Eating disorder awareness: working toward a healthier relationship with food and exercise

As one of the nation’s leading providers of healthcare services, HCA Healthcare offers specialized care for patients with eating disorders. HCA Healthcare operates the only inpatient and outpatient eating disorder program on the East Coast to receive The Joint Commission’s disease-specific certification for adolescents, teens and adults at Dominion Hospital in Virginia. At HCA Healthcare’s Parkland Medical Center in New Hampshire, a team of experts provides a disease-specific certified program for adolescents and adults. This National Eating Disorders Awareness Week, learn more about eating disorders, start a conversation and share supportive resources and treatment options…

Eating disorder awareness can make a big difference: The earlier an eating disorder is detected and treated, the better a person’s chances are for a full recovery. Knowing the risk factors, signs and symptoms can help you recognize these patterns in yourself and your loved ones so that you can seek necessary treatment.

What you eat and how you exercise both play important roles in your overall health. Spending some time thinking about weight, diet, activity levels and general health can be valuable for improving lifestyle habits, but for people with eating disorders, thoughts about food can become obsessive and result in eating patterns and other behaviors that may be dangerous to their health.

Who is at risk for eating disorders?

National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. Although eating disorders are most common in teens and young adults, no one is immune to the risk of developing an eating disorder. They can affect people of all ages, regardless of weight, race, ethnicity, socioeconomic status, and sexual or gender identity. The emphasis on body image starts early in life, with research suggesting children as young as three can develop a negative body image. Meanwhile, rates of obesity continue to rise among children and adults in the U.S., which can lead to serious health problems.

Common eating disorders

There are several eating disorders, each with different signs and symptoms.

Anorexia nervosa

People with anorexia nervosa avoid food or restrict caloric intake to the point where they may become dangerously underweight — even as they continue to think of themselves as overweight. Some people with anorexia eat very little food or only certain kinds of food. Others may consume large amounts of food and then induce vomiting or use laxatives to purge their bodies and avoid weight gain. Although the disorder most frequently begins during adolescence, anorexia can affect people of all ages. If anorexia goes untreated, those who suffer from the disorder may be at a higher risk of complications and death from malnutrition or suicide.

Bulimia nervosa

Individuals with bulimia nervosa eat unusually large amounts of food and then use compensatory behaviors such as induced vomiting, fasting, exercise or laxatives to prevent weight gain. Those suffering from this disorder may have a normal body mass index, but could also be overweight. There are several signs and symptoms of bulimia including frequent trips to the bathroom after meals, chronic sore throat, tooth decay from vomiting and gastrointestinal distress.

Binge eating disorder

Binge eating disorder is similar to bulimia but without purging. People with this disorder typically eat large amounts of food, often in a short amount of time, even if they are not hungry. They may feel great shame and distress over this habit and may frequently diet but not actually lose weight. People who struggle with binge eating disorder, the most common eating disorder in the United States, tend to be of normal or higher-than-average weight.

Avoidant restrictive food intake disorder (ARFID)

As with anorexia, people with avoidant restrictive food intake disorder (ARFID) may severely restrict the type and amount of food they eat. However, people with ARFID are not motivated by distorted body image or fear of weight gain. ARFID is more common in young children but can occur in adults as well. While many children are picky eaters, children with ARFID do not eat enough calories to grow and develop properly. Symptoms in children or adults may include lack of appetite or interest in food, upset stomach or abdominal pain, limited range of food preferences and dramatic weight loss.

How to start a conversation about eating disorders

If you struggle with an eating disorder or think you recognize some of the signs or symptoms of an eating disorder in yourself or a loved one, the first step is to seek help. While feelings of guilt and shame are often attached to eating disorders and body image, many sufferers find it difficult to discuss. If you are concerned about a loved one and you’re not sure how to approach the topic, consider gently sharing your concerns and suggesting that they get a check-up at the very least.

Because the topics of weight, diet and exercise often come up in discussions of health, even a trip to the doctor’s office may feel overwhelming. It is important to keep in mind, early treatment for eating disorders increases the chances of full recovery.

The following steps can help you prepare for a healthcare visit or a conversation about eating disorders.

