Understanding and treating eating disorders

Eating disorders are serious illnesses—and surprisingly common—but recovery is possible. How can research help?

December 3, 2015

As Techiya Loewen drove home from work several years ago, she thought about the steps that she would take if she found her teenage daughter, Rachel, dead when she arrived. It wasn't unusual for her to consider this as she neared the house. For nearly four years, the family had been in a "living hell" since Rachel developed a severe phobia towards food.

"There was no hope," recalls Techiya. "Rachel considered suicide so often that it seemed like an inevitability. She couldn't study. She couldn't concentrate—even when her weight was reasonable."

Despite the fact that Rachel went through a period of consuming just 500 calories every other day, it was difficult for her family to get treatment for her. Rachel didn't have "classic" anorexia, as she wasn't imprisoned by body image issues, so she was denied services at her local eating disorder program when she was 12. Shortly after that, when she was down to 77 pounds, she was admitted to the re-feeding program at McMaster Children's Hospital in Hamilton, Ontario, where she was diagnosed with anorexia, anxiety, and obsessive-compulsive disorder.

Rachel Loewen, who has recovered from anorexia, hugs her mom, Techiya Loewen.
Photo by Peter Lee. Reproduced with permission from The Record (Waterloo Region).

"Looking back, I know that, logically, it doesn't make any sense," explains Rachel, "but I had strong suicidal ideations [thoughts] because the idea of death was less frightening than eating."

Although Rachel's story may seem unique, as many as 990,000 Canadians suffer from eating disorders.Footnote 1 Approximately 80% of those affected are female, and the illnesses can be quite complex.

"It's unlikely that someone will present with a straight eating disorder," says Dr. Jennifer Couturier, the medical co-director of the Pediatric Eating Disorders Program at McMaster Children's Hospital.  "There are often additional issues, particularly anxiety or depression, and it can even become a coping mechanism for some kids."

This complexity factored into the experience of Laura SmithFootnote *, whose eating disorder developed when she was seventeen and continued into her twenties. In addition to binging and purging, she engaged in periods of food restriction where she would challenge herself to increase the number of hours that she could go without eating. Her behaviour gave her a sense of accomplishment, a "feeling of control", but sometimes she simply wanted to punish herself (or her "uncooperative body").

"I don't remember where it started, exactly, but I learned to associate 'fat' with 'stupid', 'lazy', and 'worthless,'" explains Laura. "It was reinforced everywhere, too. From the way that people talked about each other to the ridiculous beauty standards in magazines, the message was clear: fat is bad."

As her disorder progressed, her perception of herself grew darker. "If I didn't do as well as I'd wanted to on a school assignment or if I said the wrong thing in a social situation—which happened a lot, I think—then I was clearly stupid. And therefore fat. And therefore worthless," she adds, then sighs. "It sounds so silly now. But at the time, my head was swimming with it. There was barely room for anything else."

Yet, there is hope for recovery. Promising treatment practices, such as Family-Based Treatment (FBT), are helping people across the country. With FBT, which is an out-patient treatment, parents are engaged as part of the treatment process and find ways to interrupt the eating disorder behaviour. (In cases of anorexia, there is also an emphasis on re-feeding and weight restoration.) Although not every patient is a good candidate, research has shown that long-term outcomes are better with FBT than with individual treatment.

Given its efficacy, Dr. Couturier wanted to explore the best ways to implement FBT at treatment centres across Ontario. With funding from the Canadian Institutes of Health Research (CIHR), she and her team recruited four sites—out of the 22 in the province—to uncover barriers and challenges to implementing the FBT approach "with fidelity to the treatment manual" at these sites.

"We wanted to show that it could be implemented in the community," she says. While she is still collecting the final outcomes, the implementation success (of approximately 80%) shows that evidence-based treatments such as FBT can be made available in a number of places—with the right training and resources.

Still, getting access to the right services and treatments can be difficult for patients. Dr. Rick Audas, Associate Professor of Health Statistics and Economics at Memorial University in Newfoundland, is leading a CIHR-funded research team that is examining mental health services for children and youth in Atlantic Canada. Part of their focus is on eating disorders.

"It's not like a cancer diagnosis, where you go through a range of options," explains Dr. Audas. "It's not a 'straight run' to get services for these issues. And it's important to document the challenges that families face in achieving health for their children. We want to shine a light on these inequities."

By doing so, Dr. Audas and his team will help pinpoint the types of services needed for mental health care. Thus far, the study has highlighted the fact that there is "little-to-no middle ground" for eating disorder services in Newfoundland and Labrador, in particular. "There aren't enough options for patients who aren't quite sick enough for the limited out-patient services or hospitalization," notes Dr. Audas. "That leads people to look for private care, and we're concerned that people aren't getting help because they can't afford it." 

The road to recovery can be a long one, but research about the best services and treatments to offer people suffering from eating disorders will help guide more patients back to a state of health. "It doesn't feel like a battle until you want to stop—and can't," says Laura. "Years later, you can still be triggered by stress or something else, so it's reassuring to know that support is out there."

For Rachel, who is now 19 and starting university, the future looks bright. "Over this past year, I've been in a really good place," she says. "I'm pursuing my dreams, and I have all the tools that I need to thrive."

Types of Eating Disorders

  • Anorexia nervosa: Characterized by excessive food restriction and intense fear of gaining weight, the extreme weight loss associated with untreated anorexia is often life threatening. The person affected might view restrictive eating as a sign of mastery and control, so it can become an obsession (almost like an addiction).
  • Bulimia nervosa: This eating disorder involves episodes of binge-eating followed by purging, which could include self-induced vomiting, use of laxatives, and/or excessive exercise. Similar to anorexia nervosa, the person affected may have an intense fear of gaining weight and an obsessive desire to lose weight.
  • Binge eating disorder: Characterized by recurrent episodes of eating an unusually large amount of food in a specific amount of time (such as a 2-hour "binge"), this eating disorder does not involve purging behaviours after a binge. The person affected may feel a complete loss of control over his or her eating, along with feelings of guilt, shame, and disgust. Over time, binges can become a compulsion.

Advice for Families

  • Focus on a healthy lifestyle that includes all types of food, including dessert, and stress that all food is okay in moderation.
  • Encourage discussion and critical thinking about the ways in which different body types are portrayed in the media.
  • Teach body acceptance. For parents, this can include being a role model by limiting self-criticism and/or avoiding critiques of another person's appearance.
  • Talk about healthy ways to deal with stress and relationships.
  • Get help. If there's a problem, talk to a family doctor and local service provider.

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