STATEMENT

Congresswoman Sheila Jackson Lee

I would like to thank you all for coming to this briefing today, which brings much needed attention to an often invisible topic, children and eating disorders.

I would also like to applaud the Eating Disorders Coalition for Research, Policy & Action for working with us on this briefing and for their leadership in shedding light to this issue. It has been well overdue for Congress to pay attention to the lives that are lost and devastated by the toll of eating disorders.

I am founder and Chair of the Congressional Children's Caucus. The caucus is a bipartisan organization comprised of 67 members of Congress and devoted to promoting children's interest as a crucial part of the national agenda. I am committed to continue to focus on children's issues as a national priority, because I understand that meeting the critical needs of our youth is vital to their well-being and future success. As is becoming more evident and as is the focus of this briefing, the high toll of eating disorders is one of the serious health threats to our children.

As the speakers will illustrate, eating disorders are not simply a passing phase but rather are long term and life threatening illnesses. Eating disorders frequently co-occur with our psychiatric disorders such as depression, substance abuse, and anxiety disorders. In addition people who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure which may lead to death. Recognition of eating disorders as real and treatable disease, therefore, is critically important. Without access to appropriate treatment people often die from the physical consequences of eating disorders. However, with appropriate treatment and health insurance coverage the possibility of recovery is significantly greater.

Females are more likely than males to develop an eating disorder. Only an estimated 5 to 15 % of people with anorexia or bulimia and an estimated 35% of those with binge-eating disorder are male. An estimated 0.5 to 3.7 % of females suffer from anorexia nervosa in their lifetime. An estimated 1.1% to 4.2 % of females have bulimia nervosa in their lifetime. However, no longer are eating disorders striking only women of affluent, celebrity status. Now we find children of color, boys and people of lower socio-economic status struggling with eating disorders.

In my home state of Texas Elisa Ruth McCall, a vibrant 21-year old college student died after years of struggling with an eating disorder in 1997. She left behind her journals that chronicle her battle with the eating disorder, which her parents use in their mission to educate children and communities about this growing public health threat. I salute Leslie and Rick McCall for their efforts, and all other families, professionals and friends who are leading the fight to address eating disorders.

Now the time has come for Congress to play our role in addressing the problem and pain caused by eating disorders. It is my hope that my colleagues and their staffers who are here today learn how we as Members of Congress can support efforts to eliminate the problem of eating disorders, especially as it relates to our children and their well being.

I thank you all for coming today. Your attendance is testament that this issue is of critical importance.

Meet Mindi

Mindi Rold, eating disorder survivor, Galt, California

“What a miracle! I could not understand how desperate you were to get out of the prison of anorexia. You have had a very sad life. Well, you have finally experienced the freedom from the disease. You are a survivor and a winner.”

These words were told to me 9 years ago at the age of 19 after finally, for the first time in my life finding help. February 1, 1993 is the day I really started living life. Before that time I was not living, but battling something greater than myself every moment of the day. I never imagined I could stand before you today and share my story with you. I am honored and devoted to try to explain the destruction and damage eating disorders can cause. Sometimes I feel like I am much older because of my experiences. I do not have many memories before the age of 6. I have been told that I was put on a diet as an infant because I was gaining too much weight. I also have been told I was a happy go lucky girl who always had a smile on her face. I often have wondered where that little girl went because I have no childhood memories of her.

Instead these are the childhood memories I have.

