Today is Eating Recovery Day, which was started by the Eating Recovery Center. The aim of the campaign, #DontMissIt, is to help individuals recognize the warning signs of an eating disorder and not to miss out on a full life due to the disease.

Eating disorders are gravely misunderstood, not just by the public, but by many, many healthcare professionals. The more we talk about eating disorders—what they really look like, what actually works (and doesn’t work), how loved ones can help—the better. Which is why I’m happy to share my interview with Beth Riley, LISW-CP, CEDS, the executive director of Eating Recovery Center, The Carolinas in Greenville, South Carolina.

Below, Beth shares a slew of significant insights about everything from signs that family and friends tend to miss to how to approach your loved one if you think they’re struggling. Also, stay tuned tomorrow for an interview with Madeleine Wilson, who’s recovered from an eating disorder.

Q: When people talk about eating disorders (in the media, for instance) what do you think is left out of the conversation?

There are many significant features of eating disorders that are left out of conversations and misunderstood even by experienced healthcare providers. Eating disorders are not choices and have nothing to do with will power. Eating disorders are serious medical and mental illnesses, which means they are even more complicated to treat than other diseases. If someone is diagnosed with an eating disorder, their brain has been hijacked and they cannot simply eat more or less, or change their behaviors on their own accord. Eating disorders are the deadliest of all mental illnesses.

It is a myth that individuals with eating disorders are all emaciated young white women. The majority of individuals with eating disorders are normal weighted or above. Eating disorders do not discriminate and are diagnosed in all ethnicities, age ranges, genders and socio-economic status.

Binge-eating disorder (BED) is the most prevalent of all the eating disorders. Most people with BED do not want to admit that their behaviors and symptoms include: eating a large quantity of food in one sitting, feeling out of control while they are bingeing and feeling distress.

If an individual with BED is put on a diet and asked to exercise more, this will only increase their bingeing behaviors, resulting in feeling worse about themselves and more hopeless.  Confounding the issue is the fact that children and teens typically gain 20-40 pounds in their mid-sections 1-2 years before puberty. Since society and healthcare providers are focused on “anti-obesity treatment,” often these pre-pubescent children are being prescribed diets and exercise regimens for weight loss.

Instead of being put on a diet, it is important that parents, teachers, coaches and healthcare providers consider the developmental stage of the young person and avoid focusing on weight since this is a normal part of puberty. If a child is told they need to lose weight at this stage of their development, this can trigger negative thoughts about themselves and their bodies resulting in low self-esteem, depression and anxiety. Dieting results in alterations in brain chemistry and can trigger the onset of an eating disorder in those that are genetically pre-disposed to developing one.

Typically, individuals with eating disorders are high functioning at work, school or sports which makes it confusing for them, loved ones, doctors and coaches to see the illness. Even the results of blood work can be normal. A low heart rate (under 60 beats per minute) can be a sign of an eating disorder but is often mistaken for an athlete’s heart by coaches and healthcare providers.

Diagnosing an eating disorder needs to be done by an eating disorder expert who understands and knows how to look for the many signs and symptoms of an eating disorder. “Healthy eating” and exercise can actually be unhealthy if taken to the extreme. An example of this would be an individual who eats a high protein, low carb diet with limited fat and exercises over an hour a day. This individual is likely running at a calorie deficit and a negative energy balance which could lead to short and long-term complications, including permanent bone loss, cognitive impairment, infertility, cardiac complications and even death.

Q: What eating disorder signs do loved ones tend to miss? Why do you think these signs go unrecognized? (For instance, one potential sign of an ED, restricting one’s food intake, is lauded and recommended in our society. It’s very much normalized. So it can be tough to tell when someone is slipping into an eating disorder.) 

[They tend to miss] excessive exercise without adequate caloric intake that interferes with social functioning and daily life. Signs that someone is too focused on exercise include:

  • feeling the need to exercise after meals
  • exercising when injured or in inclement weather
  • missing social or family events or arranging their lives around exercise
  • becoming agitated, anxious or moody if they can’t exercise. They may be restless, fidgety, hyperactive, and have difficulty sitting down.

