News 05
News Articles About Eating Disorders
Dying to be thin
Eating disorders take a toll on your body, your mind and your spirit. Whether it's anorexia, bulimia or binge eating, abusing food can lead to serious health problems. Ed Bloch and Jena Leuenberger are no strangers to these disorders.
The two business partners have counseled patients with eating disorders for the past 10 years in California.
Saturday, March 10, 2001
EATING DISORDERS often start with a simple diet and develop into a larger psychological problem. Two counselors have opened a clinic in Lawrence to help those suffering from anorexia, bulimia or binge eating problems.
They are also engaged, and have overcome an eating disorder in their own relationship. Ten years ago, Leuenberger was a binge eater who used exercise to purge. She enrolled in a therapy class to overcome the disorder, and now helps others in need.
Bloch and Leuenberger recently moved to Lawrence and founded the Life Enrichment Center, 1311 Wakarusa Drive, the city's first outpatient clinic for people with eating disorders.
"This is so prevalent in our society at a lot of different levels, and it's not just the one who's throwing up 20 times a day, or who's near death," Bloch said. "There are millions of young women who are engaged in these behaviors. It's affecting their lives and it's only the beginning of the disease for them."
Losing touch
Leuenberger said a disorder can start small, with a simple diet, and build to life-altering behaviors. Today's society has everything to do with the prevalence of eating disorders, she said.
"Everything is so externalized, and the more women get into dieting that's where they start losing themselves, losing touch with their bodies," Leuenberger said. "A diet is some external rule. It's not telling you when you're hungry. It's saying 'eat this when' so we stop trusting our bodies and start trusting this menu item that has no life."
Bloch, a licensed clinical social worker, says 1 percent of females have anorexia while 4 percent suffer from bulimia.
"The prevalence of it here is much greater than I think Kansans would ever believe," he said. "There's a lot of shame related to the behavior, so they don't talk about it."
Young women are especially vulnerable. Bloch estimates between 15 percent and 20 percent of women on college campuses have an eating disorder.
"The incidence is rising all the time and the prevalence is greater every year," he said.
Letter writing as a therapeutic tool
A novel method of family therapy for persons suffering from eating disorders, therapeutic letter writing
(TLR), is presented. The protocol used for letter writing, its advantages and limitations, and a variety of applications are reviewed.
The concept of TLR grew out of the study of narrative therapy, and was strongly influenced by ideas of Lorraine Wright and Maureeen Leahey about nurses and families, as well as the work of W.R. Miller around stages of change.
Emulating mom boosts self-esteem and body image
Little girls who emulate their mothers are less likely to suffer from low self-esteem and eating disorders, regardless of the mother's own body image, psychologists reported.
"We found that if little girls said, 'I want to be like my mom,' they had a better body image, less eating disorders, and better self-esteem--all these great things," lead author Dr. Jane Ellen Smith. "We don't know what it is about wanting to be like your mom that contributes to better self-esteem."
When healthy eating goes extreme it becomes an unhealthy obsession
It shouldn't come as any shock that doctors are now identifying a whole new, particularly American, form of eating disorder -- the compulsion to eat only perfectly pure, perfectly organic, perfectly nutritious food.
"By now, everybody knows that eating healthy is good for you," says Steven
Bratman, author of Health Food Junkies (Broadway Books), a book that defines the new food problem. "However, what seems to happen to a surprising number of people is that when they get into eating healthy, they get into it in a really obsessive way."
Anorexic teens use herbal remedies to lose weight
With increasing numbers of American adults turning to herbal supplements and other forms of alternative medicine, it should be no surprise that adolescents are doing the same. But according to a group of Canadian researchers, some of these young people are using herbal supplements not to improve their health, but to damage it.
Predicting children's reported eating disturbances at 8 years of age.
The impact of maternal eating disorders and disturbances is much stronger than that of fathers and is specifically directed at their daughters.
J Am Acad Child Adolesc Psychiatry. 2001 Mar;40(3):364-72.
Predicting children's reported eating disturbances at 8 years of age.
Jacobi C, Agras WS, Hammer L.
Psychological Institute III, University of Hamburg, Division of Behavior Therapy, Germany.
