Families and clinicians must form a shield against eating disorders

Families and clinicians must form a shield against eating disorders

If we as professionals and parents do not start changing and protecting our youngsters, who will do it? Dr. Eva Trujillo explains why we (the world) cannot afford to wait in addressing eating disorders.

When my friend June Alexander asked me to write for the World Eating Disorders Action Day on why we can’t wait in treating eating disorders, many ideas came to my mind. One that concerns me a lot is how often in my practice I see patients for whom intervention has been sadly delayed.  These patients invariably have been “diagnosed” with many medical or mental diagnoses, except for eating disorders, until they are extremely underweight or have lost a lot of weight. 

Eating disorders can be present at any weight, in any body shape, at any age, and in any ethnic group, race, gender or socioeconomic status. Many people with eating disorders can be extremely ill even when they appear to be in a normal or “healthy” weight range, or even overweight. (1)

Delayed diagnosis is dangerous 

A few years ago, my team surveyed a group of patients about the timing each of them took to access our health service and we also asked how many health professionals they had seen before their first visit with us. Unfortunately, the average time was three years and during that time the patients had received on average consultations with six different health professionals. 

Nowadays, even though in my local community this waiting time has reduced because patients are referred a little earlier, probably because my group is there and many doctors know about us, the earlier access for correct diagnosis and intervention  is still not the rule. This is sad and dangerous for our patients. 

As a clinician, I feel very frustrated to see patients whose health has deteriorated because they were not guided correctly. Some patients have been in therapy for even decades and are still underweight, some patients are still restricting/binging/purging while being treated for many medical symptoms, other patients are in weight supression (which means having a weight lower than the highest adult weight), and some patients have seen several doctors and have a different diagnosis for each symptom. 

My biggest concern is the great burden that this delay for an effective treatment has placed on their physical and mental health and their family´s quality of life. 

Caught in the spiral of an undernourished brain

Regarding the physical burden, eating disorders can affect every organ, every cell, every system in the body. One of the organs most affected with ED symptoms is our brain. Although the brain weighs around three pounds (,1.36kg) it consumes up to one-fifth of the body´s calories (2). 

When the brain is “attacked” with behaviors like fasting, restriction, purging and/or dieting, it does not get all the calories needed and will manifest with obsessive thinking about food and difficulties to concentrate. If there is a vulnerability to these disorders, it is very easy to enter a spiral that can be very hard to change. 

Once caught in this  spiral, “the undernourished brain will think, process and feel differently” (3). So a timing approach is crucial for these disorders, especially during  critical stages of physical and psychosocial development.  

This is no childhood fad – adults suffer too  

According to a study recently published by Dianne Neumark-Sztainer and colleagues (4), “the majority of young people have some type of eating, activity, or weight-related problem at all stages from adolescence to adulthood”. When these problems start, contrary to popular beliefs, these are not phases or fads and studies have demonstrated that they do not get better when they reach adulthood. The stigma and normalization of abnormality are big obstacles for a timely and good approach. 

Most if not all of our patients share the common experience of being on a diet to lose weight just before starting with the eating disorder symptoms. Diets, even they are not the only factor for the development of an eating disorder, are definitely a central mechanism for their development. Diets cause many problems, not only to do with weight.  

We must change NOW, in our families and in our professional practices

We still have too much to learn, too much to disseminate. But nothing will change if we do not start now, in our own families, which are our best shields, and in our practices as professionals. 

We must recommend families to eat together, we must teach our children to love their bodies, regardless of their weight or shape; nobody takes care of what you don´t love. We must teach other professionals and carers to early recognition for a timely diagnosis and treatment, especially now that there are so many myths and regulations about obesity and what in the field of eating disorders is a symptom, in the obesity field is part of the treatment. Patients with obesity are told to eat less, to restrict, to avoid certain foods, to over-exercise…all this in the ED field is an illness symptom. 

We must change and we must change now. For our patients, for those who suffer and for those who are gone. We owe them. We must show people who are vulnerable that they can be healthy in any weight. 

If we as professionals and parents do not start changing and protecting our youngsters, who will do it?

References

1. Nine Truths About Eating Disorders, Academy for Eating Disorders, 2014.
2. National Eating Disorders Association website
3. Trujillo, E. “Creo que tengo un trastorno alimentario: Cómo Comenzar de Nuevo”, 2012
4. Neumark-Sztainer, D. et al, “Eating, Activity and Weight Related Problems from Adolescence to Adulthood”, Am J Prev Med, Aug;55(2):133-141,  2018.

About World Eating Disorders Action Day 2019

This year grassroots activists, volunteers, and over 250 organizations in 40+ countries are calling for caregivers to receive support, health care workers to be properly trained, and access to immediate, evidence-based treatment.

Why We Can’t Afford to Wait

• Worldwide over 70 million people are estimated to be affected by an eating disorder,
• Eating disorders have the HIGHEST MORTALITY RATE of any psychiatric illness
• Eating disorders affect people of all genders, sexual orientations, ages, socioeconomic class, abilities, races, and ethnic backgrounds. It is time to take action.
• Good news! When treated EARLY and correctly, eating disorders have the highest and fastest recovery rate!   

How to support World Eating Disorders Action Day, June 2, 2019

1. Join the movement, show your purple on social media! Use hashtag #ShowUsYourPurple

2. Follow conversation on social media. Use hashtags #ShowUsYourPurple #WeDoActNow

3. Host or attend an event. See  http://www.worldeatingdisordersday.org/2019-events-2/

4. Donate. To support the work see http://www.worldeatingdisordersday.org/get-involved/participating-organisations/.

5. Discuss eating disorders. Through open, supportive dialogue, we can create change.

E-book release: Come as you are, eating disorders can’t wait

 

As a Participating Organisation supporting 2019 World Eating Disorder Action Day, The Diary Healerhas released  a new ebook, Come as you are, eating disorders can’t wait. Stories from around the world illustrate that recovery from an eating disorder IS possible, at every age. The first step, is to seek help. Click here to purchase a copy for $9.97 (AUD) – all profits support eating disorder services.