Confronting the silent struggles of eating disorders
Twenty-three year old Ellie Herman, of Selinsgrove, Pennsylvania, knows just how stressful it can be to navigate through the senior year of high school and four years of college. It can feel like things are out of control.
To regain that sense of structure, she enhanced her workout regimen and focused on one thing she could control — her eating habits and overall health.
“I started eating better foods — mostly whole foods — and I was playing tennis and running for fun,” she said. “But slowly I started not only eating healthier, but only eating certain foods and not eating at all between meals. And then it got to a point where I’d stress over whether or not I should eat a piece of gum. It was, for me, a way of coping with school stress, applying for college and feeling in control.”
According to statistics by a variety of health organizations, eating disorders have the highest mortality rate of any mental illness. In fact, 20 percent of those suffering from anorexia alone will prematurely die from complications related to the eating disorder, including suicide and heart problems. In the United States there are about 10 million women battling anorexia or bulimia and one million men, according to the National Eating Disorder Association.
Billie Crayton, a native of Mifflinburg, Pennsylvania, experienced heart problems related to her eating disorder.
“About eight years ago, there was a time when things were falling apart and I couldn’t do anything to control it. My thinking got all twisted and I had it in my mind that if I could control what I ate, things could get better. I was nothing but skin and bone, but I was in complete control,” Crayton said. “I would go four to five days at a time without eating, then finally eat a few crackers and sleep. I remember people who I hadn’t seen telling me how great I looked and I thought, ‘My goodness, I must be doing this right then.’”
That turned out to be far from the truth.
“My ribs were sticking out, my breasts were gone and my hair was falling out, but apparently I looked good,” she said. “I wound up having some sort of heart ‘event.’ They weren’t calling it an attack. My body was giving out and I ended up at the cardiac ward where the doctor and I had a long talk about health and being healthy. Between that and realizing that I could wear the same size shorts as my 10-year-old daughter, I realized I needed help.”
Nina Sauers, of Mifflinburg, Pa., was just 12 years old when she first experimented with purging (self-induced vomiting) as a response to the teasing she received for being a “chubby kid.”
And the condition only escalated when she worked her way through high school.
“I was really overweight at the time,” the 33-year-old mother of four said. “Most people only associate eating disorders with thin people, but there are all kinds of eating disorders, including binge eating and bulimia.”
Sauers started trying to lose weight with healthy dieting and exercise, but when she hit a plateau, her methods became more severe.
“I started to use laxatives, all kinds of Epsom salts, mineral oil, ballerina tea, magnesium citrate and other products. Most are cheap and can be purchased without parental input,” she said. “I also started becoming obsessive about what I ate. I counted calories, exercised all the time and avoided every chance I could to be around food.”
While she lost a lot of weight throughout the process, her body wasn’t able to hold up. She almost ruptured her esophagus from all the laxatives and pills and still experiences major stomach and intestinal issues.
“I didn’t treat my body well, and now I’m reaping the consequences,” she admitted.
The long road to recovery
Herman realized that her situation was concerning and she started counseling.
“I went to college, and I got the ‘freshman negative-15.’ It was easy to fall back into my old habit and to feel in control with a dining hall that always had carrots,” she said. “Through my four years at Albright, I managed to be an overachiever in the classroom while maintaining a body fat percentage that would scare many. I was a compulsive cardio lover and over-exercised in a very rigid schedule.”
But then, upon graduation, Herman’s situation fell apart.
“I think my body honestly just couldn’t handle what I was doing to it anymore, and it finally overrode my brain,” she remembered.
After getting the help she so desperately needed, Herman is currently enjoying a new outlook on life.
“Now, I have never been happier or healthier. I’m about 20 pounds heavier than I was before my eating disorder, but I am thrilled. It took approximately 20 million jars of peanut butter to get here,” she joked. “I also started weight training rather than doing cardio day in and day out, and I think it is so important to have that sort of relationship with your body.”
Crayton said that those with eating disorders have a warped view on reality, so much so that things which should set off red flags instead go under the radar.
“Food is so essential and giving that up, our bodies start dying slowly. I had a hard time showering, getting dressed and doing just about anything. My lowest weight was 101, which may not sound too low, but I was an athlete my entire youth, so the mass I lost was mostly muscle,” she said. “It got to a point where I could take my hand and wrap it around my thigh.”
The long road toward recovery has involved counseling and mindful eating, but Crayton has learned that an eating disorder isn’t something that can be ended with a quick cure.
“When I started to really eat again, the weight naturally came back on, but I still find myself fighting often not to return to that old way of thinking,” she said. “The thoughts of how easy it would be to start again come and go, but then I try to think about how bad it got, what I lost and how close I came to losing more.”
Sauers went through a number of hospitalizations and therapy sessions for her condition, but still has to be mindful of any negative thoughts.
“I believe you can recover from an eating disorder, but recovery means having more than just a healthy body — you also need a healthy mind and soul,” she said. “My weight still fluctuates and I try to be careful not to fall into old thoughts and habits because it is very easy if you don’t have a good support system. You have to be honest with yourself and it really helps to have someone to help keep you accountable.”