Between the ages of 7 and 8 I started to feel very uncomfortable in my body. I hated to go clothes shopping and I received subtle messages that as I look back played a role in the beginning stages of my anorexia. The chubby cheeks my grandma and aunts loved to squeeze. On the soccer field my dad called me thunder thighs. I also started developing and remember being excited to get my first bra. My mom even started reading me books preparing me for my first menstrual cycle. And then there was my first diet. My dad and grandma were always trying to lose weight. I never thought much about it until one day my grandma and dad said they were going on Weight Watchers. I asked if I could join too. I was in the stage of baby fat and hated being called chubby by family members. I went to my doctor who said I did not need to go on a diet. He said I was starting to develop early and as I grew the baby fat would disappear. I was stubborn and finally he said he would write a note to Weight Watchers to allow me to lose at the most 10 pounds. The day I joined Weight Watchers changed my life. For many victims their eating disorders begin with a diet. I was 8 going on nine. My world changed overnight. My thinking about food changed from just eating when I was hungry to labeling foods good and bad, controlling my portions, fat intake and soon how few calories I could live on. Within a month adults were complimenting me on my self-control-wishing they could stick to a diet like I could.  After three months we no longer went weekly to save money, but that did not stop me. I had lost 12 pounds and asked myself why stop there? I was a success, unlike my dad and grandma. I realized how I excelled at dieting. It quickly took control. Most evenings I cried myself to sleep feeling guilty for fighting with my parents and wanting my inner torment to stop. Losing weight was taking a toll on my body.

I was competing in a select soccer league and taking dance lessons. I had to eventually quit both because I fainted on the soccer field. I was no longer allowed to do the activities that helped me feel like a normal child. On my way to school one day in the Spring I felt overwhelmed with guilt and other feelings so I ran all the way home and told my parents I needed help. I could not stop what I was doing. The following Monday morning I was diagnosed with anorexia nervosa and admitted into a hospital.

I was nine years old, dehydrated, my electrolytes were unbalanced and I was having uncontrollable seizures. I didn’t know what to think. I truly though it was a diet that went out of control. After getting stabilized they sent me upstairs to the psychiatric ward where other patients were hyperactive children, schizophrenics and suicidal teenagers. I was the only eating disorder patient. The ward was based on behavior modification. If you did what they wanted you achieved points. I worked with a psychiatrist who prescribed an antidepressant and used threats to get me to eat. I had no contact with a nutritionist and was not gaining at the rate they wanted. They threatened to put a tube down my throat 3 times a day and often I was locked in my room as a form of punishment. The hospital was a quick fix. It was also my family’s first introduction to the frustrations of getting adequate and effective treatment. The frustration continued throughout the years and I still see it with parents today. Our insurance at the time only would authorize this treatment program, which really didn’t know how to appropriately treat someone with anorexia.

The insurance company also put a cap on the number of days they would cover. Despite the fact that I was still mentally and physically a wreck I was discharged early. I remember the day I left thinking everything will be ok. I also remember for the first time seeing my dad cry in relief that they still had their daughter. I never imagined that was only the beginning. During the next year my father looked throughout our surrounding areas for an eating disorder counselor who could finally start treating the root cause of this terrifying cycle I could not seem to escape. The first one we found was an hour away, but he had written a popular eating disorder book and seemed very knowledgeable. After a month of seeing him he told me he did not think he could help me. He had never encountered a child my age that had an eating disorder and he did not think our time would be effective. At the time my early onset of anorexia had many doctors frustrated in how to best treat me. That began years of trying to find a counselor and a hospital that really knew about and effectively treated anorexia.

This was the beginning of my childhood lost. I spent over 12 years in and out of hospitals trying to find help and break free from the prison of anorexia. My dad drove me weekly 2 hours one-way to a counselor. Eventually that counselor would not see me because I lost too much weight per our contract she had set up for me. Two years later I entered another hospital, an eating disorder clinic. I was there for two months and then the following year I was back in for three months. If I were a certain “weight” the insurance company would authorize a stay based on medical need, but if I was one pound more they would not. My parents quickly learned that they needed to educate the medical doctors on how the system worked.

In the hospitals the focus was on eating and gaining weight within the time allotted by the health insurance companies. A pattern developed. I would get discharged from a hospital and slowly lose the weight again. It was a drastic change going from being fed and in a secure environment to being on my own and having to feed myself. The hospitals never worked with me to get at the underlying issues; such as the fact that I did not think I deserved food or freedom from the torment of anorexia. I developed a negative thinking pattern at a very young age that caused me to believe that I deserved to be punished and did not deserve happiness. The hospitals, counselors and medical doctors supported this thinking by rewarding me only for weight gain. The way I chose to punish myself was through the anorexia. The hospitals did not deal with my thinking. The anorexic voice quickly became the only voice I knew. The voices would tell me lies and pretty soon I could not separate the truth from the anorexic voice. In my family we called it “Annie.” It was so real to me that pretty soon I only believed what Annie told me.

