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On May 16, visitors to www.Turnto10.com discussed eating disorders online with Suzanne Riggs, MD, eating disorders and adolescent health expert at Rhode Island Hospital and its Hasbro Children's Hospital. Below are excerpts from the chat. Moderator: Welcome to today's Doc Chat. Dr. Riggs is ready to take your questions regarding eating disorders. Dr. Riggs: The emphasis today on being thinner than you ought to be is what starts youngsters on dieting, but eating disorders have been known in medical literature since the 1600s. The media and fashion industry create the sense that someone who is at their ideal weight is actually overweight. When a young girl goes to get a prom dress and is actually at her ideal weight, she will find that most of the dresses are made for girls who are unhealthily thin. drummerboy451: What percentage (about) of pre-adolescents would you say have an eating disorder? Dr. Riggs: One percent have a full-blown eating disorder called anorexia nervosa and as many as 15 percent have bulimia nervosa. There are many other youngsters who have what is called a subclinical eating disorder and they could have many serious medical complications as a result of that behavior. Janie: My daughter restricts eating more and more but not amounts; she's more concerned about fats but will eat normal amounts of other foods. Dr. Riggs: Restricting fats in the absence of the medical need to do so may be the first sign of an eating disorder. Everyone needs a certain quantity of fatty acids in their diets for essential functioning of the nervous system. If you do not get enough fat in your diet, your body will take from your muscle and you will lose lean body mass. kneon: I am a recovered anorexia victim of over four years. I suffered terribly during my high school years, but I am now recovered at 22, and will be graduating from RIC with a nursing degree. What percent of anorexia victims actually recover and live healthy lives? Dr. Riggs: At least one-third of youngsters recover healthy eating habits and escape from undue emphasis on weight and shape. Those youngsters that are treated aggressively and early in their illness have the greatest chance of recovery. Janie: Thank you for the information--she's very open in talking about it. Is talking the best first step? Dr. Riggs: Talking and perhaps consulting your physician, also, consulting a nutritionist. Janie: She's off to college in the fall—is that a high risk time? Dr. Riggs: The beginning of adolescence and times of transition, like going to college, are times for increased onset and relapse of eating disorders. Janie: To kneon - what intervention would have helped you in high school? kneon: I had a lot of support from my parents...I was in and out of Hasbro 7 times, and I think the thing that helped me most was moving to college and taking responsibility for myself. I know the more the food was pushed the more I rebelled. In high school love from friends and family was the best medicine. Dr. Riggs: An organization called Eating Disorders Awareness and Prevention is helpful. You can visit their Web site at www.edap.org. Janie: I have to run, but thank you, and good luck all! Erin: What do you do to get by the feeling that you could have done more when a person loses the battle. Dr. Riggs: I personally would say that I don't have any patients who have lost the battle yet. I feel sad that they have lost many years of their teenage lives battling these illnesses. I usually feel like I've helped in some way keeping them alive, hoping they will figure out what they need to do to aid in their recovery. They do that work with their therapist. My job is to keep them healthy enough to take advantage of that therapy. Fergus: How about kids with the opposite problem: eating almost nonstop during the day, sometimes healthfully and sometimes junk, but more food than is healthy. Is that clinically a disorder, or does it simply require more parental intervention and supervision? Dr. Riggs: There is a disorder called binge eating disorder where one binges but does not purge, as in bulimia. Erin: I mean the family; I recently lost a 21 year-old cousin and I think everyone feels we could have done something differently. Dr. Riggs: The tragic thing for me is when a youngster with an eating disorder turns 18 and refuses care. I may know this patient, or one like her. I have had patients have a cardiac arrest and still refuse care. Occasionally a family successfully convinces a judge to force their daughter or son to have medical care to keep them alive. Erin: I think the family here was afraid of losing her to a runaway if an adversal proceeding was instituted. I feel I should have pushed them harder to go forward in court. But I'm not the important one; I feel the mother has the regret of not having done it or more of something. Is there a resource for her? Dr. Riggs: There are sometimes support groups for parents with family members with eating disorders, not necessarily for those who have lost someone. Butler Hospital, the Anorexia/Bulimia Association of RI and the Harvard Center for Eating Disorders would be resources for such a group. Erin: You did know her. Difficult Mother's Day. Thanks for your time. kneon: To Erin: I know being there and living through this is hard to do, and no matter what my parents did or said I was the only one who could help myself when I thought the time was right. You cannot blame yourself. The best you could do was offer advice and help. Dr. Riggs: Kneon, excellent comment. The patient, in the end, is the only one who can do the work to get better. Friends, family should offer support and be firm on the side of health. Mercedes: I am a binge eater. I try to control myself, but often cannot. Any advice? Dr. Riggs: Keeping a diary where one writes