By Deborah Jeanne Sergeant
It may seem like resolving an eating disorder would be as simple as sticking with a regimen of eating standard serving sizes of a variety of foods.
Unfortunately, it’s not that easy.
According to the National Eating Disorder Association, of the 9% of Americans who experience an eating disorder in their lifetime (about 1-3% of the population at any particular time), most have a separate mental health problem that may contribute to the disordered eating.
The average age of onset is around 12 years old, with that average beginning to skew younger to 8-10 years old. The rate is twice as high among females than males.
The eating disorder often is the more visible presentation of a deeper problem.
“It’s like an iceberg where you see these symptoms where people are under or overeating or binge eating,” said Molly Ranney, dietitian with Highland Hospital. “That’s the top of the iceberg. But what’s underneath that’s triggering it? It’s what you need to unpack and figure out a different way to respond to have success with overall health.”
Eating disorders are about far more than poorly fueling the body. Ranney and others who help patients with eating disorders look at the why of the eating disorder.
“We eat for reasons other than fueling our bodies,” said “Biologically, that’s our drive. But why people eat, it’s for the fact that we’re happy, sad, glad, tired. All of those reasons can trigger us to overeat or binge eat or not eat enough. Some people, when certain feelings arise, don’t eat. Sometimes, it’s a feeling of control when we look at anorexia nervosa. We understand that it’s the one thing they can control in a world where many times there are things we cannot control.”
Food can become an unhealthy coping mechanism. Tied into that element is the relationship people have with food based upon their experiences. Ranney said that some people closely tie food with comfort, such as a mother offering a treat to distract a child from pain or disappointment. Others associate food with fear, such as the fear of eating disappointing a parent who expects the child to restrict food intake to maintain an unrealistic model-like appearance or perform better at athletics.
“We learn about food from the time when we’re very small,” Ranney said. “It’s one piece of the puzzle. There’s so much more to disordered eating than just measure foods and follow the Food Guide Pyramid.”
Repeat patterns such as obsessively counting calories for anorexia nervosa or purging after binging for bulimia become trusted rituals for patients—a source of comfort despite the negative physical and psychological side effects. Breaking those patterns is not easy. It typically takes professional help to assist patients in solving the puzzle of why food has such control over their lives and what to do about it.
“You need someone for who you can really lay it all out,” Ranney said. “They’re not related to you so they won’t have a judgment. They’re part of the person’s team and they’re helping people to improve themselves and their relationship with food can make all the difference in the world.”
She recommended talking with a primary care provider to find a mental health provider that specializes in eating disorders or checking with a workplace employee assistance program. With the continuation of virtual sessions, more people are able to access mental healthcare than ever. Removing schedule and distance barriers has improved access, as has providers offering sliding scale fees; however, “one of the biggest barriers we have is we don’t have enough mental healthcare providers and ones that specialize in eating disorders,” Ranney said.