[music] Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active managing stress, and regular check-ups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Additional funding by Jazzercise of Charleston.

>>Lori Casey: Thank you for joining us for this edition of Being Well.

I'm your host, Lori Casey.

And today, we're talking about eating disorders, and I'm joined by Laura Jacob and Lindsay Wilson with EIU Health Services.

Ladies, thanks for coming over and talking to us today.

>>Lindsay Wilson: You're welcome.

>>Lori Casey: Let's get started by talking about how big of a problem are eating disorders in our country.

>>Lindsay Wilson: Well, I definitely think they're growing.

I think that it impacts millions of people in the United States every year.

And I think it's important to understand that it's not just a fad diet, it's not just a lifestyle choice or a phase, that it is much more than that; it is pretty severe and can impact a person emotionally, as well as physically.

>>Lori Casey: And what kind of forms can eating disorders take?

>>Laura Jacob: Well, if you're talking about the different types of eating disorders, there's anorexia nervosa, which is the mainly restricting type, restricting food intake severely.

There's bulimia nervosa, which there may be restricting, as well as there's binging, and there's compensatory behaviors to kind of make up for that binging, which would be like using vomiting, laxatives, diuretics, enemas, excessive exercise, and then fasting, a lot of times.

And then, the fasting can lead to more binging.

There's binge eating disorder, which is like bulimia, only without the compensatory behaviors.

And then, there's what they classify as eating disorders not otherwise specified, which basically is the same, only they don't meet the exact criteria for those diagnoses.

So, there at risk, for sure, of developing a full-fledged eating disorder, but they haven't quite met all the criteria.

>>Lori Casey: So, it's a lot more than just a young girl choosing not to eat and restricting her diet.

It's a broad spectrum of things that can fall under this category of eating disorders.

When we think of eating disorders, I think we think a lot of, you know, young girls, but if affects a lot of people.

There are some demographics, and age groups, and people that it's on the increase, correct?

>>Laura Jacob: Yes, I would say so.

>>Lori Casey: And who would that be?

>>Laura Jacob: Well, I think a lot of people would be surprised to find out that it is, well, definitely, it's increasing in young men and boys, and that tends to be a lot of times related to physical appearance, wanting to look muscular, wanting to look cut or defined.

And within that group, there's a high percentage of young men and boys that are gay that develop eating disorders.

So, more so than the general population.

There's increased incidents among middle aged women.

A lot of that has to do with, and I think that people would be surprised by that, as well.

It may be something that persisted throughout life, or just is surfacing, resurfacing, based on maybe a stressful event: divorce or death of a parent, or something like that.

Most people tend to think that it is limited to young white girls, and that's not true.

It affects all races and ethnicities.

A lot of times, it is not reported as much or treated as often.

And then, the elderly actually, I think a lot of people would be surprised to find that there; it is pretty prevalent among the elderly.

>>Lori Casey: Really?

>>Laura Jacob: Yes.

>>Lori Casey: And why would that be?

That's very surprising to me.

>>Laura Jacob: Yeah.

Well, a lot of times, it may be something that, again, persisted throughout their life and resurfaced from a stressful event, like the death of a spouse, an illness, or loss of independence.

If someone is no longer able to take care of themselves, and then they're, you know, having to be helped or in a healthcare facility, a lot of times they'll develop there.

Or it may be something that, again, just surfaces at that age.

>>Lori Casey: Okay.

Well, let's talk about how some of these things can trigger and start an eating disorder.

Lindsay, what would be some things that... >>Lindsay Wilson: Well, I don't think that there's necessarily one factor that creates an eating disorder.

I think there can be several things in play.

But I do think that there can be triggers, like you were talking about, the different stressors in life that may lead to that.

And once a person does have those eating disorder behaviors, there can be triggers for those behaviors.

You know, I just got off the phone with mom, I'm really stressed, and how do I manage that stress?

Well, I will go binge and then purge, potentially.

So, I think that that can... >>Lori Casey: And what about, are there, with eating disorders, is there some other underlying psychological issue at work here, that it is a lot more than just: "I want this boy to like me, and I want to be skinny?"

