Eating Recovery Center Director of Nursing, Carolyn Jones gives insight into the prevalence of eating disorders in adults, in the NextAvenue.org article, “Why Eating Disorders Are a Concern for Adults, Too”. To read the entire article click here, or read below.
Why Eating Disorders Are a Concern for Adults, Too
Research showes anorexia, bulimia and binge eating are on the rise among older people
Few would question the benefit of being able to feel younger than one’s chronological age. And, fortunately, many people in middle age feel exactly that way. In a 2009 Pew Research Center survey, nearly half of all respondents age 50 and older reported feeling at least 10 years younger than their actual age.
But when one doesn’t like what he or she sees in the mirror, because of real or imagined weight gain, it could lead to drastic and dangerous action. While some people in middle age and older take positive steps to change their diets and their fitness regimens to ward off extra pounds, others channel their concerns in an unhealthy, obsessive direction, and fall victim to an eating disorder.
(MORE: The Fiftysomething Diet)
Eating Disorders Develop in Different Ways
There are three main types of eating disorders: Anorexia nervosa, whose sufferers have an extreme fear of gaining weight and a distorted body image, and practice drastically restricted eating habits; bulimia nervosa, whose symptoms include recurrent, frequent episodes of binge eating followed by forced vomiting, excessive use of laxatives or excessive exercise to compensate for the excess intake; and binge eating disorder, in which a person loses control over his or her eating but does not follow with any type of purging, and can become overweight. Eating disorders can destroy an individual’s health and in some cases be fatal.
Eating disorders affect teenagers more than adults, but their prevalence in older people is on the rise. Studies conducted in Australia in 1995 and 2005 found that while a higher percentage of younger people had eating disorders than adults, the rate of eating disorder incidence rose far more dramatically in older people — the percentage of people 65 and older who engaged in anorexic behavior or binge eating tripled during the 10-year-period.
Among people who suffer from adult-onset eating disorders, says Carolyn Jones, director of nursing at the Eating Recovery Center in Denver, some may have had the disorders all their lives with symptoms either previously undiagnosed or not manifested; others may have had an eating disorder in the past, underwent treatment, and then relapsed in adulthood; and another group experienced their first onset in middle life.
The Causes of Eating Disorders
Eating disorders, whether in teenagers or adults, may be triggered by a variety of factors including low self-esteem, depression, troubled relationships, physical or sexual abuse, cultural pressures to be thin, and a genetic predisposition, according to NationalEatingDisorders.org. Dr. Kathryn Zerbe, a professor of psychiatry at Oregon Health and Science University and the author of Integrated Treatment of Eating Disorders: Beyond the Body Betrayed (2008), says: “The over-50 population differs in that they also have a fear of getting older. Plus, stressful life events, such as loss, difficulty handling transitions, medical problems and other psychiatric issues like depression and anxiety, may also come into play.”
An eating disorder that arises for the first time after age 50 always demands a full medical workup, Zerbe says, “because loss of weight at this age, depression, poor appetite and cognitive changes may represent a manifestation of a physical, not a psychiatric, illness, such as cancer or dementia.”
Symptoms of Eating Disorders
Symptoms of eating disorders may not always be obvious. People with binge-eating disorder or bulimia nervosa may be of normal weight or even overweight. If you’re concerned that a friend or loved one may have an eating disorder, watch for these signs:
- A refusal to eat or a denial of hunger.
- An intense fear of gaining weight.
- A negative or distorted body image.
- Excessive exercise.
- Fear of eating in public.
- A withdrawal from social activities.
- Preoccupation with food.
- Very thin appearance.
- Self-induced vomiting.
- Excessive exercise.
- Going to the bathroom after eating or during meals.
- Damaged teeth or gums.
- Constant dieting or fasting.
- Possible drug or alcohol abuse.
- Frequently eating alone.
- Eating to the point of discomfort or pain.
- Feeling depressed or disgusted over the amount eaten.
If you or a loved one exhibits these symptoms, it’s important that he or she consult with a doctor or psychiatrist who specializes in eating disorders, although it may be difficult to convince the person to go along. “One of the hallmarks of an eating disorder is an ambivalence,” Jones says. “One day they know they need help and the next day they don’t. They’re often in denial.” Expressing your concern and a sincere desire to listen may help.
A friend or relative, Zerbe says, can help the affected individual begin to see the risks in valuing having an “ideal body” more than their health, so that they can get the help they need and make the most of the years ahead of them.
