By Lauren Todd
This summer, I had to ignore much of what I have learned regarding healthful eating. I overlooked recommendations to consume more vegetables, pondered methods to increase consumption, and pushed what I knew about obesity to the back corner of my brain. I interned at Klarman Eating Disorders Center, where the population differed greatly from those which I am likely to learn about in my classes.
Klarman is a residence program for girls ages 13 to 23 who have eating disorders. It is part of McLean Hospital, where Ray Charles, Sylvia Plath, and John Nash have been treated in the past. When I was not exploring the 200-year old hospital’s underground tunnels, I worked with the nutrition staff to plan, prepare, and analyze the nutritional content of meals served each day. Between giant shopping trips at BJ’s and cooking breakfast, lunch, dinner, and two snacks from scratch, the nutrition staff has a packed schedule. During my internship, I had little time to even sit down, yet working with health care professionals so devoted to their jobs and patients was well-worth it.
Drawing from my internship experience, I will provide a quick update on current trends and research about the immediate and long-term dangers of eating disorders.
Eating disorders affect a relatively high number of children, adolescents, and adults. A countrywide study released earlier this month surveyed 2453 Canadian children aged five to twelve and observed that the prevalence of eating disorders was twice the prevalence of type-2 diabetes. These children are not simply picky eaters; further analysis revealed that nearly half of children with disordered eating required hospitalization for unstable vital signs. Eating disorders have serious consequences. Anorexia is the most fatal psychiatric disease. In July 2011, Jon Arcelus analyzed 36 studies that examined the rates of death among individuals currently suffering with eating disorders and compared them with death rates of the general population. Anorexic individuals were approximately six times as likely to die as individuals without anorexia. Bulimic individuals were approximately twice as likely to die as individuals without bulimia.
The emotional ramifications of eating disorders should not be under-exaggerated. This same study found that one in five deaths among individuals suffering from anorexia is due to suicide. Someone with an eating disorder may feel isolated because so many of their behaviors are kept secret. At Klarman, it was common practice for staff to check under the tables for peanut butter or make sure all salad dressing had been consumed.
Anorexia is characterized by a failure to maintain 85% ideal body weight, body dysmorphia, fear of weight gain, and amenorrhea. It takes a major toll on the heart, bones, and digestive system. Health professionals, patients, or parents sometimes refer to the anorexia as a separate person, such as “Ana” because the eating disorder distorts rational thinking, affects cognition, and makes the patient indistinguishable from his or her former self. It is common for an individual with anorexia to cite vegetarianism, food intolerance, and food allergies as reasons for restricting intake. By cutting out meat products, dairy products, or whole food groups, individuals have a simple explanation for restriction. This summer, fast food was not the enemy. Meals like pizza or Chinese food may be triggering or stressful for someone with an eating disorder, but breaking that fear may be essential for recovery.
The symptoms of anorexia may appear to be opposite of those of bulimia, but the two diseases are flip sides of the same coin. Individuals with bulimia may not appear sick because they are commonly within a healthy weight range. Bulimic patients consume large amounts of food in one time period (called a binge) and then rid their bodies of that food by vomiting, using laxatives, or exercising excessively (called a purge). According to Walter Kaye in a 2008 study, approximately 25% to 30% of bulimic individuals have had a past history of anorexia. For this reason, relapse prevention is a critical component of treatment for anorexia.
Individuals with bulimia may have swollen cheeks, calluses on their hands from self-induced vomiting, and poor dental hygiene. Yet the consequences of bulimia are more severe than these issues. Frequent vomiting leads to dehydration, sodium loss, and potassium loss, resulting in electrolyte imbalances that interfere with normal cardiac rhythm. According to the National Eating Disorders Association, some bulimic individuals may even suffer life-threatening esophageal ruptures.
Eating Disorders Not Otherwise Specified
Disordered eating may not fit neatly into the somewhat rigid guidelines that diagnose eating disorders. A new media trend is to assign cute titles to deadly eating disorders. Think “pregorexia.” But these disorders are serious! They are deemed “eating disorders not otherwise specified” and are more common than classic bulimia or anorexia and come with severe psychological and physiological consequences.
The term “eating disorders” is misleading because some symptoms are not related to food intake. In fact, eating disorders are often not about the food at all, but that is an issue to be discussed at a different time. Individuals with eating disorders commonly use exercise to control their weight. Although exercise is essential to maintaining health, excessive exercise can take a toll on the body and mind.
Compensatory exercise means exercising to rid the body of calories, fat, or carbohydrates that have been previously consumed. For example, a person who engages in compensatory exercise may run to burn off the cookie that she ate earlier that day. It is similar to the classic form of bulimia, but instead of vomiting, the individual works out.
Compulsive exercise is another form of exercise abuse, in which the individual feels an overwhelming need to work out. Such a person will exercise no matter what: when injured, sick, or in the middle of a blizzard. Compulsive exercise can become extreme. In her book “Stick Figure,” Lori Gottlieb described how, when she was hospitalized for anorexia, she would secretly exercise in her room when the nurses left her alone.
Although no single cause of eating disorders has been determined, the consensus among professionals I worked with this summer is that genes load the gun and environment pulls the trigger. Eating disorders cause severe harm to the body and should not be overlooked by health care professionals, nutritionists, or anyone affected. A person with an eating disorder cannot simply stop the behavior. Some healthcare professionals may incorrectly state that eating disorders cannot be treated, which may prevent an individual from getting the care that he or she needs. But luckily, Klarman does not take partake in this philosophy. This summer, recovery was a common outcome of eating disorders. In fact, seeing girls graduate from Klarman embracing recovery was my favorite part of my internship. With the proper psychological, nutritional, and physical treatment, recovery is an option, no matter how short or long-lived the eating disorder.
Lauren Todd is a second year student in the Nutrition Communication program at the Friedman School. Her professional interests are in eating disorder prevention. She likes to procrastinate by painting, crocheting, and playing fantasy football.