OBJECTIVES: To examine differential parental influences on eating attitudes and behaviors of 8-year-old children with a specific focus on gender effects and to assess the specificity of this relationship. METHOD: One hundred eight infants were monitored from birth and interviewed at age 8 for eating disturbances and negative affect with an adaptation of the McKnight Risk Factor Survey. Parental measures included the Three Factor Eating Questionnaire subscales Disinhibition and Restraint as well as body mass index, assessed at study entry. RESULTS: No gender differences were found for frequencies of children's self-reported eating disturbances. Higher maternal restraint scores predicted worries about being too fat in girls but not in boys. Higher maternal disinhibition scores also differentially predicted weight control behaviors in their daughters. Negative affect in the child was (weakly) predicted by higher maternal body mass index. No association between paternal predictors of disturbed eating and the child's eating disturbances and negative emotionality was found. CONCLUSIONS: The impact of maternal eating disorders and disturbances is much stronger than that of fathers and is specifically directed at their daughters. The clinical importance of these disturbances in terms of precursors of adolescent eating disorders has to be determined by monitoring the sample through puberty.
Female Athletes Who Stop Menstruating May Face Heart Disease Risk
Women who stop menstruating because of excessive exercise may be at risk for developing future health problems. Athletic-induced amenorrhea (absence of menstruation) is known to cause premature osteoporosis and infertility. For instance, a young woman who hasn't menstruated in four years may have the bone strength of a 50-year-old.
It's estimated that almost three million girls and young women compete in American high school and college sports. Nearly a quarter of all female athletes may have an abnormal menstrual cycle. While studies have shown that women and girls who participate in sports and fitness programs are generally healthier and have higher self-esteem, it is important they are aware of what is called the Female Athlete Triad.
This recently recognized syndrome is made up of three distinct yet interrelated conditions: disordered eating, amenorrhea and osteoporosis. Well-meaning coaches, friends and parents may encourage weight loss in female athletes due to a mistaken belief that excessive leanness enhances performance. These young women may be goal-oriented, compulsive perfectionists, and the long-term effects of the Triad can be quite serious.
We know when post-menopausal women stop having their menstrual period, their risk of having cardiovascular disease increases significantly. We believe female athletes in their early 20s may be at risk for premature heart disease, too. However, no one has studied the correlation between lack of menstrual periods and premature heart disease. Medical College of Wisconsin researchers are now undertaking such a study.
The Medical College is in a unique position to perform this study because of its world-renowned Cardiovascular Research Center and the only Women's Sports Initiative Program in the Midwest, based at the Froedtert & Medical College Sports Medicine Center.
Initially, the Medical College is looking at runners, although gymnasts and ballerinas also have high rates of amenorrhea. To qualify for the study at this time, women must be at least 18 years old, run 25 miles per week, have missed a menstrual period for more than six months and not be on birth control pills. Participants are compensated $100 for their involvement.
The two-to-three hour screening involves filling out an exercise and diet survey and ruling out physical causes of amenorrhea, such as pregnancy or thyroid conditions. Bone health then is measured using a bone mineral density scanner, which takes five minutes. The cardiovascular health of participants is examined with a non-invasive ultrasound technique that assesses the ability of blood vessels to dilate under different conditions.
Loss of blood vessel dilation is one of the earliest manifestations of cardiovascular disease in post-menopausal women and is thought to be the first precursor to the development of heart disease.
All study participants will have an opportunity to receive medical counseling to help them regain their menstrual cycles. Treatment of the Triad often requires intervention via a team approach. A physician, nutritionist and psychologist with expertise in treating female athletes may need to work with athlete, coach, parent and others. Nutritional monitoring, hormone replacement and reduced training may be recommended.
Staying In Line
Dr. Valerie Kaye, a psychiatrist at SFU's Health and Counselling Services has had a lot of experience with people who struggle with disordered eating. She notes that many of the individuals she counsels are "people who exercise a lot, but their focus is using calories and perfecting their body shape...what they care about is how many calories they can burn." Kaye also says that in terms of weight and size, "most people have a set point and no amount of dieting or exercise is going to make that shape substantially different."
Charlotte Olson trains hard. She is a member of SFU's Women's Basketball Team where the players engage in rigorous training six days a week. Through her experience in competitive sport, she has learned to listen to her body and knows when it's time to take a break.
"I think you can almost get addicted to working out" says Charlotte, noting that "your body needs to rest and a lot of people don't realize that".
