Eating Disorder Education

Anorexia Nervosa:

This diagnosis is defined by (1) a restriction of energy intake leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health; (2) an intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain; and (3) disturbed body image, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. People who meet these criteria may either restrict by not consuming enough calories each day (restricting type), or they may binge and purge during the current episode of anorexia (binge-eating/purging type).

Bulimia Nervosa:

This diagnosis is defined by (1) eating a large amount of food in a discrete period of time and feeling out of control while eating; and (2) inappropriate compensatory behaviors to prevent weight gain (e.g., self-induced vomiting, misuse of laxatives, diuretics, fasting, excessive exercise); (3) binge eating and inappropriate compensatory behaviors both occur at least once a week for 3 months; and (4) self-evaluation is unduly influenced by body shape and weight.

Binge Eating Disorder:

This diagnosis is defined by (1) binge eating that is associated with three or more of the following (a) eating much more rapidly than normal, (b) eating until feeling uncomfortably full, (c) eating large amounts of food when not feeling physically hungry, (d) eating alone because of feeling embarrassed by how much one is eating, (e) feeling disgusted with oneself, depressed, or very guilty afterward; (2) marked distress regarding binge eating; and (3) binge eating occurs at least once a week for 3 months.

Other Specified Eating Disorder:

This diagnosis is reserved for sub-clinical eating disorders, in which the disorder causes clinically significant distress or impairment but does not meet the full criteria for one of the disorders listed above. Examples of “other” eating disorders include:

• Atypical anorexia nervosa, in which the individual’s weight is within or above the normal range
• Bulimia nervosa of low frequency or limited duration
• Binge-eating disorder of low frequency of limited duration
• Purging disorder, in which recurrent purging behavior to influence weight or shape occurs in the absence of binge eating
• Night eating syndrome, in which eating occurs after awakening from sleep or by excessive food consumption after the evening meal

Unspecified Eating Disorder:

This diagnosis captures any type of eating disorder that causes clinically significant distress of impairment but does not meet the criteria for any of the eating disorders listed above. Some of the disordered behaviors that fall into this category include:

• Orthorexia: an unhealthy obsession with “health” foods; avoidance of foods that are non- organic and/or may contain sugar, animal products, white flour, fat, or preservatives
• Diabulimia: a person with Type 1 diabetes who purposefully skips or decreases their insulin in an effort to lose weight
• Pregorexia: a slang term that describes a pregnant woman who reduces her caloric intake so as to avoid healthy weight gain during her pregnancy
• Drunkorexia: a slang term that describes severe restricting of food to compensate for the calories consumed from binge drinking; also refers to bingeing on alcohol and then purging

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Many people affected by eating disorders also struggle with other mental health issues; this is known as “comorbidity.” Mental health issues that are often experienced by people with eating disorders include, but are not limited to:

• Depression: decreased interest in activities that were once pleasurable, changes in sleep patterns and weight, irritable or moody, frequent crying
• Anxiety: generalized worry, obsessive-compulsive tendencies, easily stressed, catastrophize seemingly minor issues, fear of social situations
• Substance use: frequent intake of alcohol, nicotine, and/or illegal drugs (these are often used to numb the feelings of anxiety, depression)
• Post-traumatic stress disorder: intense fear, helplessness, or horror after experiencing or witnessing an extreme traumatic stressor; ongoing re-experiencing of traumatic stressor (common for survivors of abuse)
• Attention Deficit Hyperactivity Disorder (ADHD): impulsivity, inattentiveness, and/or hyperactivity that significantly impairs ability to effectively participate in school, home, work, etc. (symptoms must have been present before age 7 to be diagnosed)

Common Personality Traits of People with Eating Disorders

Because eating disorders affect people from all walks of life, there is no one “type” of person who is more or less likely to have an eating disorder. However, there are some common personality traits that are consistently displayed by people with eating disorders, so it is useful to know what these traits look like, as this might help you understand how a person’s behaviors may be closely linked with the eating disorder. It is important to remember that personality traits are rooted in genetics, just like eating disorders, and that people don’t necessarily “choose” to develop these traits.

Common personality traits of people with eating disorders include, but are not limited to:

• Perfectionism: intense focus on doing things perfectly and maintaining a perfect image; constantly feeling as though your efforts are never good enough
• People-Pleaser: concerned with meeting others’ needs before meeting one’s own needs; difficulty with saying “No” to people’s requests for fear that they will be upset or disappointed in you
• Stubborn or Strong-Willed: insist that things be done your way
• Impulsive: less likely to “think things through;” more likely to make rash decisions; may manifest in risk-taking behaviors, stealing, and/or shoplifting
• Dichotomous Thinking: classify things into polar opposites; “black-and-white thinking;” all-or-nothing (e.g., foods are either “good” or “bad”)
• Hypersensitive: extremely sensitive to how others treat you and react to you; easily flustered when you think others might be dissatisfied with you

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Eating disorders wreak havoc on the body. If you or someone you love has an eating disorder, it is imperative to have a complete physical evaluation immediately so as to treat any medical complications before they turn deadly.

