Through after-school specials or sensationalized news programs, many of us feel fairly educated about what eating disorders are. But along the way, we haven't been schooled in the most common eating disorders, which are rarely discussed or accurately portrayed. Even more importantly, however, there are steps each of us can take to prevent these debilitating and sometimes deadly diseases from taking root in someone we love.

Demystifying the Myths
Lisa Fix-Griffin has spent the last 18 years as a licensed psychotherapist at OSF Saint Francis Medical Center's Eating Disorders Program, a 22-year-old endeavor. "It evolved out of Dr. Donald Rager's care and interest in patients he was treating who had eating disorders," she said. "He enlisted the help of then-dietitian Gail Fleming Koch to assist with the patients' nutritional needs. The program grew into a state-of-the-art treatment center with a multidisciplinary team of psychotherapists, nurse, dietitian, occupational therapist, physician, and psychiatrist. The program is unique in that it's the only center between Chicago and St. Louis that exclusively treats individuals with eating disorders."

She said the OSF program offers comprehensive treatment with traditional outpatient services, partial hospitalization, intensive outpatient, free-of-charge support groups (one for the patients, the other for family and friends), and staff available for presentations and consultative services. "Some people ask about inpatient treatment. This level of care was replaced with partial hospitalization in 1995. The treatment remains very intensive, but the patients don't stay overnight and have weekends at home. It's been shown to help those previously being admitted into 24-hour care. It's more cost effective and provides advantages in socializing and practicing skills outside of the treatment setting. If medical stabilization is needed, there may be a brief inpatient stay on a medical floor."

Unlike the mental picture many of us carry, Fix-Griffin said the treatment site is a professional building on Main Street in East Peoria. "Some envision a sterile hospital ward with patients in gowns hooked up to IV's and feeding tubes. The program consists of rooms and offices that create a casual environment. Patients and staff wear everyday clothing."

When patients first come for treatment, they're given a thorough initial assessment and ongoing symptom reduction, she said. "This starts with stabilizing food intake, including balance and variety regardless of diagnosis. If underweight, it's critical to promote weight restoration to re-establish normal body functions, including cognitive improvements. Helping patients develop insight into the disorder, such as its functions, and to develop communication, self-regulation, and other coping skills are essential therapy components."

To help understand what eating disorders are, it's important to know what they aren't. Fix-Griffin shared the following myths and misconceptions:

• Myth #1: You have to be thin to have an eating disorder. "The majority of individuals with eating disorders are normal in weight. The least common of the disorders is anorexia nervosa. There's a weight criterion for this diagnosis. This disorder tends to "advertise" itself because the person will be noticeably thin but to different degrees. Some may be very emaciated and skeletal in appearance. Others may be very slender, right at 85 percent of their expected body weight, which is a level of thinness envied by many women. I lost count long ago of patients questioning whether they really had a problem or if it was serious enough because they weren't low weight."
  
• Myth #2: If you vomit, it's bulimia. "Forty to 50 percent of those meeting criteria for anorexia nervosa induce vomiting. There are subtypes such as restricting type or purging type. For a diagnosis of bulimia nervosa, there must be regular episodes of bingeing, which is characterized by eating large amounts of food in a discrete period with a sense of lost control. Binge eating is a counter regulatory process to food restriction/dieting."
  
• Myth #3: Anorexia is the main eating disorder. "As noted before, anorexia nervosa is the least common disorder, effecting 1 to 5 percent of the female population. Bulimia nervosa is the second most common. Eating Disorder Not Otherwise Specified is the most prevalent type, which has variable presentations. An example would be a person restricting her food intake, then eating a normal amount or a forbidden food, feeling distressed, and then purging."
  
• Myth #4: Obesity is an opposite problem from an eating disorder. "Obesity is a condition-not a disease in and of itself. People develop an obese status for a variety of reasons. Most people with binge eating disorder will become obese in time, but obesity isn't a sign of an eating disorder. Obesity has increased exponentially in our country due to numerous factors such as imbalances in nutrients consumed, overall intake, energy needs, and lack of adequate physical activity."
  
• Myth #5: Binge eating is the opposite of anorexia. "People often view binge eating or compulsive eating as the opposite of anorexia, but individuals with eating disorders are more alike than dissimilar. They fall on a continuum, but common characteristics are poor self-concept, lack of assertive skills, approval-seeking, conflict-avoidant, feelings of ineffectiveness, and issues with identity and personal control. Some people with anorexia nervosa have difficulty accepting their human aspects and needs. It's hard for them to acknowledge neediness, greediness, and to allow themselves pleasure/indulgence. Those with bulimia are afraid of not getting what they need but reject it when they do, feeling undeserving. Those more prone to overeating fear not having enough, almost a hoarding in an attempt to fill up emptiness they feel."
  

She said it's key to understand that these disorders are illnesses. "Eating disorders are very complex, serious, and potentially life threatening psychiatric illnesses. They have the highest mortality rate of any emotional illness, and there are myriad medical complications that can develop from them. They can be more aptly thought of as thinking disorders in which there's an alteration in how one thinks, feels, perceives, and judges. Psychological issues are expressed through the body and behaviors."