I often felt crazy, weird and would cry out to God nightly to take it from me. It was not that I did not want to get better, but I did not know how to actually do it. How do you change the only thing you know? I never achieved a healthy weight throughout my adolescence. By age 12 I was prescribed birth control pills not because I was sexually active, but because they were afraid of me developing osteoporosis. They also warned me that I could stunt my growth and the opportunity to be able to bear children. I heard it, but my drug of choice, anorexia, was the only safe and consistent thing I had.

I led two lives. I put on the happy face long enough in public. My parents always knew it was a lie. They could see through my hollow eyes. It was like I was controlled by something greater than myself. At a desperate place I attempted suicide by overdosing on Prozac- the medicine I was on at the time. I wanted my pain to go away. I felt so alone. It already had been over 10 years of trying to get me help. The next treatment that my insurance would authorize was a convalescent home. For two weeks I lived in a home with elderly patients in Sacramento getting tube feedings and working as the “bingo” lady. It was a humiliating experience. When discharged I set my sights on college. I begged them all to let me go thinking maybe college could change me. I excelled my first semester of college. I thought I was doing ok until I was called into the college’s president’s office. They sent me to be evaluated by an eating disorder specialist who told me I could die any day with a heart attack and that I would die if I continued in this pattern. The school, being private, told me they could not be liable for my death. They told me that I could not return the next semester. Within a month I was back home, lying in our local hospital with IV’s, near death and the lowest weight I had been sense 7 years old. My parents were desperate after years of attempting to find me a counselor or a hospital that could actually help escape the prison I was in.

They knew another hospital would not help me. It would stabilize me, but not help me learn to live again. I needed something different-long-term. Shame, guilt, loneliness, hopelessness overwhelmed me. College was everything to me and I had lost that too. I knew I would die from anorexia if something did not change in my life. But how? The only thing I knew was living in the prison. I had already lost my childhood. I had a choice to make. I knew God saved me for a reason and somehow someway had a plan for me. Desperate, but not hopeless my father called throughout the world looking for a residential program that they could somewhat afford. At this point they were already in debt due to past medical bills. It is not unusual for a one-month stay at a program to cost over $30,000. How realistic is this? My parents told me if I had cancer they would do anything to get me help and they saw anorexia as just as important. They sacrificed cars, vacations and even a home to try to get me help.

After days of calling around my dad found a residential program in Miami called Pathways. It currently is under a new name. Pathways was based on the 12 step model treating several different forms of addiction. It was economical too. It cost a total of $3,000 a month, including living expenses. I lived in apartments with three other patients. I was responsible for maintaining the house, grocery shopping and cooking for myself. You had to want to be there or you were kicked out. February 1, 1993 was the beginning of a long and difficult recovery.

Pathways had counselors, nutritionists, psychiatrists and doctors who had experience treating eating disorders. Several had recovered from some addiction too. They helped me work on Mind and the lies I had come to believe about myself. They helped me mourn the little girl and childhood I rejected and never could reclaim. Recovery was a process. I developed a willingness and courage to trust that I would be ok. I realized I no longer needed the protection of anorexia and I no longer needed to punish myself. At my graduation the counselors told my parents that when I entered Pathways they thought I was a hopeless case because of my age and the years I had battled anorexia. The saying goes the earlier the onset of an eating disorder the harder to break free. Pathways helped me build a foundation and helped me learn how to live without an eating disorder. It was not easy because my memories, my life up until that point, were only of anorexia and the negative thinking that I had come to believe. I had to rediscover who I really was. I allowed my body as well as my mind and spirit to return to health. Though healthy now I live with the consequences of anorexia. At age 27 I already have osteoporosis despite the years on hormones. Also, due to the years of stress I put on my body I was diagnosed with fibromyalgia. I also stunted my growth. I am only 5”2. I have been told I would be taller today if not for the eating disorder. My menstrual cycle has never returned. Now married that hits home. I have an 80% chance of not being able to conceive. I put my body through so much abuse during a crucial time of development. It is a daily reminder of the destruction eating disorders can cause at an early age.

