has been working with people with eating disorders for almost 30 years, said disordered eating means not having a comfortable, healthy, manageable relationship with food, and if a parent has a history of disordered eating, their child may not have a good role model.
“A serious eating disorder has the potential to affect and disrupt virtually every system of a person’s body,” said Marcia Herrin of Herrin Nutrition Services in Lebanon. Herrin founded the Dartmouth College Eating Disorders Prevention, Education, and Treatment Program, and teaches pediatric residents at the medical school about nutrition and eating disorders.
“When the body belongs to a child or adolescent who is still growing, the results can be heartbreaking.”
Hormonal and glandular systems are out of whack. Frequent vomiting breaks down teeth. The heart (a muscle) and brain shrink. Metabolic and endocrine abnormalities associated with malnutrition, Herrin noted, can lead to “cognitive deficits,” that is, the inability to think.
“The risk to bone health is the most serious long-term complication, Herrin said. “There’s a short window to fix it during adolescence, but if not fixed then, the person may be dealing with a lifelong problem. There’s no treatment for osteoporosis.”
Changes in bone mass and abnormalities of the brain underscore “the need for swift and aggressive treatment” because this damage may not be reversible, Herrin said.
Binge eating can lead to obesity, type 2 non-insulin dependent diabetes. High levels of blood sugar increase the risk of heart disease. Gastrointestinal and bowel problems such as bloating, constipation and stomach pain are typical of an eating disorder, and the extreme — nausea, vomiting and a distended stomach — may be signs of an impending stomach rupture, which can be fatal.
When to seek help
“Every now and then a person or a parent will call me who isn’t sure if a person or their child has enough of an issue to need help. I always say we aren’t going to do that person any harm by doing an evaluation,” Damon said.
One obese patient of hers had a son who played football that she was worried about; he didn’t want to eat any carbs. Damon gave him some perspective about what he needed to grow and be strong and he was receptive.
Corkery agreed: “Early detection and intervention, even if it doesn’t meet the full diagnostic criteria for an eating disorder, it’s much easier to work on improving health if you’re not trying to overcome years’ worth of behaviors.”
Because many people do not get help soon enough, “It’s way better to get a professional perspective than wish you had two to three years down the line. It’s easier to deal with any behavioral medicine problem when it’s less entrenched,” Damon said.
What causes someone to develop an eating disorder?
“What we thought was the cause has changed,” said Kathy Corkery, a licensed social worker and clinical director of the Center for Eating Disorders Management in Bedford.
“We were trained that it was a control issue, often with a trauma history. But now real thinking and research points to correlations between a genetic propensity for illnesses, with some being more susceptible in combination with environmental stresses/influences and triggers.”
At the Center for Eating Disorders Management, all patients see a licensed social worker or mental health provider to determine if there is any co-occurring psychiatric illness first.
Regular counseling often includes family counseling in the case of younger children (Corkery has seen a child as young as six). Counselors work with parents to improve food and nutrition and manage emotions that contribute to unhealthy behaviors.
Therapies may specifically address trauma, and there is group therapy and peer support. The goal is to improve the quality of life, the clinical director said. Meal plans are basic and there’s a concentrated focus on medical care by nurse practitioners, so clients don’t have to be hospitalized.
“Some of our clients are very physically compromised, whether 70 pounds or above 500 pounds. So we monitor their medications, do urinalysis, EKGs and vital signs. It’s a complicated illness.” Insurance covers the treatment.
“There is a much greater incidence of anxiety, depression, obsessive-compulsive disorder (OCD) and addiction in the population with eating disorders,” Damon said. “If coexisting conditions aren’t recognized and adequately addressed, it’s very hard to get the eating disorder under control.”
Up to 69 percent of patients with anorexia nervosa and 33 percent of patients with bulimia nervosa have a coexisting diagnosis of OCD, according to the National Eating Disorders Association. Also, according to the National Center on Addiction and Substance Abuse, up to 50 percent of individuals with eating disorders abused alcohol or illicit drugs, a rate five times higher than the general population.
Family-based treatment for childhood anorexia is a game changer, Marcia Herrin said. In the past treatment consisted of psychological education with the child, pointing out the error of their ways and trying to figure out other psychological issues. Sometimes this helped depression, but the child still didn’t get better from the eating disorder.
Support and strategies
There are many aspects of treating eating disorders, but for it to be successful, parents need to step up and take back control of the kitchen and meals, according to Herrin, author of The Parent’s Guide to Eating Disorders.
Adolescents and parents need to be trained and supported by professionals to take over their child’s eating habits, which is hard for Americans, she said.
Many parents have high-functioning kids who are used to more freedom. “The kids think they know better and aren’t used to dad/mom saying, ‘You have to eat this; you can’t just eat quinoa or brown rice for dinner,’” said Herrin.
“It’s very hard for modern parents to set limits on presumably competent children. Moms worry about their relationship with their teen, but their health depends upon it.”
Herrin’s advice for parents struggling to set limits is to “fight the disorder, not your child.”
The stakes are high. Anorexics have the highest rate of suicide of any mental health disorder, and they are also susceptible to sudden death from heart issues. Death rates are also higher than normal in people with bulimia and “eating disorder not otherwise specified” (a diagnosis for those with a mixture of atypical anorexia or bulimia).
An anorexic who is 24 percent below her desirable body weight is already in a medically concerning state, said Damon.
“To get her on a meal plan, I always start with a discussion that includes the parent. What is she willing or able to eat? What ‘fear foods’ is she resistant to eating? The ‘voice’ of an eating disorder, the thought process, is not a wellness voice. I try to be flexible about food to not create the mindset that accompanies an eating disorder.
“The challenge for a lot of dieticians that don’t do this work,” Damon said, “is that a lot of messages support eating fruits and veggies, for example. But someone with an eating disorder translates this to ‘only’ and discredits other food groups. A meal plan gives structure and then there is lots of discussion, support and negotiation to find some way to eat adequately.”
Mary Ellen Hettinger, APR is an award-winning reporter, editor and writer, and accredited public relations professional. She won a bronze award in 2017 from the Parenting Media Association for her news feature on perfluorochemicals in NH’s water supply.