While there are tremendous health benefits to be gained from being physically active and excelling in sport, sometimes it gets taken too far-to the point where exercise becomes an obsession. When people put their health and well-being into jeopardy for the sake of burning calories in an attempt to achieve the "perfect body", a downward spiral into body image dissatisfaction and disordered eating is not far off.
Dr. Valerie Kaye, a psychiatrist at SFU's Health and Counselling Services has had a lot of experience with people who struggle with disordered eating. She notes that many of the individuals she counsels are "people who exercise a lot, but their focus is using calories and perfecting their body shape...what they care about is how many calories they can burn." Kaye also says that in terms of weight and size, "most people have a set point and no amount of dieting or exercise is going to make that shape substantially different."
Eating disorders and body image preoccupation can often become issues for people when they are seeking control in their lives. When so many things in our world seem out of control, having 'control of the body' makes people feel personally effective. We live in a culture where we are inundated with constructed images of what we "should" look like. These images often appear in the context of trying to sell us something.
Everything is marketable, including the image of the "perfect" body. Kaye notes that for eating disorders, "there are cultural factors [which contribute] in terms of expectations for thinness and our connection between thinness and wealth and success," and she adds that the media plays a role in its "portray[al] [of] hundreds of thousands of images that show us that we should be thin to be accepted."
While the media does play a role in how people come to conceptualize beauty, Kaye says that it is not our thin-conscious culture alone that causes people to develop eating disorders. She notes that participation in certain environments (such as dance, gymnastics or wrestling, where thinness or specific weights are issues) carries the potential of being a risk factor for eating disorders. However, a person's psychological makeup is also a contributing factor to the development of eating disorders. Additionally, Kaye says that other factors can be having a history of family or childhood obesity, as well as coming from families where depression or excessive stress occur. Essentially, there is no one specific factor, but a variety of factors that need to be present for a person to develop an eating disorder, and for everyone, the factors are different. Some common warning signs of eating disorders are: expressed anxiety about being fat, avoidance of eating with others, highly active, develops rituals around eating, going to the bathroom right after eating, rigidity, withdrawal, and depression.
To help someone with an eating disorder, Kaye says its important to raise the issue, and to "educate yourself and then offer it to the individual." She also advises that it is "really important that the eating disorder doesn't become the focus of their relationship," and she stresses the importance of "trying to maintain your relationship and not focus on the eating disorder as their whole being." Kaye notes that, "if someone's self-esteem is purely about what their body shape is, there are problems," and she says, "it's a tragedy when somebody's eating disorder becomes their whole identity."
The diet industry takes in over $40 billion per year (Council on Size & Weight Discrimination), yet Kaye notes that, "95 per cent of people who lose weight on diets will regain that weight over two years and many of them by far more." Clearly, diets are not successful. Additionally, Kaye notes that "dieting may be a trigger" in the development of an eating disorder. She says that if you eat only half of what you would normally eat because of a diet, you are leaving your body hungry, and therefore are "predisposing yourself to have a binge later on." Kaye stresses the fact that when a person diets, "you start losing normal cues about when you're full and when you're hungry...so that your body no longer can tell you what your needs are." Kaye wants to dispel the notion that being larger is unhealthy. She says that being "15 per cent underweight is a lot more problematic than 15 per cent overweight", and she notes that, "losing the same 30 pounds over and over again is far more harmful for you than just staying where you are."
The Eating Disorder Resource Centre of B.C. states that eating disorders are more pervasive in areas such as dance, figure skating, gymnastics, running, swimming, rowing and riding. Men are more at risk of developing disordered eating or muscle dysmorphia (obsessive dissatisfaction with body image) if they are bodybuilders, gymnasts, wrestlers, jockeys or "obligatory runners". According to Kaye, "In any sport where specific weight requirements or...body shape are important, clearly those areas are higher risk areas for eating disorders."
