Families and clinicians must form a shield against eating disorders

If we as professionals and parents do not start changing and protecting our youngsters, who will do it? Dr. Eva Trujillo explains why we (the world) cannot afford to wait in addressing eating disorders.

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Families and clinicians must form a shield against eating disorders

By Dr. Eva Trujillo

When my friend June Alexander asked me to write for the World Eating Disorders Action Day on why we can’t wait in treating eating disorders, many ideas came to my mind. One that concerns me a lot is how often in my practice I see patients for whom intervention has been sadly delayed. These patients invariably have been “diagnosed” with many medical or mental diagnoses, except for eating disorders, until they are extremely underweight or have lost a lot of weight.

Eating disorders can be present at any weight, in any body shape, at any age, and in any ethnic group, race, gender or socioeconomic status. Many people with eating disorders can be extremely ill even when they appear to be in a normal or “healthy” weight range, or even overweight. (1)

Delayed diagnosis is dangerous

A few years ago, my team surveyed a group of patients about the timing each of them took to access our health service and we also asked how many health professionals they had seen before their first visit with us. Unfortunately, the average time was three years and during that time the patients had received on average consultations with six different health professionals.

Nowadays, even though in my local community this waiting time has reduced because patients are referred a little earlier, probably because my group is there and many doctors know about us, the earlier access for correct diagnosis and intervention is still not the rule. This is sad and dangerous for our patients.

As a clinician, I feel very frustrated to see patients whose health has deteriorated because they were not guided correctly. Some patients have been in therapy for even decades and are still underweight, some patients are still restricting/binging/purging while being treated for many medical symptoms, other patients are in weight supression (which means having a weight lower than the highest adult weight), and some patients have seen several doctors and have a different diagnosis for each symptom.

My biggest concern is the great burden that this delay for an effective treatment has placed on their physical and mental health and their families  quality of life.

Caught in the spiral of an undernourished brain

Regarding the physical burden, eating disorders can affect every organ, every cell, every system in the body. One of the organs most affected with ED symptoms is our brain. Although the brain weighs around three pounds (,1.36kg) it consumes up to one–fifth of the body´s calories (2).

When the brain is “attacked” with behaviors like fasting, restriction, purging and/or dieting, it does not get all the calories needed and will manifest with obsessive thinking about food and difficulties to concentrate. If there is a vulnerability to these disorders, it is very easy to enter a spiral that can be very hard to change.

Once caught in this spiral, “the undernourished brain will think, process and feel differently” (3). So a timing approach is crucial for these disorders, especially during  critical stages of physical and psychosocial development.

This is no childhood fad – adults suffer too  

According to a study recently published by Dianne Neumark-Sztainer and colleagues (4), “the majority of young people have some type of eating, activity, or weight-related problem at all stages from adolescence to adulthood”. When these problems start, contrary to popular beliefs, these are not phases or fads and studies have demonstrated that they do not get better when they reach adulthood. The stigma and normalization of abnormalityare big obstacles for a timely and good approach.

Most if not all of our patients share the common experience of being on a diet to lose weight just before starting with the eating disorder symptoms. Diets, even they are not the only factor for the development of an eating disorder, are definitely a central mechanism for their development. Diets cause many problems, not only to do with weight.  

We must change NOW, in our families and in our professional practices
We still have too much to learn, too much to disseminate. But nothing will change if we do not start now, in our own families, which are our best shields, and in our practices as professionals.

We must recommend families to eat together, we must teach our children to love their bodies, regardless of their weight or shape; nobody takes care of what you don´t love.We must teach other professionals and carers to early recognition for a timely diagnosis and treatment, especially now that there are so many myths and regulations about obesity and what in the field of eating disorders is a symptom, in the obesity field is part of the treatment. Patients with obesity are told to eat less, to restrict, to avoid certain foods, to over–exercise…all this in the ED field is an illness symptom.

We must change and we must change now. For our patients, for those who suffer and for those who are gone. We owe them. We must show people who are vulnerable that they can be healthy in any weight.

If we as professionals and parents do not start changing and protecting our youngsters, who will do it?

About Dr. Eva Trujillo

Dr. Eva Trujillo is located in Monterrey, México and is coFounder and  CMO for Comenzar de Nuevo, International Eating Disorders Treatment Center and CEO and coFounder of Comenzar de Nuevo Foundation, a non profit organization dedicated to the education, prevention, dissemination of knowledge, treatment and research of ED specifically in the Latino Community. ( www.comenzardenuevo.org). Dr.Trujillo has worked tirelessly to ensure the dissemination of best treatment practice for eating disorders, access to knowledge, research, networking and collaborative work within the latino community of professionals.   She is Past President of the Academy for Eating Disorders (AED), Past President and coFounder of the  AED Hispano Latino American Chapter, Past President  and coFounder of the Mexican Association of Eating Disorders Professionals, Past President and Founder of the International Chapter of the International Association of Eating Disorders Professionals (iaedp). She is Clinical Professor at the Tec Salud School of Medicine, Fellow of the Academy for Eating Disorders and Fellow of the International Association of Eating Disorders Professionals. Her organization, Comenzar de Nuevo, was distinguished by the AED with the Public Service Award in 2012 and she was awarded by iaedp in 2014 with the Special Recognition Award for Dedicated Service and in 2018 was recognized for her 10 years of service, dedication and commitment to the Board of Directors of the Academy for Eating Disorders. She is the spokesperson for Comenzar de Nuevo and has given more than 150 lectures around the world. Dr. Trujillo is the mother of three children and has been happily married for 23 years.

References

Why We Can’t Afford to Wait

How to support World Eating Disorders Action Day, June 2, 2019