Males, and particularly boys, might start with a focus on getting fit in an attempt to achieve society’s ideal of six-pack abs and a muscular physique. They may start drinking protein shakes and take supplements instead of eating food.

“Healthy eating” can be taken to the extreme and is known as Orthorexia (i.e., the individual will only eat what they prepare and the only fats they will allow are from nuts, avocados, olive oil or coconut oil. They refuse to eat at restaurants and feel a need to rid themselves of any food that is not considered “clean” through fasting, exercise or cleansing rituals).

Often the attempt at healthy eating starts with eliminating certain food groups, such as dairy, gluten or meat. If a child or adolescent suddenly becomes a vegetarian or vegan, this could be a sign of a budding eating disorders. Individuals will no longer go out to eat or eat in social settings and refuse invitations to go out with friends or family.

When someone is in the throes of an eating disorder, there are typically changes in personality. They may seem more depressed, anxious, irritable, and tend to isolate more. They might obsess about counting calories, monitoring exercise, counting steps, making food for others and not eating it themselves.

You might notice they are putting more fat-free condiments on their food (salsa, hot sauce, mustard, vinegar, salt, pepper.) Food rituals are common, such as eating foods in a certain order, separating food on their plates, only eating off certain plates, cutting or tearing food into small pieces.

Binge eaters may not eat much in front of others but will eat late at night after everyone has gone to bed. You might notice food missing in the morning, wrappers in their room or car or charges for fast food on the credit card. Gastro-intestinal complaints such as stomach pain, cramping, constipation or indigestion are common. Often doctors order multiple rounds of tests only to find there is nothing physically wrong.

Q: If a loved one notices a few signs what should they do?

Any signs of an eating disorder should be taken seriously and addressed as soon as possible. Learn as much about eating disorders, such as by going to Eating Recovery Center’s website at www.eatingrecovery.com.

It is best to approach the loved one when you are both in a calm environment. It is important to suspend all judgement and blame (even self-blame) when talking to your loved one.

If it is a child be sure to keep the language simple and let them know it is not their fault but that they have an illness that needs treatment. Explain that you will be taking them to a place that will help decide the best treatment for them and remind yourself that even though they may be angry and hate you at the time,  it is the role of a parent to take care of a child (if your child had cancer you would not hesitate to seek immediate treatment for them.)

If the loved one is an adult, express your concerns and suggest professional help in a caring manner. Offer to assist them in locating an eating disorder expert and even to go to the first appointment.

Q: What can a loved one do if the person doesn’t think they have a problem and refuses to seek help?

Individuals with eating disorders are often in denial about the severity of the illness and may not want to give it up if it is serving a purpose (for example, it may be their way of managing stress or coping with a change or loss).

Complicating the situation, malnourishment can also lead to cognitive compromise making it even more challenging to have rational conversations with these individuals. They may not agree to seek treatment initially which can be frustrating and even scary for a loved one. They may say they can handle it themselves.

It is important not to give up on them. Continue to educate yourself and others who are close to the individual. Research treatment options and even consult an eating disorder expert about how to approach your loved one. Attempt to convince them to get an assessment by an eating disorder expert and even offer to accompany them.

The majority of healthcare providers have little to no training in diagnosing and assessing eating disorders and are not necessarily the best place to start.  In fact, a doctor with no formal eating disorder education could do more harm than good in getting your loved one to treatment (they might perform blood tests and send them home saying they are fine, or they might compliment them on their weight loss, healthy eating and exercise behaviors).

You may have to enlist the support of other important people in your loved one’s life to help convince them to seek treatment (boyfriends, peers, relatives, co-workers).

Ask your loved one what they value in life and point out how continuing with the eating disorder is not in line with those values (i.e., having children, career opportunities, graduating from college, enjoying time with friends).

