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No Body is Perfect: Understanding Eating Disorders

Published On August 2, 2013 | Austin MD, July/August 2013

No Body is Perfect: Understanding Eating Disorders

As the Texas legislature evaluates a bill classifying eating disorders as a mental health disease and therefore mandating coverage, advocates call for a better understanding of eating disorders.

By ANN CHOI

Several terms are used to diagnose eating disorders. Any form of psychological instability expressed as an abusive eating habit can be labeled as an eating disorder. Others define the illness as eating or fitness habits disruptive enough to hinder one’s quality of life. Doctors will diagnose patients who show more defined symptoms with one of three terms: Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. However, another term, “Eating Disorders Not Otherwise Specified”, is used to diagnose the many indefinite symptoms of eating disorders.

Defining what an eating disorder is not, on the other hand, is a little easier.

“It’s not just a rich or white or female disease; it’s a human disease,” Brad Kennington, a licensed therapist and the Chief Operating Officer at Cedar Springs Austin, said. Cedar Springs Austin is the only eating disorders facility that provides partial-hospitalization eating disorder treatment in Austin.

Kennington said the notion that only white affluent females have eating disorders comes from the lack of studies done on other racial or socioeconomic groups and insufficient understanding of what eating disorders are.

“Eating disorders affect people regardless of their age, race, financial or social status,” he said. He adds that the idea that eating disorders are a female problem is a myth—males develop eating disorders too. “A 2007 Harvard study showed that 25 percent of anorexics and bulimics are male and 40 percent of binge eaters are male,” Kennington explains.

According to National Institute of Health, more than 11 million Americans suffer from a varying degree of eating disorders, with the number steadily increasing each year. Eating disorder patients show higher mortality rates than any other psychiatric disease including Alzheimer’s disease, autism and schizophrenia. The mortality rate for anorexia or anorexia-related diseases is 12 times higher for females aged between 15 to 24 than all other causes of death, according to the South Carolina Department of Health.

Advocates and experts in the field stress the importance of dispelling the stereotypes of eating disorders in order for one to seek proper treatment. However, the misguided stigmas on eating disorders and the financial burden of affording treatments are driving patients away from receiving help they need early, if at all.

“People think that because [an eating disorder] is a psychiatric disease, you can just get better on your own,” Sarah Weber, an eating disorder specialist at University of Texas at Austin Counseling and Mental Health Center, said. “But eating disorders not only hurt your mind. They also cause brain damage and heart failure,” she added. “You can’t fix your brain and heart on your own.”

Several factors, both nature and nurture, can trigger eating disorders. “It is said in the [eating disorders] field that genes load the gun and the environment pulls the trigger,” Kennington said.

One recent study by University of San Diego School of Medicine suggests that certain changes in neural circuitry results in restricted eating in those suffering from anorexia and overeating in those suffering from bulimia.

The environment puts equal, if not more, susceptibility on individuals, than the wiring of genes. “It’s not about food, fat or fitness. It’s about feelings,” Kennington said.

Eating disorders often occur as a coping mechanism during a change of environment or unstable relationships. Individuals undergoing times of transition such as adolescence, loss of job, loss of a family member or divorce are more likely to develop eating disorders. “Eating disorders for patients become a way to regulate strong, negative feelings,” he added. “Their eating disorders become their coping mechanism and a confidant. It becomes part of their identity.”

Kennington said treating eating disorders is particularly challenging because people with eating disorders believe their illness meets their needs. Their destructive view of food and the process their body uses to cope with changes or stress on a daily basis is inseparable.

“I had a patient say to me, ‘my eating disorder needs me, Brad,’” Kennington said.

People suffering from eating disorders have a higher relapse rate than other substance abusers, such as alcohol or drug users. Unlike substance abuse patients who must altogether avoid the substance in order to recover, eating disorder patients have to engage daily with their substance of abuse: food.

