Healthy Weight

Eating disorders can seem the domain of the rich and famous, the models and the actresses, of Victoria Beckham and Princess Diana, in reality they are widespread–across financial groups, ethnicities, and genders (would you believe that nearly 1/4 of  preadolescent cases of anorexia occur in boys, with binge eating disorder hitting males and females equally?)–and are, in addition, deadly serious.

In fact, the numbers are hard to get your head around.  Approximately 24 million people in the U.S. have an eating disorder in one form or another. And–more challenging yet–a paltry 10% of those will receive treatment.

Whereas we like to think of ‘those with mental illness’ as other than us–think of schizophrenia or bipolar disorder; we prefer to see them as diseases that could never touch us–eating disorders are like European sparrows–common in every state and hard to eradicate.

We’re all familiar with the terrifying anorexia nervosa, which can turn into bulimia nervosa (a disorder on its own, characterized by binge eating and purging [usually by vomiting, although some use laxatives, or even extreme exercise. binge-purge cycle, using vomiting or laxatives] when the starving person can’t take it any more.

At first blush, it looks like bulimia is the get-out-of-jail-free card: eat all you want and stay skinny. This is not a slam-dunk, however.

Although bulimics are often ‘normal’ weights, they are usually extremely unhappy with their body shape and size and live in fear of gaining weight. Additionally, the purging causes a number of physical symptoms, ranging from a chronic sore throat to gastrointestinal problems to electrolyte imbalance to worn tooth enamel. (In fact, I have an aunt and a cousin–her daughter–who both suffered so badly from bulimia they had to have their teeth completely re-surfaced. Don’t fancy that insurance covers that either.)

Sometimes the patient binges without purging–binge eating disorder.  If you subtract the bingeing and eat mostly at night, you might have night eating syndrome.  Here the sufferer grazes all evening, sometimes waking up to eat. She feels she can’t eat in the morning but may have to eat in order to get to sleep.  Add to this people who restrict according to any number of current fads: gluten-free (for those without celiac disease),  sugar-free,  carbohydrate-free, etc.


75% of “normal” weight women [which, I acknowledge, is a rather loosey-goosey kind of term] believe themselves to be overweight, while 90% overestimate their body size.  Reading fashion magazines wreaks havoc with women, both young and old. In an article titled “Still killing us softly: Advertising and the obsession with thinness,” researchers ran a number of studies on women after exposure to fashion magazines such as Seventeen.

In one of their surveys researchers told girls between the ages of 11 and 17 that they could have three magic wishes–anything they wanted. What came out as the number one wish, far, far ahead of number two? The winning wish for these young women was  to lose weight and keep it off” (Kilbourne, 1994).

When the same team surveyed middle-aged women (no age was provided, so I’m assuming these women were clearly years older than myself), asking them what they would most like to change about their lives, more than half of them said their weight.

Back to the those adolescent girls. Eating disorders is actually the third most common illness to be found in that population (it follows only asthma, and–ironically–obesity).

But there is more shocking news yet to come. I did a little unofficial survey amongst family members, asking which mental illness they thought had the highest mortality rate, and I got a plurality of “bipolar”s with a “schizophrenia” thrown in for good luck.  I actually give them partial credit, since bipolar disorder has the highest suicide rate of all the disorders (although eating disorders, are, tragically, giving it a run for its money)–but. . .

20% of people who suffer from anorexia, one of the more common of the eating disorders, will die prematurely due to complications related to the disorder, complications from heart problems to osteoporosis to gastrointestinal complications to dental problems. . .to suicide.

Suicide has become such a real problem that, if we include all eating disorders in the numbers, a the American Psychological Association highlights the findings of a 2003 Archives of General Psychiatry study which found that those with these conditions are 56 times more likely to suicide than their peers.

In point of fact, eating disorders have a higher mortality rate than any mental illness.  For anorexia alone approximately one in 10 cases ends in death.  If you narrow the scope to women between the ages of 15 to 24, the mortality rate from anorexia is 12 times higher than any other cause of death.

So. . .to turn to treatment.  Sadly, if you simply look at the statistics, it’s just bad news heaped on top of bad. A mere 10% of those with eating disorders ever receive treatment at all, and only 35% of those get treatment at places that specialize in treating eating disorders.

The costs to treat these illnesses are staggering in themselves. In the US, just outpatient treatment alone, which includes therapy and medical monitoring, can cost $100,000 or more. That’s cheap compared to costs of inpatient treatment, which can be $30,000 a month–or more. And–hold on to your hats here–it is generally estimated that those with eating disorders need between 3-6 months of care.  I saved the “best” for last: health insurance companies more often than not deny coverage–surely of inpatient stays, and sometimes of outpatient care, as well.

Those shockingly high costs stand in the face of distressingly lowgovernment expenditures on research into causes of and treatments for eating disorders. Check out the chart below, published by the National Institute of Health in 2011.

Research dollars spent on Alzheimer’s Disease averaged $88 per affected individual in 2011. For schizophrenia the amount was $81. For autism $44. For eating disorders the average amount of research dollars per affected individual was just $0.93.

Perhaps the lack of spending and the ineffective treatment are linked in a vicious cycle. Indeed, eating disorders are one of the most difficult of the mental illnesses to treat.  McAleavey (2008) writes that, “because eating disorders are often difficult to treat and the individuals who have them often exhibit significant comorbidities, the long-term success rate (3-5 years or more)–defined as recovery and abstinence from the disorder behaviors–is in the 40% to 50% range, at best.”

Of course it’s a matter of your perspective:  true, half of those treated don’t get better, but that means that half of those treated DO.  This absolutely obligates us to do our best to get our children, friends, spouses–anyone we love and care about who is suffering from an eating disorder–into treatment, and the quicker the better, as early diagnosis and treatment greatly improve chances of recovery.

And treatment takes Ms. Clinton’s proverbial village. Best practice usually requires a psychologist to identify the most important issues, help develop a treatment plan, and work with the patient to replace destructive behaviors with more constructive ones; a psychiatrist who might be needed to deal with what are often underlying depressive issues; and a family therapist.  Important theories of the “causes” of eating disorders include family triangles, history of depression and self-injury, and previous sexual abuse, although the experts are far from a definitive answer.

Because there is so much collateral damage from these disorders, the team isn’t limited to mental health workers. There is need for a primary care physician, to monitor the patient’s health–and a nutritionist may be on hand to  assess the patient’s nutritional intake and work to create a better nutritional plan.

And, fortunately, researchers have begun barking up new trees, looking into whether any DNA variations are linked to the risk of developing eating disorders, and utilizing neuroimaging studies to try to better understand eating disorders and possible treatments. In fact, already one study found different patterns of brain activity between women with bulimia and healthy women.  Clearly, looking for new avenues instead of relying on the same old treatments that have failed us in the past is cause for hope.

Should you yourself want to do something, there are many things to do, some maybe very close to home (which is a strong preference of mine), and a number of organizations that do good work. I just list one here, the National Eating Disorders Association.

Unlike so many organizations, NEDA is not just looking for money. You can volunteer, attend on of their walks, register to receive advocacy alerts–or, of course, donate financially (no one ever turns that away).

If it’s you, dear reader, with a “hidden” eating disorder, take a risk on treatment.  The tremendous physical and psychic toll the disorder inflicts costs all those whom you love and love you, not “just” yourself.  It’s a good week to take the first step.