SINCE ANOREXIA, BULEMIA AND BINGE EATING ARE OFTEN ASSUMED TO BE LIFESTYLE CHOICES THEIR INSIDIOUS NATURE IS NOT APPRECIATED UNTIL TOO LATE.

STAY WITH US AS WE TALK WITH PSYCHIATRIST ZUBI SULEMAN ON EATING DISORDERS NEXT ON "KENTUCKY HEALTH."

>> "KENTUCKY HEALTH" IS FUNDED IN PART BY A GRANT FROM THE FOUNDATION FOR A HEALTHY KENTUCKY.

IT WOULD BE AN UNDERSTATEMENT TO SAY THAT WE ARE A WEIGHT AND BODY CONSCIOUS COUNTRY.

THE PRESSURES THAT WE EXERT UPON OURSELVES, OUR FAMILY MEMBERS AND OUR FRIENDS TO MOST NOTABLY LOOK THIN HAS LED TO MANY TO DEVELOP AN UNHEALTHY RELATIONSHIP WITH FOOD.

THOUGH MANY OF US THINK THAT EATING DISORDERS ARE A LIFESTYLE CHOICE, NOTHING COULD BE FURTHER FROM THE TRUTH.

COMMONLY RECOGNIZED EATING DISORDERS, ANOREXIA, BINGE EATING AND BULEMIA ARE SIGNS OF DISORDERS MANIFESTED THROUGH CONTROLLING FOOD INTAKES.

SERIOUS SHORT-TERM AND LONG-TERM CONSEQUENCES FOR PEOPLE WITH EATING DISORDERS.

MOST IMPORTANTLY AN INCREASED RISK FOR SELF HARM BEHAVIOR AND SUICIDE.

TO HELP US GET A BETTER UNDERSTANDING OF EATING DISORDERS AND THEIR TREATMENT WE HAVE AS OUR GUEST Dr. ZUBI SULEMAN, GRADUATE OF THE JENA SEND MEDICAL UNIVERSITY IN PAKISTAN AND COMPLETED HER RESIDENCY IN PSYCHIATRY AT THE UNIVERSITY OF LOUISVILLE HOSPITAL.

DISTINGUISHED FELLOW OF THE AMERICAN PSYCHIATRIC ASSOCIATION, PRESIDENT OF THE KENTUCKY PSYCHIATRIC MEDICINE ASSOCIATION, PRESIDENT OF THE ALL PAKISTANI PHYSICIANS OF KENTUCKY AND INDIANA AND A MEMBER OF THE KENTUCKY EATING DISORDER COUNCIL.

SHE IS CURRENTLY WORKING AT THE VETERANS AFFAIRS MEDICAL CENTER IN LOUISVILLE, KENTUCKY.

Dr. SEWELL,-- Dr. Dr. SULEMAN, THANK YOU FOR BEING CAN WITH US TODAY.

I BET YOUR FAMILY IS PROUD OF YOU.

>> I GUESS.

>> EATING DISORDERS, ONE A TERM WE DON'T HEAR A LOT ABOUT.

SO WHAT GOT YOU INTO THAT?

>> WELL, I THINK AT THIS POINT, IT'S MY PASSION.

AND I AM SO GLAD THAT WE ARE TALKING ABOUT EATING DISORDERS TODAY BECAUSE A LOT OF PEOPLE DON'T EVEN KNOW WHAT EATING DISORDERS ARE.

AND THEY, EVEN IF THEY DO, THEY DON'T LIKE TO TALK ABOUT IT.

AND WHEN THIS IS SUCH AN IMPORTANT TOPIC BECAUSE WE ARE LIVING IN AN ERA WHERE PEOPLE ARE SO SUPER FOCUSED ON PHYSICAL APPEARANCE, AND THEN THEY IT CORRELATES WITH THEIR LEVEL OF CONFIDENCE.

THERE IS SO MUCH GOING ON IN REGARDS TO, YOU KNOW, STIGMA, BODY SHAMING AND BODY IMAGE, AND I WOULDN'T BE WRONG IN SAYING THAT THE SOCIAL MEDIA HAS A LOT TO DO WITH THAT THESE DAYS.

THERE ARE SO MANY MISCONCEPTIONS.

PEOPLE BELIEVE THAT BODY IMAGE IS AN ISSUE OF YOUTH AND WOMAN BUT IN REALITY, WE ALL HAVE A PERCEIVED BODY IMAGE WHEN AFFECT DIFFERENT ASPECTS OF OUR LIVES.

