Eating disorders have long been somewhat mysterious – or even romanticized – diseases. However, eating disorders can be detrimental to a person’s physical and mental health, and sometimes even fatal. We spoke to the Center for Balanced Living’s Dr. Jason McCray and got to the bottom of what exactly eating disorders are, and how to help a loved one who may be affected.
Healthy New Albany: What are some common misconceptions about eating disorders? How do you combat those misconceptions?
Dr. Jason McCray: The biggest misconception is that they are mostly about vanity. Many people who are not aware of the research conducted over the last ten years believe that eating disorders are mostly about wanting to be skinny or look good. The Academy for Eating Disorders published a position statement in 2009 summarizing the research literature and concluding that eating disorders are serious, neuro-biological illnesses. It is incumbent on those of us in the field to continually do a better job sharing these advances in understanding with the general population and the rest of the healthcare community. We have reached a place where we can offer a pretty compelling explanation for how specific dysfunction within the brain drives the core symptoms of the eating disorder. The Center for Balanced Living is happy to partner with any groups in the community who would like to learn more about this research or our working developing treatments based on the latest research findings.
HNA: Many people know about anorexia nervosa or bulimia nervosa. Can you explain the other types of eating disorders, such as binge-eating disorders?
JM: As you said we have reached a place where many people are aware of anorexia and bulimia but binge-eating disorder is actually the most common eating disorder in the country. There are roughly as many people with binge eating disorder as there are with anorexia and bulimia combined. Binge eating disorder involves eating an objectively large quantity of food (larger than most people would consider eating under similar circumstances) in a relatively short period of time while experiencing a subjective sense of “loss of control” meaning that they feel as though they could not stop even if they wanted to. We are coming to understand some of the brain function involved in this loss of control and how it is much more than just “not having the willpower” to stop. There are other, less well-known eating disorders as well, such as avoidant/restrictive food intake disorder (ARFID), where someone excessively avoids foods based off of textures, colors or smells, leading to being malnourished, or night eating syndrome, which involves waking up in the middle of the night to binge eat with the same loss of control discussed earlier that people with binge eating disorder experience.
HNA: Eating disorders are seen as a woman’s disease. How common are they in men? Does treatment take on a different form with men?
JM: Each of the eating disorders carries a different gender composition for those impacted. Anorexia nervosa affects about 90 percent women and 10 percent men. Bulimia nervosa impacts about two-thirds to three-fourths women and one-fourth to one-third men. Binge eating disorder is nearly an even split between women and men. Overall, about a quarter of people with eating disorders are men and there are about 10 million men in the U.S. who will have an eating disorder at some point in their life. For men and women, treatment involves focusing on nutritional intake to create a healthy, balanced way of eating so that metabolism can re-regulate to healthy functioning. Much of what happens in therapy early on is organized around making sure that food happens appropriately and that the affected person is not doing anything to make up for what they are eating in an unhealthy way. Much later in treatment when body image concerns can be more appropriately and readily addressed, treatment may look a little different for women and men. But early on they are very much the same.
HNA: What are some warning signs or symptoms of eating disorders to look out for in loved ones?
JM: Any abrupt changes in eating or exercise habits can be the cause for a little extra attention. Oftentimes people who eventually develop an eating disorder began by trying to make relatively reasonable, healthy changes. When people begin to cut out whole food groups, that can become concerning. When eating and exercise habits become rigid and a person becomes very angry when asked to modify those plans, it is a cause for concern. When someone loses a large amount of weight very quickly, that is concerning as well. If you notice someone regularly going long periods of time without eating (more than four to five hours), that can be a sign someone is becoming at risk. If you notice that someone habitually goes to the restroom immediately after eating, it might be a sign that the person is engaging in purging which can become very dangerous. A good rule of thumb is that if something seems a little weird to you it probably is. If you see something, say something. Start a conversation. If you are unsure, reach out to local treatment resources. Here at the center we are always willing to talk with families and friends about how to help loved ones who may be experiencing an eating disorder.
HNA: Under what circumstances should someone seek out medical treatment for an eating disorder?
