Childhood Eating Disorders Blog

Dear Readers, This weekend, Nancy and I read about efforts in Michigan to publicize the oft over looked fact that boys get eating disorders too. One of the organizers of these efforts is the mother of a Michigan boy who died at the age of 22 from an eating disorder. The boy’s eating problems started when he, wanting to look buff, began undereating and overexercising the summer before entering high school.

Because of our worry that early warning signs in boys may go unnoticed because parents, teachers, coaches, even doctors and other adults in the child’s life may believe that eating disorders are a “girl problem,” we devoted an entire chapter to “Boys” in our book, The Parent’s Guide to Eating Disorders, 2007, Gurze Press. It is usually harder for boys to ask for help for an eating disorder because of the embarrassment of admitting that having a girl’s disease.” In this chapter, we discuss some of the reasons for newly recognized increase in male eating disorders, and how boys’ disorders differ from those of girls’. We describe approaches that work best with boys.

It is important for parents to know that it is rarer for boys to diet their way into an eating disorder, as girls usually do. When boys develop an eating disorder, they most often have one of the following risk factors that induce their eating disorder.

•    Being chubby as children and/or experiencing more teasing about body size
•    Having a higher-than-average body weight
•    Body dissatisfaction
•    Participation in high-risk sports that favor thinness or include weight classes, such as wrestling, boxing, crew, bodybuilding, weight-lifting, gymnastics, figure skating, or long-distance running
•    Depression

Take care,

Marcia and Nancy

Dear Readers,

                Eating disorders and calorie counting often go hand in hand. The desire to lose weight or stay thin often creates an intense obsession with monitoring calories. Trips to the supermarket become marathon session devoted to reading the calorie and fat counts of every item put into the shopping cart. Marcia and others who treat eating-disorder patients try to help break them of this habit and learn how to make healthy choices that will maintain a normal weight.

                 The problem is that this goal is at odds with those of anti-obesity crusaders, who would like to see more nutrition and calorie labeling. The hope is that if overweight consumers at a fast food restaurant, for example, see just how many calories and fat grams that cheeseburger they plan on ordering contains, they might choose something healthier. This is all well and good except for the fact that for a certain segment of the population, especially those of college age, this could be too much information and may help trigger or fuel an eating disorder.

                So it was with interest that Marcia and I read that Harvard just last week reversed its 10-year-old policy of prominently posting nutrition info in its dining halls. (For a nicely done commentary on this change, take a look at Elizabeth Wade’s piece on the American Council on Science and Health’s website. Our colleague David Herzog, director of the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital, advocated for this change. Marcia dealt with this very issue 10 years ago at Dartmouth College, where she headed the eating disorders prevention program. “We decided not to post calories because students struggling with eating disorders said very plainly that this information would cause them harm,” says Marcia, who is glad that Harvard is now following suit.          

                “Students recovering from eating disorders found that not having the calories listed helped them overcome their obsession and fear of calories,” explains Marcia. “Some students I’ve worked with are so dependent on nutrition labels and calorie counting that they buy all their food at the local supermarket instead of eating at the dining hall. The sad thing is that instead of being able to eat the fresh food made to order at the college dining hall, these students would end up eating less nutritious packaged foods. In working with students, I often have them practice eating in Dartmouth’s dining hall so they can handle joining friends for a nice dinner at an off-campus restaurant, or getting ready for the family Thanksgiving dinner,” Marcia explains. “Most restaurants (especially nice ones) don’t publish calorie counts, and of course neither do families.”

                For the obsessive calorie counter who is not in college and going to a dining hall, Marcia suggests buying fewer packaged foods so you have less contact with labels. I have found that when eating is based on my Food Plan, with its focus on food groups rather than calories, before long counting calories seem irrelevant. I often have patients thrilled to find that they forgot to count calories because with the food plan calories had become irrelevant. 

                Both California and New York have passed laws that require chain restaurants to post calorie counts. We’re happy to see that small, locally run restaurants in both states remain free of this requirement. At college dining halls posting this information is optional. We hope that other schools take heed of college students’ high risk for eating disorders and refrain from posting calorie and fat counts in dining halls.

Take care,

Marcia and Nancy

As anyone who hasn’t been living in a cave knows, these are precarious financial times. With Wall Street in disarray, the cost of food and gas skyrocketing and property and 401(k) values plummeting, families are looking for ways to spend less. Studies have shown that in tight financial times, people are more willing to sacrifice mental health expenditures than other forms of medical care.

These thoughts were in Marcia’s mind recently after hearing a young patient tell her about the massive binge she had engaged in over the weekend.   “I found myself calculating the food costs of the gorge - nearly $50!” says Marcia. Of course we know that there are bigger economic issues at stake here than the grocery bills of a binge eater or the sometimes highly specialized food demands of the anorexic.

For many parents of Marcia’s patients, the question is, “Can we afford the weekly visits to  Marcia, the therapist,  and our doctor, each of whom play an important role in keeping our child healthy?” And these are families with health insurance. Families who are uninsured are in much worse shape. “Even the cost of gas is an issue in my rural state of New Hampshire, where families may have to drive several hours several times aweek for treatment,” says Marcia.

A recent Wall Street Journal article, “Angst is Rising, but Many Must Forego Therapy,” tells the story of a family in New Jersey that took out a second mortgage on its home to foot the estimated $80,000 in treatment expenses over the past two years for their eating disordered daughter. “I have been thinking about sacrificing care, how it’s going to have to happen if things keep going the way they are, because we can’t keep paying $400 a week,” the 21-year-old daughter is quoted as saying. The question is, how can we make economic concerns a positive motivating force for the eating-disordered child, rather than another source of fear and anxiety?

This strategy is probably best used with the bulimic or binge eater living at home.  “I hope parents will consider sitting down with their child and discussing the economic reasons they won’t be overstocking the house with foods that support the child’s eating disorder,” Marcia advises. “Parents need to do this in a kind way with real care not to make the child feel guilty about having an eating problem.”

In the case of anorexia, where undereating  not overeating is the problem, parents may have to actually convince their child that spending a little more money for a food that he or she will be able to eat is well worth the money. After all, they can explain, if spending a few dollars extra a week to get the right kind of ice cream is going to keep their child safe and out of the hospital, then that special ice cream is probably worth its weight in gold.

Just this week Marcia met with her patient Melissa and her parents.  Melissa is a sweet 15-year-old newly diagnosed with anorexia nervosa.  Marcia had encouraged Melissa to have some frozen yogurt topped with chocolate and nuts in the evening. Melissa thought that it was best if she just had this treat once a week because her parents wouldn’t want to spend money on her favorite local organic frozen yogurt. Doug and Rebecca, Melissa’s mom and dad, made it very clear to Melissa that her health and progress with her food plan was well worth the cost of the yogurt. “You’re more than worth it to us,” both parents said in unison.

These two examples show you how family budget concerns can cut very different ways, depending on the type of eating disorder your child is battling and her personality. If you are unsure about whether or how to bring in financial issues to your child’s treatment plan, please consult your nutritionist or doctor.

Take care,

Marcia and Nancy