EVERYONE HAS THEIR OWN PERCEPTION OF BODY IMAGE AND, YOU KNOW, IF IT'S POSITIVE, WELL AND GOOD, BUT IF IT'S NEGATIVE, IT CAN IMPACT ONE'S MENTAL WELL-BEING AND SELF-ESTEEM.

>> LET ME ASK YOU THOUGH.

WE ALL HAVE A BIT OF VANITY.

THERE IS SOMETHING THAT WE ARE PROUD OF ABOUT OURSELVES THAT WE WANT TO DO.

WHEN DOES THAT VAINNESS BECAUSE PATHOLOGICAL TO SOMETHING LIKE AN EATING DISORDER.

IT USED TO BE THE THING, YOU ARE NEVER TOO THIN.

>> THERE IS A VERY FINE LINE BETWEEN NORMAL EATING HABITS AND ABNORMAL EATING HABITS SO WE HAVE TO BE VERY MINDFUL.

YOU PROBABLY HEARD A LOT OF PEOPLE SAY THAT, HEY, I'M DOING DIETING THESE DAYS.

I HAVE A SPECIAL OCCASION COMING UP.

I HAVE A WEDDING OR VERY FAVORITE OUTFIT I WANT TO FIT INTO.

BUT, YOU KNOW, AND THEN THERE IS SO MUCH GOING ON AROUND ON MEDIA AND EVERYWHERE LIKE HOW TO LOSE YOUR WEIGHT.

EVERYBODY IS FACTIZED WITH THAT-- FANTASIZED WITH THAT.

BUT AS LONG AS YOU ARE EATING RIGHT, DOING MODERATE EXERCISE, YOU ARE WITHIN THE NORMAL RANGE AND WE USUALLY DO THAT FOR SHORTER PERIOD OF TIME.

AND THEN COME BACK TO OURSELVES AGAIN.

BUT IF WE START ADOPTING SOME HARMFUL BEHAVIOR, AND SOMETHING WE START OVERLY RESTRICTING OURSELVES FROM EATING IN REGARDS TO WHAT OUR BODY DEMAND IS, THEN THERE IS A PROBLEM.

>> SO WHAT ARE THE MORE COMMON TYPES OF EATING DISORDERS THAT WE SEE?

>> YEAH, SO, ACCORDING TO GSM-5 THERE ARE VARIOUS TYPES OF EATING DISORDERS.

ANOREXIA NERVOSA.

THOSE ACTUALLY HAVE A VERY INTENSE FEAR OF GAINING WEIGHT OR BECOMING FAT EVEN THOUGH THEY'RE VERY UNDERWEIGHT.

THEY RESTRICT THEMSELVES FROM EATING EXTREMELY IN REGARDS TO THEIR BODY DEMAND IS.

I CAN GIVE YOU SOME EXAMPLE.

THERE ARE PEOPLE WHO ACTUALLY MAYBE EAT ONE CRACKER OR ONE THIN SLICE OF CUCUMBER, ONE PEANUT.

A FEW SIPS OF WATER AND THAT'S IT FOR THE WHOLE DAY.

AND THEIR BMI IS SEVERELY COMPROMISED BECAUSE OF THAT.

BUT ONE THING IS WHEN I'M TALKING ABOUT BMI, THERE IS ANOTHER TYPE OF ANOREXIA, WHICH IS WE CALL IT ATYPICAL ANOREXIA NERVOSA AND YOU SEE THOSE PEOPLE WHEN THEY HAVE LIKE NORMAL BMI OR EVEN HIGHER BMI BUT THEY'RE AS MALNOURISHED AS THE CLASSIC ANOREXIC NERVOSA PEOPLE ARE.

WE DON'T GET FOOLED WITH BMI ONLY.

WE USE A LOT OF HEALTH METRICS WHEN WE ASSESS THE PEOPLE WITH EATING DISORDER.

>> WHEN YOU USE BMI, WHAT ARE YOU REFERRING TO?

>> WELL, THERE ARE, YOU KNOW, BMI IS BODY MASS INDEX.

AND THEN WE ASSESS THAT WITH OUR WEIGHT AND OUR HEIGHT SO EVERYONE HAS LIKE A RANGE WHICH IS KIND OF NORMAL.

BUT THESE NUMBERS ARE NOT VALUABLE IN ANYMORE ESPECIALLY WHEN PEOPLE HAVE EATING DISORDER BECAUSE WE ARE SEEING A LOT OF PEOPLE WHO REALLY LOOK HEALTHY AND NOBODY CAN EVEN SUSPECT THAT THAT PERSON MAY HAVE EATING DISORDER.

BUT THEY EVENTUALLY ARE VERY, VERY MALNOURISHED.

