National Eating Disorder Awareness Week

One goal of NEDA week is to get people talking about the issue and reducing the stigma surrounding eating disorders.  Eating disorders are life-threatening illnesses and as with any illness, awareness is the key to prevention, intervention and treatment. It is important to recognize the pressures, attitudes and behaviors that surround this disorder.  Negative self-talk only contributes to the toxic environment and it can be emotionally, spiritually and physically damaging. Let us start today with a reminder of how beautiful YOU are!!  This video is part of Operation Beautiful ~transforming the way you see yourself one post-it note at a time.

Working at a children's hospital has opened my eyes to how prevalent eating disorders are. We see mostly young girls (12-18) admitted, but every now and then there are a few boys. There are the common diagnoses everyone has heard about such as anorexia and bulimia, but there are a few new disorders gaining attention. Check out the symptoms below to make sure you are not missing any important signs of those you care about.

Anorexia Nervosa is defined 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
• Restricting food or types of food, such as food that contains sugar or fat
• Being secretive about food
• Intense fear or anxiety around weight gain or being "fat"
• Feeling "fat" or overweight despite dramatic weight loss
• Loss of menstrual periods
• Extreme concern with body weight and shape
• Constipation and slow emptying of the stomach
• Thinning hair, dry skin and brittle nails
• Low blood pressure, slow heartbeat (<60 bpm)

Bulimia Nervosa is characterized by binge eating followed by purging. Binge eating is defined as eating large amounts of food, more than most people would eat in one meal, in short periods of time and then getting rid of the food/calories.

Symptoms include:

• Repeated episodes of binging and purging
• Feeling out of control during a binge and eating beyond the point of comfortable fullness
• Purging after a binge through self-induced vomiting, abuse of laxatives, diet pills and/or diuretics or fasting
• Frequent dieting
• Extreme concern with body weight and shape
• There is not always a significant weight loss with this disorder
• Dentists can usually detect signs of continued purging  from the enamel erosion on the upper, front inside surfaces of the teeth

Binge Eating Disorder, also known as compulsive overeating, is described as periods of uncontrolled, impulsive or continuous eating beyond a comfortable fullness. This is different from bulimia because there is no purging but it may be replaced with fasts, repetitive diets and feelings of shame or self-hatred afterwards.

Symptoms include:

• Binges, extremely large amounts of food within a 2-hour period at least 2 times a week
• Loss of control during binges
• Binge to reduce stress or for comfort
• Eating alone because of embarrassment
• Eating until painfully full
• Sporadic fasts/diets
• Anxiety
• Depression/low self-esteem
• Loneliness
• Body weight can very from normal to mild, moderate or severe obesity

Exercise Bulimia is less talked about because exercise is considered healthy, but too much can be dangerous. Watch this interview with Dr. Jennifer Ashton and Cal Carlin about one young woman's struggle with exercise bulimia.



Orthorexia is the fixation on "righteous eating." Although not an official diagnosis, the term was coined by Steven Bratman, MD to describe his own experience with food. While anorexics obsess about calories and weight, orthorexics obsess about healthy eating (not about being 'thin' and losing weight). It starts out motivated by health. However, they become increasingly concerned about what and how much to eat and what to do about 'slip-ups.' They usually self-punish, by stricter eating, fasts and exercise, if temptation wins. Eventually their food choices can become so restrictive that their health suffers.  The 'healthy eating' can interfere with activities, interests and relationships and become physically dangerous.

NEDA suggests the following questions:

• Do you wish that occasionally you could just eat and not worry about food quality?
• Do you ever wish you could spend less time on food and more time on living and loving?
• Does it sound beyond your ability to eat a meal prepared with love by someone else-one single meal-and not try to control what is served?
• Are you constantly looking for the ways foods are unhealthy for you?
• Do love, joy, play and creativity take a backseat to having the perfect diet?
• Do you feel guilt or self-loathing when you stray from your diet?
• Do you feel in control when you eat the correct diet?
• Have you positioned yourself on a nutritional pedestal and wonder how others can possibly eat the food they eat?

