March 01, 2024
Many health issues are easy to identify in ourselves and those we care about. That’s not always the case when it comes to eating disorders. People who have them may not know it. Or, if they do know, they may be so ashamed that they hide the problem — not only from their family and friends, but also from their doctor.
Dr. Dolores Roman, a 20-year veteran of emergency rooms and a medical director at Independence Blue Cross, has witnessed the impact that eating disorders can have on a person first-hand.
“Too often, there is shame and a stigma associated with having an eating disorder that create barriers to timely care,” said Dr. Roman. “Unfortunately, these barriers can result in the disorder going undetected until the condition has progressed to a severe stage. At that point, the individuals suffering have no other choice but to seek emergency care.”
Eating disorders are serious mental and physical illnesses that stem from how someone thinks about food, their eating and exercise habits, and their perception of how their body looks. Symptoms commonly appear in adolescence and early adulthood, but eating disorders can affect people of all ages.
“This is not just a youth-specific health concern,” said Dr. Roman. “Diagnosis can happen at any time from childhood through advanced adulthood.”
Genes play a large role in determining someone’s risk for developing an eating disorder, but specific life experiences and events are often triggers, including:
• Abuse during childhood
• Bullying
• Fat shaming
• Having a mental illness
• Stress
• Dieting
• Life transitions such as going through puberty, starting college, getting a new job, and starting or ending a relationship
“Many of the the life experiences and events that trigger eating disorders were particularly exacerbated during the pandemic,” Dr. Roman said.
The COVID-19 pandemic was an extremely stressful life experience that changed the ways we lived practically overnight. It disrupted the ways people ate, worked, went to school, and spent time together. During this period, the number of young adults and adolescents seeking treatment for eating disorders increased significantly.
Three of the most common eating disorders include binge-eating disorder (BED), bulimia nervosa, and anorexia nervosa.
Binge-eating disorder (BED)
People with BED regularly consume large amounts of food in a short time and feel like they can’t stop.Those who have this disorder come in all shapes and sizes. Some are chronic dieters and try to limit how much they eat before and/or after bingeing to “make up” for their behavior.
The biggest health risk from BED is becoming obese, which increases the risk of many other conditions, including Type 2 diabetes and cardiovascular disease.
Bulimia
Bulimia is when a person has periods of out-of-control eating that are immediately followed by efforts to get rid of the calories consumed by inducing vomiting and/or using diuretics or laxatives. People with bulimia also may over-exercise or fast to avoid gaining weight.Those who suffer from this eating disorder tend to be overly concerned with their weight and body shape. They can range from mildly underweight to overweight.
Bulimia can cause numerous health problems, many of which result from constantly exposing the throat and mouth to stomach acid due to induced vomiting.
Anorexia
Among the three most common eating disorders, anorexia is the least prevalent one but the most dangerous. People who have it typically perceive themselves to be overweight, even if they are severely underweight. They are also known to severely restrict their caloric intake and exercise excessively.Left untreated, anorexia can cause many health problems. They can include things such as thinning of the bones; mild anemia; muscle wasting and weakness; low blood pressure; dizziness or weakness; infertility; heart damage; brain damage; and organ failure. Being anorexic also significantly increases the risk of death by suicide.
Two other less commonly recognized eating disorders are Avoidant Restrictive Food Intake Disorder (ARFID) and pica.
Avoidant Restrictive Food Intake Disorder (ARFID)
ARFID is a recently recognized eating disorder. People with it limit the amount (or variety) of foods they eat to the point that it can lead to medical issues, nutritional deficiencies, or psychosocial problems.People with ARFID often:
• Feel full before eating or have no appetite at all
• Only eat foods with certain textures
• Fear that eating could cause them to choke or vomit
• Become pickier about food until it severely limits what they can eatPica
This disorder involves eating things not normally considered to be food, including dirt, clay, crayons, paper, hair, or cigarette butts. People with pica may experience stomach problems, fatigue, and other serious health issues.Pica is often triggered by nutrient deficiencies that cause cravings for things that are not food. For example, pregnant people and others who have iron-deficiency anemia may crave substances that contain iron. Among children, pica is more frequently seen in those with autism spectrum disorder and those with developmental or intellectual disabilities.
Management for eating disorders usually involves a combination of:
• Medical treatment for any physical conditions resulting from the disorder
• Monitoring and maintenance of those conditions
• Nutritional guidance and education
• Cognitive behavioral therapy
• Medication, if needed
Depending on the severity of the disorder, a doctor may recommend hospitalization, a residential treatment program, or a day treatment program.
For those who seek help, the odds are in their favor. According to Dr. Roman, “The vast majority of people progress to complete recovery with appropriate care and treatment.”
If you are concerned about your own eating behaviors (or those of a loved one), the first step is to talk to your health care provider. They can help you identify a problem, determine the best course of treatment, and prevent the issue from getting worse.
If you are worried that a loved one may be suffering from an eating disorder, it’s important to approach them with compassion. Express your concerns with care and empathy. If they’re open to talking with you, provide them with a safe place to share their struggles without fear of judgement, and encourage them to seek professional help. Your understanding and support may make all the difference in their journey towards recovery.
There’s plenty of resources available for guidance on eating disorders. Organizations that provide educational information and support include:
• National Eating Disorders Association
• Eating Disorder Hope
• Eating Disorders Coalition
• Substance Abuse and Mental Health Services Administration
• National Association of Anorexia Nervosa and Associated Disorders (ANAD)
ANAD also operates the National Eating Disorders Helpline, which provides 24/7 support at 1-888-375-7767.
All Independence Blue Cross (IBX) commercial health plans cover nutrition counseling and behavioral health treatment. Members can find eating disorder treatment resources on the organization’s Provider Finder and can access Registered Nurse Health Coaches at any time by calling 1-800-ASK-BLUE (1-800-275-2583) (TTY/TDD: 711).
