Eating disorders can affect all shapes, sizes and ages

Every year, the last week of February is designated National Eating Disorder Awareness (NEDA) week.

Eating disorders like anorexia, bulimia and binge-eating disorder are serious conditions that affect the lives of many Americans and their families every year.

According to Desiray Moore with Choctaw Nation Behavioral Health, eating disorders are any problematic behaviors and eating patterns that cause physical and/or emotional distress.

Eating disorders are classified as mental illnesses in the American Psychiatric Association‘s Diagnostic and Statistical Manual of Mental Health Disorders (DSM-IV) and can affect everybody.

“It isn’t specific to any age or gender. It can really be anyone at any age that may be affected by an eating disorder,” said Gail Schumacher, a registered dietician with the Choctaw Nation.

Several things can trigger an eating disorder. While it’s tough to pinpoint an exact cause, as with other mental illnesses, genetics, biology and psychological and emotional health can contribute.

A family history of eating disorders can also make them more likely.

Other factors, such as a history of anxiety, depression or obsessive-compulsion disorder, can take what starts as a simple diet and turn it into an eating disorder.

“Sometimes, these behaviors can come after certain emotional states. And then over time, it becomes their go-to way to cope with whatever’s going on,” said Moore.

A 2010 study that followed 496 girls until they were 20 years old found that 5.2% met the criteria for anorexia, bulimia or binge eating disorder. When the study included non-specific eating disorders or those that met most but not all the criteria for one or more eating disorders, a total of 13.2% of the girls were affected by age 20.

Eating disorders can affect males as well. For binge-eating disorder, preliminary research suggests equal prevalence among men and women. Although differences in symptoms exist, women are more likely to focus on weight loss; men are more likely to focus on muscle mass.

The difference is often attributed to how people are portrayed on different media channels.

“If you look at the way society views health and beauty, typically you’re going to have very specific images of people in the fashion industry, or movies, or music, or any of those kinds of popular culture types of things. For instance, if young girls or boys go online or watch TV, they’re confronted with these images of very skinny-looking individuals,” Moore said.

It’s important to remember that these images alone don’t cause an eating disorder. According to NEDA, while these factors can contribute to eating disorders, biological, social and environmental factors can turn these ideals into a disorder.

Eating disorders such as anorexia nervosa have been documented in medical literature as far back as the 1800s when the idea of a perfect body shape for women and men differed very much from today.

Some corporations have taken steps to represent more real-world body shapes and sizes.

Nike, Old Navy, Nordstrom and Target all have mannequins that are more reflective of actual shapes and sizes that are shopping in their stores.

Seemingly healthy athletes are at risk too.

According to a study published in the Journal of Clinical Sports Psychology, athletes struggling with disordered eating are at higher risk for Relative Energy Deficiency in Sport (RED-S), which occurs when energy expenditure exceeds energy intake, creating an energy deficiency.

This can then compromise the athlete’s metabolism, menstrual function, bone health, immunity, protein synthesis, cardiovascular health and psychological health.

When a wrestler is trying to make a weight class, or a cross-country runner may be trying to lose weight, their methods can be unhealthy.

Schumacher says proper diet and nutrition can have a much greater impact on sports performance than trying to binge eat to gain weight or purge to lose weight. Restricting or eating beyond fullness can affect your metabolism and change your mood and sleep patterns, which can negatively affect your performance.

“As a dietician, I’m there to help that person participate in their sport, whatever that may be, to the best they possibly can,” said Schumacher.

It’s important to remember that not every person dieting, exercising or taking their chosen sport seriously has an eating disorder. It’s the obsession with it that reflects a problem.

Once that line is crossed, the dangers of eating disorders are serious. Significant weight loss or gain can stress the cardiovascular system, gastrointestinal system, neurological and endocrine systems. Hair may fall out or become brittle, and a person may experience fatigue or shortness of breath.

Recognizing eating disorders can be challenging because there are multiple aspects to consider.

Schumacher says the prevalent idea that someone with an eating disorder will always look emaciated is false. “If you’re considered above weight for your height and age [it’s often thought] you couldn’t possibly have an eating disorder, and that’s not true,” Schumacher said.

There are some signs you can watch for to pick up on possible disordered eating.

“Noticing that the person is bowing out anytime, you might run and get something to eat or choose to not eat altogether,” said Schumacher. “Going to use the bathroom shortly after eating a meal could be that the individual is purging or making themselves throw up. Or it could be noticeably seeing that person’s weight change. Or a person being very rigid with their working out, they have to go and workout every day at these times, and nothing can get in the way of that. Anything that is a change from that person’s normal behavior surrounding foods can be a red flag.”

According to Moore, if you know someone well enough to know their nature or a little bit about who they are, you can try to pick up on cues about how they talk about themselves, like constantly making negative comments about their appearance.

If you find yourself in that situation, NEDA offers some recommendations for supporting someone with disordered eating.

• Educate yourself on eating disorders.
• Learn the differences between facts and myths about weight, nutrition, and exercise.
• Ask what you can do to help.
• Listen openly and reflectively.
• Be patient and nonjudgmental.

There are also some things NEDA recommends not doing in these situations.

• Accuse or cause feelings of guilt.
• Invade privacy and contact the patient’s doctors or others to check up behind their back.
• Demand weight changes (even if clinically necessary for health).
• Insist the person eats every type of food on the table.
• Create guilt or place blame on the person.
• If you or someone you know has an eating disorder, help is available at the Choctaw Nation.
• Speaking to your primary care physician is a good first step.

Integrated counselors are also available at all the Choctaw clinics to work with physicians and dietitians to help get the patient on the path to recovery. Additionally, help and resources are available no matter where you live.