Some of the physical complications associated with eating disorders are:

• Dehydration & electrolyte imbalance
• Heart muscle damage
• Irregular heartbeat
• Low blood pressure
• Muscle paralysis
• Kidney damage or failure
• Convulsions, seizures
• Liver damage or failure
• Loss of menstrual periods (i.e., amenorrhea)
• Loss of bone density (i.e., osteopenia, osteoporosis)
• Fertility problems
• Dry and brittle hair, nails, and skin
• Edema (swollen legs and feet)
• Sore throat
• Esophagus damage
• Acid reflux
• Gastrointestinal damage (e.g., bloating, constipation, diarrhea)
• Tooth enamel damage & discoloration

If you or your loved one has experienced some of these complications as a result of an eating disorder, it is imperative to immediately see a physician so as to have a thorough physical evaluation, which should include complete blood work, an EKG, and a bone density scan. Additionally, follow-up care with an endocrinologist and gastroenterologist are critical, since these are two of the body systems that are most affected by eating disorders. If you need referral to a specialist, please discuss with your eating disorder specialist at A New Beginning or your primary care physician.

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Our culture is filled with mixed messages about food, weight, and dieting. From magazines to television shows to the internet, it is hard to know what or who to believe. As the diet industry makes over $5 billion each year on people’s desires to get the body they want, it is important to be an informed consumer and know the truth about how our bodies actually work with food. Below are the top 10 myths about food and diets, and the respective truths about how our bodies really respond to the foods we eat.

Myth #1: Eating a high-protein, low-carb diet will result in weight loss.

Truth: A diet that includes a significant amount of protein while severely reducing grains, fruits, and vegetables is unbalanced and will not lead to long-term, healthy weight loss. In fact, this type of diet can pose health risks, including slow metabolism, high cholesterol, heart disease, kidney stones, and gout. Additionally, eating too few carbohydrates can lead to feeling hungry more often and strong cravings, which may eventually result in overeating. Remember, the body gains weight because of extra calories consumed, not extra carbohydrates.

Myth #2: Counting calories is normal.

Truth: Viewing food in the form of numbers, rather than taste and pleasure, detaches an individual from the body’s natural and innate tendency to regulate the number of calories needed in a meal or a day. When a person artificially regulates a process the body is designed to do on its own, feelings of frustration and deprivation can evolve, which often lead to overeating.

Myth #3: Skipping meals leads to weight loss.

Truth: Skipping meals actually slows metabolism, which means the body is more likely to hold onto whatever calories are consumed, rather than use them efficiently to fuel the body. It also tends to leave the body feeling extremely hungry, which is likely to result in overeating and increased caloric consumption. Side effects of a slower metabolism may include hair loss, decreased concentration, low energy, depression, and poor memory.

Myth #4: Foods are either “good” or “bad.”

Truth: Actually, there is no such thing as “good” or “bad” foods; our bodies only recognize the nutritional content of a food. All foods can fit into a healthy meal plan when there is balance, variety, and moderation. Rather than focusing on eating “good” foods, try to eat a balanced diet that includes carbohydrates, protein, and fat. By following this approach, your body can benefit from both salads and cupcakes.

Myth #5: Low-fat and no-fat diets will lead to weight loss.

Truth: Just like protein and carbohydrates, fat is a necessary nutritional component. Fat actually helps the body feel satiated and remain full longer, thus minimizing the chances of overeating. Additionally, “fat free” products tend to have more sugar and calories than their full fat counterparts. Severely restricting fat from one’s diet can result in constipation, gall stones, and low energy levels, and will likely affect the body’s ability to absorb fat-soluble vitamins necessary for optimal health.

Myth #6: It is best to maintain as little body fat as possible.

Truth: Maintaining a low body fat percentage is actually quite dangerous. One tenth of the brain is made up of fat, and it requires additional fat to effectively transmit messages among neurons. Furthermore, fat functions as a protective mechanism to keep organs in place; without fat, organs could rub together causing internal bleeding and death. While every body’s nutritional needs and physical compositions are different, the average woman should maintain a body fat percentage between 21-36%, and the average man should maintain between 8-25%.

Myth #7: The hCG diet is an effective way to lose weight.

Truth:hCG is actually the hormone produced by the human placenta during pregnancy, and in recent years has been used as a medication to increase a woman’s fertility. hCG diets tend to include a severely restrictive meal plan.

Myth #8: Eating at night will lead to more body fat.

Truth: While many diets claim that eating at night will cause the body to store more fat because these calories do not get burned off with regular activity, this is simply not true. The body needs calories all throughout a 24-hour period, including during the evening. In fact, the body digests food and uses calories the same way regardless of the time of day, and whatever energy gets stored at night while sleeping will be used during the following day’s activities. It is best to evenly distribute calories throughout the day, starting with breakfast and ending with a snack before bed to ensure that the metabolism remains consistently active, thus preventing overeating and subsequent weight gain.

Myth #9: Eating high-fat foods will lead to rapid weight gain.

Truth: Bodies do not naturally gain weight quickly (nor do they naturally lose weight quickly). Every pound of weight gained equals 3500 extra calories consumed above and beyond whatever the body needs calorically. Thus, if the scale is up a few pounds after enjoying nachos for dinner or popcorn at the movies, it is likely due to temporary water and/or salt retention and will resolve itself soon. While consuming these foods on a regular basis will likely result in more permanent weight gain, balancing these foods with healthier options and regular physical activity will minimize their effects on your weight.

Myth #10: All white, processed grains are bad.

Truth: While whole grains may be the healthier choice, refined grains are fine to eat so long as they’re consumed in moderation (just like with any other food). In fact, the USDA recommends getting half of all grain servings from whole grains, while the other half can come from white, processed grain sources. Furthermore, both types of grains have their benefits: white, processed grains are often fortified with important nutrients, like folic acid, thiamin, riboflavin, and iron; whole grains tend to have more natural fiber, vitamin E, selenium, zinc, and potassium.

