Expert: Ryan Hale - 4/14/2009

Question
QUESTION: Our 13 year old daughter began displaying some compulsive eating traits last year – over eating, hoarding food, etc.  These episodes were typically brought on by stress.  She was always stocky to begin with and the overeating caused her to gain weight and her self esteem and endurance on the soccer field suffered.  Her weight went from low 120s to around 130.

We were concerned and had her admitted to Alexian Brothers for binge eating.  However, the treatment program didn’t go quite so well.  At 5’2”,. Her weight went from ~ 131 pounds to 141 pounds in 6 weeks.  (They provided a heavy menu with no restrictions; they are forced to eat everything on their plate.)  We avoid any type of weight discussion, but her overall fitness suffered quite a bit.

Accordingly,  her self –esteem has suffered along with her endurance and speed on the soccer field. She is the most reclusive she’s ever been.   When I have broached the subject with her continuing care therapist and nutritionist, they want to avoid any type of weight loss discussion.  Their approach is she’ll either trim down some or grow into her weight.  

QUESTION – Should we just wait this out?  I’m concerned with the length of time her self-esteem has been so low.


ANSWER: Marie- at 13 I suspect she started high school right around the time the eating started?  If not it's still a time for big changes: schools, going from the things she did as a little girl to the things she's doing as a teenager, going from relationships you have as a "tween" to those of a teen (including boys).  I'm wondering what there may have been emotionally that could have been causing the compulsive eating.  That's a good place to start.  I've seen girls (in particular) who have come to the hospital with "anxiety attacks" horribly stomach cramps, or other symptoms, who are in fact having difficulty with their new level of maturity.  Often they are at an age where they are being expected to look a certain way, or they have more social pressure to have certain friends, they are being pressured with drugs or alcohol or to start going to parties, or they are being pressured by boyfriends to go beyond just holding hands.  Look deep into who her friends are, what she's doing with them, who she's interested in dating, what's going on at school.  Also, eating disorders rarely happen in a vacuum...look to see who else may be going through the same things (a sibling, friends, teammates).  This sounds like a real emotional thing to me.  

As for the eating disorder treatment, it sounds as if it was not what she needed.  Don't beat yourself up though, it's great you sought help.  I'm just not sure it's the exact thing that was right for her.  It sounds like she is eating compulsively and emotionally.  A program that gets eating disorder patients to eat is most often concerned with calorie dense foods and eating regularly.  It sounds like getting enough calories and not starving herself wasn't the issue.  She needs help with the reasons for bingeing and hoarding, not withholding food.  Also, with disordered eating and emotional eating, the purpose is partially to gain some kind of control in one's life.  A program that does not allow any give and take when it comes to eating sounds counter-intuitive.  I've even seen some kids getting help for eating disorders come to me and complain that they didn't feel like they had enough food choices or any say in what was on the menu.  Now, for a kid seeking some kind of control, does that sound good?

So, perhaps a different treatment plan.  I'm not sure if you've involved your family doctor, but that's a good resource to start.  Also, I'm not sure what the resources are like in your community but a good psychotherapist with experience in eating disorders would be the best place to start.  I also think that will do the most good.  If your daughter just don't click with the first one, give it time but keep looking until you find someone who your daughter really connects with.  I'm not sure what sort of therapist her "continuing care therapist" is, but someone with specific training this will help.

When it comes to the non-discussion about weight between you and her or her care providers, I feel it's really a disservice many practitioners do.  We are all afraid of throwing someone into a full-fledged eating disorder because we've heard stories about people overbearing parents made food a preoccupation and pushed them over the edge.  Well, here are the stats: people getting pushed over the edge into an eating disorder by parents making food an issue is about 1%.  Overweight kids who will risk heart disease, increased cancer risks, diabetes, and other diseases, not to mention all of the emotional issues that come with being overweight make up about half of our kids.  The risks of being overweight are much greater and real.  I suspect the patients who blame their parents for their eating disorders during therapy sessions have parents who are very controlling in other ways as well.  I believe it is those issues that is at the heart of the problem.

That's not to say you are to blame...that is to say, for some, feeling out of control is partially the reason for their eating disorder.  That is also to say, be more afraid of the weight issue than the reasons for tip-toeing around the situation.

You can help her activity by hiring a soccer coach to do some one-on-one coaching with her.  or, go to the local health club or rec center and get a personal trainer (one who has experience with kids) and have a few sessions.  it will help make the machines there less intimidating and get her moving.  If she likes other activities, push those.  I always say to find something you like to do and the fitness will just follow.  If you enslave yourself to counting calories, watching the clock or seeing what the heartrate monitor says, you'll find that it feels like work.  But if you enjoy playing soccer, riding your bike through the neighborhood, going to a park, chasing siblings or friends through the house playing tag with NERF darts, then you'll do it because it's fun.  I knew a girl who was over weight and tried a bunch of diets but nothing worked.  She eventually started loosing weight for no apparent reason.  Finally, it was discovered that she had gotten a new dog and was walking him 2-3 times per day.  She and her dog were great friends and went on these longs walks, not even realizing that it was exercise!  I knew of another kid who was overweight and wanted to start jogging, but was too embarrassed to have people see him.  His parents would follow him as he jogged at night so he could use the cover of darkness while he got into shape.  He eventually made his running route include a popular afterschool hangout and main street because he was so proud of his progress.


You can also encourage her by having her help with the grocery shopping and/or cooking.  Prepare meals together and help her make healthy choices.  Or, have her be the cook for a meal each week.  So often we're afraid to make food a preoccupation when it comes to eating disorders.  But, let me ask you:  if I told you to make a huge life change with your finances, or your job, or your home, and then said not to think about it...not to have the steps you're taking be a big part of your life, could you do it?  No, that would be ridiculous.  but we tell patients that all the time.  Don't be preoccupied by food but we're going to see a nutritionist and then your therapist, and then we're going to fix a healthy meal, and we want you to get better when it comes to eating but don't think about food.

So, my approach is to get deep into the life change, own it, take responsibility for the goals she sets and the progress she will eventually make, realize it will take a long time and a lot of commitment and that she will fall down (a lot) but that she'll get going again.  That will require getting ahold of the reasons for the eating behavior and replacing it with something else and having a sense of control over her life and her health

I feel like I've touched on a lot of different issues here.  Please let me know if you need more information or have additional questions.

---------- FOLLOW-UP ----------

QUESTION: do you have any contacts or recommendations (for therapists and/or nutritionists) in the Chicagoland area?  Our current therapist has eating disorder experience and we like her, but she does not want to address the weight issue.

Regards  

Answer
I'm sorry that I do not have any contacts there.  I know what your current therapist is thinking: if you make weight gain an issue she'll go the other way and turn into an anorexic and many bring up issues like that in therapy, however, it is impossible to confront the emotions and psychology behind the hoarding food and binge eating without addressing why she eats and hoards.  I feel that there are some real psychological issues there...not just behavioral.

Many healthcare practitioners do not like to bring up food or weight even though it is killing millions of people in our society.  if patients had issues with drinking, drugs or risky behavior they wouldn't hesitate.  But, try to get them to confront weight...I've known patients who have been over 300lbs for 50 years and have never had a doctor or therapist say "hey, you're overweight.  Let's do something about this because it is controlling your life!"

Of course you want to approach it tactfully and at the right time but the reasons for bingeing and hoarding (and eventual weight gain and low  self esteem) need to be discussed.