Health pros warn against thinness at any cost
Eating disorders are a plague hitting an increasing number of Connecticut adults and children, some as young as 10. And experts say that, too often, those closest to the victims don't even know they're suffering.
"You die looking beautiful," said Natalie Hoeffel, site director of the Renfrew Center of Connecticut in Old Greenwich, referring to the unseen internal bodily damage. "People see a good-looking young woman who looks like a model. Her family says she's healthy because she exercises three hours a day and swims and plays lacrosse. But they don't understand that she is going to drop dead on the field if we don't get her into treatment."
She and other authorities in the field said, though thousands of Connecticut adults and children struggle with eating disorders, many suffer secretly because the life-threatening psychiatric condition has gone undiagnosed and untreated.
"It's a pressing public health issue. These are serious psychiatric disorders that can lead to death," said Rebecca Puhl, deputy director of the Yale Rudd Center for Food Policy and Obesity.
An estimated 30 million Americans have eating disorders such as anorexia, bulimia and binge eating disorder, reports the National Eating Disorders Association. In Connecticut, 3.4 percent of the population has an eating disorder, with females twice as likely to be afflicted than males, according to statistics cited by the National Association of Anorexia Nervosa and Associated Disorders.
"We're concerned that there are many boys and girls flying under the radar who could be struggling with eating disorders that aren't diagnosed or treated," said Craig Brown, a founder and chief executive officer for Center for Discovery, which operates residential treatment facilities for those with eating disorders at site all over the country, including those in Greenwich and Fairfield.
What are eating disorders?
A combination of biological, psychological and social factors cause eating disorders. Anorexia, which has the highest mortality rate of any psychiatric illness, is characterized by self-starvation and excessive weight loss. People with bulimia have recurring binge-and-purge cycles, consuming large amounts of food, followed by self-induced vomiting, over-exercising or the use of laxatives. People with binge eating disorder (the most prevalent type of eating disorder) eat very large amounts of food, but they do not engage in purging behaviors.
Eating disorders can lead to serious medical consequences, including abnormally low heart rate and blood pressure, osteoporosis, kidney failure, hair loss, gastric ruptures, tooth decay, loss of menstrual cycles and death. Treatment options can range from inpatient care and residential programs to partial hospitalization programs and intensive outpatient services with a team of physicians, psychiatrists, therapists, nutritionists and others. Many people with eating disorders have additional substance abuse or psychiatric conditions, including alcoholism, depression or self-injury behaviors.
In Connecticut, an increasing number of younger teens overall and Hispanic teens in particular engaged in disordered eating between 2009 and 2011, according to the most recent data available from the Centers for Disease Control and Prevention in its Youth Risk Behavior Surveys. Disordered eating refers to harmful behaviors -- such as restricting food intake -- that could lead to an eating disorder.
The CDC data also show that nearly 18 percent of ninth-grade girls surveyed in 2011 indicated they had not eaten for 24 or more hours during the previous 30 days due to weight considerations. Compare that to the numbers from 2009, when 12.2 percent of girls reported restricting food.
Overall, food restriction rates in Connecticut were higher for Hispanic teens (11.9 percent) compared to their African American (8.4 percent) and white (8 percent) peers in grades nine through twelve in 2011.
What disturbs many professionals is that the disorders are popping up in children at earlier ages than ever. "We used to see eating disorders start at 13 or 14. Now we frequently see 10- and 11-year-olds," said Dr. Diane Mickley, founder and director of the Wilkins Center for Eating Disorders in Greenwich.
`Perfect storm' of factors
While definitive answers remain elusive, experts point to a "perfect storm" of factors that may be contributing to the growing number of youth with disordered eating.
"It's tougher to be a kid these days. It's really stressful," said Jennifer Henretty, director of outcomes and research for Center for Discovery. "But it's not easy being a parent, either. Society gives us messages that we should push our children to be well-rounded and top achievers. But many of these factors may be setting up children to be at an increased risk for eating disorders."