Experts See Hopeful Signs on Eating Disorders: Patients are being treated earlier, spending less time in the hospital and recovering faster, many healthcare experts say
Insights from Eating Recovery Center’s Ovidio Bermudez, MD, FAAP, FSAHM, FAED, CEDS, Medical Director of Child and Adolescent Services, were recently featured in a Los Angeles Times article detailing promising trends in eating disorders awareness, treatment and recovery. Below is an excerpt of the article, or click here to read the article in its entirety.
April Dunlap was 17 and weighed 165 pounds when she began a diet and exercise regimen. After three months, the 5-foot-5 teen had lost the 20 pounds she had hoped to shed. But she kept going. “It was like a drug,” she said. “I always wanted to lose a little more.”
When she hit 120 pounds, Dunlap’s mother worried that April was losing too much weight. The family’s doctor agreed. Four months after Dunlap’s diet began, she found herself in a treatment program for anorexia nervosa. After only 10 days, she had gained enough weight to be discharged from the hospital.
“If it wasn’t for my mother, it would have taken a lot longer for me to realize I had a problem,” said Dunlap, now 28 and living in Charleston, W.Va.
Dunlap’s whirlwind experience with her eating disorder is becoming increasingly common today: A new breed of patient is getting treatment well before the disease drags them into a downward spiral toward starvation, sustained heart damage, weak bones, kidney damage, long hospitalizations and numerous relapses.
Health experts are seeing a glimmer of hope that the devastation wrought by eating disorders may be easing nearly 30 years after the illnesses first sprang into the public consciousness with the death of singer Karen Carpenter from anorexia-induced heart failure. Among the encouraging signs: More patients are getting medical treatment based on sound science; they’re getting it earlier in the course of the disease; and they’re recovering faster, often without the need for hospitalization or residential care.
One eye-opening statistic appears to speak to the trend: A recent government analysis found that hospitalizations for people with the primary diagnosis of an eating disorder plunged 23% between 2007-08 and 2008-09. It was the first such decline since the federal Agency for Healthcare Research and Quality began tracking such hospitalizations in 1999.
“Any little movement is significant, and this is a pretty big one,” said William Encinosa, a senior economist at the agency who worked on the report, which was published last year.
Eating disorders, which primarily affect teenage girls, are loosely categorized as mental illnesses centered on obsessive thoughts, emotions and behaviors regarding food. Anorexia involves self-starvation leading to excessive weight loss that damages the heart, bones, nervous system and organs. An estimated 1 in 200 Americans has the disease, and the death rate is 4%.
Bulimia is characterized by bingeing followed by self-induced vomiting, use of laxatives or excessive exercise to purge food and prevent weight gain. It affects 2% to 3% of Americans and is not thought to be as deadly as anorexia, though a 2009 study in the American Journal of Psychiatry found it was lethal in nearly 4% of cases, mostly due to suicide or electrolyte imbalance caused by dehydration.
Another type of eating disorder, binge eating, rarely leads to hospitalization or death.
The stigma surrounding anorexia and bulimia have kept many patients isolated. But for a variety of reasons, eating disorders are coming out of the shadows.
Surveys conducted by the National Eating Disorders Assn. show that Americans are more familiar with anorexia and bulimia now than they were 10 years ago. That awareness has been accompanied by a weakening of the stigma associated with eating disorders that might, in the past, have prevented some people from seeking help quickly, said William Walters, who manages the telephone hot line for the New York-based organization.
“Parents are being more proactive. Coaches are being more proactive about their athletes,” he said. “People feel they can ask for help.”
Encinosa credits the heightened awareness to a combination of education in schools, TV shows on the topic and public statements by such celebrity patients as Princess Diana and Paula Abdul.
In April Dunlap’s case, a made-for-TV movie about two high school students with eating disorders put her mother, Gloria, on alert. When April began her rapid weight loss, Gloria took action.
“I could see it wasn’t normal,” Gloria Dunlap said.
Some experts are skeptical that the big drop in hospitalizations reflects actual improvement in treatment. More insurance companies are steering patients to outpatient programs or partial hospitalization, in which patients attend day programs but go home at night, said Dr. Ovidio Bermudez, medical director of the Eating Recovery Center in Denver. Perhaps the drop in hospitalizations simply means insurers are being stingy.
Nor does the federal data indicate whether deaths from eating disorders have declined, since mortality rates are not tracked.
There is no evidence that the incidence of eating disorders has dropped, Bermudez said. To the contrary, anorexia and bulimia have been spreading among populations other than white teenage girls.
Read more from Dr. Bermudez on latimes.com.
