Teen Eating Disorders
Interview of Neil Anzai, M.D.
Dr. Neil Anzai: My name is Neil Anzai, the Medical Director of Adolescent Behavior Health Services. I'm also the head of the eating disorder programs. People with eating disorders, especially anorexia nervosa do have a typical profile. They tend to be the girls who are very accomplished. They're often in the top of their classes. Before they even get the eating disorder, they're admired by most of their peers. They tend to be very academically oriented, driven to do well. They typically are described as being the perfect girls. In other words, they strive to do everything as expected and to exceed expectations.
Along with that, their personality profile is quite interesting because they tend to be very sensitive people who others turn to for help. They're great listeners. They give great advice. However, they're not able really to take care of themselves. In fact, rather than being selfish, they're almost selfless. They tend to do everything for everyone else around them, try to exceed expectations, try to be the perfect friend, try to have the perfect appearance, and they're driven to the point where they cannot see the reality. And so when they're driven to do something such as losing weight, they often go well beyond what the expectations are and keep going and that actually is the origin of the eating disorders.
There's actually been studies on semi-starvation, where a person gets starved past a certain point and then it's almost as if the anorexia takes over. They can no longer see themselves realistically. They believe they're fat when everyone else believes that they're way too thin. They don't typically see other people in that judgmental fashion, but really they're doing this for themselves and a sense of control over their body and a sense of control over all of the chaos that goes on around them. So typically anorexia starts in adolescence and carries on to young adulthood. Well, there's two eating disorders primarily that we treat, anorexia nervosa and bulimia nervosa.
- Anorexia, the symptoms are significant weight loss, often about 15 percent weight loss or more. Although with teenagers that are growing, oftentimes it's a failure to gain the expected weight that they should be gaining as they grow and develop. In addition, they have an intense body image distortion. By that we mean that they're not able to see themselves realistically. They often feel that one or all, one part of their body or all of their body is horrendously fat or too large and they're always trying to get thinner and thinner. And this, we have even some anorexics who are 60 pounds and they still feel as if they're too fat or they focus on one part of their body to the exclusion of seeing the rest of their body and just want to lose weight in that one part, even though the rest of them looks like a walking skeleton. The third part of the anorexia is a loss of menstrual period, which is really just a testament to how severely their body is impaired. They're no longer able to function normally and that's your typical anorexic patient.
- In terms of bulimia, the word bulimia comes from; the root of it is
ox hunger- so it's really defined by the binging. So the typical scenario with bulimia is that people try and lose weight. They eat less and less. Their hunger gets so intense that it's followed by periods of binge eating. Basically, your body doesn't want to starve so it tries to override your mind and get you to eat again. But these women panic when they eat. They feel full, they feel that they're going to get fat and they have to get rid of the calories in some way, so it's followed by any attempt to get rid of the food, the calories, such as self-induced vomiting, laxatives, diuretics, over-exercising, restrictive eating and sometimes ridiculous attempts at plastic surgery or liposuction.
Early warning signs for parents, however it's oftentimes difficult to tell in the beginning if it's any different than the typical adolescent or young adult, a lot of women are focused on their body and wanting to be thinner and thinner. The anorexic and the bulimics are the ones that go far beyond what's normal. So normally when you try and lose weight, your body can only take so much starvation and then it wants to gain the weight back. So being obsessed with your body, always looking in the mirror, wanting to lose weight, eating less and less over a consistent period of time would be an early warning sign. Then if it becomes bulimia, it's going to be followed by periods where they eat a lot of food or binge, followed by either disappearing to the bathroom to throw up, exercising frantically, taking laxatives, diuretics, or just an increased resolve to eat less the following day.
Usually once a parent is suspicious of it, it's usually there. So if you have any questions about whether that's the case, I'd say go and see your pediatrician, your internist. If you're a parent, take your daughter in. If your husband, a friend insists that you go with them to the doctor to explain why you're concerned, because oftentimes these patients are very skilled at making everything seem fine. It's just amazing that in some families, in some circles of friends, these patients can go undetected for months at a time.
The treatment of both of these illnesses is very complicated. I'd say first you want to go to someone who has a lot of experience treating either anorexia or bulimia because quite often we get patients who have been seen by four or five different therapists and not made any headway and so it's much harder, because usually your first attempt to get help, you have the highest percentage chance of getting it completely cured. So that each subsequent time treatment fails, patients become more hopeless. They feel as if they may never be able to get over this or they feel like this is really who they are and they should just accept it. When really when you take someone to a specialist early on in the course of the illness, the chance of recovery is very high.
Now, the treatment for anorexia is different than treatment for bulimia. For anorexia, the first thing you have to do is to get people to really learn how to eat. Not just eat normally, but they have to eat almost twice normal for six to 12 months. Now, that's a curious thing for us to do. We're taking people who sometimes are eating less than 500 calories a day and we have to get them up to about three to five thousand calories a day. And the reason for that is quite simple. If you're starving yourself for a long period of time, your body cannot possibly survive on that unless it uses conservation of energy. And so what it does basically is breaks down parts of your own body in order to feed the vital organs, the heart, lungs and brain. And so if people are getting by on 500 calories a day when they really should be between 2000 and 2500 calories a day, it means that they're making up the difference by cannibalizing parts of your body so that you can just barely stay alive. So what happens is your body gradually gets run down.
Your brain actually shrinks after a period of time of not eating enough and so then they can't really think clearly and can't help themselves out of this. And so what we have to do is to give them food. That is really their medication in treatment. Food so that their body will recover and so that they're able to use more traditional therapies later on, when in the beginning it really has to be that you're learning how to eat again and gaining the weight fairly rapidly so that you can recover.
You know, we see a lot of patients with anorexia and bulimia and most of them get much better and the majority of them are doing quite well after treatment. A lot of it depends on their follow-up care. We're able to follow some of these kids and they come back and they tell us how well they're doing. One person in particular I can say was away at college at one of the top institutes on the east coast and she got horribly ill from anorexia. She had to come back from college, had to be hospitalized. She had a rough time of it. She had to work out a lot of things, both while she was in the hospital as well as an outpatient. But when she got better, she was just this amazing young woman who has gone on to graduate school at Stanford and MIT and now is the CEO of a company in the Bay Area and doing extremely well. She was an amazing woman to start with. She got extremely sick, but now she's back to herself and she seems to be very happy and successful. She, like most of our patients who recover say they would never get ill again because of how sick they were and of how difficult the recovery is.
So I guess the message I'm trying to say is to get the treatment early. Don't put it off. Do as well as you can, stick with it, make sure you have an expert to help you through this, but then when you get better, our patients all universally say that it was worth it for them and their lives are so much better and they're happier, maybe even happier than the typical person.
(Recording Ends)- INTERVIEW CONCLUDED -
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