Wednesday, December 25, 2013

Managing eating disorders through the holiday season


Miami Herald~Kelsey Hensel was everything a teenage girl would want to be. She was smart, had a great family and was a star athlete on her high school softball team.
She also was a master at hiding her deepest secret: Her battle with bulimia nervosa — an eating disorder characterized by binging on food, overeating, self-induced vomiting and abusing laxatives. It controlled her life throughout her teenage years.
Hensel started noticing her “weird relationship with food” when she was 12. By the time she was 14, she had begun binging and purging. Her mother, who was an alcoholic, died when she was 10.
“It wasn’t about appearance to me,” she said. “It was just my way of dealing with everything I had been through. The eating disorder was a relief at the time.”
The National Institute of Mental Health defines eating disorders as an illness that seriously affects one’s everyday diet. The three most common eating disorders are: anorexia nervosa, bulimia nervosa and binge-eating disorders.
Individuals suffering from anorexia nervosa believe they are overweight — when they are typically underweight — and become obsessed with food and their weight.
Binge-eating disorder, unlike bulimia, doesn’t result in self-induced vomiting or the use of laxatives. Instead, people lose control of their eating and often end up becoming overweight or obese.
According to the National Eating Disorders Association (NEDA), 20 million U.S. women and 10 million men suffer from a clinically significant eating disorder at some point in their lifetime.
Hensel’s eating disorder became progressively worse throughout the years. When it was time for her to leave for college, she thought she would be able to get over it. She couldn’t.
“I was very ashamed because I was so confident, had everything figured out, everyone looked up to me, so to admit that I wasn’t able to eat like a normal person was awful to me,” she said. “I was always a normal weight and that was one thing I felt was difficult for me. I felt like I had to look a certain way to be bad enough and that is horrible.”
After seven years of battling her addiction with bulimia – which would develop into anorexia and binge eating from time to time – she left college in 2011 and checked into The Renfrew Center of Florida in Coconut Creek, which treats people with eating disorders.
Today, the 23-year-old resident of Palm Beach Gardens is getting ready to graduate from college and is recovering. She has friends, has a relationship with her family and is in a 12-step program that helps her work on her recovery.
“Eating disorders are very powerful and they take a lot out of you,” she said. “I am happy to be alive, and I couldn’t say that three years ago.”
Dr. Rosa Gomez de Jesus, a pediatrician specializing in adolescent medicine at Miami Children’s Hospital, says the holidays can be very stressful for people suffering from eating disorders.
“They are going to have people asking them why they’re not eating or commenting on this or that or asking why they’re too skinny, so they get a little bit concerned and nervous about that,” she said.
Although no studies have quantified whether there is an uptick among people treated for eating disorders during the holiday season, Gomez de Jesus says the number of patients she sees increases during this time, from one to two patients to as many as eight or more.
Parents concerned that their child may be suffering from an eating disorder should look out for warning signs, experts say. These include not eating with the family, rearranging food to look as if it was eaten, preparing their own meals, commenting about their weight, over-exercising, becoming obsessed with food magazines or television channels and preferring to be alone a lot.
Physical symptoms include rapid weight loss, dry skin, thinning hair, fainting spells, fatigue, weakness, irregular or no menstrual cycles and the inability to regulate body temperature, which can result in the child often complaining about being cold.
Jennifer Caceres, a registered dietician, says the pressure of feeling that you have to eat the food because a family member cooked it can exacerbate the stress during the holidays.
“Eating doesn’t mean you are going to be overweight or get fat,” she said. “You have to have a balance. That is what we try to reinforce and emphasize with patients.”
Hensel remembers the holidays being especially difficult for her. She says she spent hours obsessing about herself and her addiction, and brooded that she couldn’t enjoy the holidays of her dreams.
“It is important to have a supportive family member or loved one who is going to be with you through the holidays,” she said. “You should be able to share your thoughts with this person. Let them know that you might need their help, and reach out.”
She also advised that people who suffer from eating disorders should give themselves a break, and try to treat the holiday like any other day. As part of this strategy, she suggested engaging in fun activities with the family to get one’s mind off the food.
“Striving for perfection isn’t realistic,” she said. “Deviating from your plan is okay. A lot of people with eating disorders set these strict guidelines and end up setting themselves up for failure.”
Dr. Heather Maio, assistant vice president of clinical services and clinical director of The Renfrew Center of Florida, says that it is important for family members to be patient and supportive.
“Extra support needs to be in place,” she said. “Be kind, especially during the holidays, when everything is stressful and busy and there are a lot of guests in the house. Know that recovery is possible.”
Although treatment options vary depending on the severity of the individual’s case, a multidisciplinary approach – a combination of therapy and medication – is the most effective way to treat eating disorders.
Dr. Daniel Bober, the medical director of pediatric psychiatry at Joe DiMaggio Children’s Hospital in Hollywood, says parents can unknowingly put pressure on their children when they talk to them about food and appearance.
“Even one conversation about saying they’re looking fat or that they need to cut back has such a tremendous impact,” he said. “So much of the child’s self-esteem comes from the parent’s acceptance of them.”
Instead, he said, focus on the aspects of your child that are healthy. This way, you can build them up from the inside out, not the outside in, he said.

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