How do I choose an eating disorder treatment program?

Selecting an eating disorder treatment program for yourself or someone you care about may be one of the most important decisions you will ever have to make. Most people don't know what to look for in a quality program and not all eating disorder treatment centers are the same they differ greatly in program options, staff qualifications, credentials, cost, and effectiveness.
So you now know that you'll need to ask appropriate questions when you call an eating disorder treatment program for information, and that you should expect to receive clear answers. Here are a few of the things to find out:

  1. Cost and Insurance plans accepted
  2. Length of Program
  3. Basis of Program (spiritual, religious, cognitive-behavioral, etc.)
  4. Qualifications/Certifications of staff
  5. Schedule of daily activities

The more complete the answers to these questions are, the better able you will be to ascertain if the eating disorder treatment center is going to meet your specific needs.


Do eating disorders affect men as well as women?

Research done by doctors at the University of Iowa and headed by psychiatrist Dr. Arnold Anderson shows that men with eating disorders had significantly lower bone density than women suffering with the same condition. Severe weight loss and a deficiency in essential nutrients, particularly calcium, can cause a serious decline in bone mineral density (BMD) leading to the brittle bone disease osteoporosis.

Anderson and his team assessed the BMD of 380 people (14% of whom were men) who had been admitted to the eating disorder clinic at the University of Iowa between 1991 and 1998. Three types of eating disorders were studied: anorexia nervosa, binge/purge anorexia nervosa, and bulimia nervosa.

While all patients with these disorders showed BMD deficiencies, the researchers found that men, particularly those suffering from the binge and purge bulimia, had markedly lower bone density. The researchers suspect the serious drop in BMD for men is related to the male hormone testosterone, which is predictably lower in men suffering from eating disorders.

As the researchers explained, "Many patients are involved in contact sports or high-impact activities and need to be advised about appropriate exercise limitations until improvement in BMD is shown, to prevent fractures. On the other hand, moderate weight-bearing exercise without high impact aids in bone accretion, in addition to calcium and vitamin D intake."

The British Medical association recently blamed the media's obsession with super-thin models--men and women--for the proliferation in young people having eating disorders. In a hard-hitting report it urged magazines, advertising agencies, and fashion designers to set a better example by using more "averaged-sized" models so that young people would be shown a more realistic, healthy body image.


Why do eating disorders occur?

Eating disorders are caused by a complex interplay of factors that can include emotional and personality disorders, family stress, and possible genetic or biologic susceptibilities, all of which can be reinforced by a culture that equates attractiveness with being thin.
Eating is controlled by many factors, including appetite, food availability, family, peer, and cultural practices, and attempts at voluntary control.

Dieting to a body weight leaner than needed for health is highly promoted by current fashion trends. Research reports that women's magazines contained 10.5 times as many advertisements and articles promoting weight loss as men's magazines. Exposure to the media-portrayed "thin-ideal" on a sample of 157 female undergraduates produced depression, stress, guilt, shame, insecurity, and body dissatisfaction. Other outside influences that can influence the onset of eating disorders are certain professions and activities with stringent weight requirements and/or body image expectations.

Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress or extreme concern about body shape or weight. Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own.

Researchers are investigating how and why initially voluntary behaviors, such as eating smaller or larger amounts of food than usual, at some point move beyond some people's control and develop into an eating disorder. Studies on the basic biology of appetite control and its alteration by prolonged overeating or starvation have uncovered enormous complexity, but in the long run have the potential to lead to new treatments for eating disorders.

Research is contributing to advances in the understanding and treatment of eating disorders.

  • Scientists and others continue to investigate the effectiveness of psychosocial interventions, medications, and the combination of these treatments with the goal of improving outcomes for people with eating disorders.
  • Research on interrupting the binge-eating cycle has shown that once a structured pattern of eating is established, the person experiences less hunger, less deprivation, and a reduction in negative feelings about food and eating. The two factors that increase the likelihood of bingeing, hunger and negative feelings are reduced, which decreases the frequency of binges.
  • Several family and twin studies are suggestive of a high inheritability of anorexia and bulimia, and researchers are searching for genes that confer susceptibility to these disorders. Scientists suspect that multiple genes may interact with environmental and other factors to increase the risk of developing these illnesses. Identification of susceptibility genes will permit the development of improved treatments for eating disorders.
  • Other studies are investigating the neurobiology of emotional and social behavior relevant to eating disorders and the neuroscience of feeding behavior.
  • Scientists have learned that both appetite and energy expenditure are regulated by a highly complex network of nerve cells and molecular messengers called neuropeptides. These and future discoveries will provide potential targets for the development of new pharmacologic treatments for eating disorders.
  • Further insight is likely to come from studying the role of gonadal steroids. Their relevance to eating disorders is suggested by the clear gender effect in the risk for these disorders, their emergence at puberty or soon after, and the increased risk for eating disorders among girls with early onset of menstruation.


When is hospitalization required?

Conditions warranting hospitalization include excessive and rapid weight loss, serious metabolic disturbances, risk of suicide, severe binge eating and purging, and psychosis.


What are the medical complications associated with eating disorders?