IT'S VERY IMPORTANT TO USE OTHER HEALTH METRIC AS WITH EL.

>> WHEN YOU TALK ABOUT THE ATYPICAL FORM OF ANOREXIA, YOU SAY THEY MAY HAVE A NORMAL BODY SHAPE.

BUT THEN HOW-- I TEND TO THINK OF 134-7B WHO IS ANOREXIC IS THAT THIN PERSON YET THEY'RE MALNOURISHED BECAUSE OF THE QUALITIES OF THE FOOD THEY'RE EATING?

>> THE QUALITY AND RESTRICTION, A LOT OF PEOPLE, WAY IS GOING TO THE NEXT TYPE, BULEMIA, WHEN PEOPLE ACTUALLY HAVE A RECURRENT EPISODES OF BINGE EATING AND THEN THEY FEEL DISGUSTED, THEY FEEL GUILT ABOUT EATING AND THEN THEY ADOPT COMCENTRALLER TO BEHAVIOR, THEY PURGE, INDUCING VOMITING OR USE SOME SORT OF DIET PILLS OR DIURETICS SO WHEN THEY HAVE INCREASED FREQUENCY OF PURGING, IT CAN CAUSE ELECTROLYTE IMBALANCE AND IN PARTICULAR, P IF THE POTASSIUM CAN LOW, IT CAN CAUSE CARDIAC ARRHYTHMIAS.

THESE ARE THE HARMFUL BEHAVIORS THEY ADOPT AND THAT EVENTUALLY LEADS TO EXTREME MEDICAL COMPLICATIONS.

>> THAT'S THE YOU ABOUT LEEMIC PATIENT.

>> THE YOU ABOUT LEEMIC PATIENT.

PERSON GETS UP FROM HAVING DINNER WITH THEIR FRIENDS, GOES TO THE BATHROOM AND VOMS.

AND THEN CULLS BACK.

>> THAT'S HAPPENS.

>> THAT IS REAL.

AND IT, YOU KNOW, ONE OF THE RED FLAGS THAT PEOPLE THAT AVOID SOCIAL SETTINGS OR RESTAURANT EATING OR EATING WITH THE FAMILY BECAUSE THEY DON'T WANT PEOPLE TO KNOW HOW MUCH THEY ARE EATING AND THEY'RE GOING THROUGH DEVASTATING KIND OF STRESS THAT THEY DON'T WANT TO EAT EVERY PIECE OF MEAL OR FOOD IS TORTURE FOR THEM.

>> WOW.

WE'LL COME BACK TO THAT AGAIN.

YOU TALKED ABOUT IT.

YOU SAID BINGE EATING.

NOW WHAT IS BINGE EATING?

>> BINGE EATING IS ACTUALLY THE MOST COMMON TYPE OF THE EATING DISORDERS.

YEAH, AMONG ALL OF THEM.

AND IN THAT, PEOPLE HAVE RECURRING EPISODES OF BINGE EATING, MEANING THEY EAT LARGE AMOUNT TO THE POINT THAT WHEN THEY ARE UNCOMFORTABLY FULL.

THEY EAT EVEN WHEN THEY ARE NOT PHYSICALLY HUNGRY.

THEY EAT VERY LARGE PORTION.

THEY FEEL LIKE THEY LOSE CONTROL WHEN THEY'RE AROUND FOOD.

AND THEY DON'T EAT IN FRONT OF PEOPLE BECAUSE THEY FEEL EMBARRASSED.

AND THESE ARE THE PEOPLE THEY DO NOT HAVE ANY COMPENSATORY BEHAVIOR.

THEY JUST EAT.

>> SO THESE PEOPLE TEND TO BE OVERWEIGHT?

>> YES.

DEFINITELY.

>> AND SO YOU SAID THEY TEND TO DO IT WHEN NOBODY ELSE IS AROUND.

>> YES.

>> SO THIS IS THE PERSON WHO MIGHT IN THE MIDDLE OF THE NIGHT MITT SNEAK DOWN STAIRS TO THE REFRIGERATOR AND JUST KIND OF... >> THAT'S ANOTHER TYPE.

>> THAT'S ANOTHER TYPE?

>> YES.

SO THERE ARE SOME-- I WAS GOING TO GO OVER BRIEFLY, BECAUSE THERE ARE SOME OTHER TYPES, WHICH, UNDER THE CATEGORY OF UNSPECIFIED EATING DISORDER OR THE OTHER SPECIFIED, FEEDING AND EATING DISORDER AND ONE OF THEM IS AT NIGHT, YOU KNOW, NIGHT EATING SYNDROME AND PEOPLE, EVEN THOUGH THEY HAVE A DINNER, THEY WAKE UP IN THE MIDDLE OF THE NIGHT BECAUSE THEY CAN'T SLEEP.