Anorexia and Bulimia Aren’t the Only Eating Disorders
For decades, the eating disorder lexicon had two main entries: anorexia and bulimia. But modern research reveals that these fall woefully short of encompassing the many facets of disordered eating. In the early ’90s, the American Psychiatric Association introduced a new diagnostic category: eating disorders not otherwise specified (EDNOS). A catch-all label that includes dozens of subdiagnoses, EDNOS applies to patients who don’t meet the exact criteria for anorexia or bulimia but still have very troubled relationships with food or distorted body images. Today, EDNOS diagnoses significantly outnumber anorexia and bulimia cases. “The atypical has become the typical,” says Ovidio Bermudez, M.D.
Read more here.
Unexpected Eating Disorders Causes and Triggers
Each week, Eating Recovery Center’s Chief Marketing Officer Julie Holland, MHS, CEDS, a clinician with almost 30 years experience in the treatment of eating disorders, shares advice and insights with readers of EverydayHealth.com. In the most recent installment of her blog, The Truth About Eating Disorders (which celebrates its two year anniversary this week!), discusses unexpected triggers for eating disorders. Read the full blog post below, or click here to view other posts from Julie on EverydayHealth.com.
A major life transition or change, such as puberty or leaving for college, is a common eating disorders trigger. However, eating disorders specialists are taking note of the more unexpected eating disorders causes: manipulating medications and taking a new lifestyle diet too far. For someone with the genes or the temperament that predisposes him or her to an eating disorder, manipulating medication or eliminating food groups for a variety of reasons can trigger dangerous disordered eating behaviors.
Insulin manipulation: Diabetes and eating disorders
Most of what we eat is broken down into glucose, which our cells use for fuel. Insulin allows your cells to either use the glucose for fuel or store it as fat. However, for individuals with type 1 diabetes, their bodies no longer produce insulin. Therefore, they use daily insulin injections to help their bodies absorb glucose.
Some people with diabetes who are also genetically predisposed to eating disorders have been known to use insulin manipulation as a form of weight control. They under-dose, or skip their insulin entirely, which causes sugar to be eliminated from their bodies via urine and never to be stored as fat or used as fuel.
Although not an official medical term, this behavior is often referred to as “diabulimia.” People with bulimia nervosa will purge through vomiting, laxative abuse or over-exercise to compensate for binging, while people with diabetes restrict insulin to achieve similar results. Like all eating disorders patients, these individuals are striving for unrealistic body ideals and a desire to be thin.
This potentially deadly combination strips your body of its nutrients and fuel. People with eating disorders who are abusing insulin can find themselves weak and lethargic and, in extreme circumstances, may fall into a coma as their bodies turn to other tissues for energy. The overwhelming desire for these individuals to be thin negates any of the other medical risks such as kidney or heart failure, blindness or even amputation.
Gluten free and other diet fads: Community supported restrictive diets
We live in a society fascinated with the latest diet fads. From cleanses to anti-carbohydrate or high-protein diets, each one introduces a “new” way to lose weight and live healthfully. Most recently we’ve seen the rise of veganism and gluten free diets. Originally intended as a dietary regimen for people with celiac disease, a gluten free diet can help people who are unable to break down gluten and absorb it, minimize damaging results on their bodies.
For individuals who are genetically predisposed to an eating disorder, cutting major food groups, such as gluten, dairy or meat from their diets when it’s not medically necessary can be a serious eating disorders cause trigger. They start restricting because it’s part of a new diet designed to help them live healthfully and find themselves tumbling down that slippery slope into an eating disorder.
If you or one of your friend’s or loved ones is practicing “diabulimia” and manipulating insulin or is drastically changing his or her diet as a means to lose weight, visit the Eating Recovery Center website to find resources and treatment options and learn how to approach him or her to express your concerns.
5 Things Not To Say To Someone With An Eating Disorder
Eating disorders are complex issues with biological, psychological and sociocultural implications. While eating disorders awareness is growing among the general public and the healthcare community, this complexity is sometimes lost on even the most well-meaning friends and family members, causing them to oversimplify the illnesses in the statements they make. Regardless of intentions, there are several statements that should not be said to someone with an eating disorder. Eating Recovery Center’s Dr. Weiner was recently quoted in a PsychCentral.com article addressing this very topic. Below is an excerpt from the article, or click here to read the article in its entirety.
Everyone hates their body (or everyone overeats, or everyone skips meals sometimes).
It’s hard watching a person you love struggle. Sometimes we think relating to their words will make them feel better. So if they say something disparaging about their body or talk about skipping a meal or eating a lot in a short period of time, we quickly let them know that they’re not alone. We’ve been there. We can relate.
