In honor of National Eating Disorders Awareness Week, we’re publishing another interview with an eating disorder expert. Today, we’re talking about the importance of detecting eating disorders early, what signs to watch for, and what effective treatment looks like. I spoke with Dr. Stephanie Setliff, M.D., medical director of the Eating Recovery Center in Dallas, Texas, who has specialized in eating disorders for over two decades.
Q: Why is early detection so vital?
A: Eating disorders are complex and require a multidisciplinary team for the most effective treatment. For the best outcomes, early detection is imperative. Eating disorders always present as someone who started to diet in pursuit of the “thin ideal.” While dieting and exercise are definitely gateway behaviors, oftentimes they begin as a desire to start eating healthier or a new commitment to get into better shape.
In addition, they can begin as a manifestation of extreme anxiety driven by some internal or external event(s) that is beyond the capacity of the individual’s ability to cope. It is then transformed into something that can be managed, such as focusing on food and weight.
Another common vignette is that the person originally was diagnosed with a medical issue that affected their enjoyment of eating food, for example gastrointestinal problems, or even choking on food that then initiates a cascade of events due to fear of choking again.
It is not uncommon for primary care providers, mental health professionals and families to seek exhaustive medical workups, thus delaying the diagnosis and initiation of treatment. Because of this, it is vital that medical and mental healthcare professionals are knowledgeable about the warning signs and symptoms of eating disorders.
Q: How do you define “early detection”? What are the early signs that a loved one has an eating disorder?
A: Eating disorders can have an insidious onset and therefore be difficult to detect. Early detection involves recognizing symptoms of disordered eating before it becomes a full-blown eating disorder.
These signs include (but are not limited to): children and adolescents falling off of their growth curves; weight loss; changes in mood; changes in school or work performance; isolating; over-exercising; and becoming increasingly rigid around meal times, including what foods they will eat and which restaurants they will go to.
Loved ones can also watch for other changes in eating habits like: decreasing portion sizes; using the restroom or showering/bathing frequently after eating; and baking/cooking foods without consuming them. There may also be a newfound obsession or concern about certain body parts.
Q: How do you suggest bringing up the topic with your loved one?
A: It is not uncommon that parents and loved ones come to professionals with questions about how to talk to their family members about their concerns. It is best to be honest about what you have been observing and that your concerns are based on behaviors.
[An example is] telling the child that you have noticed they are losing weight and wonder if they’ve noticed. Or that you have noticed that they are cutting back on the amount of food they consume, or noticeably increased their workouts and are placing much more emphasis on how their body looks. Or, that they seem like they’re more tired, more irritable, more withdrawn. And that the parent is concerned that the child may be developing an eating disorder.
The timing is also crucial to get right. It should not be brought up at a meal or when the child is already overwhelmed by something in their day. And, the parent needs to be prepared to stay calm and just be concerned. The conversation isn’t meant to be a diagnostic interview but rather an information-seeking conversation. The child’s reaction is usually quite helpful. If anger and rage are the response the parent gets, they are usually on the right track.
If you are unsure how to bring up the topic, it is recommended to seek help from a professional in the field of eating disorders who are trained in what to look for, what questions to ask, and what recommendations/referrals to make.
Q: What is effective treatment for eating disorders? When you’re looking for effective treatment, what kinds of questions/concerns do you suggest parents focus on?
A: As previously mentioned, effective treatment for eating disorders involves a multidisciplinary team that consists of a therapist, dietitian, psychiatrist, and nurses. A treatment center that offers evidence-based treatment and a full continuum of care is optimal.
Best practice for the treatment of eating disorders in the adolescent population has to include a family-based treatment approach. Optimally, eating disorder treatment will include family therapy, multifamily groups, psychoeducation, skills groups, dietary services, medication management, and individual therapy.
At times an individual also may need a specialty track that includes treatment for co-morbid disorders, such as substance abuse or trauma. A primary care provider and, when appropriate, subspecialists like cardiologists or gastroenterologists need to be included in a patient’s care as well. When looking for effective treatment, it is recommended that parents and family members ensure that treatment includes all of the above factors at a minimum.
If you are concerned that a family member or loved one has an eating disorder, schedule an assessment with a treatment facility to get more information and recommendations. It is vital to recognize the signs and symptoms early to ensure proper treatment, lasting recovery, and lower rates of relapse.