down what was going on around the time the urge to binge eat begins will clue you in to things you can do to avert an overeating episode. Talking to a counselor as well as using several safe psychiatric medicines, can also help this kind of problem. Dr. Riggs: If you suspect that you, a friend or relative has an eating disorder, suggest that they talk over their dietary and eating habits with their personal physician. If that person feels that they need further evaluation or help, they will probably be referred to a medical specialist, such as myself, who cares for patients with eating disorders. I, in turn, refer patients to counselors, family therapists and nutrition experts. I assemble a team of professionals who care for the patient. Skinny: Dr. Riggs, are there signs of an eating disorder in a child? I have an eating disorder that I am being treated for. I had episodes where I was convinced I was fat and refused to eat. I am in therapy and although I still have difficulties, I am being helped. My 9-year-old daughter, who is in the 50th percentile for height and weight for her age has started with "I am fat" and she is starting to refuse breakfast. She does not eat her whole lunch at school and is very picky at dinner. Dr. Riggs: A child of someone who suffered from an eating disorder is more likely to suffer from an eating disorder. International genetic studies have confirmed this and are exploring the details right now. Distorted sense of shape and weight, saying you're fat when you're not and doing something that may not be healthy to lose weight are signs of an eating disorder. kneon: It took me a while to help myself, and realize there was more out there for me. I still have my moments, but I am able to overcome them. I have a very supportive family, and I am able to catch myself if I am slipping. I keep my long term goals in mind, and try to help others by telling them my journey Erin: To kneon: Logically I know that she couldn't help herself but it's such a waste that we couldn't get through to her or have just committed her. Now it's too late. For anyone out there who thinks it couldn't happen to you: Guess what, we thought my cousin would snap out of it one day, too. People never think it will happen to them. She's gone forever and will miss a lot, including the birth of her first niece or nephew this August. She loved children. kneon: At the time I could not help myself either...I was 15...I let the doctors do all that for me, but then I made a turn and something snapped that told me to seek help. Please do not think you wasted your time...my mother today is my hero for all the advice she gave me...for all the times she visited me in the hospital and held my hand when I was weak. I am so sorry to hear about your cousin ...she did not do it to herself on purpose Skinny: Dr. Riggs, do you approve of antidepressants to help treat eating disorders? Dr. Riggs: My philosophy is that for starving patients food is the medicine they need, first and foremost. If normalizing nutrition does not help with depression and anxiety, then I approve of the brief use of medicine for these problems. Skinny: I was given an anti-depressant and this seemed to help me have an appetite. Maybe it was "all in my head," but I still continue to take it. Erin: My cousin was on anti-depressants and that didn't ultimately help her. Everyone is different. Hope it works for you. Dr. Riggs: SSRIs often have a side effect of increasing or decreasing appetite, so it may have been a real increase in appetite due to the medicine, or improving your mood helped you to have a better appetite. Have you tried to wean yourself from the medication? Skinny: No, I would like to but I am only 117 lbs. and 5'7". I am afraid that my symptoms will reoccur and I had so many people, including my employer worried about me. I really did not have an appetite. I have to remind myself to eat a lot of the time as it is. Is there a "cure" for this behavior? Therapy helps but I am still left with my worst enemy...my own thinking. kneon: Skinny, I know when I have other people tell me that (especially my boyfriend of 3 years) I am having a bad day I feel terrible about the disorder that I had, and that alone makes me want to eat. These days are very rare, but they keep me in check. Dr. Riggs: Skinny, you are still 15-20 pounds underweight for your height. If you could slowly gain the weight, you may be able to stop the antidepressants. Skinny: I am trying. Even though I am concerned with my own health, could you give me some advice how not to pass on my poor habits to my daughter? Dr. Riggs: A parent's modeling of healthy self esteem and good eating habits is the most important thing to prevent an eating disorder. Moms should never connect their goodness and self worth to the fact that they have starved themselves on any given day. Erin: I believe that my cousin's problem stemmed from an incredible sense of no self worth. And I mean none. No will to live. It was a slow suicide. Sometimes I wonder what came first, the chicken or the egg. Was it a chemical thing from starving the brain or was it always there? Maybe enhanced by the starving? Is this usually the case or is it different for every patient? Is there a common ground in your patients? Dr. Riggs: It is a chicken or egg problem in most patients. All patients need to eat more normally so we can see the patient in a neutral condition and assess their self esteem issues. Skinny: Thank you, Dr. Riggs. I have to go back to work. Erin: I have to go, too. Thank you, doctor. Moderator: Thank you for joining us today for our Doc Chat with Dr. Suzanne Riggs. For more information, contact Dr. Riggs at the Adolescent Health Program at Hasbro Children's Hospital. Leave a message at 401-444-4712 or 444-5980. Find out more: |
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