JM: Eating disorders are serious health crises. Out of all psychiatric conditions, eating disorders are the most likely to result in death. About 20 percent of people who do not receive treatment for an eating disorder will eventually die from complications linked to the condition. Any time someone is underweight, fainting or experiencing significantly low heart rate (below 45 BPM resting heart rate), it is worth thoroughly assessing that person for medical stability. Oftentimes people think those with low resting heart rate are elite athletes. Sometimes this is true, but very commonly you see significant atrophy of the heart muscle resulting in slowing heart rate as part of the eating disorder especially when heavy exercise is involved.
HNA: People often assume that extreme weight loss is a symptom of an eating disorder or disordered eating. But one can be at a healthy weight – or might even be overweight – while still restricting their calorie intake. How can you address this when the person does not fit the “look?”
JM: I think the key is education. The simple truth is that there is no one “eating disorder look” and you generally cannot tell whether someone has an eating disorder by looking at them. People with bulimia nervosa and binge eating disorder can be extremely sick with the eating disorder and in potentially grave medical danger while being a “normal” weight or even overweight. Normalizing conversations about health, nutrition, and keeping food and exercise balanced for people of all sizes is key to reducing the stigma for those suffering with eating disorders who are in larger bodies that do not “look sick.”
HNA: What causes eating disorders? Are they more prevalent in specific demographics/populations?
JM: The main contributor to eating disorder risk is genetics. Between 50 and 80 percent of the variability in who develops an eating disorder and who does not is related to genes. A range of other factors including exposure to idealized images of women and men in the media, dieting culture, experiencing traumatic events and even some medical conditions all confer additional risk for developing an eating disorder. Generally speaking, families are not a significant contributor to the development of an eating disorder. These risk factors – genetic and otherwise – create a risk gradient ranging from very high risk to very low risk for developing an eating disorder. Research has shown that becoming significantly malnourished – expending considerably more energy than you are taking in to a degree that is more than your body can manage for longer than it can manage – is usually the activating event that sets that risk into action. Once triggered, these changes take hold in the brain and a series of brain sites begin to function differently leading the condition to pick up momentum and ultimately taking over most aspects of a person’s life.
HNA: Does medication help in treating eating disorders, or is treatment more therapy-based?
JM: When you have an eating disorder, food is your medicine. The best treatment is ensuring adequate nutrition without doing anything to compensate for that intake. There are a range of therapeutic approaches to support getting that nutrition and avoiding destructive compensatory behaviors. For some conditions – bulimia and binge eating disorder – there are medications that can be helpful to reduce symptoms, but it is ultimately the food that leads to permanent healing and recovery. There are no medications that address the primary symptoms of anorexia.
HNA: How do eating disorders impact a person’s physical health?
JM: There are few systems within the body that are not impacted by eating disorders in some way. The most dangerous health effect of eating disorders is cardiac complications. Damage to the heart and sudden heart failure secondary to electrolyte disruption are the most acutely dangerous effects. In the long run, eating disorders can result in decreased bone density, increased exercise-related injury and large-scale disruption of the endocrine system, which impacts most other parts of the body.
HNA: What is the best way to nurture and support someone who is living with an eating disorder?
JM: The most important way to help someone with an eating disorder is to ensure that they receive expert care. Most people who receive high-quality care will improve considerably and many will fully recover from the eating disorder. Be involved. Offer to participate in their treatment. There is high-quality care available locally at The Center for Balanced Living for those 16 and up, and Nationwide Children’s Hospital for those 18 and under. The center hosts free support groups on the first and third Tuesday of every month from 6:30-8 p.m. There are groups for people with anorexia, bulimia and binge eating disorder. There is also a group for the supports and loved ones of those with eating disorders. Attending these can be a first step for those reluctant to seek care. Offer to come with them to the group and provide that support as they make the difficult choice to begin the path to recovery.
About the Expert
Jason McCray, Ph.D is a licensed clinical psychologist in Columbus where he serves as the chief clinical officer of The Center for Balanced Living. The center is a free-standing non-profit organization focused on treatment, education and research relating to eating disorders and the families impacted by them. McCray became interested in eating disorders and body image while completing his doctorate work at The University of North Dakota where he studied the reactions of men to images of the male muscular ideal. As the father of a young daughter, issues related to body image, prevention and socio-cultural influences are always in the front of his mind. Striving to better understand these issues and how they interface with the burgeoning neurobiological research findings with eating disorder has become the focus of his professional inquiry.
Hannah Bealer is a contributing writer. Feedback welcome at firstname.lastname@example.org.