But in reality, this can shut the person up and stop them from sharing any more of their thoughts and feelings. (Which is a big problem because eating disorders are secretive as it is.)Worse, it can normalize their eating disorder and validate it.
While many of us might’ve struggled with some ED behaviors and thoughts, it’s very different from actually struggling with an eating disorder. Again, eating disorders are serious illnesses that require treatment.
Yes, I’ll keep your ED a secret.
Maybe you’ve noticed the signs of an eating disorder and confronted your loved one or maybe they came to you first. Either way, they beg you to keep their eating disorder a secret. I would say, “No way, no how.”
Eating disorders are dangerous. Even if someone doesn’t look emaciated and sick, they can still suffer serious problems. In her memoir, Purge: Rehab Diaries, Nicole Johns, who struggled with EDNOS, talks about being “normal weight” and having a slew of very serious health problems.
Throughout her 20s, Johns is “hospitalized for fainting, a concussion, electrolyte imbalances, and three different kinds of heart-rhythm irregularities.” During this time, she’s abusing diet pills, starving and purging. In just two years, she has to go to the ER six times because of her heart problems.
The reality is that EDs can be deadly — and secrets don’t lead to treatment, and treatment is essential. According to Kenneth L. Weiner, MD, CEDS, of the Eating Recovery Center:
Eating disorders are the deadliest mental illness. A woman with anorexia
nervosa is 5.6 times more likely to die than another woman of her same age. The
most frequent causes of death from eating disorders are suicide (32 percent),
complications associated with anorexia (19 percent), and cancer (11 percent).
The average age of death for an individual with anorexia is only 34
Eating disorders don’t discriminate; in fact, they affect men, women, boys and girls of all ethnicities and at all socioeconomic levels. Lesbian, gay, bisexual and transgender individuals aren’t immune to eating disorders either. In fact, according to some studies, gay men are more likely to have an eating disorder than straight men due to increased pressure to meet physical standards that are often considered more “attractive” within the gay community.
In a recent interview with KGNU Independent Community Radio (1390AM Denver, 88.5FM Boulder), Eating Recovery Center therapist Joe Eiben, MA, LPC, shared insights about eating disorders in the gay community. Topics discussed included eating disorder warning signs and treatment options, as well as discussion around the prevalence of anorexia and bulimia among LGBT individuals. Listen the Joe’s interview in its entirety here.
Eating Disorder Treatment in Colorado: Interview with Ken Weiner, MD
Dr. Ken Weiner, Founding Partner, Chief Medical Officer and Chief Executive Officer of Eating Recovery Center, recently spoke with Donna Feldman, Denver Health Examiner. In the interview, Dr. Weiner discussed the eating disorder treatment offered at Eating Recovery Center, and provided insight into the decision to pursue a higher level of care for those struggling with eating disorders. See below for an excerpt of Dr. Weiner’s Examiner.com interview, or click here to read the article in its entirety.
One of the driving forces behind Denver’s growing reputation as a hot spot for cutting edge eating disorder treatment has to be Dr. Ken Weiner, MD. Dr. Weiner has been treating eating disorders here for over 25 years, and is a founding partner of the Eating Recovery Center, which offers intensive inpatient, residential and outpatient treatment for both adults and adolescents. The ERC has grown from a 12 bed facility with 40 employees in October 2008 to 46 beds and 235 employees in late 2011, with locations in Lowry and downtown
I spoke with Dr. Weiner about his work, and the ERC recently, and posed the question “How does a person decide that an intensive program like this is right for them?”
Weiner: About 85% of eating disordered people do well with multi-disciplinary outpatient treatment. The other 15%, who are not responding to that need a higher level of care. Usually the patient is the driving force looking for more care, yet may still be ambivalent. The ERC offers free assessment to help with the decision.
Examiner: What is the prognosis for recovery from an eating disorder like anorexia?
Weiner: The cure rate for anorexia is over 80%, but it could take 7-10 years. Brain maturation from teen years to mid-20′s helps the recovery process. I’m more optimistic about the outcomes, but still some patients can’t be fixed (Dr. Weiner noted elsewhere that eating disorders have the highest fatality rate of all psychiatric illnesses).
Examiner: What has changed about treatment in the past 10 years?
Weiner: The biggest shift has been the focus on genetics, and the realization that eating disorders may be as heritiable as schizophrenia or bipolar disorder. Research using neuroimaging opens up some exciting possibilities for understanding what happens in the brain in eating disordered people.