THEY HAVE TO EAT ABOUT 25% PORTION OF THE MEAL.

AND THEY JUST EAT AND THERE IS NO, YOU KNOW, MEDICAL CONDITION OR DIABETES OR ANYTHING THAT CAN, YOU KNOW, CAUSE HYPOGLYCEMIA AND THEY HAVE TO EAT BUT THIS IS ONE THING.

>> SOME PEOPLE WHO WORK AT NIGHT OR UP AT NIGHT TEND TO EAT.

SOMETHING ABOUT BEING UP IN THE MIDDLE OF THE NIGHT MAKES YOU A LITTLE HUNGRY.

MAKES YOU WANT TO NIBBLE TO STUFF.

IS THIS A DIFFERENT PHENOMENA THAT IS GOING ON?

>> WELL, I MEAN PEOPLE HAVE DIFFERENT HABITS.

JUST LIKE PEOPLE HAVE DIFFERENT SLEEP CYCLE, SAME WAY WE HAVE DIFFERENT EATING HABITS.

SO IF YOU ARE UP AND WORKING LATE, AS LONG AS YOU ARE FOLLOWING NORMAL REGULAR PATTERN OF EATING AND YOU ARE NOT ADOPTING IN I KIND OF HARMFUL BEHAVIOR, YOU ARE FINE.

>> STILL OKAY WITH THAT.

>> AND I WANTED TO MENTION A FEW MORE IMPORTANT TYPES OF EATING DISORDER WHICH ALSO CATEGORIZED UNSPECIFIED.

ONE, WHICH IS THE MOST IMPORTANT IS ARFID.

AVOIDANT AND RESTRICTIVE FOOD INTAKE DISORDER.

AND MOST OF THE PEOPLE ARE CHILDREN.

YOU PROBABLY HEARD PARENTS SAY HEY, MY CHILD IS VERY PICKY IN EATING AND LIKES THIS OR DOES NOT LIKE THIS.

THESE ARE, FOR CHILDREN THESE ARFID CHILDREN ARE MORE THAN PICKY EATERS.

THEY'RE, YEAH, THEY ARE-- IT IS AVOIDANCE AND AVERSION OF FOOD AND THEY RESTRICT THE CALORIES BECAUSE NOT OF BODY IMAGE BUT BECAUSE OF PROFOUND ANXIETY AND PHOBIAS BECAUSE THEY ARE SCARED IF THEY EAT THEY MAY CHOKE ON THE FOOD OR THEY MAY VOMIT ON THE FOOD.

SO I MEAN THEIR INTAKE IS VERY LIMITED AND THAT DEFINITELY AFFECTS THEIR GROWTH.

>> THAT IS A LEARNED BEHAVIOR, I WOULD IMAGINE.

FOOD AVOIDANCE THING IF THEY'RE AFRAID THEY'RE GOING TO QHOAK OR SOMETHING LIKE THAT OR HAS SOME TRAUMATIC EVENT TAKEN PLACE.

>> POSSIBILITY.

>> HOW COMMON ARE THE EATING DISORDER IS WHEN YOU LOOK AT THEM AS AN AGGREGATE?

>> I WOULDN'T BE WRONG IN SAYING THAT EATING DISORDERS ARE A SILENT EPIDEMIC IN KENTUCKY.

ABOUT 200,000 INDIVIDUALS IN THE CITY OF LOUISVILLE HAS EATING DISORDERS AND ABOUT 00,000 INDIVIDUALS IN THE STATE OF KENTUCKY HAVE EATING DISORDERS YOU ARE.

>> YOU ARE A MEMBER OF THE EATING DISORDER COUNCIL IN KENTUCKY.

>> ONE THING IS KENTUCKY EATING DISORDER COUNCIL ESTABLISHED IN 2020 WHEN WHEN THE SENATE BILL WAS SIGNED INTO LAW BY GOVERNOR ANDY BESHEAR AND THE MISSION IS TO PROVIDE QUALITY AND AFFORDABLE CARE TO THE PEOPLE GOING THROUGH THIS DEVASTATING ILLNESS AND SO, AND I AM ALSO I FEEL LUCKY THAT I'M PART OF IT FOR THE LAST TWO YEARS AND I ALSO CHAIR ONE OF THEIR COMMITTEES WHICH IS ABOUT HEALTH SERVICE PROVIDER EDUCATION AND OUR PURPOSE IS TO INCREASE AWARENESS NOT ONLY IN THE HEALTH PROFESSION BUT PUBLIC JOURNAL AS WELL.

