Childhood Eating Disorders Blog

Exercise and healthy eating is something I normally encourage for patients of any age. However, sometimes both can be taken to unhealthy extremes. Many of my patients struggle mightily to rein in such behaviors.

My patient Susannah is a college student whose family is very health conscious. Susannah is battling a strong drive to restrict her eating and overexercise. She feels that her parents don’t understand her struggle and that their attitudes toward food
and exercise (no desserts, daily exercise without fail) are holding back her
recovery. This recent conversation we had deals with how to help her parents understand that healthy behaviors can be carried to an unhealthy extreme.

Susannah: I’ve realized that I grew up in an environment where NOT exercising every day was bizarre and dessert was a rarity. How do I explain to my parents that these behaviors actually aren’t normal? My family has at least a loose awareness of my eating/excercise habits, but doesn’t see them as disordered. I don’t want to criticize my family for the way they live, but at the same time, I know they would want to provide the best environment they can to support my eating disorder recovery. My parents do and always have meant well, and they will want to help me, I am just not sure what is the best way to talk to them about this.

Marcia: One way to explain to your parents that a lifestyle that is extremely rigid about eating and exercise isn’t normal and isn’t healthy for you is to direct them to look at cultures worldwide. Explain to them that this rigorous of a lifestyle is not widespread, and that many countries have just as high a level of health as ours, or higher, but don’t subscribe to fanatic dieting and extreme exercise. You might also say that people’s constitution varies: What works for your parents might not work for you.

You can also point out that though your parents’ eating and exercise habits haven’t caused them any harm, these habits are getting in the way of you regaining your health. Your doctor has found lab abnormalities that more generous eating and less exercise should fix.

I hope that some of you will find this conversation helpful in your own struggles.

Peace, Marcia

Dear Readers,

The issue of how to discuss eating disorders in the media is a difficult and charged topic.  When does a story on, say, anorexia shift from being a good, informative piece that will deter young girls and boys from starving themselves into a manual on how to become anorexic, complete with starvation techniques, weight and BMI goals, and pictures of super-skinny teens?

I was reminded of this difficult issue recently while reporting a PEOPLE magazine story on diabulimia. This is a phenomenon that has been going on for a long time. Only within the last six months, however, has it begun getting attention in the media. Probably not coincidentally, this form of weight manipulation seems also to have in the last six months picked up an easy name — “diabulimia” — that the press can grab on to.

It’s much easier to say “diabulimia” than “insulin manipulation,” which is essentially what the term describes, and it sounds more like an eating disorder and a disease. To be clear, diabulimia is not officially classified as an eating disorder, but the weight obsession, weight fluctuations, and related complications are similar to those of anorexia or bulimia. Young Type I  diabetics, often girls approaching puberty, discover (either on their own, through the mass media or from other diabetics), that a surefire way to lose weight quickly is to stop taking their insulin injections. If this behavior goes on long enough, serious complications can ensue, ranging from kidney failure or blindness to heart disease.

Searching the country for candidates to interview, I found many sufferers, but very few who were in the age range my editor wanted, teens to early twenties. Finally, I located a 16-year-old girl who was willing to talk to me, have pictures taken, and allow me to talk to her family and health care providers.

I flew to her home state and spent a lovely day meeting my subject, a soft-spoken, thoughtful and pretty girl, and her mother.  That evening, as I was boarding my plane to return to New York, I received a call from the girl’s mother saying that they were having second thoughts and did not want to be part of the story. Although I’m sure there were many factors that went into this change of heart, I know that the young girl’s therapist played a significant role in talking her out of participating in the article.

The previous week, I had called the therapist to ask if I might interview her for the story. She told me that she had grave objections to the way eating disorders were covered in the story, and asked me to not give her patient’s current weight, her peak or low weights, or her BMI in the story.

As a journalist, I know that such facts are the foundation on which we build a good story. Without them, readers are left unsure of how serious the subject’s condition was, how dramatic her weight loss, how gravely in danger her health was. Without these facts, will anyone really care about this young woman? What, they might wonder, makes her different from the millions of other teens who would like to shed a few pounds?

Yet having co-authored The Parent’s Guide to Eating Disorders with Marcia, I also know that all of these facts that we journalists deem essential can act as triggers. They can plant ideas in a young person’s head that weren’t there before, and the embedded values — thin is good, even thinner is better – that this story subject fell victim to are somehow validated just by the fact that a national magazine is featuring her. Even her pain and suffering seems somehow cool and dramatic.

The girl and her family did not participate, but the young woman whom we did feature in the story reported that only a day after the article had appeared she had already been contacted by another diabetic who was having major problems with diabulimia and wanted to share her story. No doubt the story gave support and hope to many diabulimics suffering in secret, but we will never know how many young people first learned about insulin manipulation through our story, and, despite all the dire consequences outlined in the article, went on to experiment with it.

I would be interested to hear your thoughts on this subject.

Be well,

Nancy