Onset of an eating disorder is typically between ages 13 and 25, although she's seen patients as young as nine and as old as 73, Fix-Griffin said. "They are more common in females than males, with a ratio of 10 to 1. No socioeconomic or ethnic group is exempt. There's no single cause, but there are multiple factors that predispose, precipitate, and perpetuate the disorder. There seems to be heritability, meaning they run in families. Relatives often have histories of depression, anxiety, and/or substance abuse like alcoholism. Genetic studies are in progress and suggest certain personality types are prone to develop them. There are family issues and dynamics that contribute to the development of these disorders also."

Are Eating Disorders Preventable?
She believes the most powerful engine driving the incidence of eating disorders is the failure to understand the connection between dieting and eating disorders. "Some risk factors can't be controlled for, but a very strong risk factor is under our control, and that's the behavior of dieting. Our culture is so pro-diet that the risks and ineffectiveness of diets are downplayed or unknown. Diet programs don't disclose their poor long-term outcomes because they're in the business of making money. Did you know the National Institute of Health task force released a position statement in 1992 that announced diets don't work? Because of the deluge of diet ideas, Americans have lost the ability to know how to feed themselves."

And the reason diets fail is because our bodies weren't designed to be skinny by choice. "The body doesn't know the difference between dieting and famine," Fix-Griffin explained. "The body adjusts and defends against the lowered intake by conserving energy. This is why so many yo-yo dieters eventually weigh more after efforts to lose. They haven't failed; the design of the diet is flawed, and they've failed to understand their physiology. Restricted intake leads to increased hunger and preoccupation with food. For those with some predisposition to an eating disorder, this process of restricting becomes very rewarding. It's a high-risk behavior just as repeated use of alcohol and other drugs can be for vulnerable individuals. The chances of developing an eating disorder are eight times higher if you diet. Because healthy eating is glorified, individuals with disorders often are reinforced for their symptoms by others complimenting them on their self-discipline and 'eating so healthy.' Although someone's intake may appear to be proper nutrition, don't assume so. A meal low in calories and fat is unhealthy if the person doesn't eat enough calories and fat overall."

Unfortunately, she said, dieting and the obsession with thinness have become part of the fabric of our society. "Indoctrinating young girls with these is a part of female socialization. This process is comprised of messages that a girl's appearance and weight are her most important qualities, that she should 'watch' what she eats, that foods are 'good' or 'bad,' that she should view her normal body fat as unsightly and reject that which is uniquely feminine, that she should compare and compete with other females through her body, and that being larger than average is the worst fate possible. To hear someone say, 'I wish I could have anorexia for a little while,' reflects the overvaluation of thinness and misunderstanding of eating disorders as the serious emotional illnesses they are."

Fix-Griffin said eating disorders always will be more common in females as long as females wish to be smaller and thinner. "This desire leads to food reduction, which sets the stage for eating disorder development. Restriction impoverishes not only the body, but also the mind. Males usually want to be bigger, larger, and stronger. What would it be like if girls had this attitude?"

The best prevention, she said, is to teach children to value themselves for their imaginations, tolerance of others, helpfulness, and ability to persist. "Encourage them to be human 'beings' versus human 'doings' so preoccupied with achieving, competing, and performing-which are so overvalued in our society. Help them appreciate what their bodies can do as instruments rather than what they look like as ornaments."

For concrete examples of how to do that, the National Eating Disorders Organization compiled a list of 10 things parents can do to help prevent eating disorders in their children:

• Avoid conveying an attitude about yourself or your children that proclaims "I will like you more if you lose weight, eat less, wear a smaller size, or eat only 'good foods.'" Avoid negative statements about your own body and your own eating.
  
• Educate yourself and your children about the genetic basis of differences in body shapes and weight and the nature and ugliness of prejudice. Be certain your child understands that weight gain is a normal and necessary part of development, especially during puberty.
  
• Practice taking people, especially females, seriously for what they say, feel, and do-not for how they look.
  
• Scrutinize your child's school for things (posters, books, contests) that endorse the cultural ideal of thinness. Also watch for the failure of their school to include images of successful females in the curriculum. Without such images, girls are left with media definitions of thinness as a primary means of success for females.
  
• Encourage children to ignore body shape as an indicator of anything about personality or value. Phrases like "fat slob," "pig out," and "thunder thighs" should be discouraged. It's noteworthy that being teased about body shape is associated with disturbed attitudes about eating.
  
• Help your child develop interests and skills that will lead to success, personal expression, and fulfillment without emphasis on appearance.
  
• Teach children the dangers of trying to alter body shape through dieting, the value of moderate exercise for health, strength, and stamina; and the important of eating a variety of nutritious foods. Avoid dichotomizing foods into "good/safe/low-fat" vs. "bad/dangerous/fattening."
  
• Encourage your children to be active and to enjoy what their bodies can do and feel like. Don't put your child on a diet or exercise program unless a physician has verified that there truly are medical concerns associated with the child's weight.
  
• Limit how much television children watch. At least occasionally, watch with them and discuss the images of females presented. Do the same with fashion magazines.
  
• Make family meals relaxed and friendly. Refrain from commenting on children's eating, resolving family conflicts at the table, and using food as either punishment or reward.
  

Fix-Griffin said in the face of such societal challenges, what continues to make her hopeful is seeing patients begin to heal. "The best part of my job is seeing those I work with discover themselves, accept themselves, and become more whole." TPW