>> MY LIMITED UNDERSTANDING, LIKE MANY PEOPLE, BECOME AWARE OF SOMEONE WITH AN EATING DISORDER, WE THINK OF KAREN CARPENTER, SINGER LONG AGO OR LINDSAY LOHAN ACTRESS.

WE THINK ABOUT PEOPLE MORE ON THE WELL TO DO SIDE AND WHITE.

IS THAT TRUE OR DO WE SEE IT ACROSS ALL SPECTRUM OF PEOPLE?

>> I WOULD SAY EATING DISORDER DO NOT DISCRIMINATE.

IT AFFECTS EVERYONE REGARDLESS OF THEIR AGE, GENDER, THEIR RACE, ETHNICITY, SOCIOECONOMIC BACKGROUND OR SEXUAL ORIENTATION.

YES.

SO IF YOU TAKE A GROUP OF AGE, THE MOST HIGH RISK GROUP IS ADOLESCENT FROM 15-19.

THERE WERE SOME STUDIES DONE WHICH INDICATED THAT ONE OUT OF EVERY 10 HIGH SCHOOL STUDENTS ARE ENGAGED IN SOME SORT OF DISORDERED EATING BEHAVIOR.

AND IF YOU LOOK AT THE GENDER, THE WOMEN ARE TWICE AFFECTED WITH EATING DISORDER COMPARED TO MEN.

THERE WERE 91% COLLEGE STUDENTS WHO WERE ENGAGED IN SOME SORT OF DIETING AND ABOUT 75% OF THE WOMEN IN GENERAL ARE CONCERNED ABOUT THEIR PHYSICAL APPEARANCE AND ALSO WORRIED ABOUT THEIR WEIGHT, SHAPE AND SIZE.

>> SAME THING WITH THE MEN?

ANY OF THOSE NOT AS MANY?

THEY HAVE THE SAME CONCERNS AS THE WOMEN DID?

>> YES, SO THERE IS KIND OF MISCONCEPTION THAT MEN DO NOT HAVE EATING DISORDER.

WE ARE SEEING THAT AS WELL.

>> WHAT ARE THE THINGS THAT HAVE CAUSED PEOPLE TO DEVELOP EATING DISORDERS?

IS IT AN UNDER LYING MENTAL ILLNESS OR DOES THE EATING DISORDER GIVE RISE TO THE ILLNESS OR GENETICS?

>> IT COULD BE ONE OR TWO OR MAYBE MULTIFACTORIAL.

IT COULD BE GENETICS AND FAMILY HISTORY, A LOT OF PSYCHIATRIC ILLNESSES ARE CONTRIBUTING TO THAT LIKE DEPRESSION, ANXIETY, OBSESSIVE COMPULSIVE DISORDERS, SUBSTANCE USE DISORDER, PERSONALITY DISORDERS.

THERE ARE SO MANY SOCIAL FACTORS LIKE BULLYING, PEER PRESSURE, FAMILY DYNAMICS WHEN THERE IS A MOTHER MODELING AND A CONSTANT CRITICISM ON YOUNG GIRLS ABOUT THEIR APPEARANCE AND THEIR BODY WEIGHT AND SHAPE.

HISTORY OF ABUSE AND TRAUMA AS YOU MENTIONED.

THERE ARE CERTAIN JOB REQUIREMENTS LIKE MODELING, DANCING, CERTAIN KIND OF SPORTS, WRESTLING, AND ONE THING, WHEN I MUST MENTION THAT WEIGHT STIGMA IS SUCH A DEVASTATING REALITY.

WHEN WE TALK ABOUT WEIGHT STIGMA, IT'S SUCH A NEGATIVE ATTITUDE, BELIEF AND DISCRIMINATION TOWARDS THE PEOPLE AN INDIVIDUAL WHO HAVE HIGHER WEIGHTS.

THERE ARE SO MANY WEBSITES, THERE IS SO MUCH ON SOCIAL MEDIA WHO ARE ACTUALLY PROMOTING THOSE KIND OF MIND SETS AND HARMFUL BEHAVIOR.

AND TELLING PEOPLE TO ADOPT THOSE AND CALLING IT A LIFESTYLE CHOICES AND I THINK IT'S DANGEROUS AND THERE ARE SO MANY SOCIAL PRESSURES ON PEOPLE, THEY BELIEVE THAT THERE HAS TO BE AN IDEAL PERFECT BODY SHAPE TO BE SUCCESSFUL.

