ABOUT EATING DISORDERS....Facts, Not Fiction:

• Approximately 30 million Americans live with an eating disorder (ED). 

• Eating Disorders include many diagnoses such as Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder, to name a few.

• Eating Disorders are the third most common chronic illness among adolescent females in the United States.

• 10 million boys and men in the U.S. will suffer from an eating disorder in their lifetime.

• 1/3 of those with an Eating Disorder are men (10 million). Men have an increased risk of dying because they are often diagnosed much later than women.  This is largely due to the misconception that men do not experience eating disorders.

• People with Eating Disorders come in all shapes, sizes, races, cultures, sexes, and ages, and many patients are not appropriately diagnosed because of this.  For example, one of the sickest patient populations that we currently see are teens and young people who are initially deemed "overweight or obese", and lose a significant amount of weight, often in a very short period of time. They then appear as "healthy" to others and receive much external positive reinforcement, when in reality, they are actually quite ill, but flying under the radar until they end up hospitalized for medical instability (i.e. HR's in the 30's).

• Anorexia is the most deadly mental illness, with the highest mortality rate of any other mental illness.

• The rate of children under age 12 being admitted to a hospital for eating disorders rose 119% in less than a decade.

• Over 70% of those with EDs will not seek treatment (due to stigma, misconceptions, lack of education, diagnosis, and lack of access to care).

• Up to 80% of patients who receive and complete evidence-based eating disorder treatment will recover or improve significantly.

• Biologically-Based Eating Disorders: EDMSC, a sub-specialized practice that takes into account that the nature of Eating Disorders (ED) can be biologically-based illnesses (50-80% of the risk for anorexia is genetic), also sees many "healthy" adolescent siblings, because these siblings are statistically at a higher risk to develop an ED, and their well-informed parents want us to catch the illness as soon as possible. 

MYTH BUSTING:

• "People choose to have an eating disorder."  This is probably one of the most common and horrific of all the myths regarding ED’s.  A common, REAL profile of young people who develop EDs are intelligent, "rule-following" kids who may or may not have external stressors and often make a decision based on mis-information. They may decide to "start a little health kick", "give up sweets for Lent", "misunderstood a health teacher", or are encouraged to "eat cleanly" by a coach (just to give a few examples). Once kids who are biologically/genetically predisposed to an ED start to restrict their intake or increase their exercise, weight loss often quickly ensues and the ED is "off to the races" with the young person completely having lost control of what started out as a well-intended "self-improvement".  When I ask patients with ED’s (when they sometimes feel guilty) whether they would wish this illness on their worst enemy, the answer is 100% of the time, "NEVER!!"

Anything that causes restriction leading to weight loss in a vulnerable young person can lead to an ED (some common examples that we see are patients who require jaw surgery and are on a prolonged liquid-only diet, or patients with an acute or chronic health problem that led to unintentional weight loss, etc).  Despite no intention to lose weight, these patients often develop the same "ED Mindset".

• "Parents are at fault for their child having an ED."  Nothing could be further from the truth.  Parents often feel tremendous guilt for missing the signs of an eating disorder. ED’s are extremely tricky and do not want to be exposed.  In fact, evidence-based treament for children and adolescents with EDs involves parents "re-feeding" their children, as children with EDs are unable to re-feed themselves. This is the reason we use these evidence-based treatments such as Family-Based Therapy (FBT), which includes The Maudsley Approach.

• "Young people with EDs are just attention seeking and when they get hungry enough, they will eat."  This is NOT true!! These young people are not able to feed themselves because of the nature of their illness, so parents are often advised by well-meaning, but uneducated people, to "lay off" and allow their children to continue to starve, which just delays diagnosis and treatment, and worsens prognosis.

COMMON SIGNS AND SYMPTOMS IN PATIENTS WITH EATING DISORDERS: 

These symptoms may initially be interpreted as individual issues, leading to appointments with specialists who focus on one symptom, but are unaware that with all signs and symptoms identified, everything can be attributed to the ED, which can affect every organ in the body:

• Bradycardia (HR less than 60)

• Hypotension (age-related, but generally less than 90/60)

• Orthostasis by HR (increase in HR from lying to standing that is greater than 20 points)

• Orthostatic hypotension (decrease in systolic BP by 20 points or decrease in diastolic BP by 10 points when going from lying to standing)

• Dizziness (particularly with positional changes)

• Weakness/fatigue (later symptom)

• Flat affect, angry or irritable affect (particularly around food), emotional regression, depression, or anxiety

• Syncope or pre-syncope (fainting or coming close to fainting)

• Cold intolerance and/or hypothermia

• Pallor (paleness)

• Lanugo ("peach fuzz" that is most common on the face, arms, abdomen, and back)

• Abdominal pain or fullness after eating small amounts of food

• Bloating

• Constipation

• Chest pain/palpitations

• Easy bruising or bleeding

• With Anorexia Nervosa (AN): Labs can be normal, or we can see liver enzymes increase as a result of starvation. We may also see low white blood cell, red blood cell, and platelet counts as a sign that the bone marrow has sustained some damage

• Obsessive body checking 

• Secondary amenorrhea (loss of menses, though this varies VASTLY and is not a requirement for the diagnosis of AN)

• Delayed puberty

BULIMIA NERVOSA (BN):

Purging: (may be with or without bingeing, so one may notice their child eating a very large volume of food prior to bathroom use)

• Puffy face/cheeks

• Using the restroom or showering immediately after meals

• Clogged toilets, sinks, or showers

• Dental erosion or increase in cavities

• Blood in the stool from a tear in the esophagus (appears as black, tarry stools)

• If using laxatives--abdominal cramping and diarrhea

• Dehydration

• Lab findings with BN: Electrolyte abnormalities (i.e. low potassium, low chloride, high bicarbonate), anemia if an esophageal tear is present, and high amylase levels (just to name a few)

• Hidden food and/or vomit in the bedroom

• Irregular menses in females