>>Lindsay Wilson: Sure.

Yes, definitely.

Well, I definitely think that eating disorders are often co-morbid, which means that it's not just an eating disorder, it's also anxiety, or depression, or OCD that also needs to be treated.

And with eating disorders, anxiety is almost always a part of it.

You know, the anxiety, the irrational fears and thoughts of gaining weight and what that means.

Depression is often common, as well.

There's often low self-esteem, withdrawal from friends, so we're isolating ourselves now, so other depressive symptoms can develop, as well.

And I also think that OCD often is very similar to eating disorders.

With OCD, we see a behavior, an obsession, and then a compulsion to help reduce that person's anxiety.

So, for example, if a person has an obsession with clean hands, they may have irrational thoughts that their hands are dirty, and the only thing they feel can bring that anxiety down is for them to wash their hands, which would be the compulsion.

With eating disorders, sometimes it can be very similar.

This anxiety that, oh gosh, I ate too much food, and the only thing that's going to bring my anxiety down may be to purge, or over-exercise, or restrict the whole next day.

So, I definitely think that there are often many other things at play, and things that need to be treated.

>>Lori Casey: Are people with eating disorders, do they have, I don't want to stereotype, are they a certain type of personality?

Are they going to be more of a type B or a type A personality?

>>Laura Jacob: A lot of times, very perfectionistic.

>>Lindsay Wilson: Yes.

Yeah, they have very rigid thinking.

Often with the eating disorder, it's like I said earlier, it's not just a diet, but it becomes much more than that; it can be very rigid rules about what they can do, what they can't do, when they can eat, and when they can't eat.

So, perfectionistic qualities often are a part.

>>Lori Casey: So, we'll get into some of the signs in just a minute, but I want to talk about the long-term health effects.

If someone has an eating disorder, you know, what, we all know you can die from an eating disorder; we've seen, you know, I think of Karen Carpenter, singer from the 70s, died because she was an anorexic.

But talk about some of the long-term health effects.

>>Laura Jacob: Okay.

Some of the things that, one of the things that we think of first is osteoporosis, loss of bone mass.

There's a lot of things that contribute to that, especially with anorexia.

When a person's body fat percent goes so low, they will have decreased estrogen production.

And this is something you see normally in a woman who is going into menopause; this is normal.

But when a young girl develops decreased estrogen production, then there may be loss of menstrual periods.

Estrogen is important in developing bone mass, and young people will develop their peak bone mass between the age of 18 and 20, so if you're, you know, having low estrogen levels very young, you know, from adolescence, a lot of times you're not going to develop the proper amount of bone mass, and are going to develop low bone mass and osteoporosis much younger.

There's, also feeding into that would be low body weight.

Stress on the bones is normal and healthy, so just walking around, a normal weight person puts stress on their bones, and that promotes strengthening of the bones, mineralization of the bones.

And so, when you're at a lower body weight, that, you don't have as much stress on the bones.

As well as intake of protein, vitamins and minerals, and calcium.

So, there are several things that are feeding into that development.

>>Lori Casey: And those are a lot of things that you can't really reverse.

You know, if you had that when you were a child, you can't really, you know, reverse that.

>>Laura Jacob: Exactly.

I think sometimes that we do treat them with hormones, estrogen, to help to prevent that from happening.

Another health effect would be loss of muscle tissue, including heart muscle tissue.

So, that's a major problem; they will develop low heart rate, low blood pressure, and muscle tissue loss, and heart failure.

And you brought up Karen Carpenter, and that's why she died; she had heart failure.

So, there can be effects on fertility later in life.

>>Lori Casey: And I would think with bulimia, the constant vomiting, that there's stomach problems, teeth problems, esophagus problems.

>>Laura Jacob: Absolutely.

Tooth decay, yeah, gastroesophageal reflux disease, or GIRD, there could be stomach ulcers, abnormal movement in the digestive tract, so constipation, that kind of thing.

Electrolyte abnormalities, so the sodium and potassium, calcium levels in the blood can be altered by vomiting, by the use of diuretics, by the use of laxatives, which can lead to arrhythmias.

>>Lori Casey: Okay.