According to the National Eating Disorder Association, only ten percent of people with an eating disorder will receive treatment, with 35% of anorexics making a full recovery. However, 7.5 percent of anorexics will die within 10 years and 19 percent will die within 20 years.
Reducing the odds
Do you want to reduce the odds that one of your children develops an eating disorder?
Begin at the dinner table, according to Joyce Whitford, a registered dietitian with Geisinger Medical Center for 41 years.
“A family that eats together tends to be more healthy together,” she said. “It allows parents and their children more time to discuss their day and you’ll get to see their eating habits in action.”
Whitford advises though that eating disorders can be hard to spot at first because of the nature of the condition.
“It usually starts out innocently. People may say they are going to start exercising and just take it too far. They just want to clean up their eating and lose a few pounds,” she said. “When that happens, they feel successful. Other people may praise them, and that can feel really good. But then, over time, it spirals out of control.”
With eating disorders, the spiraling can happen more in inches than miles, which can also make the condition that much harder to acknowledge.
“Sometimes, a person could be at a good weight for them, but then just say they’d like to be a little thinner. They have this tummy they’d like to address or if they shave off a few pounds they’ll feel a lot better about themselves,” Whitford said. “But then it goes too far.”
Some of the red flags, she said, include people who completely cut out a certain food group, make an overemphasis on body size, become obsessive about calorie counting or exhibit an extreme fear of weight gain.
Eating disorders affect people of all ages, Whitford said.
“They are not age discriminatory. So many people think of it affecting just teenage girls, but in clinic we see all ages and sizes. We may see a 65-year-old woman and then a few nine or 10-year old boys who are struggling and then a guy in his 30s. We see it across the board,” she said. “Girls typically start struggling with eating disorders around 13 or 14, but boys tend to start younger. With them, it starts out with binge eating and excessive exercise. They aren’t typically concerned about what the weight is, but more about obtaining a more muscular physique.”
Crayton admits her situation breaks the stereotype of what eating disorders are — and specifically who they can affect.
“Here is the thing most people don’t think about — this hit me in my 30s. When people think about eating disorders, they think of teenagers, but it really can affect anyone at any age,” she said. “It was especially devastating for me because I was a mom of a young daughter, and I basically lost a year of her life. I was sleeping all the time — sometimes 16 hours a day — and she was so very little. I realized she was getting the wrong idea about body image, food and health.”
How to help
Crayton suggests that parents look for potential red flags such as a drastic change in eating patterns, a sudden lack of interest in activities that once were enjoyed, avoidance of social situations such as holiday parties where food is plentiful and wearing baggier, loose clothing to hide potential weight changes.
“Eating disorders are very similar to drug abuse because most people won’t notice the problem until it has taken hold,” Crayton said. “These are both isolating disorders — you keep people away and will do and say what you need to in order to make sure that happens.”
Sauers added, “look for changes in behavior. Constant bathroom visits after meals with the water running in the sink can be sign of someone purging. Watch for someone who keeps making up excuses on why they can’t eat a meal with the family, or who seems especially obsessed with calories and other nutritional facts,” she said. “I wore hoodies and sweatpants in the summer and other baggy clothing. I’d wear ankle weights under my pants. I became withdrawn from family and friends, because let’s face it, getting together usually involves food. Also watch for changes in mood, sleep patterns and physical features such as hair, fingernails and other things that will be affected by change in nutrition.”
When it comes to talking to someone who you feel may be struggling with an eating disorder, Whitford advises that language is very important.
“Any support you can give someone when they are struggling is very important. When I see someone for an eating disorder, many times they’ll say a friend brought up the conversation, and after they recover, they admit they really appreciated that,” she said. “Communication is important. You don’t want to start out saying the other person has a problem, but more things like ‘I’m worried about you’ and ‘I care about you.’ ‘I notice you are not eating. I notice you’ve lost a lot of weight.’”
And with this sort of intervention, patience is critical.
“A lot of times, at first, you’ll get denial. This isn’t a one-and-done approach,” Whitford said. “When someone is going through something like this, sometimes the best thing to do is to plant the seed of help. You bring it up, test the water, be patient and then give them a little time before bringing it up again. Offer to go on a walk or do another activity with them. Remember, it is not going to be easy or necessarily pleasant, but it is something, as a friend, that needs to be done.”
For those you suspect may be struggling with an eating disorder, there is help in numerous places. Whitford advises going through the individual’s primary care provider, which can then help assess the situation and, if needed, develop a multi-disciplinary approach including help from a dietitian, therapist and physician monitoring the physical effects.
“Overall, when treatment is needed, it can be tailored to the individual,” Whitford said. “Doctors can monitor labs, family psychotherapy is available, nutritional therapy can get involved. There may be a need for certain medications such as antidepressants, and sometimes, in severe situations, there may be a need for hospitalization.
“Ultimately,” she said, “The earlier the intervention, the better.”
Zaktansky writes for the Sunbury, Pennsylvania Daily Item.