SO I THINK IT'S VERY, VERY IMPORTANT TO INCREASE THE AWARENESS ABOUT WHAT EATING DISORDERS ARE AND ALSO AT THE SAME TIME, I THINK IT'S VERY IMPORTANT TO CREATE A WEIGHT INCLUSIVE ENVIRONMENT WHERE WHICH IS FRIENDLY AND RESPECTFUL TO ALL INDIVIDUALS REGARDLESS OF THEIR SHAPES SIZE AND WEIGHT.

>> WHAT ARE THE RED FLAGS THAT SOMEBODY IN YOUR SOCIAL SOICIAL MAY HAVE AN EATING DISORDER.

>> IT IS VERY HARD TO FIND PEOPLE OR TO SAY THIS PERSON HAS AN EATING DISORDER.

THEY KEEP IT SECRET.

THEY DON'T DISCLOSE IT AND EITHER WE CAN FIND OUT WHEN AS A PHYSICIAN WHEN WE ARE SEEING A PEOPLE AND THEN WE FIND SOME PHYSICAL SIGNS, OR EITHER FAMILIES, THE ONES WHO NOTICE SOME SORT OF ABNORMAL BEHAVIOR OR CHANGE IN THE BEHAVIOR.

SO VERY COMMON THINGS, I WOULD SAY RED FLAGS ARE, THEY SKIP THE MEAL.

THEY MAKE EVERY SINGLE EXCUSE NOT TO SIT WITH THE FAMILY TO EAT.

THEY AVOID ALL SOCIAL GATHERINGS WHERE YOU GO OUT ON THE RESTAURANT AND EAT TOGETHER.

THEY HAVE VERY RIGID EATING HABITS.

THEY MAY CUT MAYBE ONE CUCUMBER 234 SO MANY PIECES AND MAYBE EAT A COUPLE OF THOSE PIECES AND THAT'S IT FOR THEM.

I ALWAYS SAY CHECK YOUR GARBAGE CANS.

BECAUSE THEY MAY THROW THE FOOD IN THERE.

>> REALLY?

>> YES.

>> AND THEY ARE SO OBSESSED WITH THEIR PHYSICAL APPEARANCE, THEY SPEND SO MUCH TIME IN FRONT OF THE 34EUROR.

THEY'RE NOT SATISFIED WITH THEIR BODY APPEARANCE.

THEY CONSTANTLY COMPLAIN THAT THEY'RE FAT.

THEY CHECK THEIR WEIGHT MULTIPLE TIMES A DAY.

THERE ARE SO MANY FACTORS.

A CHANGE IN MOOD, IRRITABLE, GRUMPY, ANXIOUS, IT MAY AFFECT THEIR GRADES 234 SCHOOL OR PERFORMANCE AT WORK.

MEDICAL COMPLICATION.

SPENDING TOO MUCH TIME IN THE BATHROOM AND YOU WANT TO KNOW WHAT IS GOING ON.

ARE THEY THROWING UP OR WHAT IS HAPPENING?

>> WHAT ABOUT EVEN JUST YOU OBSERVE THAT THEY LOOK DIFFERENT TO YOU NOW?

>> EXACTLY.

>> THAT'S THE THING.

>> AND SOMETIMES ACTUALLY THEY WEAR MULTIPLE LAYERS OF CLOTHING >> SO AT WHAT POINT IS IT OKAY FOR US TO SAY WAIT A MINUTE.

ARE YOU OKAY?

IS THERING?

GOING-- IS THERE SOMETHING GOING ON HERE?

>> I THINK WHEN WE ALL ARE AWARE HOW COMMON THE EATING DISORDERS ARE AND WHAT THE RED FLAGS ARE, I THINK IT'S EXTREMELY IMPORTANT TO REACH OUT TO THE PERSON AND REASSURE AND SUPPORT, JUST TELL THEM, YOU KNOW, I THINK WE CAN HELP YOU IN SOME WAY.

IT'S VERY IMPORTANT BECAUSE THEY GO THROUGH THE HIGHEST LEVEL OF DISTRESS CONSTANT.

>> IT SEEMS AS THOUGH IT IS A SELF FULFILLING PROPHECY OR AT LEAST THEY GET INTO A SPIRAL OF GOING DOWN BECAUSE AS THEY AREN'T EATING WELL, THEY'RE MORE PRONE TO GET SICK AND HAVE OTHER ISSUES.

IS THAT TYPICALLY WHAT HAPPENS?

>> EXACTLY.

>> SO WHAT ARE SOME OF THE COMPLICATIONS THAT CAN OCCUR WITH SOMEONE WHO HAS THESE EATING DISORDERS.

