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Eating unwell

(article, Marissa Lippert)

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“I’ve noticed recently that my teenage daughter has been watching her food intake extremely closely. I’m concerned she may be headed down an unhealthy path with an eating disorder. How do I know when it’s time to seek help, and how do I approach her?”

With so much focus lately on obesity, not to mention the country’s gigantic portion sizes, it’s easy to overlook problems at the other end of the food spectrum, where not eating enough is the problem and miniscule portion sizes are a cause for concern. 

The latest version of the "Beverly Hills, 90210" television franchise, “90210,” has inspired concern that some of its actresses are simply too thin. The oft-repeated question is: Do these actresses, along with other skinny celebrities, serve as negative influences on teens and young adults?

[%image reference-image float=left width=400 caption="One in five American women suffers from an eating disorder."]

Hollywood aside, it’s important to take these matters seriously and not let altered or extreme eating behaviors progress. According to the Alliance For Eating Disorders Awareness, eating disorders afflict up to 24 million Americans each year and nearly 70 million worldwide — adults, teens, and even young children, male and female alike. One in five women suffers from an eating disorder, and an estimated 11 percent of high-school students have been diagnosed with an eating disorder. 

Disordered eating can be an incredibly painful, emotionally and psychologically exhausting battle for both the victims and their loved ones. A recent interactive “Patient Voices” piece on the New York Times  website highlighted the impact eating disorders can have. As one 17-year-old female who struggles with anorexia said, “People so don’t understand this disease. As much as it seems like a choice, it’s not conscious. This is not something I’ve chosen. This is something I’ve been dealt.”

Recovery can be a long and difficult path, but the more parents, family, and friends engage in open communication about food, healthy eating, and healthy body image, the more comfortable things become — and hopefully, serious conditions can be prevented.  

Here’s a quick rundown of the various types of eating disorders, some signs of trouble to watch for, and resources to contact.  

h3. Defining eating disorders 

Bulimia: Individuals suffering from bulimia eat large quantities of food (healthful or unhealthful) in a very short period of time, an act known as binging. In turn, the food consumed is often purged in order to alleviate a feeling of guilt and a fear of weight gain. Bulimics have a compulsive, compelled feeling to purge food shortly after eating. Binge-purge episodes may occur multiple times a day or a few times a week or month.

Anorexia nervosa: Anorexia is restrictive eating coupled with an intense fear of gaining weight.  Anorexics often use food as a method of controlling stress, anxiety, and life. The condition is commonly coupled with body dismorphic disorder: thinking you're fat when in reality you're extremely underweight. Typical symptoms include the absence of menstrual cycles; bone-density loss; thinning hair; brittle nails; dry, cold skin; fine hair that develops over skin as a protective mechanism to maintain body temperature; low blood pressure; slowed heart rate, which can be life-threatening; and a general irritable mood. Over-exercising, diet pills, and appetite suppressants may partner with food restriction.    

Binge-eating disorder (BED): Binge-eating disorder is defined as the compulsive urge to consume excessive quantities of food, typically done in secrecy in a very short amount of time without purging. It’s possible to put away as many as 10,000 to 20,000 calories in a single binge episode. (The average individual usually takes in 1,500 to 3,000 calories in a day.) Symptoms tied to BED may include depression; anxiety; eating far past the point of satiety; feelings of guilt or shame; hiding or sneaking food; and eating alone. Individuals suffering from BED may be a normal weight, overweight, or obese.   

Orthoexia: This is a newly defined type of eating disorder characterized by obsessing over health food, calories, nutrients, and the need to “purify” the body only through "healthful" foods — nothing processed or toxic, primarily organic and raw foods. This condition manifests itself in psychological obsession. Orthoexics can often spend multiple hours preparing just one meal for the day. They are typically consumed with thoughts of food, vitamins and minerals, and nutrient quality.  
h3. Signs and symptoms

Below are some common signs of developing or serious eating disorders. For additional signs and symptoms, see the eating-disorder website Something Fishy.

 Dramatic or rapid weight loss
 Brittle nails, hair loss, pale yellow/gray skin tone
 Extreme fatigue, anxiety, shift in mood, depression
 Complaints of being cold, wearing baggy clothing 
 Obsessive writing or conversation about thinness and weight
 Weighing oneself on a scale multiple times a day
 Obsession over fat, calories, protein content in foods
 Frequent trips to the bathroom after meals and throughout the day
 Moving food around the plate, cutting food up but not eating much
 Restricting food intake, compulsive exercising for a number of hours
 Eating alone, reclusive, fear of food prepared by anyone else or at a restaurant
 Hiding or hoarding food, being secretive
 Frequent headaches, colds
 Loss of menstrual cycle
 Low blood pressure
 Loss of self-esteem, discouraging comments about self
 Reading about weight loss or visiting websites that promote eating disorders (yes, there are such things)
h3. Resources and help

The first thing you should do is sit down and talk with your daughter. In any intervention regarding an eating disorder, it’s important to communicate with the individual you’re concerned about. If you’re unsure of how to approach the situation, seek out the assistance of someone close to the person — a friend, teacher, coach, or health professional. 

It’s important for anyone intervening to remember that these are often delicate situations, and simply sitting down with the individual and expressing concerns and asking questions in a non-judgmental manner is a critical step forward. Continuing to engage in conversation is key. 


h1. Resources and treatment

Eating Disorder Referral and Information Center

National Eating Disorders Association

Something Fishy 

National Association of Anorexia Nervosa and Associated Disorders


Many eating-disorder victims will deny that anything’s wrong, but still be racked with guilt and angst. They may feel that if they acknowledge there’s a problem, it’s a sign of failure, weakness, or lack of control. 

Often, it’s beneficial for them to explore a variety of therapies to overcome their illness and achieve their recovery goals. Looking into intensive in-patient or out-patient treatment programs is often the next step toward getting help (see sidebar). Treatment programs typically involve nutrition education, family counseling, and psychological therapy (interpersonal, cognitive behavioral, and psychotherapy). Extremely severe, life-threatening situations may require hospitalization and medication.  

For some people with eating disorders, treatment and recovery may be a lifelong path, and the sooner problems and concerns are addressed, the better. From a personal perspective, I think it’s so important as parents, friends, and colleagues to talk about the goodness of food and what it provides our bodies: energy; healthy skin, hair, and nails; disease prevention; enhanced athletic and intellectual performance; and so much more. Food should empower and excite us, sustain and nourish us.
Building a comfortable, strong connection to fresh, wholesome food from the get-go and emphasizing healthful body images (both at home and in the media) can lessen the stigma of eating disorders and hopefully serve to prevent them.

p(bio). Marissa Lippert* is a registered dietitian and nutrition consultant in New York City.

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