Today I live in a small rural town in Northern California working as a teacher, and an eating disorder educational speaker and consultant. I work with the Eating Disorders Coalition, which sponsors today’s briefing and the Kristin Watt Foundation to bring awareness to children, parents, teachers and medical professionals. I also work with girls one on one who are struggling with eating disorders. I provide support, recovery tools, nutritional plans and hope. Their eyes light up when they realize they are not alone and are not crazy. I am committing my life to prevent these girls from losing their childhood the way I did. I ask you to help them as well.

Terry (a mother) and Jamie (a sister) Rustemeyer shared their story about, Melissa, who died after being bulimic for two years, just days after her 16th birthday.

TERRY RUSTEMEYER:

I am not a professional speaker, I am a mother who would like to tell you a little bit about my daughter.

Melissa was born July 11,1983, she was my first born child. Melissa was sunshine and rain, laughter and tears. She was a good daughter and a good friend, two things she took very seriously. I believe she was the best she could be, yet she wanted to be perfect and to her thinness equaled perfection; she believed if she was thin her life would be perfect. Unfortunately, Melissa was also bulimic and she died because of it on July 22, 1999, 11 days after her sixteenth birthday.

How did it all begin? When Melissa was 14, a boy told her she was too fat, it was at this time she began her descent into bulimia. She left me many hints about her behavior, and two months after her disease began, we took her for help. I remember not knowing what to do, I also vividly recall my feeling so alone and isolated, because no one wanted to talk about eating disorders.

Bulimia deals with bingeing and purging and there is a lot of shame and guilt about the bodily functions involved, something we as a society do not find palatable, so we do not discuss it. I remember one time Melissa and I watched a TV movie about bulimia, of course since it is a movie the main character is cured in 90 minutes. Too bad it is not that simple in real life. But the movie did show the young girl battling not to vomit after eating, and Melissa climbed in my lap and I held her and stroked her throat so she would not vomit. I remember calling our family practitioner asking for help and being told, Melissa needed to see a psychiatrist, as there was nothing she could do.

When we first tried to find help for Melissa, I had no one to ask, and I looked in the phone book and found one name under therapists treating eating disorders, and I do not live in a small town. This therapist was not taking any new patients and had no place to refer Melissa.

Melissa has seen a psychiatrist before for depression, so we went back to her, did the doctor fail Melissa? I don't think so, I believe Melissa was so caught up in the cycle of bingeing and purging she was not able to be honest with herself or others as to how serious it was. She had no idea how dangerous her eating disorder was.

Did Melissa want to die, no she was 16, and invincible, nothing was going to happen to her, unfortunately she was wrong, dead wrong.

I cannot tell you the emotional and physical devastation the loss of your child brings to a family; we were four and now we are struggling to be three. With the help of my family, friends, and a support group, I am beginning to heal, but unlike some one who has surgery, my incision does not heal evenly,

There are times for no reason my wound opens up and weeps, and other times it begins to close, but the edges of the wound do not come together evenly.

When your child dies you feel like you're the only one in the world this has happened to. When your child dies of an eating disorder, you not only feel alone, but for me there was a feeling of shame.

Melissa may have lost the battle, but I will not stop fighting the war. I have joined the eating disorder coalition, and no longer feel shame, but have received hope. We must advocate for more research and policy for treatment of eating disorders. As there are many Melissa's out there.

Where did Melissa learn this behavior, was it from TV, teen magazines, or friends? I do not know, what I do know is that I can guarantee that everyone in this room knows someone or knows someone who knows someone who has an eating disorder, that is how rampant it is among our young.