How can you spot more diet myths? Follow these three simple guidelines:

• If it sounds too good to be true, it is. Long-term, healthy weight management does not happen with quick fixes. Instead, our bodies rely on eating a balanced diet that includes all foods and regular physical activity. Pills, food additives, hormones, or any other trick touted as the next weight-loss solution will not give you the healthy, long-term results you want.

• If reputable health organizations do not support the trend, you shouldn’t either. Be an informed consumer and do your research. Before putting your money into the next trend, check it out and see what the experts have to say. Look for research studies to support the results touted by the diet company, and check out who’s conducting and funding the research. If a pharmaceutical company pays for studies to show the effectiveness of a diet pill, question how reliable and valid the outcomes may actually be.

• If you’re not sure, ask a professional. If ever you have doubts about whether a new diet product or program may be effective for you, consult with a Registered Dietitian who can help you understand how your body may positively or negatively respond.

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When searching for the right provider for you or your loved one, there are many things to consider when determining if this person will be a good match. The following interview questions may help you in determining which provider will be the best fit for you. As they answer your questions, be mindful of your personal reactions to what they are saying – your instinct will help you determine if this person feels like a good fit for you or your loved one.

• Are you licensed by the state in which you are practicing?
• How long have you been specializing in the treatment of eating disorders?
• Have you worked with a diverse clientele, including men and racial/ethnic minorities with eating disorders?
• Have you had clients successfully recover from their eating disorders?
• What is your treatment style/approach?
• What is your belief about why people develop eating disorders?
• What is your belief about when and how people should try to stop using eating disorder symptoms?
• How do you handle medical emergencies, in which symptom use is severe or somebody threatens to harm themselves or others?
• What is your belief about whether or not people should take medication to help them recover from an eating disorder?
• If I don’t already have a treatment team established (e.g., psychiatrist, nutritionist), can you provide reliable referrals? Have you worked with these professionals before? Are they knowledgeable about how to specifically work with people who have eating disorders?
• Do you allow family members and/or friends to participate in therapy if the client prefers that?
• What is your belief about if and how parents can help their children recover from an eating disorder?
• What is your appointment availability? How often will we meet? How long do the appointments last?
• How long will the treatment process take? When will we know it’s time to stop treatment?
• Can I use my insurance to pay for services?
• Are you available via phone or email in between sessions?

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The signs listed below are a condensed compilation of behavioral, physical, and psychological signs that, when grouped together, are characteristic of individuals affected by an eating disorder. It is important to keep in mind that some of the signs on this list are fairly normative (e.g., uses food to numb distressing emotions) as independent issues and are experienced by many people who do not have eating disorders. However, the combination of these more normative behaviors with other severe, non-normative behaviors (e.g., vomits after eating) likely indicates an eating disorder. This list should not be used exclusively to diagnose an eating disorder, nor should it be used as a replacement for professional treatment. If you suspect that you or a loved one is affected by an eating disorder, please seek professional treatment immediately. Full recovery is possible!

For a more complete list of the many behavioral, physical, and psychological signs of an eating disorder, please download the “Signs of An Eating Disorder” document linked below.

Top 10 Behavioral Signs of an Eating Disorder

• Counts/restricts calories
• Exercises excessively
• Consistently uses laxatives, diuretics, caffeine pills, or other weight-loss medicines
• Vomits and/or uses the bathroom right after eating
• Hides or hoards food
• Binges, eats large amount of food in a short period of time
• Avoids social situations with food, including family mealtimes
• Follows rigid eating and/or exercise routines
• Severely limits or cuts out certain food groups (e.g., carbs, white flour, sugar)
• Consistently wears baggy clothing to hide body

Top 10 Physical Signs of an Eating Disorder

• Sudden change in weight or consistent fluctuations in weight
• Significantly underweight or overweight, not accounted for by medical complications
• Swollen glands around the cheek and jaw bone due to self-induced vomiting
• Consistently cold hands and feet, even in warm temperatures
• Irregular or absent menses (amenorrhea)
• Persistent cough and/or stomach pains
• Frequent bloating, constipation, diarrhea
• Dry and/or brittle hair, nails, skin, and lips
• Frequent dizzy/fainting spells
• Low bone density

Top 10 Psychological Signs of an Eating Disorder

• Preoccupied with food, weight, dieting, calories, thinness, body size, and/or specific body parts
• Always planning the next meal or diet
• Fears gaining weight or becoming “fat”
• Obsessed with being healthy and eating health foods
• Feels distressed if can’t follow diet or exercise plan
• Fears eating certain foods
• Consistently feels guilty, ashamed, angry, and/or embarrassed after eating
• Uses food to numb distressing emotions
• Perfectionistic, especially with respect to food, eating, and body image
• Black-and-white thinking, especially with respect to food, eating, and body image

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Eating disorders, unhealthy dieting behaviors, and concerns about one’s body size and shape can affect children of all ages. While eating disorders most often develop between ages 14-19, children as young as 6-years old report wanting to be thinner and actually fear being “fat.” By age 9, many children report feeling “better about themselves” when they are dieting, and by adolescence over half of all girls and one third of all boys admit to using unhealthy behaviors to control their weight. As these statistics demonstrate, eating disorders are an epidemic in the United States, affecting over 10 million people at any given time. Most notably, anorexia nervosa has a mortality rate twelve times higher than all other mental illness, and 1 in 10 people with an eating disorder will lose their life to this deadly disease.