Allison McNeill, the Head Coach of SFU's Women's Basket Ball Team is in her 11th season at SFU, and she says that it is "no question" that eating disorder behaviors and body image preoccupation are issues in the competitive sport community. Charlotte Olson agrees. While she feels that on her own team, body image is not really an issue, t she feels on the whole, both men and women are concerned about it. While eating disorders and body image concerns are generally thought to be issues related to females, Charlotte says that regarding body image preoccupation, "I know a lot of guys who are really concerned with that too." Kaye says that males who have eating disorders tend to be involved with athletics and she feels that often they "engage in over exercise and using steroids" as a means to deal with negative body image. She notes that in our society, women experience "an expectation...[to be[ the 'Super Woman', the perfect student, the perfect parent, the perfect girlfriend, the perfect mom." Eating disorders become coping mechanisms, and Kaye says they are related to feeling pressure to be a certain way. She notes that "women are more affected by eating-related concerns than men," and that eating disorders are more commonly found in women than men 9 to 1.
McNeill says that in sport, body image is not only a concern, but performance is an issue as well. She notes that some people get into the mentality that "I can perform better if I'm lighter, I can perform better if I'm more cut." While McNeill feels that issues of disordered eating and body image are all over competitive sport, she feels that it's more of an issue in sports where people are judged based on how they look and the size of their body. She feels fortunate that in basketball, "you go out and play...it's a performance sport, it's a team sport, no one is out there grading us on 'are our legs shapely enough'...we don't have that kind of pressure." Charlotte believes that disordered eating and body image become issues in competitive sport because individuals get caught up with being the best you can be in every aspect of your life. She trains extremely hard, while realizing: "You can only do so much that your body can handle, you can only be the best that you can be, not the best that someone else is", and she is aware that "there are a lot of people who might have trouble with that."
In terms of eating disorders impacting performance, McNeill says "I think that they can have a huge impact, nutrition is so important to performance in athletics," and she notes that an improper diet can make a world class athlete mediocre. She says that while sometimes people think that really cutting back on fat or caloric intake will improve performance, it ends up hurting your performance because you're weak physically, you can't train at the level you want to.
"I have been around both bulimic athletes and anorexic athletes" says McNeill, "it's amazing how well it can be hidden...they seem to be eating when everybody else is eating, but they're not". She stresses the importance of athletes being aware of the issues and says that it needs to be discussed at a fairly young age. She says, "if we educate [the athletes], then I think you're making better decisions down the line." McNeill realizes that "the fear of gaining a little weight...is just not healthy, and sport can be a bad place for that."
Eleven years ago, when McNeill first started coaching at SFU, she recalls that the team used to have weekly weigh-ins. New on the SFU scene, McNeill recalls she was going to "crack the whip" and make everyone weigh-in. One player refused. McNeill remembers insisting that the player weigh-in and she recalls that "she looked me straight in the eye and said, 'No I'm not'". When they discussed it further, the student told McNeill about her experience with bulimia throughout high school. Restored back to health, weighing herself was no longer a part of her life. "I don't do that anymore," McNeill recalls her saying. Regarding the weighing of players, McNeill confesses "I'm embarrassed to say I did it", noting that the student "did open my eyes". She says "that was the end of it, I haven't... [weighed players] since. I don't even ask them what they weigh...as long as they're healthy and they're fit and training at a level that is commensurate with the level that we should be training at here, as a university program, then I'm pretty happy".
McNeill notes that while men may not have as much of the eating disorder experience as women do, they have the additives and the chemicals that they're looking to build their bodies, get stronger and bigger, and that's become much more common. She says, "When I was a competitive athlete...you didn't hear about steroid use, it seems to be a lot more popular now."
In terms of promoting health and well-being on her team, McNeill says, "I want to empower my female athletes", noting that "we're very supportive of each other in our training." She says that the team works with the theme "we're not here to see through each other, we're here to see each other through." McNeill feels that eating disorders are more of an issue in women's sport.
"We're just a microcosm of the whole society, where we're bombarded daily with not looking right", says McNeil. She encourages strength, health and fitness on her team, and to counteract some of the media messages, and at one point banned all fashion magazines from their road trips, seeing it as very contradictory for athletes to be training for hours, needing to eat a lot and then being sent messages from magazines which suggest cutting back on food. "Big and tall is beautiful," says McNeill. Regarding her larger players, she says, "I'm really proud of the fact they're big, they're encouraged to be big."
For the team, McNeill emphasizes that the focus be on, "getting stronger for our sport, we're not trying to get cut to look good in a swimsuit." She speaks to the power of being active and healthy, saying it's a thrill to go into the weight room and be strong.
Eating Disorder Awareness Week is February 1-7. For more information on Eating Disorders, contact the Eating Disorder Resource Centre of B.C. at 631-5313.
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