Provide evidence that they have been living in a manner contradictory to those values (i.e., they no longer socialize with their friends since they won’t eat at restaurants, they don’t go on dates with their boyfriend or husband or they can’t concentrate at work or school).

Q: How can loved ones be supportive in general?

It is important that loved ones understand that the individual with an eating disorder is not able to think or act rationally when they are in the midst of the illness. Eating disorders are like phobias so using reason and logic is not going to help. The individual is having delusional thoughts about weight, food their bodies and themselves and you are not going to talk them out of their beliefs.

It is hard to grasp that your highly intelligent loved one who is performing well at school, work, sports and daily activities is incapable of eating anything that contains fat. This is partly due to the fact that the more individuals restrict, exercise, purge or binge, the more addictive the behaviors become.

Attend family therapy sessions, and follow the recommendations of the treatment team. Suspend all unnecessary activities so that you and your loved one can focus on recovery. Be available to eat meals with your loved one and model normal eating behavior.

Find out what triggers your loved one’s ED thoughts and behaviors and make adjustments accordingly (for example, exercising in front of them or talking negatively about your body).

Don’t blame yourself for past behaviors but stay focused on what you can do now to be part of the solution.  Advocate for your loved one (especially if they are a minor) at the doctor’s office (remind the staff to do blind weights and not to discuss weight, shape, exercise, diet) at school or around loved ones.

Assist your loved one in planning for family events and develop strategies to help them handle situations that could be triggering. Focus on feelings instead of food, body, or weight talk. Spend family time playing games or watching movies instead of exercising together (for those who are not allowed to exercise).

Instill hope and be patient. When they talk about wanting to leave treatment, encourage them to stay. Recovery is very difficult but entirely possible for those that stay the course and have supportive loved ones.

Q: What do you want readers to know about eating disorder recovery?

It is a long and arduous process with a lot of ups and downs. Typically the recovery process takes between 3 and 7 years. Just when you think your loved one has turned the corner new symptoms will emerge. They might be able to tolerate more food, have stopped bingeing or been able to refrain from exercise. But the emotions they have been attempting to avoid begin to surface, and they seem more depressed or anxious.

As they refrain from behaviors, they actually need more emotional support. It is important that loved ones keep in mind they are in this for the long haul and need to take care of themselves throughout the process.

Eating disorders have the highest rate of relapse during the first year of recovery. So it is important to know the signs and symptoms and encourage your loved one to continue to seek treatment even if they seem better and are saying they are fine.

Q: Anything else you’d like readers to know about eating disorders? 

Don’t put off treatment. It will only get worse. There is no ideal time to seek treatment. There will always be something going on in your life that can serve as an excuse.

It is also never too late to seek treatment. Many middle-aged women and men need help but fear they will be the oldest in the room. This is simply not true.

Follow the advice of qualified eating disorder experts. If they recommend a higher level of care than you think you or your loved one needs, listen to them. If you went to the oncologist and they recommended a treatment protocol, you would most likely heed their advice. You would not want to do it but you would go to any extreme necessary to get the prescribed treatment.

Eating disorders are showing up at younger ages and children and teens have a high risk of long-term medical complications since their brains, hormones and bones are still developing.

Keep in mind that someone who is labeled a picky eater could actually have Avoidant and Restrictive Feeding and Intake Disorder (ARFID).  ARFID can be associated with severe malnourishment and long-term medical complications so an evaluation from an eating disorder specialist is critical.

Many athletes, particularly cross country runners have eating disorders. Eating disorders run in families so if you or a family member had an eating disorder, your child or relative has a higher probability of developing one.

Eating disorders can be prevented by eating family meals together; recognizing and accepting that bodies come in all shapes and sizes; reducing stress; refraining from labeling foods as “good” or “bad”; eliminating body shaming talk and spreading awareness in the community.

***

Share your #DontMissIt moment or story of recovery on social today! For additional information about Eating Recovery Center, call 877-789-5758, email [email protected], or visit www.eatingrecoverycenter.com to speak with a Masters-level clinician.