The Truth About Eating Disorders: Common Myths Debunked

The Truth About Eating Disorders: Common Myths Debunked

by Julie Holland, MHS, CEDS

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Because most eating disorders (approximately 95 percent) surface between the ages of 12 and 25, parents are often a first line of defense against the development of these illnesses in their children.* Despite increased prevalence of eating disorders in the United States, widespread misconceptions about eating disorders remain that challenge identification, diagnosis and early intervention. To truly protect and advocate for their children, it is important that parents understand the truth behind common eating disorder myths.

Myth: Eating disorders aren’t serious illnesses.

Truth: Anorexia nervosa, bulimia nervosa, binge eating disorder and eating disorder not otherwise specified (EDNOS) are very real and very serious mental illnesses. Each disorder has clear diagnostic criteria in the Diagnostic and Statistical Manual, the go-to diagnostic reference for mental healthcare professionals. Another reason to take eating disorders seriously is that they can be deadly. Anorexia nervosa has the highest mortality rate of any psychiatric disorder. In fact, women ages 15 to 24 years of age who suffer from anorexia nervosa are 12 times more likely to die from the illness than any other cause of death.**

Myth: Eating disorders are just about food.

Truth: While eating disorders generally involve obsession with calories, weight or shape, these illnesses are rooted in biological, psychological and sociocultural aspects. Restriction, bingeing, purging or over-exercise behaviors usually signify an attempt to control something of substance in the individual’s life. Because friends and family mistakenly believe that eating disorders are just about food, they will often encourage their loved ones to “just eat more,” “just eat less,” or “just eat healthier” to be “cured” of this illness. In reality, eating disorders often require some combination of medical, psychiatric, therapeutic and dietary intervention to achieve full recovery.

Myth: Eating disorders are a women’s illness.

Truth: While research shows that eating disorders affect significantly more women than men, these illnesses occur in men and boys as well. While males used to represent about 10 percent of individuals with eating disorders, a recent Harvard study found that closer to 25 percent of individuals presenting for eating disorder treatment are male. The widespread belief that eating disorders only affect women and girls can prevent accurate diagnosis of an eating disorder in a man or boy, even among healthcare experts.

Myth: Eating disorders don’t develop until the teenage years.

Truth: Consider this—research found that up to 60 percent of girls between the ages of 6 and 12 are concerned about their weight or about becoming too fat, and that this concern endures through life.*** Not surprisingly, the incidence of eating disorders in children is on the rise. Between 1999 and 2006, hospitalizations for eating disorders in children 12 and younger rose 119 percent, according to a 2010 study by the American Academy of Pediatrics.

Myth: Only very thin people have an eating disorder.

Truth: While anorexia is characterized by extreme low weight, many individuals struggling with bulimia, binge eating disorder and EDNOS are normal-weighted. The misconception that an eating disorder can only occur if someone is very thin contributes to misdiagnosis or delayed diagnosis in many cases, even among those patients seeking support from medical and mental healthcare professionals. Unfortunately, many healthcare experts lack eating disorder exposure and training, which highlights the important role of eating disorder specialists to ensure effective diagnosis and early intervention.

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In addition to educating themselves about basic eating disorder information and understanding myth from fact, parents should also trust their instincts when it comes to eating disorders in their children. Eating disorders can thrive in secrecy, but parents often intuitively know if something is wrong with their children. While parents may feel terrified of saying the wrong thing, but also not want to stay silent, they are an important champion for diagnosis and effective treatment. If concern arises, consult with an eating disorder specialist sooner rather than later—early intervention is critical to lasting eating disorder recovery.

 

*Substance Abuse and Mental Health Services Administration (SAMHSA), The Center for Mental Health Services (CMHS), offices of the U.S. Department of Health and Human Services.

**American Journal of Psychiatry, Vol. 152 (7), July 1995, p. 1073-1074, Sullivan, Patrick F.

***T.F. Cash & L. Smolak (Eds.), Body Image: A Handbook of Science, Practice, and Prevention. New York: Guilford Press. 2011.

Gluten-Free: Diet Trend or Medical Necessity?

