February 20–26 is National Eating Disorders Awareness Week this year. Led by the National Eating Disorders Association, NEDAwareness week is dedicated to bringing attention to the realities of eating disorders as a mental illness, and to provide support and visibility to individuals affected by eating disorders. 

Considering how prevalent eating disorders are—9% (29 million) of the U.S. population will have an eating disorder in their lifetime—the aftereffects that we face as a society because of the stigmatization of mental illnesses are still alarming. Eating disorders have the highest mortality rate of any mental illness. Each year, 10, 200 deaths are the direct result of an eating disorder, and about 26% of people with eating disorders will attempt suicide. 

On the positive side, not only is help available, but the majority of people also fully recover after receiving treatment for eating disorders. In efforts to encourage people to seek help early on, we should educate ourselves not only to dismantle our preconceived notions about eating disorders but also to learn the truth about the mental illness. 

In this article, I talked to Dr. Weiselberg, whose area of focus is on adolescent medicine and eating disorders. He defines eating disorders, clarifies the misconceptions surrounding eating disorders, and gives advice as to what a person can do when they are struggling with their relationship with food.

Introduction 

Please introduce yourself, including your name, education, and profession. 

EW: My name is Eric Charles Weiselberg, MD. I am an attending in the Division of Adolescent Medicine at Cohen Children’s Medical Center of Northwell Health. I was a biology major at Stony Brook University, and I went to medical school at Downstate Medical Center in Brooklyn. Then I went to my pediatric residency at NorthShore University Hospital and my adolescent medicine fellowship at Schneider Children’s Hospital.

What does a doctor in the field of adolescent medicine do?

EW: So there’s two times in people’s lives where there’s the most fast, ongoing change that’s ever going to happen. One of those is in the first two-three years of life. The other one is during adolescence, where there’s so much physical change and also a great deal of emotional change that happens within a short period of time. So [adolescent medicine] is the one field that really works on both the medical, psychosocial, and emotional aspects of development. 

What is the age-range of adolescents?

EW: Typically, adolescence [begins] when puberty starts. That’s different for different kids, sometimes fifth or sixth graders may be in there. But especially when someone starts to be in middle school or junior high school, we would consider them to be adolescents, no matter where they are in their pubertal development.

There are many different kinds of eating disorders, but can you give a general definition for what an eating disorder is?

EW: In general, it’s an unhealthy relationship with food and eating that leads to emotional/mental distress and dysfunction in your health [or vice versa]. 

You could start from the physical part like wanting ‘to lose five pounds,’ which soon starts to affect you mentally. Then you want to lose more weight, restricting what you eat, and the physical part [of an eating disorder] further damages your mental health. 

Or it starts from the mental health part, [like] from distress, poor body image, poor self-esteem, that results in a negative impact on [your relationship with food and eating]. It goes in a big circle; so when someone has an eating issue, we recommend therapy and medical care.

Myths about Eating Disorders

Eating disorders are centered around food.

EW: One of the things we stress really early in treatment is that [eating disorders are] not about food. Parents say, I’ll buy them whenever they want to eat, or I’ll make less, and we say there’s no magic food. On the surface, it seems to be about weight, food, and body image. But eating disorders can also develop as an unhealthy coping mechanism to deal with [sadness, anxiety, trauma, low self-esteem]. Part of recovery is about identifying triggers of eating disorder behaviors [like dieting, binging and purging] and learning [healthier] strategies to cope with them. 

An eating disorder looks a certain way, like if you’re thin, you “must have an eating disorder.”

EW: We have this image of what people [with an eating disorder] are supposed to look like, but people can be on all different sides of the spectrum. People can be petite, people can be tall, some people with eating disorders can be classified as overweight. Not everyone with eating disorders is underweight. And not everyone who is underweight has an eating disorder.

Only females have eating disorders. 

EW: So in the 1970s, the early studies [on eating disorders] focused on Caucasian females of certain high achieving families; it was felt that about one in 10 eating disorder patients were male. But now we see that patients are as diverse as our community. They are male, female, from every religion and ethnic group. Everybody from every walk of life [can develop an eating disorder].

It’s not possible to recover from an eating disorder.

EW: When [a teenager] has to be referred to an eating disorder specialist, nutritionist, or therapist, 75 to 90% of teenagers do fine and recover with treatment from eating disorders. Some teenagers may go on to have kind of a roller coaster type of recovery, some ups and downs in recovery, but the majority do just great.

Advice

What are some behaviors that people can look out for as a sign that they’re developing an unhealthy relationship with food?

EW: It’s sometimes very hard to recognize an eating disorder in yourself. The symptoms kind of creep in slowly, and people are often somewhat defensive about it. But some signs are constantly changing goals [about your diet, exercise, weight, etc]. Let’s say you set a goal of not eating a certain snack like chips, and later you say ‘Well, now it’s not good to eat any snack,’ that’s a red flag.

If [your actions] start affecting your concentration, like you’re trying to do schoolwork, and you’re thinking of what you’re going to eat later that day, or you’re trying to fall asleep at night, but you’re thinking of calories, there’s a problem going on. 

When people start to develop or have an eating disorder, what are resources that they can turn to for help?

EW: Definitely reach out to a parent, or any adult. It can be an aunt, neighbor, guidance counselor, or teacher you feel comfortable with. You can reach out to your doctor. There’s also the National Eating Disorder Association helpline [1-800-931-2237]; people can call it and ask, “What do I do?” 

We often see adolescents because they’ve gone to their parent and say ‘you know, I think I need help. I’m thinking about [food] too much. I’m not sleeping at night. Something’s not right. I think I need to speak with someone.’ They don’t have to be doing this alone.