Is Your Teen into the eTriggers Trend?
Last week, Dr. Ovidio Bermudez, Medical Director of Child and Adolescent Services at Eating Recovery Center, was featured on SheKnows.com, a website dedicated to the provision of intelligent information, helpful resources and community support for women. In the article, Dr. Bermudez shares insights on how technology can trigger rigid behavior that fuels extreme dieting and exercise for kids and teens struggling with eating issues. Read on for an excerpt of the article, or click here to view the article in its entirety.
Though not a clinical term, eTriggers is a shortened way of referring to electronic- or technology-based activities that could potentially trigger someone to engage in dieting, exercise or disordered eating behaviors, says Ovidio Bermudez, M.D., the medical director of child and adolescent services at Eating Recovery Center in Denver, Colorado.
Kids and teens may use game consoles, computers, tablets and phones to study diet and exercise techniques. For example, calorie-counting smart phone or tablet apps that manage calorie intake or exercise-focused video games that measure current weight and calories burned. Healthy when used in moderation, but when taken too far, they can enable damaging behaviors.
In addition, there’s a myriad of websites, such as pro-anorexia or pro-bulimia websites or forums, that offer harmful tips to help children and adolescents learn and practice disordered eating behaviors, Dr. Bermudez adds. It’s important to recognize that these activities do not “cause” eating disorders. Eating disorders are complex, heritable diseases that involve bio-psycho-social factors, says Dr. Bermudez. “These triggers can simply kick-start one behavior that may be taken to an extreme, and they can serve as enablers for unhealthy food- or exercise-focused behaviors that have already begun.”
They want to be the best
Through websites, phone apps, games and social media forums, technology can trigger or enable an eating disorder. “An important part of the mindset of individuals struggling with eating disorders is a desire to learn ‘how to do it better’ and how to compete with others,” says Dr. Bermudez. “Both of these can be cemented by accessing information related to losing weight.” Plus, they compare themselves to other people with eating disorders and motivate themselves to “do it better” by learning new ways to drop weight and bond with others around their successes or failures in eating disorders behaviors.
Eating Disorders: Hope for Recovery
Last week, Eating Recovery Center’s Dr. Craig Johnson, Chief Clinical Officer, spoke with Dr. Susan Hickman on her VoiceAmerica radio show, “The Mind of the Matter.” The segment focused on the unprecedented growth of eating disorders, especially in child and adolescent patient populations, as well as developments in eating disorder research and treatment approaches. Listen to the segment below.
Does Your Child Have an Eating Disorder?
In this article for BlogHer.com, the largest community of engaged, influential and info-savvy woman bloggers, Eating Recovery Center therapist Liza Feilner, Primary Therapist at the Behavioral Hospital for Children and Adolescents shares advice for parents that suspect their children may be suffering from an eating disorder. Below is an excerpt featuring Liza’s insights, or click here to view the article in its entirety on BlogHer.com.
Eating disorders affect five to ten million young and adult women and one million men in the United States. What is a parent to do when we suspect our child may be exhibiting symptoms of disordered eating? Come to think of it — what are symptoms of disordered eating?
To answer these questions, I called up Liza Feilner, a licensed professional counselor and senior therapist at the Eating Recovery Center’s Child and Adolescent Behavioral Hospital who for nine years has been working inpatient with individuals suffering from eating disorders.
A lot of us don’t always have the opportunity to observe our children’s eating behaviors throughout the day, meeting up with them only at dinner time. In the following list, Feilner offers some tell-tale signs that a child may be exhibiting symptoms of an eating disorder.
“Remember, you’re looking for changes to previous patters that they’ve set with their eating,” says Feilner.
Symptoms of disordered eating
Weight loss or weight fluctuation. These are well-known indicators, though Feilner warns that neither of these in themselves are the only determinant that somebody is struggling with an eating disorder.
Significant changes in food behavior. “If suddenly they’re cutting out a particular food group, that may signify a change in food behavior,” warns Feilner. “For example, they may cut out fats or carbs or certain foods and begin getting more rigid with what they are willing to eat.”
Limiting intake. “I already ate.” “I’m not very hungry tonight.” If your child is consistently skipping meals or otherwise trying to limit their food intake by pushing food around the plate or taking really small bites to make it seem like they are eating, watch closely for other symptoms of disordered eating.
Ritualistic behavior. Eating disorders tend to turn the consumption of food into a very rigid ritual. Any peculiar eating behaviors — such as finishing one item on the plate before moving on to another, for example — should signal a parent to become more observant.