Diabulimia is a scary new fad that I recently learned about. Type 1 diabetes often manifests at a young age when children and young adults may already be self-conscious. Having to deal with their disorder and body image proves to be too much for some. They learn that their body is dependent on insulin, but that insulin encourages fat storage. So they manipulate their doses, taking just enough to avoid going into diabetic ketoacidosis. This is dangerous because their blood sugar levels run higher than normal and they become dehydrated, fatigued and lose muscle tissue. Without intervention, these patients are at risk for an earlier onset of diabetic complications such as eye disease, kidney disease and limb amputations due to vascular disease. The long term damage that can result from this behavior is no joke. If you have any concerns, let someone know, early intervention can make a world of difference. 


Thin:
I'm sitting at my desk, watching the 2006 HBO documentary 'Thin.' A feeling of sadness overwhelms me as I see these young girls literally sob as they choke down their food. They beat themselves down until they are completely shattered. Many struggle with control issues, negative thoughts, depression and anxiety.  They manipulate those around them to feed their disease. They have so much going on inside, that they can't enjoy all the amazing things in life. When asked what kind of things she could have avoided if she had gotten help at 15, Jen, now 28, fights back tears.

 "Damn, I would have enjoyed so many things! I looked back at twelve years and said 'What do I remember?' I remember sitting at tables. I remember going to Thanksgiving dinners with pre-packaged meals for ME and to sit at the table with other people, eating MY food, while everyone else was enjoying Thanksgiving. It was embarrassing! It was shameful! And now, I'm 28 and I'm a little girl with no period. And my boyfriend said to me 'I want to spend the rest of my life with you but at the rate we're going, I'm going to bury you in five years."

The other issue brought to light in this documentary is insurance coverage, or lack thereof, forcing many girls to leave treatment before they are ready. This is almost a guarantee that ED will win the battle. The cameras continue to follow one of the girls after she is forced to return home. While her children are watching a cartoon, she sneaks away to purge in the other room. Heart breaking. Eating disorders have a tight grip on those affected and can continue to be life-long battles just like alcoholism or drug addictions. It's hard to comprehend, only those with enough money get the treatment they need, and it frustrates the hell out of me!

Media Watchdog Program:

This program was created to promote positive media messages regarding size, weight and beauty. Unrealistic and computer enhanced images can put a lot of pressure on young girls. This group of volunteers monitors TV, radio, newspaper, magazine and internet ads or programs to discourage negative or irresponsible advertising. Ads worthy of praise are those that display a variety of natural body shapes and sizes, attribute similar positive characteristics to heavy and thin people of diverse identity groups, incorporate images of people eating balanced meals and ads that include women in situations which imply equal social power and an understanding that women are more than objects of beauty. Ads that may spark protest are those that include emaciated models, computer enhanced images, a large person whose attributes or character are portrayed negatively and those that glamorize images of people on diets or portray people relying on food as a way to respond to stress, frustration or loneliness. Below is a video released by Dove that I think every woman should see.

Body Image:
There was a time in my teenage years where I was very hard on myself. I look back at journals and I beat myself up quite a bit. I would pick out all of my negative attributes....I thought my thighs were too bulky, my bum too big, my ears were shaped funny, my nose too pointy and so forth. I would focus on calories (fat free this, sugar free that) not on whole, balanced meals. There was even a time when I tried diet pills, frustrated to find  they only made me sick. Not once did I talk about the positive things, what made me beautiful on the inside. At that point in my life, the outside was what I thought defined me as a person. It is amazing what a difference 5-10 years makes. Now, I look at food much differently. I focus on nourishing my body with healthy, nutrient-rich foods but also delight in savory, flavorful eats. I still need to work out the perfect schedule for keeping on top of my workouts, but I don't stress about it. It is important to me to live a healthy lifestyle, but it is just as important to enjoy my life. Life is too short to dwell on the negative.

 I believe one of the most important relationships we have, is the one with ourselves. This relationship sets the bar for all other relationships. Love your body and nourish it with the things it needs: balanced meals, exercise, a little dessert, love, acceptance, praise, etc. I hope that someday those girls (and every other girl/woman/boy/man) realize it is possible to enjoy life and maintain a healthy relationship with food and exercise. We are so much more than figures, ladies! We are all unique, we weren't cut out of the same cookie cutter for a reason. Celebrate and love who you are because you, my friend, are fabulous!

Make a promise. Instead of putting each other down, let's build each other up!

Additional Sources:

• National Eating Disorders Association. http://www.nationaleatingdisorders.org/index.php
• Operation Beautiful. http://operationbeautiful.com/
• "Diabulimia - Eating Disorder."  MedicieNet http://www.medicinenet.com/script/main/art.asp?articlekey=81960