Fortunately, there is hope! As a parent you play a key role in shaping your child’s life. While you may not be able to protect your child from the heartbreaking struggle of an eating disorder, you can be proactive in getting the support and treatment s/he needs. If you suspect that your child is struggling with an eating disorder, trust your intuition and take the necessary steps to protect your child:

• Seek Help: Eating disorders are not a trend or a phase, they are not just about wanting to be thin, and they are not a frivolous cry for attention. They are serious, complex diseases that will not go away on their own. It is essential to seek the help of an expert treatment team who specialize in working with individuals affected by eating disorders; this team may include a therapist, registered dietitian, pediatrician, and a psychiatrist.

• Seek Information: One of the best ways to understand what your child may be going through is to educate yourself about the complex nature of eating disorders. Knowledge is power! As a loving parent, your initial instinct may be to “fix” whatever is troubling your child; however, in the case of an eating disorder, it is important to understand your child’s disease and learn how you can be supportive throughout his/her recovery process. Read books, visit websites, and connect with other parents who may be going through a similar experience.

• Seek Support: Eating disorders affect millions of families, thus you are not alone in this. It is imperative that you seek support for yourself while your child is undergoing his or her treatment. Many parents find themselves feeling angry, scared, sad, guilty, and lonely, and it’s important that you have a place to process these emotions. Furthermore, your child’s recovery will likely involve family therapy, in which certain familial dynamics and experiences may need to be addressed and resolved before your child can fully heal. Seeking individual therapy for yourself, couple therapy for you and your partner, family therapy, and/or support groups is a great way to ensure that your emotional needs are met in a healthy way while your child focuses on his/her own recovery.

The treatment specialists at A New Beginning are here to support you in your efforts to detect and address an eating disorder in your child. Our team of highly skilled clinicians are happy to answer any questions you may have about these deadly diseases, and to provide additional resources that may assist you in helping your child. Furthermore, our expert mental health professionals are ready to serve you and your family with compassion, skill, and commitment. We welcome the opportunity to consult with prospective clients who may be interested in pursuing treatment, and together we will create an individualized treatment plan that will set them on the path of recovery.

At A New Beginning, we wholeheartedly believe that full recovery is possible!

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How do I support my loved one during their eating disorder recovery process? This is often the first question parents and partners will ask when they find out that their loved one has an eating disorder. In a valiant effort to be supportive, they often learn many things that don’t work. So, what does work? This list covers ten things to remember when supporting a loved one as they go through the journey of recovery from an eating disorder.

• Eating disorders are not about food. These illnesses are creative coping mechanisms designed to help a person manage distressing emotions. When feelings like hurt, fear, anger, and loneliness are not appropriately expressed, they may manifest as an eating disorder. Thus, avoid making comments about how much she should or shouldn’t eat, how she looks, and how she could be “healthy.” Instead, ask her how she’s feeling, how you can support her, and what she needs to feel comforted.
• You are not to blame. Eating disorders are caused by a combination of genetic, biological, and environmental triggers. No one person or event is ever the sole cause. While you may play a role in the development of the eating disorder, that is only one piece of the puzzle. It is important to focus on your role in the healing process and how your relationship can be a safe place for your loved one to begin their recovery.
• Recovery is a long and winding road. Patience is key. The average length of treatment for an eating disorder is several years. Full recovery requires consistent treatment with skilled professionals. Stopping the eating disorder behaviors is only one step in the healing process; working through the emotional pain is necessary and this process takes time. Allow your loved one to fully participate in treatment without pressure to recover quickly. Also, remember that recovery moves forward and backward, so do your best to support your loved one when she takes a few step backs in her healing – this is a normal part of the process and is usually only temporary.
• Knowledge is power. Educate yourself about eating disorders. Not only will this knowledge empower you to better understand what your loved one is going through, but it will also demonstrate to them that you care and that you are willing to do what it takes to help them get well. For starters, check out www.nationaleatingdisorders.org, www.bedaonline.com, and www.gurze.com.
• Participate in treatment. Depending on your loved one’s recovery process, they may invite you to participate in couple or family therapy. For them, learning how to appropriately open up to you and lean on you for support can be key to their recovery. Remember, this invitation does not mean you are to blame for their eating disorder, but that your relationship with them may be a safe place for them to heal.
• Medication can help. The majority of eating disorders are rooted in an anxiety disorder, such as OCD or social phobia. Additionally, some people with eating disorders are also affected by depression, ADHD, PTSD, and/or substance use. For many, psychotropic medication (i.e., antidepressants, mood stabilizers) can significantly improve their abilities to manage the eating disorder behaviors as they learn new coping skills. Medicine usually does not need to be taken long-term, but can aid in the healing process for several months or years. If your loved one decides to take medication, do your best to support their decision even if it is not your personal preference to take medication.
• Things may get worse before they get better. Before an eating disorder can be eliminated, the emotional triggers must be explored and then new coping skills must be learned and implemented. There is often a period of time, usually early on in the process, when behaviors will increase while distressing emotions come to the surface. While new ways of coping are being taught, many people will often fall back on the eating disorder because it works so well. Thus, remember that progress is not always marked by behaviors, but by a person’s willingness to explore painful issues underlying the eating disorder.
• You may need support, too. Supporting a loved one through their recovery process can be very taxing on you. Many people in your role feel confused, shocked, angry, scared, sad, and hopeless…all at the same time! It is important that you have support to help you express all of your emotions so that you can be emotionally available to help your loved one with their recovery. Consider working with your own therapist or confiding in a friend who understands the complex nature of eating disorders.
• Your loved one is not their eating disorder. They are a person with real feelings and real needs, and the eating disorder is just one part of them. Try to focus on other aspects of who they are – admirable qualities, achievements, goals, and interests. Let them know that you see so much more than the eating disorder and that you love them, even though you don’t love their eating disorder.
• Full recovery is possible. People do heal from these illnesses and go on to enjoy very fulfilling lives. With high-quality treatment, your loved one can live without worrying about food, how she looks, or how much she weighs. She will feel happy and content, no longer burdened by the emotional weight of her pain. While this endpoint may seem far off right now, know that it is attainable and that your compassionate support will strengthen your loved one’s recovery process.

