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June 2018 Many years ago, when I was thinking it would be great to lose a few pounds, I joked with a friend about “becoming anorexic for a little while.” My friend got really serious and told me not to wish that, even as a joke. She knew the truth about eating disorders; I did not. But I would soon learn. As it happened, my career path took me to the Alta Bates Hospital in Berkeley where I spent eight years caring for patients with eating disorders, mostly with anorexia nervosa, a disease I would come to hate. I often met with patients whose skin was pulled tautly over their overly prominent bones. I would ask them what they thought their body looked like. Sometimes they would concede they were a “little thin,” but most would tell me they still needed to lose a few pounds. With anorexia, patients have a profoundly distorted body image. They do not recognize they’re starving themselves to death. Anorexia often starts when a person begins dieting to lose weight and feels a little thrill when they’re successful. For some people, especially teens, losing weight provides a sense of control in a world that feels very much out of their control. The addiction process begins to take root. The weight-loss goal becomes a moving target. When the dieter approaches the original goal, she resets the goal to lose more weight, until she’s lost all sense of proportion. In our society, we glamorize thinness, ignoring the fact that human beings are genetically predisposed to have all sorts of different body types and sizes—and that health, rather than beauty, should be the ideal. This is compounded when parents tell their adolescent children they need to lose weight to look better or when parents have an unhealthy relationship with food and body image themselves. Eight million Americans suffer from eating disorders, the most common of which are anorexia, binge-eating disorder and bulimia nervosa. Anorexia is definitely the most dangerous. About 1 percent of adolescent females suffer from anorexia, and the percentage is higher in groups where body image is a primary focus, as in competitive athletics, gymnastics and ballet. Although girls are more likely than boys to suffer from anorexia, more boys are being diagnosed than ever before—especially among competitive athletes who focus on body image in sports like wrestling, body building, crew and running. If your child is involved in any of these activities and you’re concerned about a possible eating disorder, find out whether the coach turns a blind eye or is someone who will help you address the issue. It is far easier to prevent anorexia or reverse it in the early stages than it is to treat it once it has taken hold. Over time, people with anorexia lose so much fat that they cannot think or function properly. The brain and other essential organs require fat to remain healthy. If the anorexic patient is suffering from conditions that require medication, the lack of fat renders the medications useless. These patients cannot undergo therapy, because they do not have the mental faculties to engage. Sadly, only about 60 percent of anorexia patients have a full recovery, and that’s including patients who start treatment early. About 4 percent of anorexic individuals die of complications of the disease. While anorexia is about control, binge eating and bulimia are about lack of control and the shame that accompanies it. Binge eating occurs when a person regularly and dramatically overeats. Bulimia occurs when a person overeats and then compensates by fasting, self-induced vomiting, or other means to avoid gaining weight. The body becomes used to this pattern and adjusts, so the person with bulimia cannot hold food down. However, with treatment, the vast majority of patients who suffer from both binge eating and bulimia can have full recoveries. If you have some degree of unhappiness, depression, anxiety, low self-esteem or preoccupation about your body, it may be worth exploring these with your medical or behavioral health provider. If you believe your child may have an eating disorder, seek treatment immediately. Eating disorders are more than a passing phase or lifestyle choice; they are complex conditions that require expert care. Serena Jones is a Licensed Clinical Social Worker who works in the Behavioral Health Department of MCHC Health Centers—a local, non-profit, federally qualified health center offering medical, dental and behavioral health care to people in Lake and Mendocino Counties.