Let's talk about some of the early signs and symptoms that parents should be looking for.

What would be something that maybe might be kind of subtle, that they may not think, oh, what's the big deal?

Let's talk about that.

>>Lindsay Wilson: Well, there's definitely, as I was saying earlier, preoccupation with weight and food, the very rigid rules, what I can eat, what I can't eat, when I can eat, when I can't, excessive exercising, excuses for not eating, "Oh, I already ate, or I'm not hungry, I don't feel good, I'm going to eat later."

And even, there can be signs for binging and purging.

You know, if we seem to be going through food much quicker, or there's a lot of empty wrappers, empty containers, things like that, the smell of vomit, or frequent trips to the bathroom after a meal, or even to a private room after a meal.

Many times, you know, we think if they're just going to their bedroom that, well, they're not going to the bathroom.

But I have worked with several individuals who will find ways to vomit in their room, so if it's private, that can be a sign, too.

And then there's, of course, weight fluctuation can be a sign; if they are decreasing in weight, but also if they're increasing in weight, that can be a sign of an eating disorder of some kind.

And then, as she was saying, you know, damage to the teeth, some physical signs like that can be a sign of an eating disorder, as well.

>>Lori Casey: So, do people with an eating disorder, can they become very good at covering it up and finding ways to keep it a secret?

>>Lindsay Wilson: Yes, I would definitely agree with that statement.

I also think a part of the eating disorder is manipulation.

They become very good at kind of manipulating different situations, so that their eating disorder can continue.

>>Lori Casey: Like, give me an example.

>>Lindsay Wilson: Well, as I was saying earlier, looking for excuses, kind of manipulating a situation, so that they have a reason not to eat.

Even manipulating situations where, I'm trying to think of an example, maybe they'll tell their family, okay, this is what I need from you.

For example, I may need to tell you if I feel full, so that I'm not eating more, and then using that as, okay, well I'll just tell them that I'm full, so that they won't make me eat more, kind of a way to restrict, if that makes sense.

>>Laura Jacob: Another thing that sometimes, they'll refuse certain food groups.

Like suddenly, may become vegetarian as a way of not eating certain things.

Or they may refuse certain foods or components of food, like carbohydrates or fat; they may eat a completely fat free diet, which is not a healthy thing.

We tend to think of fat as being an unhealthy thing, but we do need some in our diets, so.

>>Lori Casey: Can you talk about the importance of modeling behaviors, and the way that we perceive food?

We as kids take our cues about food and the value of food from how we grew up.

Can you talk about that, and how maybe some things you might be doing might actually be detrimental?

>>Laura Jacob: Yeah.

I think that parents do need to model healthy behaviors, not talk about in a negative way about their own body, or be constantly dieting or talking about dieting, or needing to go on a diet.

Not saying negative things about the child's weight or body definitely is a thing that a parent should stay away from, even, you know, a well-meaning parent; it's just not a good thing.

That can really send a child into an eating disorder.

Intuitive eating; you know, promoting intuitive eating in the household.

And so, what that means is kind of, of course, you know, eating when you'’’re hungry, so paying attention and honoring hunger cues, and stopping when you're satisfied, not full, but satisfied, and allowing your children to do that, too.

So, not making them clean their plate, or just offering foods and letting them choose their portions, and eating as much as they want of it, and not making them eat certain things or things like that.

>>Lindsay Wilson: And I think similarly, you were saying, you know, not pointing out their weight or how much they need to lose or gain, or whatever, but also pointing out other positive characteristics about them, teaching them that self-esteem is not based solely on how you look, but the other qualities that you have.

I think as children, we grow up developing different beliefs about other people, ourselves, the world, through what we see at our house.

And so, if we're developing a belief that, well, food will comfort me.

Oh, if I'm sad, I'll eat a cookie, and that comforts me.

Then, we can start to develop those beliefs that that's the purpose of food or, you know, kind of go into behaviors that way, too.

>>Laura Jacob: Yeah.

Well, to add to that, actually, being alone, you know, children being alone when they're eating a lot is probably an unhealthy thing, where they're maybe seeking comfort or companionship in food.

