The director of the MUSC Health Friedman Center for Eating Disorders wants families to be aware of new anorexia and bulimia research, including an encouraging study that found two thirds of women who suffer from anorexia or bulimia will eventually recover. Renee Rienecke says that shows an eating disorder doesn't have to be a life sentence.
That's good news for the estimated 20 million women and 10 million men in this country who may suffer from eating disorders at some point in their lives. In this Q and A, Rienecke discusses the new research and what families can do to help loved ones struggling with anorexia or bulimia.
Q: What is research revealing about eating disorders that might surprise people?
It has to be a perfect storm for someone to develop an eating disorder. There are psychological factors. There are genetic factors, personality, societal, biological – many things need to fall into place.
Genetics plays a big role. If you look at the research, 50 to 80 percent of the reason someone develops an eating disorder is because of genetics, which is huge. There are also certain temperaments and certain personality profiles that are more likely to develop eating disorders; this is very genetic, too. The temperament we’re born with won’t change too much in our lifetime, so I think the biological factors play a much bigger role than people tend to think.
Q: Men haven't typically been the focus of discussions about eating disorders, but now we're seeing reports with titles like: "The hidden, growing plight of eating disorders among men." Is that because there's been an increase in the objectification of men?
It’s possible. I don’t know how much eating disorders are increasing among men versus how much we are doing a better job of identifying them. But I do think objectification is an equal opportunity issue. It can apply to both men and women.
Q: What about kids? What are researchers learning about eating disorders at young ages?
A recent study out of England identified four distinct risk factors related to elevated eating disorder symptoms at age 12: body dissatisfaction in boys and girls, depressive symptoms in girls, dietary restraint at 7 years old in boys and onset of eating disorder symptoms at age 9 in boys and girls.
Q: What's your advice for parents?
If you’re concerned about your child’s eating behavior and weight loss, talk to your child’s physician. The MUSC Health Friedman Center for Eating Disorders provides comprehensive eating disorder treatment for people 8 to 24 years old with anorexia nervosa, bulimia nervosa, and other unspecified or restrictive eating conditions.
Q: Is there anything that can be done to prevent eating disorders?
There aren’t a whole lot of prevention studies that have shown to be effective. Until research shows us something that really works prevention-wise, helping kids have a healthy relationship with food and their body and good self-esteem is important. As far as solid prevention efforts, there is nothing out there that we can point to exactly.
Q: What role does our exposure to images of 'perfect' bodies in the media play in contributing to eating disorders?
Society definitely does not help things, but everyone lives in the same societal and cultural context and not everyone develops eating disorders. There is no doubt the media plays an important role, and there are interesting studies that show it. There was a study done several years back in Fiji looking at eating disorder attitudes and behaviors right before western television was introduced, and rates of eating disorder attitudes and behaviors skyrocketed after that. I think media contributes to the issue, but it may not be as influential as people think it is.
Q: What research is the Friedman Center doing?
We’re collecting a great deal of data on our patients. Data are collected when people come into the clinic, a couple of weeks into the treatment program, a month into the program, when they finish and at their three-month follow-up. We’re collecting data on demographic statistics, eating disorder symptoms, depression, anxiety, family dynamics, family expressed emotion and obsessive compulsive symptoms, among others. These data will not only allow us to keep track of how our patients are doing clinically, but will allow us to develop a deeper understanding of the nature of eating disorders and the use of family-based treatment approaches in treating adolescents with eating disorders.
Q: What are the most common eating disorders you see?
One of the most common we see is anorexia nervosa, a condition where a person is at too low of a weight for his or her age, height and weight history. The patient may also have an intense fear of gaining weight or becoming overweight, or exhibit behavior that interferes with weight gain. Overvaluation of body image and the denial of the severity of low weight are also symptoms associated with anorexia.
Bulimia involves binge eating. It doesn’t have to necessarily be a large amount of food, but a binge episode is characterized by a loss of control, feeling like they can’t stop or control their eating once it’s started. Purging or some sort of other compensatory behavior happens afterward, which could include self-induced vomiting, laxative use, over-exercising or fasting. There is also overvaluation of shape and weight just like with anorexia.
You can’t have both a diagnosis of anorexia and bulimia. A diagnosis of anorexia trumps a diagnosis of bulimia. Sometimes you hear people say, 'I have both anorexia and bulimia,' but technically, you can’t have both at the same time.
Q: The Friedman Center is relatively new – it opened last summer. How many patients have you seen, and what are the main treatment options?
There have been about 70 cases of people looking for treatment since the center’s opening. FBT, or family-based treatment, is the most effective method for helping adolescents with anorexia get better. Emerging research has found FBT to benefit adolescents with bulimia nervosa as well. The earlier someone with an eating disorder gets treatment, the easier it may be to recover.
Kids with anorexia are usually ambivalent about getting help. They don’t really want to get better. So to put someone who may not want to get better in charge of their own treatment when it’s a potentially life-threatening illness is a really bad combination.
Having parents become involved in saying, 'We’re going to help you even if you don’t want to,' helps a lot. If left to their own devices, a lot of kids would starve themselves to death. The eating disorder is clouding their judgment, so parents are going to make eating-related decisions for their children temporarily, and make sure that treatment happens.
Q: What other services are offered at the Friedman Center?
We have several options. First, there's diagnostic evaluation and assessment. Outpatient evaluations consist of a psychological assessment with me, and a medical evaluation from the program's pediatrician, Dr. Elizabeth Wallis. Inpatient consults are also available.
We also offer a three-and-a-half hour intensive outpatient program for children 17 and under on Monday, Wednesday and Friday mornings. The program’s services include therapeutic meal support, medical and psychiatric monitoring, parent education groups and evidence-based group psychotherapy. In addition to the scheduled programming, parents and patients meet with a program therapist twice a week for family and individual therapy.
In our outpatient therapy program, psychologists and therapists provide evidence-based treatment for patients from 8 to 24 years old and their families. Outpatient treatment is also available for families who have completed the intensive outpatient program.
Finally, we offer outpatient medical management. Our pediatrician focuses on the unique physical needs and concerns of eating disorder patients. Follow-up care is also available for families who have completed the intensive outpatient program.
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