Gluten-Free: Diet Trend or Medical Necessity?
By Julie Holland Faylor, MHS, CEDS

 

Open a magazine, visit a restaurant or shop for groceries and you’re likely to observe the gluten-free diet craze. Books, magazines and blogs claim various health and weight loss benefits from eliminating gluten from our diets, restaurants tout separate gluten-free menus, and grocery stores have added whole aisles dedicated to gluten-free foods. In fact, the gluten-free eating trend has become so pervasive that there’s even a gluten-free Girl Scout cookie!

For many people, gluten-free eating is the latest fad. However, for people like me with celiac disease, it’s a necessity. According to the National Foundation for Celiac Awareness, only 1 in 133 Americans have celiac disease, a genetic autoimmune illness that damages the small intestine and restricts the body’s ability to absorb nutrients from food. People who have this disease cannot tolerate gluten, a protein found in wheat, rye and barley. If any gluten is ingested, even a small amount, uncomfortable medical symptoms develop shortly afterwards, including abdominal pain, diarrhea, vomiting and constipation. In addition to those with celiac disease, there is a portion of the population who have non-celiac gluten sensitivity. These people also cannot tolerate gluten, and while they may experience similar symptoms, they don’t experience the same damage to their small intestine.

As an eating disorder specialist, two things are concerning to me about the swift rise in gluten-free diets—the connection between dietary restriction and eating disorders, and the impact of the growing popularity of elective gluten-free eating on people without medically-verified gluten intolerance or celiac disease.

Eating disorders often begin with a seemingly innocent diet—medically indicated or otherwise—and many diets call for the elimination of entire food groups like gluten, dairy or meat. Sometimes, dietary restriction can lead to disordered eating behaviors like “orthorexia,” a condition characterized by an unhealthy preoccupation with healthy eating. In other cases, dietary restriction can lead to a full-syndrome eating disorder (the dieting behavior activates the latent genetic predisposition toward developing an eating disorder—remember, eating disorders are hereditary! Link to first post) For individuals without a medically diagnosed gluten intolerance that elect to stop eating gluten, I encourage them to think about why they are making this significant change to their diet. In general, whole grains are an important part of a balanced pattern of eating, and labeling foods as “good” and “bad” can stigmatize eating and reinforce the cycle of dieting and dietary restriction. A simple best practice following any significant change in food intake is to consult with a registered dietitian to establish an optimal nutrition plan. While doing so, it is important to specify that the gluten-free change is a dietary preference rather than a medical necessity. Regardless of our diet choices or mandates, it is important to keep wellness and balance in mind.

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Additionally, the gluten-free diet fad creates a misperception that gluten-free is merely a preference, not a medical necessity. As a result, gluten-free standards have relaxed to the point where many products and menus claiming to be free of gluten actually contain some measure of wheat, rye or barley. This makes it more challenging to practice a medically-indicated gluten-free diet. While food products must list their ingredients, gluten-free menus at restaurants can be blatant offenders, not taking the time to truly understand what gluten is and in what products it is used. In my personal experience at many restaurants, I have ordered meals from these special menus that actually contained gluten ingredients like soy sauce, and I felt terribly sick shortly after. In a sense, it seems as though elective gluten-free eating has trivialized a celiac disease diagnosis. I encourage those with gluten intolerance to be hyper-vigilant about their product choices and restaurant visits—in light of the gluten-free trend, we have to listen to our bodies even if a label or menu item claims to be gluten-free.

In today’s culture, dieting is pervasive. Gluten-free eating is all the rage this year, the latest in a long line of fads and gimmicks like low/no-carb, high protein, raw, fat-free, sugar-free—the list goes on and on. While the majority of diets are elective in nature, some diets—including the dietary restrictions of individuals with celiac disease—are medically indicated. Regardless of the motivation for the diet or the diet’s underlying philosophy, it is important to understand the connection between dieting and eating disorders. In fact, research has found that 35 percent of “normal dieters” progress to pathological dieting, and of those, 20-25 percent progress to partial or full-syndrome eating disorders.* With this statistic in mind, caution must be exercised when any sort of dietary restriction is taking place.

 

* Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The Spectrum of Eating Disturbances. International Journal of Eating Disorders, 18 (3): 209-219.

“Fat Talk,” Body Image and Eating Disorders

“Fat Talk,” Body Image and Eating Disorders
By Julie Holland Faylor, MHS, CEDS

 

After consuming a high-calorie food, have you ever said “I need to hit the gym now!” or “I know that went straight to my thighs!”