Family meals, having routine family meals together seems to be protective against kids developing eating disorders.

>>Lori Casey: Mmhmm.

So, how early can an eating disorder start, do you think?

Is it getting younger?

>>Lindsay Wilson: I definitely think it's getting younger.

You were talking earlier about who this is impacting, and I do unfortunately think that at a younger and younger age, children are starting to worry about their looks and their weight, and what they can eat or what they should eat shouldn't eat.

So yeah, I think it is starting younger.

I don't know that there's an age limit or an age at which it can start or can't start.

>>Lori Casey: So, let's talk about how should, what advice do you have for a parent if they're seeing that their young son or daughter may be exhibiting some of these signs that you talked about?

How do you even start that conversation?

>>Lindsay Wilson: I think the first thing, to start, is to educate yourself, whether it's going to a trusted website, like the National Eating Disorder Association website, or calling a professional, a doctor a counselor, a nutritionist, to ask some important questions.

But educating yourself would be my first encouragement.

And the next would be that, when you approach your child, to come from that caring place that you're coming from, and to be very cautious that you're not laying on blame or guilt.

Because, I think sometimes, if we are very concerned and scared for our child, it can come across as harsh and blaming.

And we don't want that, because then they will be less likely to open up.

So, using attentive listening, reflective listening can help a lot.

>>Lori Casey: And, you know, a lot of times you may be dealing with a teenager, and they're difficult to talk to anyway.

And, you know, you do run that risk of you bringing that up and then running to their room and being alone, which is not a good thing, either.

So, how do you, what other thoughts do you have on talking to your children about this, and getting past that point of, you know, your child is mad at you for even bringing it up?

And then, they're in denial about having an eating disorder.

>>Lindsay Wilson: I think it can be important to keep in mind that, if they do run to their room or they're angry, that it's not you; a big part of it is the eating disorder, and that there's this part of the eating disorder that doesn't want to be found out, that wants to be hidden, kept secret.

So, it can be a scary thing for that person, to feel like that part of them is now known or being, you know, broached.

So, keeping in mind that it's not you, its part of the eating disorder I think can help.

>>Lori Casey: So, at what point do you take your child to therapy: nutrition, their general practitioner, do you go straight to a psychiatrist, psychologist, counselor?

I mean, what options do you have if it's not something that you as the parent can help them with?

At what point does someone need professional help?

>>Laura Jacob: I think as soon as you start seeing consistent behaviors would be good.

The earlier something is treated, the earlier an eating disorder or disordered eating is treated, the more likely it's going to be successful.

And there's going to be less likely that there's going to be lasting health effects.

>>Lori Casey: So, what is the typical treatment plan if someone goes, if a child, or even an adult, goes to see a counselor about an eating disorder?

I mean, what do you kind of talk to them about, how do you get to the root of the problem?

>>Lindsay Wilson: Sure.

Well, I think treatment plan's going to be dependent on that person: their needs, their severity.

But typically, in counseling, what we'll focus on first is behaviors, and how can we start changing those.

But I think deeper than that is the irrational thoughts, irrational fears; how do we challenge those.

The belief system that may be in play from growing up, and the different things we learned or observed; do we need to develop a new belief system, one that's true and healthier.

And then, healthy coping.

So, if we're using the eating disorder to help us mask emotions or deal, feel like we're in control, how else can we manage those emotions that will be healthier?

But like I said, I think a treatment plan's going to be dependent on that person.

And I do think it's very important to not just use counseling, but to also use a nutritionist's help, a medical help, because a counselor cant' look at a person's heart and make sure that it's okay, and that's going to be important, too.

>>Laura Jacob: And ideally, it's a treatment team, like Lindsay was saying.

As far as the nutrition portion of it goes, we will look at more of the physical things, physical symptoms.

We try to find out what the eating pattern is like to start with, why it's that way, what are their beliefs about what's healthy.

We try to set an appropriate goal weight, which is going to be at least 90% of the expected weight for height.

Address any possible nutritional problems that there are, deficiencies, and really try to work with that patient to develop a plan, so we're not just dictating what, this is what you're going to do.

I mean, because that can just cause, you know, problems right there.