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As a medical professional, you play an integral role in the detection and treatment of eating disorders in your patients. Unfortunately, most people affected by eating disorders withhold this important information from their doctors due to embarrassment, fear of being judged, not wanting to address it, or simply not realizing the severity of their condition. Thus, it is imperative that medical professionals, such as pediatricians, gynecologists, dentists, and endocrinologists, feel comfortable addressing this serious issue with their patients.

The following information is designed to help you understand what warning signs to look for in patients who may be affected by an eating disorder, what questions to ask your patients if you suspect an eating disorder, and to whom to refer your patients for high-quality, specialized care.

KNOW THE WARNING SIGNS: The first step in helping your patients affected by eating disorders is to know the warning signs. Consider information from many sources, including your observations of the patient, reports from the patient and/or loved ones, as well as medical symptoms/complications.

Common Observable Signs:

• Consistent fluctuations in weight at each appointment (e.g., 130 pounds then 145 pounds then 120 pounds)
• Significantly underweight or overweight, not accounted for by medical complications
• Swollen glands around the cheek and jaw bone due to self-induced vomiting
• Scar tissue on the tops of fingers due to acid from self-induced vomiting
• Tooth enamel damage and discoloration due to acid from self-induced vomiting
• Esophageal damage or inflammation
• Dry and brittle hair, nails, and skin
• Lanugo (fine baby hair) around the scalp
• Wearing clothes that are too big and baggy
• Extremities and limbs that are colder than might be expected based on room temperature
• Sudden changes in diet, such as cutting out meat, carbohydrates, sugar, or white flour
• Parent, spouse, or loved one reports that patient’s weight has dramatically changed

Common Medical Complications

• Irregular or absent menses (amenorrhea)
• Dehydration and electrolyte imbalance
• Heart muscle damage
• Irregular heartbeat
• Low blood pressure
• Muscle paralysis
• Kidney damage or failure
• Convulsions, seizures
• Liver damage or failure
• Osteopenia or osteoporosis
• Fertility problems
• Edema
• Sore throat
• Esophageal damage
• Acid reflux
• Gastrointestinal damage (e.g., bloating, constipation, diarrhea)
• Failure to gain weight when otherwise indicated
• Dizziness and fainting
• Unexplained stomach pains

ASK QUESTIONS:

If a patient presents with some combination of the aforementioned warning signs, the second step is to ask questions. Don’t be shy to inquire about how they feel about their bodies and food; most people affected by eating disorders report feeling relieved when someone finally notices and talks to them about it.

Questions to consider asking include, but are not limited to:

• How do you feel about your body?
• Have you ever participated in any behaviors to control your weight?
• Have you ever taken any medications to control your weight?
• Do you feel comfortable eating in social situations, such as school, work, family, etc.?
• Is your menstrual cycle regular?
• Have you ever been teased or received negative comments about your body?
• Have you recently changed your diet (become a vegetarian, vegan, or cut out food groups)?
• How often and for how long do you exercise? What happens if you miss a workout?
• Do you find yourself thinking about food and/or your body most of the day?

KNOW HOW TO RESPOND:

As you ask these questions, it is important to know how to respond to the patient in a way that is supportive, caring, and judgment-free. During your discussion with the patient, try to follow these four guidelines:

• All too often, people affected by eating disorders fear that others will think less of them once their eating disorder is exposed, so creating a warm, safe environment in which they can talk about their struggles with you is imperative to dispelling the secrecy surrounding their disorder.
• Continue to probe and ask questions; it is very unlikely that the patient will offer up details on his/her own without your prompting.
• Provide education on the relationship between the patient’s eating disorder behaviors and his/her current physical symptoms.
• At the end of the discussion, thank your patient for being brave enough to share this very personal information with you. Convey your genuine concern for their well-being, and reassure them that you will provide support in getting the proper care they deserve to fully recover.

PROVIDE REFERRALS:

Lastly, if it seems as though your patient is affected by an eating disorder, provide referrals to specialists who are qualified to treat these deadly illnesses.

• Like any complex disease, eating disorders require specialized, multi-faceted care from a team of highly skilled professionals.
• Depending on the severity of the eating disorder, the treatment team will likely include some combination of the following professionals: psychotherapist, dietitian, psychiatrist, family and/or couple therapist, group therapist, and various medical professionals (including you, the referring physician).
• If your patient is hesitant to seek help, encourage him/her to schedule a consultation just to learn about available treatment options.