If you have concerns, take some time to consider how you’ve been feeling about your body and your eating habits. You may want to write down your thoughts in a journal or notebook to take to the doctor’s office. You can use these questions to guide your thinking:

• How do you feel about your body?
• What does healthy eating mean to you?
• Do you eat when you’re stressed or bored, even if you are not hungry?
• Do you eat so much that you feel uncomfortably full?
• Are there situations in which you’d be more likely to skip a meal or eat more than usual?
• What are your activity levels like? What kinds of physical activities do you enjoy? How much time do you spend exercising?
• What questions do you have about what’s healthy for your body?

If you have questions about your eating habits, you don’t have to wait for the doctor to bring up the topic. Talk openly and honestly about your concerns and struggles with eating or body images. When your doctor makes a recommendation — whether it concerns weight loss or evaluating a possible eating disorder — make sure you have the tools and resources you need to follow up, such as suggestions for helpful literature or the contact information of a dietician. You and your doctor should work together to set specific, achievable goals using methods that are most likely to work for you.

The National Eating Disorders Association offers steps to help you encourage a loved one with eating and/or body image issues to seek help:

• Learn as much as you can about eating disorders. Read books, articles, and brochures. Know the difference between facts and myths about weight, nutrition, and exercise. Knowing the facts will help you reason with your friend about any inaccurate ideas that may be fueling their disordered eating patterns. 
• Rehearse what you want to say. This may help reduce your anxiety and clarify exactly what you want to say. Other people have found writing out their main points helpful. 
• Set a private time and place to talk. No one wants to have personal issues dissected in front of a crowd, so make sure you find a time and place where you will have time to discuss your concerns without being rushed or in front of a crowd. 
• Be honest. Talk openly and honestly about your concerns with the person who is struggling with eating or body image problems. Avoiding it or ignoring it won’t help!
• Use “I” statements. Focus on behaviors that you have personally observed, such as “I have noticed that you aren’t eating dinner with us anymore,” or “I am worried about how frequently you are going to the gym.” It’s easy to sound accusatory (“You’re not eating! You’re exercising too much!”), which can cause a person to feel defensive. Instead, stick to pointing out what you’ve observed. If you can, also point out behaviors not related to eating and weight, which may be easier for the person to see and accept. 
• Stick to the facts. Raising concerns about a potential eating disorder can bring up lots of emotions, and it’s important not to let those run the show. Instead, talk about behaviors and changes you have observed and calmly point out why you are concerned (“I have seen you run to the bathroom after meals and feel worried you might be making yourself throw up.”).
• Be caring, but be firm. Caring about your friend does not mean being manipulated by them. Your friend must be responsible for their actions and the consequences of those actions. Avoid making rules, promises, or expectations that you cannot or will not uphold. For example, “I promise not to tell anyone.” Or, “If you do this one more time, I’ll never talk to you again.”
• Remove potential stigma. Remind your loved one that there’s no shame in admitting you struggle with an eating disorder or other mental health issue. Many people will be diagnosed with these issues during their lifetimes, and many will recover. 
• Avoid overly simplistic solutions. Being told “just stop” or “just eat” isn’t helpful. It can leave the sufferer feeling frustrated, defensive, and misunderstood. 
• Be prepared for negative reactions. Some eating disorder sufferers are glad that someone has noticed they are struggling. Others respond differently. Some may become angry and hostile, insisting that you are the one with the problem. Others may brush off your concerns or minimize potential dangers. Both of these responses are normal. Reiterate your concerns, let them know you care, and leave the conversation open.
• Encourage them to seek professional help. Many eating disorder sufferers require professional help in order to get better. Offer to help the sufferer find a physician or therapist if they don’t have one, or attend an appointment where the eating disorder is discussed. Getting timely, effective treatment dramatically increases a person’s chances for recovery. If your loved one is ready to seek treatment or you want to explore options, the NEDA Helpline is a great place to start.
• Tell someone. It may seem difficult to know when, if at all, to tell someone else about your concerns. Addressing body image or eating problems in their beginning stages offers your friend the best chance for working through these issues and becoming healthy again. Don’t wait until the situation is so severe that your friend’s life is in danger. Your friend needs a great deal of support and understanding.

Recovery from an eating disorder can be a long process that requires help from qualified healthcare professionals as well as the love and support of family and friends. It is important to remember the first step in recovery is seeking help.