The Specialist:
The chief of the Mount Sinai Eating and Weight Disorders Program, Dr. Tom Hildebrandt is a clinical psychologist. He treats adults and children who need to gain weight or who have too much weight. His center oversees the care of 200 patients.
Who’s at risk:
Doctors estimate that as much as 10% of the American population has some kind of an eating disorder.
“Eating disorders encompass a diverse set of subtypes, but they all begin with a fundamental disturbance in eating,”Hildebrandt says. “There’s an overvaluation or disturbance in the way someone perceives their shape and weight.”
Probably the most common and certainly the most well-known eating disorder is anorexia nervosa, which presents as an obsessive desire to be thin.
“Anorexia is an underweight disorder in which patients severely restrict the amount of food they allow themselves to eat,” Hildrebrandt says. “Anorexia is costly and difficult to treat, and it usually manifests for the first time in adolescence.” Bulimia nervosa, or bingeing, is one of the most common types of overeating disorders.
Some people are considered more at risk of developing an eating disorder than others. Genetics are definitely involved.
“Anorexia is seven times more likely to affect women than men, though it is important to note that men and boys can develop anorexia,” Hildebrandt says. “Another set of risk factors is a constellation of traits that we call harm avoidance — things like picky eating and excessive worrying.”
Eating disorders operate in ways similar to addiction. “People with anorexia get stuck in their preoccupation with dieting in a way similar to how alcoholics relate to alcohol — they just can’t relate to food in the same way as people who don’t have a problem,” Hildebrandt says. “People with anorexia have come to feel like eating food is a punishment, so they want to avoid that painful experience. In order to recover, they actually have to relearn how to eat food.”
Signs and symptoms:
The red flag of anorexia is sudden weight loss.
“In particular, we look for diets that become all-consuming,” Hildebrandt says. “There’s simultaneously a preoccupation with food and an unwillingness to eat it. Something parents can look out for is: how much time, energy and effort does your child put into maintaining his or her shape and weight?” There can also be an over-investment in exercise as a means of controlling shape and weight.
Considering that almost everyone in our culture is unhappy with something in their appearance, how can you tell when the preoccupation has become unhealthy? “We advise parents and loved ones to look out for changes in eating habits and any sudden changes in weight,” Hildebrandt says. “Adolescents should stay on roughly the same part of the growth curve. If their growth falls by 15-20%, that’s worrying.”
The diagnosis of anorexia is made by a licensed mental health professional following the Diagnostic and Statistical Manual of Mental Disorders. “Some of the factors that go into making this diagnosis include the loss of a significant amount of weight, a fear of fat and preoccupation with shape and weight,” Hildebrandt says.
Traditional treatment:
Anorexia is a very difficult disease to treat, but with the right interventions patients can recover. “For adolescents and young adults, family-based intervention is the most helpful. This entails the parent sitting down with the child every meal and feeding and re-feeding them until they eat enough,” Hildebrandt says. “Food is their medicine, and the idea is that the people who love you most in the world are going to deliver it to you.” Adults can receive intensive intervention in an in-patient setting.
The first phase of treating anorexia is weight restoration. “This is about helping people to eat enough calories, to get their weight to a healthy level and to return to eating what they used to eat,” Hildebrandt says. “The crucial thing is that there’s no getting out of eating the calories. If patients don’t eat the food in front of them, then they have to drink a high-calorie drink.” This process usually takes about 6-8 weeks, but can continue for as long as it takes.
The second phase returns some control to the patient as he or she proves able to eat enough to maintain weight. Advising parents, the expert says, “It’s like passing the baton back to the patient. First you let kids spoon out their own food, then they get access to their old life back. Slowly they can return to hanging out with their friends and going to school.”
The third phase is identifying the pressures that drove the individual into the eating disorder in the first place — and supporting recovery. “These people are recovering from a major medical illness, and that makes all the normal challenges in life that much harder,” Hildebrandt says.
Anorexia can be extremely difficult for families, but it demands that parents take action. “Something for parents to know is that ‘waiting for your child to grow out of it’ really doesn’t work with eating disorders,” Hildebrandt says. “The sooner we can intervene to help teens and young adults return to health, the better chance they have to make a full recovery.”
Research breakthroughs:
Some of the work being done to combat anorexia focuses on the role of emotions in this disease.
“What we’re finding is that people with anorexia have developed an aversion or disgust to food,” Hildebrant says. “The emotion of disgust developed to protect us from poisoning, but anorexic patients have learned that food is disgusting as if it were a toxin. So then they have to relearn how to tolerate food.” Doctors are also investigating new treatment methods, ranging from deep brain stimulation to novel medications.
Questions for your doctor:
If dieting and thinking about dieting plays a big role in your life, ask your doctor, “What are the medical risks for constantly being on a diet?” If you’ve been diagnosed with anorexia or suspect you might be at risk, ask your doctor, “Can you refer me to a specialist?” Parents also need to be vigilant. If your child’s position on the growth curve changes, ask the doctor, “Is this weight loss a cause for concern?” And if your child is diagnosed with an eating disorder, ask the physician, “What kind of treatment are you providing?” Ask, “Can you refer me to someone whose specialty is treating eating disorders?”
“If you fear that your child or loved one is struggling with anorexia or any kind of disordered eating, don’t hesitate to seek treatment for them,” Hildebrandt says. “You need to be proactive and pursue a treatment for your child just as actively as you would if they were diagnosed with cancer.”
What you can do:
Get informed. There’s trustworthy information online for adults patients and parents of children with eating disorders. Check out the National Eating Disorders Association, the Academy for Eating Disorders and Mount Sinai.
Get support. If your child suffers from anorexia or another eating disorder, talking to other parents can be a great resource for practical advice. Hildebrandt recommends the Maudsley Parents site.
Do not allow children to diet. “There’s no way for you to know if your child has a predisposition to eating disorders, so don’t allow them to diet,” says Hildebrandt. “Instead, you want to help your child think about activity and food choices in a healthy way — not simply in terms of weight and dieting.”
By the numbers:
— About 1 in 10 adults suffers from some kind of eating disorder.
— Anorexia is seven times more likely in women than in men.
— About 50% of adults with anorexia will have a relapse in the first year.
— Anorexia has the highest mortality rate of any mental illness.
Source: Dr. Tom Hildebrandt