Kennington said our society is much more recovery-friendly towards people with addictions than people with eating disorders. More people are informed of the gravity of substance abuse and have access to treatments, while eating disorders are not as openly discussed. In addition, the message of being attractive and unrealistically thin is deeply embedded in our media.

“Our culture’s obsession with dieting and all the images we see of perfect, albeit air-brushed, images of men and women pressure us to achieve the unachievable: physical perfection,” he said.

Ironically, super foods such as energy drinks or diet supplements such as pre-packaged meals or low calorie foods contribute to a culture of developing unhealthy relationships with food.

“Our food system is broken,” Weber said. “It’s contributing to people being anxious and paranoid about their food intake.”

Weber explains the food system, which is taking on two extreme directions. Diet products and energy drinks that promise low calories and high energy are unnatural and chemically processed, and quickly gaining popularity. Meanwhile, junk and fast food get unhealthier and more affordable.

“Instead of being in the middle, we have these outlying categories where people don’t have access to food that is real—food that is grown out of ground,” she said.

According to a recent survey by United States Department of Agriculture, food deserts, where residents, especially those with low income, lack access to distributors of healthy food such as grocery stores or farmers markets, are growing both in rural and urban areas nationwide.

“Few people can figure out how to be in the middle like we used to be 100 years ago,” she added.

Eating disorders take a toll on patients psychologically, physically and beget other illness such as depression, obsessive com- pulsive disorders and heart failures, if not treated properly or early. The treatments, however, are costly and often are not covered in insurance policies.

According to South Carolina Department of Mental Health, the cost of eating disorder treatments can range from $500 to $2,000 per day. Patients who need hospitalization or in-house treatment can spend around $30,000 per month, for up to six months. The cost of outpatient treatment, which requires visiting an eating disorder facility on a regular basis, can run up to $100,000 until full recovery.

Unlike other psychological diseases, eating disorder patients require close physical monitoring due to strains that are put directly on the body. “The treatment is expensive not because it can be, but because it has to be,” Weber said.

Cedar Springs Austin’s 10-hour or 6-hour partial-hospitalization programs include psychiatric treatment such as counseling, group therapies and fitness sessions as well as physical treatments like vitals monitoring and meetings with dieticians.

In Texas’s 83rd Legislative session, Rep. Garnet Coleman (D-Houston) authored a bill that would recognize eating disorders as mental illness mandating health insurance coverage. Last session, HB 3227 passed the Texas House floor; the furthest the bill has gone in Rep. Coleman’s 16 attempts to pass it, accord- ing to The Austin American-Statesman.

Opponents of the bill argue against it because it mandates businesses to pay for a treatment in addition to the required changes taking place under the Affordable Care Act.

“By requiring coverage for eating disorders, the bill could increase costs to employers, raise insurance premiums and copays, and reduce wages. Ultimately, a new mandate could add to the growing number of uninsured individuals in Texas,” the HB 3227 wit- ness statement reads.

Texas Association of Business and National Federation of Independent Business were registered as opposing witnesses but did not testify at the hearing of the bill. Representatives from each group could not be reached for a comment.

Mara Gittess, an eating disorders specialist and certified counselor based in Houston, testified before the Texas House Insurance Committee. Gittess said many professionals in the field such as the National Eating Disorders Association, Texas Children’s Hospital and Texas Medical Association supported the bill.

Supporters argued that the bill would recognize the severity of eating disorders and the gravity of the results of this disease, ultimately encouraging treatment. “80 percent of those who have accessed care for their eating disorder do not get the intensity of treatment they need to stay in recovery,” Gittess said in an e-mail interview.

Patients with eating disorders need an average of three to six months in in-house treatments; three to five years are needed for patients to fully recover.

Gittess argued that the bill would not only provide proper, full treatments but also prevent further physiological damage and the larger cost of an extensive hospital stay due to an unrelated disorder. “The bill would save numerous lives,” she added.

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