I miss Melissa, with every fiber of my being, every minute of everyday. Eating disorders can kill just ask me, I know.

JAMIE RUSTEMEYER:

As far as I can remember, I thought there was nothing wrong with my sister Melissa, in my heart she had it going for her. I thought she'd have a better life than me even with her eating disorder, I never thought she would die.

I found out about her eating disorder almost a year before her death, I was in such denial, I felt she could get over her eating disorder and the stuff she did to her body would not harm her. I believed she was strong, mainly physically. Obviously I was wrong.

I thought that I could build a greater bond with her by getting her laxatives. It made me feel great to make her happy, but awful to see her chug the laxatives in front of me.

The night before her death was odd for me. Seeing her stay in the bathroom for almost twenty minutes, worried me so much, that I wanted to run in there and stop her. It still hurts me that I was the last person to talk to her. I can never forget the last thing I said to her, I said thank you over and over again. I never realized that I was thanking her for every thing she did for me.

The day she died, all I remember is feeling like everything was a dream and I was running from it. I always expected to see her in the regular places we talked and spent time together. It was so hard waiting for someone to come home who was never going to be there again.

For the first year all I felt was anger, sadness, and denial of her death. My main objective was to run away from it. I endlessly slipped into denial and started to do things I now regret. Eventually marijuana and vodka became my new best friends, bad ones though, after Melissa.

Even though there were times Melissa used me to get what she wanted, I would not trade anything for the times we shared. I've learned a lot in the past two years, except how to express how I fell when somebody asks me "do I look fat"?, which makes me want to scream at them or smack some sense into them. Since Melissa would ask me that same question. And when I wrote this, I could not help but think of all the times she and I spent together, aimlessly wondering what would have happened if she wasn't bulimic.

On July 11th, she would have had her 18th birthday, and I can't help but wonder what she would be doing, what she'd look like and if I'd be here talking to you today.

Sometimes is hurts to hear people talk about their siblings, I want to cry knowing that i'll never see Melissa again. She wanted to be perfect, and loved by everyone, without realizing that she was closer to perfection from the start.

Though she will forever be physically gone, I will never forget her. She made a big impression in the lives of everyone she met and touched, and I will forever love her. And like my mom says, "I miss Melissa."

Joe Kelly, father and co-founder of Dads & Daughters

Good afternoon. I am Joe Kelly of Duluth Minnesota, executive director of Dads and Daughters, the national education and advocacy nonprofit strengthening father-daughter relationships and transforming pervasive cultural messages that value daughters more for how they look than for who they are. I am a board member of the Eating Disorders Coalition for Policy and Action. I’m hear to stalk about DADs’ first deputy director, Heather Henderson.

DADs joined the eating Disorders Coalition because of Heather’s death, and her friends’ desire to pursue prevention of, and access to treatment for, eating disorders.

I first met Heather when my wife Nancy Gruver hired her for New Moon Publishing, the magazine company Nancy owns.

Heather became editor-in-chief of HUES – Hear Us Emerging Sisters, a multi-cultural magazine for college age women. HUES boldly challenged the appearance-first value system that undermines girls and women – and that leads to eating disorders.

Eventually, in large part because there aren’t enough advertisers who market products to young women without simultaneously telling them they’re not good enough – and despite Heather’s brilliant work – HUES folded.

Selfishly, that was good news for me. I was starting Dads and Daughters, and knew how we’d benefit from Heather’s zeal, talent, organization and courage. So, we spent the next one and a half years working for gender justice – and becoming good friends. Heather was a mentor to me as we strove to make fathers realize how much influence we have in raising strong, smart and bold girls – as well as the influence we have to make the world better for all kids by fighting the attitudes that keep our children in narrow, destructive gender straightjackets.

