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House Call: Pay attention to warning signs for eating disorders

I have cared for a number of patients with eating disorders over the years. One young woman stands out. She suffered from anorexia and bulimia that started in her teen years. She worked with a dietician and me over a number of years and was able to overcome her illness. She had great courage.

When she was pregnant I had the honor of caring for her. She wanted to do the best for her baby and made a deal with me that I could weigh her monthly as is routine in prenatal care, but she did so with her back to the scale and I was not to tell her what she weighed. She had two healthy babies under my care and is still thriving today, many years later.

Eating disorders are serious mental health issues which when identified and addressed early, can have good outcomes. They are not just a problem of food and control.

It’s hard to imagine anyone starving to death in our country in this age of abundance and concerns over an increasingly overweight population, but this happens; most frequently women and girls who have anorexia nervosa that is not successfully treated. It can be difficult to recognize the difference between a healthy concern for weight and an unhealthy obsession with being thin, but there are warning signs:

Sudden weight loss

Fixation with weight, food, calories, fat and dieting

Exclusion of certain foods or types of food

Recurring comments about feeling fat or overweight

Anxiety about gaining weight or being fat

Denial of hunger

Food rituals

Avoidance situations involving food

Extreme exercise routines

Self-alienation from friends and activities

General behaviors and attitudes that weight loss, dieting and food control are becoming primary concerns

Binge eating disorder is more common that anorexia. Many people who struggle with binge eating describe feelings of loss of control, shame, and guilt. As with anorexia, there are signs, which are as follows:

Eating unusually large amounts of food

Feeling out of control

Eating when full or not hungry

Rapid eating

Eating until uncomfortably full

Eating alone or in secret

Dieting frequently, with or without weight loss

As with anorexia, bulimia nervosa is wrapped up with self-esteem being too enmeshed with body image. It also can have a good outcome when treated early. Warning signs are as follows:

Disappearance of large amounts of food or finding wrappers and empty containers

Purging behaviors: self-induced vomiting or abuse of laxatives

Extreme exercise routines

Swelling in the cheeks

Calluses on the back of the hands and knuckles

Discolored or stained teeth

Schedules or rituals for binge-and-purge sessions

Self-alienation from friends and activities

General behaviors and attitudes that weight loss, dieting, and food control are becoming primary concerns

If you notice warning signs in a family member or a friend you may wonder what to do or say. Mental health issues can be difficult to talk about without people becoming defensive. Arrange a time and place to talk in private. Stay calm and express your concern without being judgmental or oversimplifying. Encourage getting a consultation with a professional that is knowledgeable about eating disorders. Be supportive and understanding no matter what happens and no matter how your family member or friend reacts.

If you or someone you know decides to seek treatment for an eating disorder, a good place to start is with your primary care provider. The Emily Program in Spokane offers assessment, counseling, group therapy, nutrition counseling, medication, and medical care.

Eating disorders can have serious health consequences, so be aware and take them seriously.

Dr. Bob Riggs is a family medicine physician practicing at Group Health’s Riverfront Medical Center. His column appears biweekly in The Spokesman-Review.


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