>> AS YOU MENTIONED, IT SPIRALS THROUGH, IT AFFECTS YOUR OVERALL HEALTH AND DEPENDS ON THE SEVERITY OF THE ILLNESS AND HOW LONG THEY HAVE BEEN ENGAGED IN THOSE KIND OF HARMFUL BEHAVIOR.

THERE COULD BE A LOT OF DIFFERENT COMPLICATIONS AND I FEEL LIKE FOOD IS FUEL FOR YOUR BODY AND WHEN THE BODY IS NOT GETTING THAT FUEL, IT AFFECTS FROM HEAD TO TOE.

SO EVERY PART OF YOUR BODY IS COMPROMISED WHEN YOU ARE NOT EATING.

I CAN MENTION A FEW VERY, VERY IMPORTANT, YOU KNOW, COMPLICATION MEDICALLY.

THERE IS ONE CALLED REFEEDING SYNDROME.

>> DON'T TELL ME THAT'S LIKE A COW REGURGITATING.

>> NO, THAT'S A TYPE OF ONE OF THE TYPE I MENTIONED TODAY A LITTLE LATER.

REFEEDING SYNDROME IS SOMETHING WHICH IS A SIGNIFICANT ELECTROLYTE IMBALANCE.

WHEN WE TRY TO REINSTITUTE THE NUTRITION IN A PERSON WHO WAS STARVED FOR VERY LONG TIME.

THAT'S ONE OF THE MEDICAL COMPLICATIONS.

AND IT IS ASSOCIATED WITH A LOT OF CARDIAC PULMONARY AND NEUROLOGICAL PROBLEMS.

ANOTHER ONE IS A BONE HEALTH.

EVEN THE YOUNGSTERS HAVE OSTEOPOROSIS AND SOMETIMES THESE ISSUES ARE IRREVERSIBLE.

AND ALSO AMEN ORIA IN GIRLS, AND AS FOR PSYCHIATRIC RESPECT, THOSE ISSUES EATING DISORDER HAS THE SECOND HIGHEST MORTALITY RATE, SECOND TO OPIOID OVERDOSE.

>> GIVEN WHAT YOU HAVE SAID, WHAT ARE SOME OF THE THINGS DO YOU FOR THAT PERSON THAT COMES IN TO SEE YOU?

>> WE HAVE A LOT OF TREATMENT OPTIONS.

FIRST OF ALL IS THE DIAGNOSIS OF THE EATING DISORDER AND ALSO, YOU KNOW, WE DO A VERY DETAILED HISTORY, WE USE A LOT OF SCREENING TOOLS DETAILED PHYSICAL EXAMINATION AND WE SEE THE LEVEL OF SEVERITY THAT DETERMINES A LEVEL OF CARE WHICH COULD BE OUTPATIENT, INTENSIVE OUTPATIENT OR REHAB OR HOSPITALIZATION.

AND WHENEVER WE WORK WITH ONE PERSON IT HAS TO BE A COLLABORATION BETWEEN A TEAM WHICH IS ACTUALLY LIKE A AN INTERNIST, PSYCHIATRIST, NUTRITIONIST AND PSYCHOLOGIST.

SO WE ALL WORK TOGETHER TO HELP ONE PRN PERSON.

AND THE GOAL OF ALL THE TREATMENTS ARE BASICALLY TO MEDICALLY STABILIZE THAT PERSON, RESTORE THE BODY WEIGHT AS MUCH AS WE CAN AND ALSO TO REVERSE THE MEDICAL COMPLICATION AS MUCH AS WE CAN.

WE TRY TO MAKE SURE THEIR NUTRITIONS ARE ALL COMING BACK TO THE RIGHT TRACK.

EDUCATING THEM ABOUT WHAT IS THE RIGHT FOOD AND WHAT IS NOT AND FROM A PSYCHIATRISTIC STANDPOINT, WE HELP THEM WITH, IS THERE ANY CO-MORBID PSYCHIATRIC ILLNESS WE TREAT WITH MEDICATION AND ONE OF THE MOST IMPORTANT THINGS IS PSYCHO THERAPY AND THAT COULD BE INDIVIDUAL OR FAMILY-BASED PSYCHO THERAPY.

>> I IMAGINED, IF SOME OF THESE PATIENTS HAVE CHEMICAL DISORDERS, THAT WHEN YOU INTRODUCE PHARMACEUTICAL AGENTS.

>> YES.

>> AND SO I'M SURE-- WHO IS THE PERSON WHO INITIATES THE CONTACT WITH SOMEONE LIKE YOU?

IS IT THE PATIENT THEMSELVES?

OR IS IT FAMILY AND FRIENDS WHO SAY, HEY, SOMETHING IS WRONG HERE.

>> ALL OF THEM.