At the end of a Monday last September, Heather and I started talking about the details of her taking a few days off later in the week – her sister was getting married on Saturday … and Heather, having fresh struggles with her eating disorders, had arranged for a Thursday evaluation to see if she could get into a 30-day outpatient treatment program in Minneapolis. That’s a 3-hour drive…there are no treatment programs in Duluth a city of 80,000 with three hospitals. Heather said she’d been twice denied inpatient treatment when she was younger – once told she was too sick for treatment, and once told she wasn’t sick enough.

Tuesday, after weeks of work, Heather completed the grant applications for a pilot father-daughter program DADs will launch this fall with the YMCA. She proudly piled them on my desk with an air of satisfaction.

Wednesday morning, Heather didn’t come to work – very unlike such a committed and responsible person. Eventually, I went up to her house to see what was up.

I found Heather laying face down on the kitchen floor, with her two dogs snuggling protectively against her.

She was dead of a heart attack at age 27 after an 11 year struggle with bulimia and anorexia.

I want to speak today for the voice Heather gave to the world, and the impact her death had.

Of course, it was devastating for her fiancé Sean Taylor. A courageous man – he works with incarcerated teenage boys – Sean openly shared his grief, and still does today. Having finally found a life partner, her life was snapped off. His life is never the same. Now, he is developing the pilot program for which Heather’s grant applications got funding.

Heather’s family was, of course, deeply scarred in ways very similar to what you’ve heard from others.

My family was turned upside down – Heather was a big sister to our 2 daughters. Mavis, away at college, wanted to come home – “All my friends are helping and hugging me, and I’m getting my feelings out – but nobody here knows Heather!”

Dads and Daughters ground to a halt. Heather was half the staff, and ran all the internal operations. Her loss was simply immeasurable. For months, as new colleagues and I tried to keep things going, I’d every day want to ask for her help. Somehow, with support from our board, friends and allies, Dads and Daughters survived. Although we’d all give anything to have Heather back, her spirit of justice – and the obscene irony of her death – spurs us on today.

In the days and weeks following her death, I received hundreds of heartfelt emails, cards and calls from people working alongside DADs– many of them national leaders. It turns out Heather built –by email and phone —a virtual community of concerned researchers, parents, activists, health care folks – you name it. Heather used DADs – and her own passion – to feed and support their commitment to strengthening father involvement and combating corrosive appearance-first cultural messages.

Heather made the world better not just for each of us, but for countless people that none of us – including Heather – will ever know.

With remarkable courage, Sean and Heather’s family publicly acknowledged that she died from anorexia and bulimia. Their courage is but a reflection of the immense bravery Heather showed in fighting her illness – and, even more, in finding the energy and spirit to go beyond her personal battle to fight for gender justice.

Heather’s life and death offers each of us both indictment and redemption.

Her eating disorder is an indictment of what we let our culture get away with doing to girls and women. Like many eating disorders victims, Heather was talented, intelligent and effective at an early age. But insidious, corrosive marketing messages like “Inner Beauty Only Goes So Far” told her that her accomplishments didn’t matter next to attaining some unattainable ‘look”.

As a father of two women, I say that this is far too steep a price to pay.

As a man, I say that we men also pay too steep a price for this. Those messages sell us the lie that we should value the size of a partner’s cleavage over the size of her heart. Swimming through this cultural muck, we are scarred and crippled in our ability to fully embrace human connection with another human being.

There is an oft-used civil rights slogan– Your silence will not protect you.

Heather was not silent – and her life continues to call out. Heather did not choose silence, but Sadly, Heather’s voice was also not enough to protect her.

I think her voice could not protect her because there are not yet enough other voices to join hers. There are not enough of us screaming bloody hell about what our culture gets away with doing to girls – and to boys.

But, paradoxically, I see redemption in the particular measures of Heather’s life and the chords of Heather’s voice. She set an incredible example for how to speak truth into our culture’s power. When one voice like Heather’s is raised, the profiteering purveyors of the harmful lies know that she speaks for hundreds, even thousands of others.

Discouragement didn’t stop her or make her a statistic of passive silence. Heather, and all the children who come after her, expect the same of us.