CONSULTATION AND EDUCATION:

The treatment specialists at A New Beginning are here to support you in your efforts to detect and address eating disorders within your patient population. Towards this goal, A New Beginning has recently implemented a “community education” service to help educate and support physicians in this most-important area. If interested, our clinical therapists will meet with you and/or your staff to provide helpful information regarding the detection, treatment, and resources available to help patients with eating disorders.

Additionally, our team of highly skilled clinicians are ready to serve your patients with compassion, skill, and commitment. We welcome the opportunity to consult with prospective clients who may be interested in pursuing treatment, and together we will create an individualized treatment plan that will set them on the path of recovery.

At A New Beginning, we wholeheartedly believe that full recovery is possible!

Click here to download this information as a PDF.

School personnel, including teachers, coaches, aides, nurses, and counselors, are an important line of defense when it comes to recognizing eating disorder behaviors in students. With children and teens spending over six hours a day in class and additional time in before- and after-school activities, school personnel may be the first to notice changes in students that could be indicative of an eating disorder. Recognizing these changes, such as skipping lunch or fluctuations in weight, and then knowing how to effectively address these changes are the keys to successfully helping students recover from these illnesses.

The following information is designed to help all school personnel better understand how to identify students who may be at risk for developing an eating disorder or who are already affected by one, and then how to appropriately respond to and support these students.

KNOW THE STATS:

Did you know that children as young as 5- and 6-years old report wanting to be thinner and fear being “fat”? By 5th grade, nearly half of all kids are “sometimes” or “very often” on diets, and the majority of them live with parents who are also dieting. By the time puberty strikes, over half of adolescent girls and one-third of adolescent boys engage in unhealthy behaviors, like self-induced vomiting and restricting calories, to control their weight. The majority of eating disorders develop between 14-19 years of age; approximately 10-20% of these disorders affect teenage boys. Without proper treatment, most eating disorders will continue into a person’s adult years, affecting over 10 million individuals in the United States at any given time. Most alarming, anorexia nervosa is the deadliest of all mental illnesses, with a mortality rate that is twelve times higher than any other mental illness.

KNOW WHAT TO LOOK FOR:

Eating disorders affect children, teens, and adults from all walks of life. In fact, most eating disorders are not noticeable to the naked eye. Many people affected by eating disorders maintain a fairly normal-looking weight, thus making it seem like there is no problem. As a result, it is crucial to know of other observable signs of an eating disorder so that swift action can be taken before the disorder becomes too entrenched and dangerous. The warning signs include, but are not limited to:

• Consistent fluctuations in weight
• Significantly underweight or overweight, not accounted for by medical complications
• Swollen glands around the cheek and jaw bone due to self-induced vomiting
• Scar tissue on the tops of fingers due to acid from self-induced vomiting
• Tooth enamel damage and discoloration due to acid from self-induced vomiting
• Persistent cough due to esophageal damage from self-induced vomiting
• Dry and brittle hair, nails, and skin
• Lanugo (fine baby hair) around the scalp
• Wearing clothes that are too big and baggy
• Extremities and limbs that are colder than might be expected based on room temperature
• Sudden changes in diet, such as cutting out meat, carbohydrates, sugar, or white flour

School personnel interacting with kids on a daily basis may also watch for other signs that a child may be at risk for developing an eating disorder:

• Identify trends among peer groups who skip meals, talk negatively about their own and others’ bodies, spend lengthy amounts of time in the bathroom after meals, and/or follow restrictive food rules.
• Listen for students who are being targeted and teased because of their weight or body size/shape.
• Students who are high-achieving, perfectionistic, and people-pleasing may be more at risk for using their bodies to gain a sense of control in their lives.

PROVIDE ACCURATE INFORMATION:

In working with children and teens, it is important to provide educational information that may aid in the prevention of eating disorders. Too often, eating disorders develop, in part, out of misinformation about how the body works and uses food. The following steps may help students develop and maintain a healthy relationship with food and their bodies:

• Promote variety, balance, and moderation by offering diverse meal choices and appropriate portion sizes.
• Avoid labeling foods as “good” and “bad;” teach kids to appreciate both the nutritional and pleasurable qualities of all foods.
• Avoid situations that single out students based on their body size, weight, or shape, such as group weigh-ins for sporting activities or BMI reporting.
• Teach students about the dangers of eating disorders using informal discussions and formal lessons.
• Screen all outside presenters to ensure their message to students promotes balanced eating and respect for one’s body; avoid presentations that may encourage dieting or emphasize physical appearances.

PROVIDE SUPPORT & RESOURCES:

If you suspect that one of your students may be affected by an eating disorder, it is important to respond in a way that is supportive, caring, and judgment-free. During your discussion with the student, try to follow these guidelines:

• Do not be afraid to share your concerns with the student; the conversation may save his/her life. Despite their likely denial and defensiveness, trust that your willingness to confront them is secretly comforting.
• All too often, people affected by eating disorders fear that others will think less of them once their eating disorder is exposed, so creating a warm, safe environment in which they can talk about their struggles with you is imperative to dispelling the secrecy surrounding their disorder.
• Continue to probe and ask questions; it is very unlikely that the student will offer up details on his/her own.
• With the student’s knowledge, share your concerns with his/her parents or legal guardian.
• At the end of the discussion, thank your student for being brave enough to share this very personal information with you.

