National Eating Disorder Awareness Week

This week is commemorated to raising awareness of eating disorders. Most college campuses are hosting programs for education, outreach, support and intervention. Even well meaning programs can perpetuate myths about eating disorders and dysfunctional eating or, worse, reinforce among participants worries over their bodies, food, and exercise that encourages disordered eating and dieting behaviors.

A few recent articles have tried to correct common misunderstandings.

As examined last year in “The hidden faces of eating disorders,” those suffering from eating disorders don't always fit the image seen in media. The Ottawa Sun writes of the increase in serious eating disorders being diagnosed in young boys, age 12 and younger:

More boys with eating disorders

...boys make up 10% of adolescents with eating disorders. But [Dr. Mark Norris] said a recent national study found that among children 12 and younger, boys make up 20% of youngsters with eating disorders. In North America, about five out of every 100 teens suffer from an eating disorder. Norris said boys and girls show the same anxieties and stresses that lead them to restrict what and when they eat. A complex combination of genes and personality are at play, said Norris, adding kids who are anxious and perfectionists are more at risk....

Among teens, boys who are athletic develop more eating disorders than non-athletic types.... Physicians are getting better at spotting the symptoms of eating disorders in boys, said Norris. A decade ago, a teenage boy with a low heartbeat would more likely turn up at a cardiology clinic than at an eating disorder clinic....

The most heart-stopping and disturbing piece about eating disorders — one that calls out to be read in full [link in headline] by every healthcare professional — is the personal story of a young woman whose bulimia was so severe she landed in the emergency room. Her story poignantly illustrates that eating disorders are weight blind, nor are they stereotypical mental problems and attention-getting growing-up acts. At First, Do No Harm, a site where people share their experiences with the healthcare profession, she writes:

Binging? Purging? Vomiting blood? Try dieting…

Two years ago, I landed myself in the ER at around 2 AM. I’d been puking my guts up multiple times per day, every day, for months ...[and found] the toilet was filled with blood. The doc in the ER was compassionate and thorough, if somewhat clueless about eating disorders... the doc apprised my internist’s office of my situation and released me. Three hours later (approximately one of which was spent sleeping) I made my way into my new doc’s office. I explained that recently I had lost about a bunch of weight starving and puking nonstop and that now I was restricting much less but still bingeing and throwing up constantly; I told her that I’d had an active eating disorder for about four-five years and I filled in the details of the previous night’s ER episode. She asked about my highest and lowest weights—despite several times losing dramatic amounts of weight quickly and unhealthily, I’ve never been “thin,” and when I told her my highest weight, she said it was “great” that I’d lost the weight ...

Then she put me on the scale. I told her I didn’t want to know my weight, and that she at least respected, but then I got off and she said to me, “well, you’re overweight, but I’m sure you knew that... She goes on to tell me that what she wants to do is put me on a modified Weight Watchers plan and have me come back in a month and weigh me again. (... I am so sick with an eating disorder I am barfing up blood and she’s talking about a DIET?!)

I tell her that I’m really not interested as I’m already working with a nutritionist. She then asks me, in a hostile tone, what exactly I want from her; I’m at a loss for words since I figure it’s pretty self-evident that, um, she’s a doctor and I want her to…monitor my health? ... she then asks why I have an eating disorder—“were you raped or abused or something, or is this just kind of a going-off-to-college/growing up thing?”

She did not do a physical exam other than weight and blood pressure; she did not discuss the ER incident. She did not bring up the possibility that, given that I was puking blood, more tests might be necessary... I’m not sure what level of insensitivity or stupidity you have to reach to actually think that the most important thing you can tell a 21 year old with an eating disorder is that she should lose weight...

The medical community needs a serious wake-up call: not only can there be health at a range of sizes, there can also be illness at a range of sizes. WEIGHT IS JUST A NUMBER!!!

Not only are many eating disorder symptoms being recognized as the physiological and psychological bodily response to weight loss and dieting, dieting can appear indistinguishable from the “healthy” eating and exercise tips being encouraged in our culture today. It is not normal eating, it is dieting and dysfunctional eating, and has even led to a growing form of eating disorders coined by Dr. Steven Bratman, M.D., medical director of Prima Health, as orthorexia nervosa.

There are a number of college eating disorder prevention and treatment programs being conducted this week teaching similar “healthy behaviors,” such as eating “right,” exercising and building self esteem by healthy habits. One Eating Disorder Week initiative for children calls itself “grow your kids slim,” claims that childhood obesity is disordered eating of epic proportions, and offers similar healthy tips for parents. The author believes these are healthy eating and exercise, and different from “unhealthy dieting.” Harriet Brown, author and mother of a recovering teen, received some scary literature from eating disorder professionals that she shared with her readers as an illustration of “what’s wrong with the way we think about food and eating these days:”

Now this is scary

... First off, the newsletter came with a title that suggests that its goal is to empower parents to help heal eating disorders.... But then — now remember this is all going out under the aegis of eating disorders — there's a list of “10 Healthy Eating Tips for Your Child." And here's where things get ugly.

“1. Encourage your child to drink water. Lots of it. Drinking water is essential to losing weight as it keeps the metabolism healthy and functional. Plus, lots of kids feel the urge to eat when, in fact, they are not experiencing hunger, but thirst. Are you aware that drinking soda pop leeches the calcium from your child’s bones? Water is undoubtedly the better way to go!”

Note the assumption here: That “healthy eating" involves losing weight. For a child... Plus, drinking lots and lots of water to feel full is a classic eating disorder strategy. I thought we were trying to heal eating disorders here, not cause them.... Again, this is a strategy designed to fool the child into feeling like s/he has actually eaten something with calories in it. A big no-no....

Instead of “healthy eating” and worrying about the health and appearance of bodies and food, it is “normal eating” that's been forgotten. As incredible as it may sound, a lot of young people don’t know what it means to eat normally and not continually focus on, and fear, what they eat. The closest definition of normal eating was published in 1991 in Radiance Magazine:

Normal eating is being able to eat when you are hungry and continue eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it — not just stop eating because you think you should. Normal eating is being able to use some moderate constraint in your food selection to get the right food, but not being so restrictive that you miss out on pleasurable foods. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is three meals a day, most of the time, but it can also be choosing to munch along. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful when they are fresh. Normal eating is overeating at times: feeling stuffed and uncomfortable. It is also undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life. In short, normal eating is flexible. It varies in response to your emotions, your schedule, your hunger, and your proximity to food. — Ellyn Satter, R.D., A.C.S.W.