The focus on body mass index -- an indicator of fat based on height and weight -- doesn't help matters.
"Medical providers focus on keeping people's weight under control without thinking about quality of life issues and someone's natural body type," said Margo Maine, of West Hartford's Maine & Weinstein Specialty Group and a founder and past-president of NEDA.
Social media exacerbates the problem, from the pressure to look good on Facebook and Instagram to the "pro-ana" (pro-anorexia) and "pro-mia" (pro-bulimia) sites filled with "thinspirational" messages and how-to tips.
"Youth are avid consumers of mass media," Puhl said. "We need to look closely at the messages and values associated with body weight and fitness and how they are being internalized by kids."
Adults are vulnerable, too. "People think Facebook is just for the young. But there are many women at home on the computer who are worried about looking good in selfies," Hoeffel said.
In fact, many eating disorder experts report treating more older women in their 30s through 70s.
"Age does not immunize people from eating disorders," Maine said. "There is tremendous pressure on women to be everything and everything includes being feminine which means being thin, pretty, fashionable and having the right body type."
Although early intervention can lead to a full recovery, many people don't seek treatment due to denial and the inability of health care professionals to recognize early symptoms. Other challenges include inadequate insurance coverage and societal pressure to be thin. Just last month, NEDA criticized clothing retailer J. Crew for creating a new triple-zero size.
"A woman who walks into a doctor's office having lost 20 to 25 pounds gets accolades for losing the weight but no questions about how she lost the weight," Maine said.
Identifying males with eating disorders can be tough because they are more secretive and shun treatment. Nationwide, males comprise 5 percent to 15 percent of people with anorexia and bulimia.
"Physicians, psychologists and social workers are less likely to detect an eating disorder in boys and men because they're just not looking for it," said Rebekah Bardwell Doweyko, program director of Walden Behavioral Care in South Windsor, which opened in 2012. "Even when they do admit to having a problem, men are less likely to seek treatment because they're ashamed of having what they consider to be a `female' illness."
Teenage boys face pressure to maintain a certain body type, particularly in sports where weight matters, such as wrestling, gymnastics, football, track and rowing.
"Boys will take extreme measures to fit into a certain weight class and those behaviors can lead to an eating disorder," Doweyko said. "Sometimes coaches can inadvertently make these behaviors worse with their demands. Coaches have a huge role and responsibility in protecting the health of their athletes."
Experts urged families and schools to take a larger role in prevention and detection, and some have answered the call.
School-based strategies to prevent and identify eating disorders and weight stigmatization drew strong support in a recent study from the Yale Rudd Center for Food Policy and Obesity. The initiatives included adopting weight-related anti-bullying policies, adding eating disorders content to the health curriculum, and training staff to spot the warning signs.
While challenges abound, advocates believe increased awareness about the dangers of eating disorders will benefit people of all ages and backgrounds on the road to recovery.
"These are curable illnesses," Mickley said. "There are many reasons to be hopeful."
This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).
More InformationEating disorders in Connecticut
About 3.4 percent of Connecticut's population has an eating disorder. Many of those affected are young. Here are some facts on youth and eating disorders in the state.
Nearly 18 percent of ninth-grade girls surveyed in 2011 (compared to 12.2 percent in 2009) indicated they had not eaten for 24 or more hours during the previous 30 days due to weight considerations.
Food restriction rates were higher for Hispanic teens (11.9 percent) compared to their African American (8.4 percent) and white (8 percent) peers in grades nine through 12 in 2011.
The rate of food restriction among Hispanic male teens grades nine through 12 was 13.3 percent in 2011, up from 10.1 percent in 2009. Hispanic male teens were more likely to restrict food than Hispanic female teens (10.1 percent) in 2011 -- an inverse of national statistics showing females are more likely to engage in disordered eating than males.
Source: Centers for Disease Control and Prevention's Youth Risk Behavior Surveys