CONSULTATION & EDUCATION:

The treatment specialists at A New Beginning are here to support you in your efforts to detect and address eating disorders among your student body. Towards this goal, A New Beginning has recently implemented a “community education” service to help educate and support school personnel in this most-important area. If interested, our clinical therapists will meet with you and/or your staff to provide helpful information regarding the detection, treatment, and resources available to help students with eating disorders. Additionally, our team of highly skilled clinicians is ready to serve your students and their families with compassion, skill, and commitment. We welcome the opportunity to consult with prospective clients who may be interested in pursuing treatment, and together we will create an individualized treatment plan that will set them on the path of recovery.

At A New Beginning, we wholeheartedly believe that full recovery is possible!

Click here to download this information as a PDF.

Eating disorders are complex, multi-dimensional diseases that have many origins, including genetics, personality characteristics, environmental stressors, and unhealthy interpersonal relationships. Despite the fact that about 40% of an eating disorder is rooted in genetic and biological predispositions, many steps can be taken in one’s environment to dramatically reduce the risk of a person developing this illness. Because parents interact with their children daily, serving as attachment figures, teachers, and role models, they are uniquely positioned to protect their children from the many risk factors that may later develop into an eating disorder.

Below are the top 10 ways parents can effectively protect their children from developing an eating disorder.

• Model a healthy body image. How you perceive your own body will dramatically influence how your child sees his/her own body. Thus, be intentional in how you talk about your body, especially when your child is listening. Make positive comments about body parts that you like, all of the wonderful things your body allows you to do, and what makes your body feel good. Also, avoid spending long periods of time in front of the mirror, changing clothes, or trying to artificially enhance/alter your physical appearance.

• Model a healthy relationship with food. Your child is very likely to take cues from you about what and how to eat. Thus, show your child that eating all foods is okay, so long as they are eaten in moderation. Avoid labeling foods as “good” and “bad,” counting calories, or cutting out certain food groups because they are deemed unhealthy. Instead, teach your child how to appreciate foods that keep the body strong, foods that are tasty, and foods that are new and interesting.

• Eat meals together as a family. Most families keep very busy schedules and struggle to find times when everyone can sit down together to a meal. However, in spite of these hectic days, it is imperative that some meals be shared on a consistent basis. While most people think of dinner as the time to come together, also consider if there are breakfast and/or lunch times that could be shared as a family. Research shows that regular family meals can help children foster a healthy relationship with food, while also keeping open communication among family members.

• Avoid making negative or critical comments about your child’s body or weight. Even comments that may seem benign or humorous to you, such as “You definitely have the Smith family nose,” or “You’re just big-boned,” could be perceived by your child as critical and demeaning. Children, especially adolescents, are particularly sensitive to these comments and will likely experience decreased self-esteem and heightened awareness of their body’s imperfections.

• Talk with your child about media messages related to weight and eating. Discuss how the media is hyper-focused on people’s bodies and fluctuations in weight, how it uses airbrushing and other techniques to portray unrealistic body types, and how it emphasizes thinness and weight loss as the key to happiness. Help your child to think critically about the negative media messages portrayed on TV and in magazines, and encourage him/her to engage in media outlets that promote bodies of all shapes, sizes, and colors.

• Avoid talking about others in a weight-biased and/or body-focused manner. Comments and jokes you make about others’ bodies will likely be internalized by your child, sending the message that looking a particular way decreases a person’s self-worth and value. Thus, avoid making “fat” jokes, pointing out someone who is over- or under-weight, or jumping to conclusions about a person based on how they look (e.g., lazy, weird, gross). If you hear your child making jokes or comments about someone’s weight or body, intervene immediately and help them understand why this is inappropriate and hurtful.

• Avoid engaging in power struggles about food with your child. Making your child eat a certain type or amount of food will only cause conflict between the two of you, and will make mealtimes a stressful event for everyone at the table. Instead, provide healthy and diverse food choices for your child, and then allow him/her to decide what and how much s/he wants to eat. When children feel like they are in control of their food, they are much more likely to make healthy choices that are compatible with their bodies’ needs.

• Respond to your child’s awareness of hunger and fullness. Babies are born with the innate ability to eat when they’re hungry and stop when they’re full (aka eating “mindfully”). Unfortunately, our environments tend to shape our eating behaviors around schedules and other external cues. To help your child return to this natural way of eating, allow your child to eat if they’re hungry, even though a meal may not be scheduled at that time. Furthermore, do not force them to keep eating if they report that their stomach is full.

• Monitor your child’s relationship with food. Listen to the way your child speaks about food and how it affects his/her body. Pay attention to sudden changes in your child’s eating behaviors, such as new food rules or rituals (e.g., stops eating sugar or white bread, only eats a certain number of calories each day). Notice if your child avoids social situations involving food or if s/he consistently has excuses for not wanting to eat with the family. Any abrupt and/or suspicious changes should be addressed immediately.

• Ask questions if you have any concerns about your child’s eating. Gently approach your child with any questions or concerns you may have about his/her eating behaviors, and ask how you can help. If they respond to you with defensiveness or hostility, it is likely that they are struggling and do need help. Remain calm and respectful, but don’t give up in demonstrating your concern for their well-being. If these conversations make you uncomfortable or you simply don’t know what to say, find someone (e.g., therapist, friend, teacher) who can assist you and your child.

The treatment specialists at A New Beginning are here to support you in your efforts to detect and address an eating disorder in your child. Our team of highly skilled clinicians are happy to answer any questions you may have about these deadly diseases, and to provide additional resources that may assist you in helping your child. Furthermore, our expert mental health professionals are ready to serve you and your family with compassion, skill, and commitment. We welcome the opportunity to consult with prospective clients who may be interested in pursuing treatment, and together we will create an individualized treatment plan that will set them on the path of recovery.