Medical complications can frequently be a result of eating disorders. Individuals with eating disorders who use drugs to stimulate vomiting, bowel movements, or urination may be in considerable danger, because this practice increases the risk of heart failure.

In patients with anorexia, starvation can damage vital organs such as the brain and heart. To protect itself, the body shifts into "slow gear": monthly menstrual periods stop, breathing pulse and blood pressure rates drop, and thyroid function slows. Nails and hair become brittle; the skin dries, yellows, and becomes covered with soft hair called lanugo. Excessive thirst and frequent urination may occur. Dehydration contributes to constipation, and reduced body fat leads to lowered body temperature and the inability to withstand cold.

Mild anemia, swollen joints, reduced muscle mass, and light-headedness also commonly occur in anorexia. If the disorder becomes severe, patients may lose calcium from their bones, making them brittle and prone to breakage. They may also experience irregular heart rhythms and heart failure. In some patients, the brain shrinks, causing personality changes. Fortunately, this condition can be reversed when normal weight is reestablished.

Scientists have found that many patients with anorexia also suffer from other psychiatric illnesses. While the majority have co-occurring clinical depression, others suffer from anxiety, personality or substance abuse disorders, and many are at risk for suicide. Obsessive-compulsive disorder (OCD), an illness characterized by repetitive thoughts and behaviors, can also accompany anorexia. Individuals with anorexia are typically compliant in personality but may have sudden outbursts of hostility and anger or become socially withdrawn.

Bulimia nervosa patients -- even those of normal weight -- can severely damage their bodies by frequent binge eating and purging. In rare instances, binge eating causes the stomach to rupture; purging may result in heart failure due to loss of vital minerals such as potassium. Vomiting causes other less deadly, but serious, problems -- the acid in vomit wears down the outer layer of the teeth and can cause scarring on the backs of hands when fingers are pushed down the throat to induce vomiting. Further, the esophagus becomes inflamed and glands near the cheeks become swollen. As in anorexia, bulimia may lead to irregular menstrual periods. Interest in sex may also diminish.

Some individuals with bulimia struggle with addictions including abuse of drugs and alcohol, and compulsive stealing. Like individuals with anorexia, many people with bulimia suffer from clinical depression, anxiety, OCD, and other psychiatric illnesses. These problems, combined with their impulsive tendencies, place them at higher risk for suicidal behavior.

People with binge eating disorder are usually overweight so they are prone to the serious medical problems associated with obesity, such as high cholesterol, high blood pressure, and diabetes. Obese individuals also have a higher risk for gallbladder disease, heart disease, and some types of cancer. Individuals with binge eating disorder also have high rates of co-occurring psychiatric illnesses -- especially depression.


Are eating disorders linked to media messages?

Teenage girls who use dieting tactics such as appetite suppressant pills, laxatives, vomiting after eating or severely restricting their calories are more likely to be heavy readers of women's health and fitness magazines, a team of researchers reports.

"We found there was a moderate to strong positive association between reading frequency and these dieting behaviors," lead author Dr. Steven R. Thomsen, associate professor of communications at Brigham Young University, told Reuters Health.

To investigate whether there is a correlation between eating problems among teenage girls and the growth in circulation of health-related magazines targeted at young women, the researchers surveyed 498 girls at two Salt Lake City-area high schools, asking them about their weight loss methods and their magazine reading.

The findings were published in the May/June issue of the American Journal of Health Education. The research was funded by a grant from the Wendell Ashton Fund, Thomsen said.

The study found that eating disorders were common: 15% of the girls said they had taken diet pills, 11% had used laxatives, 9% had made themselves vomit, and slightly more than half had restricted their calories to less than 1,200 a day as part of a diet.

Overall, 92% of the girls said they read health and fitness magazines, with 45% of the girls reporting they read the magazines frequently, or at least once a month.

However, the researchers found that girls who used laxatives, diet pills, vomited or ate restricted diets were more likely than girls who did not use such dieting behaviors to be heavy readers of the magazines.

For example, 73% of girls who used diet pills were frequent readers of the magazines, while only 42% of girls who did not use diet pills were frequent readers. Similarly, 79% of the girls who vomited to control weight gain were frequent readers of the magazines, compared to only 43% of girls who did not vomit to control weight gain.

However, the study does not prove that the magazines caused such a reaction in the girls. It is also possible, Thomsen noted, that girls with a propensity to abusive dieting sought out such magazines for dieting tips and ideas.

"We can't state that one causes the other," Thomsen said. "Based on all the previous research we've done and what these young women have told us, I believe that young women who already have begun to develop eating disorders may turn to these magazines for reinforcement and information. I think the best argument is that they serve as a perpetuating function rather than an initiating function."

Thomsen said that editors and writers for the magazines need to keep in mind that these women may distort the health-oriented messages they send. "They need to be aware that there is a group that takes a message different than what it is intended to be," he said. "Even when these magazines attempt to advise or suggest moderation, sometimes, the young women focus on the images and pictures, ignoring the advice but remember seeing thin bodies."

Finally, parents should "not panic" if their daughters read the magazines, but should investigate the girls' motives for doing so, he said. "I would question, 'why are you reading them, how do you feel about your body,'" he said. "That would give me a cue to the mental state of my daughter."