They already have maybe issues with that, so just getting them in on the plan, creating a plan with something that they find, you know, acceptable, starting with little steps.

Maybe they don't do any animal products at all, they're a vegan, so their calcium's going to be a problem there, protein's going to be a problem.

So, maybe they'd be willing to drink soy milk or something like that.

So, coming up with a plan to address those kinds of things.

Watching for physical signs of deficiencies, and things like that.

>>Lori Casey: Okay.

Will people ever outgrow this eating disorder, or do they just find a way to have some control over it?

What do you think?

>>Lindsay Wilson: Yeah, I think that recovery, I don't know that it ends necessarily, and it's definitely not a one day, oh, I'm recovered situation.

I think it's a place where they learn to manage it in much healthier ways, and to maintain the progress that they've made.

>>Lori Casey: So, as we wrap up here, let's talk a little bit about, give some advice to parents who are out there watching, or maybe to an individual, you know, who may realize that, well, this may not be normal.

Let's talk a little bit about advice for parents; what should they do?

Because this has got to be a difficult thing to be dealing with.

>>Laura Jacob: Well, I say just, you know, model healthy behaviors, don't push too hard, don't push them to clean their plate.

And as far as from a dietician standpoint, I would say that, you know, just realize that this is kind of, you know, realize when it becomes not normal behavior, or watch for the signs and things like that.

>>Lori Casey: Yeah.

I mean, you as a parent, you've got to be aware and notice that.

Because, as you said before, the person can find lots of ways of covering it up; they're very good at that.

Lindsay, what advice would you have?

>>Lindsay Wilson: I would encourage them, like I said before, to educate themselves, definitely.

Call and consult with a professional, ask questions.

Do your best to get that person into treatment, because even if there aren't behaviors yet, let's say there's just low self-esteem, okay, well we can work on that, so that hopefully we won't get to a place where there's behaviors.

So, I don't know that it matters where they are on that continuum, you know, whether they've been engaging in behaviors for years or, you know, haven't yet, but have low self-esteem, I think that treatment can be very positive.

>>Lori Casey: Okay.

Well, Laura and Lindsay, thank you so much for coming by Being Well today.

Interesting topic and we hope that the information you shared can help some of our viewers out there.

>>Lindsay Wilson: Yes.

>>Laura Jacob: Thank you.

>>Lori Casey: Thanks.

[Music Plays] >>Ke'’’an: Knowing your target heart rate as you work out can help you gauge how hard you're pushing yourself.

Holly Firfer tells us more in today's Health Minute.

>>Holly Firfer: Exercising at the right intensity helps you get the most out of your workout and strengthens the heart.

>>Fitness Instructor: The heart is like any other muscle in the body.

We want to work on strengthening it.

By doing exercise, we work on making the heart more efficient at pumping blood to the muscles.

>>Holly Firfer: Monitoring your heart rate lets you know if you're working too hard or not hard enough.

Measuring your progress starts by calculating your maximum heart rate, which is about the highest number of beats the heart can sustain during one minute of exercise.

>>Medical Expert: Which is easily calculated by 220 minus your age.

>>Holly Firfer: So, if you're 40 years old, your maximum heart rate is about 180 beats per minute, but you should not often push your heart to that extreme.

Instead, experts say exercise within 60 to 80% of your maximum heart rate.

For a 40 year old, this means getting your heart pumping between 108 and 144 beats per minute.

Using a heart rate monitor can help you keep track, or you can learn to tell by how you feel.

>>Interviewee: I want to be where I'm not quite out of breath, but I'm not, I can't take an easy breath.

I can't sing, for example.

>>Holly Firfer: Yeah, she'll have to leave the singing and celebrating for after the workout.

For today's Health Minute, I'm Holly Firfer.

>>Lori Casey: Production of Being Well is made possible in part by: Sarah Bush Lincoln Health System, supporting healthy lifestyles.

Eating a heart healthy diet, staying active managing stress, and regular check-ups are ways of reducing your health risks.

Proper health is important to all at Sarah Bush Lincoln Health System.

Information available at sarahbush.org.

Additional funding by Jazzercise of Charleston.

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