>> ALL THE ABOVE?

>> ALL OF THEM.

WE ARE HERE TO HELP.

IF YOU ARE NOT SEEKING HELP, WE CANNOT HELP YOU.

>> IF I'M SITTING AT THE DINNER TABLE AND WE HAVE A CHILD THAT IS SITTING THERE, NOT EATING.

AGE I HURTING THE SITUATION BY SAYING YOU MUST EAT?

YOU ARE NOT GETTING UP FROM THE TABLE UNLESS YOU FINISH EVERYTHING ON YOUR PLATE IF YOU THINK THEY HAVE AN EATING DISORDER?

>> HAVE YOU TO OBSERVE AND SEE IF THERE IS A PATTERN.

IF IT'S ONE TIME, MAYBE, YOU KNOW, A KID DOESN'T WANT TO EAT.

IF THERE IS ANY ORGANIC ISSUES LIKE PLEL PROBLEMS, YOU RULE OUT ALL THE CONDITIONS AND THEN YOU OBSERVE IF THERE IS ANY PATTERN TO IT.

AND WHEN THERE IS ANY PATTERN, YOU JUST KIND OF ADDRESS THAT AND SEEK HELP.

WHEN.

>> WHEN A PERSON DOES SEEK HELP, IS IT LONG-TERM HELP OR DO THE PATIENT GET TO A POINT WHERE THEY GET BETTER AND DON'T REQUIRE TREATMENT ANYMORE.

>> THAT'S A LONG WAY AND AGAIN, DEPENDS ON THE SEVERITY OF ILLNESS IF YOU ARE COMING EARLY, IT'S ALWAYS LIKE PREVENTION AND EARLY INTERVENTION ALWAYS SIGNIFICANTLY REDUCE THE RISK AND MEDICAL COMPLICATION ASSOCIATED WITH EATING DISORDERS.

SO EARLY IS ALWAYS BERT AND BETTER AND DEPENDS ON THE LEVEL WE TRY TO HELP.

>> I WAS REALLY IMPRESSED WITH THE PROBLEM.

SUICIDE IS A SIGNIFICANT PROBLEM.

>> IT IS.

LET ME TELL YOU, THERE IS ONE STUDY WHICH INDICATES THAT IN EVERY 52 MINUTES, THERE IS ONE DEATH BECAUSE OF EATING DISORDER.

52 MINUTES OUR BELITTLING PEOPLE, TALKING ABOUT SOMEONE NOT EATING OR THAT REAL THIN INDIVIDUAL BECAUSE OF SOMETHING, WE ARE MISSING THE ENTIRE POINT OF THE WHOLE THING.

>> YES.

>> IF YOU I DON'T SCREEN PEOPLE, IT'S LIKE YOU ARE MISSING SUICIDE.

>> WHAT IS THE QUESTION I NEED TO ASK SOMEBODY IF-- >> THERE ARE A LOT OF SCREENING TOOLS, A LOT OF OF QUESTIONS AND THEN THERE ARE SOME QUESTIONS IN SCREENING TOOLS FOR THE PRIMARY CARE PHYSICIAN.

THERE ARE SOME FOR THE PSYCHIATRIST.

THERE ARE EXTENSIVE ONES, SO WE JUST GO THROUGH ALL THOSE QUESTIONS.

>> AND THAT'S A GREAT WAY OF GETTING OUT OF THAT.

YOU DON'T WANT US TO TAKE OVER YOUR BUSINESS.

I KNOW WHAT IT IS.

BUT I WANT TO THANK YOU FOR BRINGING THIS TO OUR ATTENTION BECAUSE AGAIN, IT WAS ONE OF THOSE THINGS, I DID NOT KNOW A WHOLE LOT ABOUT.

I APPRECIATE Dr. SULEMAN YOU BEING HERE TO DISCUSS THIS.

I WANT TO THANK YOU FOR BEING WITH US TODAY.

I HOPE THAT YOU HAVE A BETTER UNDERSTANDING OF THE CAUSES, COMPLICATIONS AND TREATMENT OF EATING DISORDERS.

IF YOU OR A FAMILY MEMBER HAVE AN EATING DISORDER, PLEASE SEEK CONSULTATION WITH YOUR HEALTHCARE PROVIDER.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS PLEASE GO TO WWW.ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

I LOOK FORWARD TO SEEING YOU AGAIN ON THE NEXT "KENTUCKY HEALTH."

PLEASE IF YOU KNOW WHO HAS AN EATING DISORDER OR EVEN SUSPECT IT, BRING IT TO THEIR ATTENTION, GET THEM CARE BECAUSE IT IS A SERIOUS PROBLEM.