Do you call your comfortable jeans “fat pants”?

When asked how you’re doing, have you ever responded with a quip like, “I’d be better if I didn’t have to squeeze into a bathing suit this weekend!”?

 

At one time or another, we have all been guilty of using disparaging self-talk related to weight, size, or shape. This tendency is so commonplace in today’s culture that there is actually a term for negative body commentary, used by the general public and clinical circles alike: “Fat talk.”

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Whether we say these comments aloud or just in our heads, “fat talk” can have a significant impact on the way we feel about our bodies and ourselves. For most people, disparaging self-talk just makes us feel inadequate or depressed. However, negative body image plays a significant role in the development and maintenance of eating disorders. For individuals that are predisposed to developing an eating disorder (in other words, if eating disorders run in their families), seemingly harmless comments about themselves—or unsolicited comments from others—can contribute to the development of anorexia, bulimia, or binge eating disorder, or trigger a relapse for those in recovery from these serious illnesses.

 

Because “fat talk” is pervasive in our society and has the potential to impact our—and our young loved ones’—body image and self-worth, it is important that parents understand this phenomenon. Below are five considerations to help combat “fat talk” and cultivate positive body image in our lives and homes:

Be aware. “Fat talk” is everywhere; if you pay attention, you will find that fat jokes and “fat talk” are speckled throughout movies, sitcoms and books, even those geared towards adolescents and young adults. It is the fodder of seemingly every comedian in the world, and it underscores countless ad campaigns touting products and services promising to make us thinner, prettier and more desirable. For women and girls in particular, “fat talk” has become a bonding ritual of sorts—we often connect with others over mutual dissatisfaction with our weight, shape and size. Awareness is the first step in any meaningful behavioral change, so consciously try to identify the ways you and those around you use “fat talk” in your daily lives.

Be kind—to yourself, and to others. Our body weight and shape have nothing to do with who we are as individuals, mothers, daughters, friends, and employees. When you feel the urge to insult yourself related to your body size, shape or weight, instead think about the value you bring to your family, friendships, workplace or community. Also, avoid drawing attention to others’ body and weight insecurities. Our comments may come from a good place—we may think we’re supporting or motivating others with these messages—but we can never know the true impact of our words on others. Err on the side of kindness and make it a practice to not talk about others’ bodies.

Model healthy attitudes and behaviors. The most important thing parents can do to help their children develop a healthy body image is model healthy attitudes and behaviors toward body weight, size and shape. Kids are behavioral sponges—they watch what their parents do, they listen to what they say and they develop their worldview accordingly. Rather than toning down the “fat talk” around your children, try to remove it from your vocabulary altogether. Adults in your life may benefit from this change as well—family members and friends may notice the absence of “fat talk” from your conversations and follow your lead.

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Normalize eating in your home. Our thoughts and behaviors around food and eating are often closely linked to how we feel about our bodies. With that in mind, don’t allow or encourage dieting in your home. Don’t stigmatize foods as “good” or “bad”—all foods are okay in moderation, and the goal should be to consume a diverse, balanced diet with as much real, unprocessed, natural foods as possible. Do help to cultivate the social aspect of meals by turning off the television, putting down cell phones and making conversation with loved ones at the table. Additionally, talk to your children about their meals outside the home—who did they eat with, what did they eat, what did they talk about—to help them think critically about their patterns.

Frame exercise as fun and healthy. “Fat talk” often paints exercise as a punishment for eating too much or the wrong kinds of foods, or as a means to “fix” a perceived body flaw. Be sure to position regular physical activity as a fun and healthy habit for children and adults alike—in fact, it can be even more fun when families get active together. Exercise doesn’t have to involve a treadmill or weights—it can be walking the dog, building a snowman or playing softball with friends, family or colleagues.

 

Let me be clear—“fat talk” can adversely impact body image and self-esteem, which is a contributing factor in the development of eating disorders, but it doesn’t cause an eating disorder. Eating disorders result from a complex interplay of biological, psychological and sociocultural factors. However, it is important to understand the connection between “fat talk,” body image and eating disorders, particularly as it pertains to helping our children develop healthy body image and attitudes toward food, eating and exercise.