Let us make ours a culture where children feel inner strength, a society where young people have ready access to mental health care, a world where every individual and institution values children for who they are, rather than undermines them for how they look.

Thank you.

Children with Eating Disorders: A Growing Public Health Concern

Susan Ice, M.D., Medical Director, The Renfrew Center

Eating Disorders: Vital Statistics

• Millions of Americans diagnosed annually
• 90% + are adolescent and young women
• Highest mortality rate of any mental illness -- up to 20%

Eating Disorders: Lifetime Prevalence

• 0.5-3.7% of females suffer from anorexia nervosa
• 1.1-4.2% of females suffer from bulimia nervosa

• 2-5% of males and females suffer from binge eating disorder
• 4.5% females, 0.4% males report bulimia in first year of college

Eating Disorders: Prevalence

• 0.5-1% of adolescents have anorexia nervosa
• 2-3% of adolescents have bulimia nervosa

Eating Disorders: Incidence

• Doubled since 1960s
• Increasing in younger age groups, as young as 7 years
• Occurring increasingly in diverse ethnic and sociocultural groups
• 40-60% of high school girls diet
• 13% of high school girls purge
• 30-40% of junior high girls worry about weight
• 40% of 9-year-old girls have dieted
• 5-year-old girls are concerned about diet

Source: Journal of the American Academy of Child and Adolescent Psychiatry

Eating Disorders: Anorexia Nervosa

Characteristics

• Emaciated look
• Physically active
• Profound weight loss
• Loss of menses
• Body image distortion
• Fear of weight gain

Medical Complications

• General Health
  • Cardiovascular compromise
  • Osteoporosis
  • Metabolic slowdown
  • Multiple organ compromise
• Suicide
• In adolescence
  • Growth retardation
  • Pubertal delay
  • Peak bone mass reduction

Medical Complications of Treatment

• Potential negative body response to food and nutritional supplements
• “Refeeding” could cause medical crises:
• cardiac failure
• electrolyte disturbances

Eating Disorders: Bulimia Nervosa

Characteristics

• Individual “looks normal”
• Bingeing and purging behaviors
• Individual overly concerned about her body
• Secretive

Medical Complications

• Dehydration
• Heart problems
• Electrolyte disturbances
• Gastrointestinal problems

Associated Psychiatric Disorders

• Addictions
• Personality disorders
• Depression
• Manic-depression
• Post-traumatic reactions

Eating Disorders: Binge Eating

Characteristics

• More prevalent: ½ of all clients of diet clinics
• Represented across all ages
• Equally represented between sexes
• Associated with problems of obesity
  • Cardiovascular
  • Diabetes
  • Musculoskeletal
  • Infectious diseases

Eating Disorders: Risk Factors

• Genetic
• Temperamental
• Familial
• Peer group
• Sociocultural forces promote ideal body image as thin
  • Fashion industry
  • Media
  • Entertainment

Eating Disorders: Treatment

• Early detection and intervention necessary
• Treatment must be as complex as the illness
  • Nutritional
  • Medical
  • Psychiatric
  • Psychotherapy with patient, family
• Varied levels of care

Eating Disorders: Recovery

• 1/3 recover after initial episode
• 1/3 fluctuate with recovery and relapse
• 1/3 suffer chronic deterioration
  • Multiple re-hospitalizations
  • Marginal members of society
  • Minimal work capacity
  • Limited social relationships

Eating Disorders: Congress’ Role

Authorize funding for and access to comprehensive treatment

• Adopt APA guidelines for medical necessity for eating disorders
• Guarantee patient’s right to privately pay
• End exclusion of eating disorders from mental health insurance policies
• Pass mental health parity legislation

Authorize funding for continued research

• Risk factors
• Treatment outcome studies
• Prevention strategies

Authorize funding for education

• Increase public awareness of signs, symptoms, treatment, long-term consequences
• Improve access to competent providers
• Develop programs for the training of professionals in treating eating disorders

Eating Disorders: The Future

It’s up to each of us.