At A New Beginning, we wholeheartedly believe that full recovery is possible!

Click here to download this information as a PDF.

General

• 100 Questions About Eating Disorders by Carolyn Costin
• Eating Disorder Sourcebook by Carolyn Costin
• Goodbye Ed, Hello Me by Jenni Schaefer
• 50 Ways to Soothe Yourself Without Food by Susan Albers
• Regaining Your Self: Breaking Free From the ED Identity by Ira Sacker & Sheila Buff
• Hunger Pains: The Modern Woman’s Quest for Thinness by Mary Pipher
• Males with Eating Disorders by Arnold Anderson
• Reviving Ophelia: Saving the Selves of Adolescent Girls by Mary Pipher
• Self-Esteem Workbook by Glenn Schiraldi, Matthew McKay, & Patrick Fanning
• When Food Is Love: Exploring the Relationship Between Eating and Intimacy by Geneen Roth
• Women Who Hurt Themselves by Dusty Miller
• Homecoming: Reclaiming and Championing Your Inner Child by John Bradshaw

Anorexia

• Anorexia Workbook by Steven Hayes, Michelle Heffner, & Georg Eifert
• Eating Disorder Sourcebook by Carolyn Costin
• Skinny Boy: A Young Man’s Battle and Triumph Over Anorexia by Gary Grahl
• Gaining: The Truth About Life After Eating Disorders by Aimee Liu

Bulimia

• Overcoming Bulimia Workbook by Randi McCabe, Traci McFarlane, & Marion Olmstead
• Life Without Ed by Jenni Schaefer & Thom Rutledge
• Bulimia: A Guide to Recovery by Lindsey Hall & Leigh Cohn

Binge Eating

• Appetite Awareness Workbook by Linda Craighead
• Breaking Free From Emotional Eating by Geneen Roth
• Crave: Why You Binge Eat and How to Stop by Cynthia Bulik
• Feeding the Hungry Heart: The Experience of Emotional Eating by Geneen Roth
• The Good Eater: One Man’s Struggle With Binge Eating Disorder by Ron Saxen
• Overcoming Binge Eating by Christopher Fairburn

Body Image

• Body Image Workbook by Thomas Cash
• Body Wars by Margo Maine
• Do I Look Fat In This? by Jessica Weiner

Click here to download this information as a PDF.

• Andrea’s Voice: Silenced by Bulimia, Her Story and Her Mother’s Journey Through Grief Toward Understanding by Andrea & Doris Smeltzer
• Dads and Daughters by Joe Kelly
• Eating Disorder Sourcebook by Carolyn Costin
• Eating With Your Anorexic by Laura Collins
• How to Help Your Teenager Beat an Eating Disorder by James Lock & Daniel le Grange
• Surviving an Eating Disorder: Strategies for Families and Friends by Michelle Siegal, Judith Brisman, & Margot Weinshel
• When Your Child Has an Eating Disorder: A Step-by-Step Workbook for Parents and Other Caregivers by Abigail Natenshon
• Your Dieting Daughter: Is She Starving for Attention? by Carolyn Costin

Click here to download this information as a PDF.

Websites

• Academy for Eating Disorders: AED is a professional organization that conducts rigorous research and provides state-of-the-art professional training/education on eating disorders.
• Binge Eating Disorder Association: BEDA is a national organization dedicated to providing help and hope for people affected by binge-eating disorder, which is now the most common type of eating disorder in America. On this website you can access information about binge eating disorder, qualified treatment providers, and register for their annual conference.
• Do Parents Cause Eating Disorders?: This 3-minute video interviews experts in the field to debunk the pervasive myth that families are to blame for their children’s eating disorder.
• Eating Disorders Coalition for Research, Policy, and Action (EDC): The EDC is a non-profit organization in Washington, DC dedicated to advancing the federal recognition of eating disorders as a public health priority. They host Lobby Days on Capitol Hill in which people from all walks of life get together to speak with their Congressmen about the importance of eating disorder treatment services.
• www.EDReferral.com: This website provides a comprehensive directory of eating disorder professionals throughout the country, including therapists, dietitians, and in-patient treatment facilities.
• Gurze Books: This publication company specializes in books on eating disorders and related topics, such as body image and obesity. On this website, you can purchase books at discounted prices; read various articles and newsletters about eating disorders; and find links to treatment centers, organizations, and other websites.
• National Eating Disorders Association (NEDA): NEDA is the largest non-profit eating disorder organization in the country. They host a variety of events around the country (e.g. conferences, NEDAwareness Week events) and their website provides a wealth of information about eating disorders, treatment, and upcoming events.
• Something Fishy: This website is dedicated to raising awareness about eating disorders. You can access a variety of information about these illnesses, and search for treatment providers.

Smart Phone Apps

• Recovery Record: This app helps users by consistently assessing throughout the day what and how much they are eating, and how they are feeling.
• No More Diets: This app helps you identify emotional issues that drive your eating behaviors, while also helping you identify your own body’s hunger and fullness cues.
• Self Esteem Daily Affirmations: This app provides affirmations, with the option of creating a list of favorites.
• Optimism: This app provides a mood chart that helps users develop strategies to manage depression, bipolar, or other physical and mental health conditions.
• Positive Thinking: This app helps users adopt positive thinking through the use of motivational and inspirational quotes.

Click here to download this information as a PDF.