Eating Disorders

In recent years eating disorders and disordered eating have become an important concern on campus as well as in society in general. We live in a society that is obsessed with size, weight, and image, and are bombarded with unrealistic, unhealthy images of what women and men are supposed to be and look like. It is no wonder that some research has found that well over half of all American women report disgust or disappointment with their bodies and that girls are beginning to diet as young as elementary school age. And, although most people with eating disorders are female, the reported incidence of eating disorders in males appears to be rising.

Eating disorders and disordered eating are complex and multidimensional problems. Transitioning to college while separating from families and friends, forming romantic relationships for perhaps the first time, and attempting to manage new levels of anxiety and stress, is a particularly vulnerable time. We know that some of our students come to UCLA with eating disorders or disordered eating and that some will develop eating disorders or disordered eating while they are here. It is estimated that more than 5 million Americans meet the clinical criteria for an eating disorder (anorexia nervosa, bulimia nervosa, and binge eating disorder) and that adolescent and young adults are particularly vulnerable. Far more millions of Americans struggle with disordered eating attitudes and behavior that interfere in their lives and may or may not escalate at some point to a diagnosable eating disorder.

It may be easiest to think about eating disorders and disordered eating on a continuum from healthy concern to eating disordered. On one end, some concern about or attention to size, weight, body, appearance, nutrition, or exercise can be viewed as extremely common or normative. But on the other end, when there is an obsession with thinness, when the restriction of food intake is more severe, or when binge purge cycles become more frequent and when the preoccupation with body image grows more distorted, a specific diagnosis of an eating disorder may be rendered. The middle of the continuum is the most heavily populated and while those struggling with disordered eating may not meet the specific criteria for a clinical diagnosis, they may suffer a great deal of pain and require intervention.

As clinicians we are often asked to provide signs of disordered eating as it is oftentimes difficult to recognize when a person's thinking or behavior has become problematic and they may be developing an eating disorder. Some of the most important questions to consider when you are concerned about yourself or someone you care about include:

1. How much time does the person spend thinking about food, eating, nutrition, weight, appearance, and exercise?
2. Does the focus on these things permeate everyday life and interfere in other activities (i.e., school, social life)?
3. Does the person categorize food as "good" or "bad", feel guilty after eating, and/or make judgments about themselves based on what they have or haven't eaten?
4. Does the person appear to have a distorted body image and complain about "feeling fat" when they are of average or below-average weight?
5. Does the person use food to deal with emotional issues (i.e., for comfort, to reduce stress, anxiety, depression, or loneliness)?
6. Does the person avoid eating and/or appear uncomfortable or anxious eating in the company of others?
7. Does the person exercise excessively and/or make judgments about themselves based on whether or not they have worked out today?

The other question we are often asked is what to do or don't do if you are concerned that someone you care about may have disordered eating or an eating disorder. So, if you are concerned about a friend, loved one, or roommate, here are some guidelines to help:

1. Do talk to your loved one and express your concerns. Let them know that you care, are concerned, and want to help. Try to keep the focus on your loved one's health and well-being, not their weight or appearance, without criticism or judgment.
2. Do pick an appropriate time and place to discuss your concerns with your loved one. Try to choose a safe and confidential location with few distractions.
3. Do be prepared for your loved one to deny having a problem and to reject your help. People often have difficulty acknowledging that this has become a problem, feel ashamed and/or embarrassed, and don't want to admit that they're out of control. Try to end the initial conversation in a way that will allow you to come back to it at a later date and let your loved one know that you are there to provide help and support.
4. Do be patient and supportive. Be available to listen to your loved one and listen with understanding, respect and sensitivity.
5. Do seek out information and resources and encourage your loved one to seek professional help as soon as possible. You may want to discuss your concerns with a professional to learn more about disordered eating and eating disorders and how to best approach your loved one. You may suggest your loved one seek help from experts who specialize in treating eating disorders and disordered eating including a therapist, nutritionist or physician.

In terms of what not to do if you are concerned that someone you care about may have disordered eating or an eating disorder, here are some suggestions:

1. Don't try to solve your loved one's problem or take action alone. Seek out professional help.
2. Don't blame your loved one for having a problem or nag them about eating or not eating. This is a time they will need your love and support.
3. Don't spy on your loved one. People with disordered eating and eating disorders are already very self-conscious and if they sense you're spying they may resort to greater secretiveness and have an increased sense of shame.
4. Don't make comments about your loved one's body or appearance or compare them to other people. Pay attention to what you are saying (i.e., don't refer to foods as "good" or "bad", don't make compliments or criticisms of others based on their body or appearance).
5. Don't forget to take care of yourself. Consider getting help for yourself from a therapist.