Expert: Ryan Hale - 8/10/2009

Question
QUESTION: What lifestyle questions should one ask to assist you in identifying a suspected anorexic, in order to identify possible major lifestyle problems?

ANSWER: Rozel- Eating disorders can be complicated because they are reflections of many things going on in someone's life.  There is the eating issue, there is the health and medical issue, there are issues with the need for proper nutrition and then there is the psychological aspects that often include family, school, depression, sociological factors, and the need for control of one's life.  Let's take them one by one:

The anorexic often develops medical problems secondary to malnutrition.  They can have hair and skin that is brittle or "dull" looking because there are not the proper nutrients in the diet which help maintain body tissues.  They can have very poor bone density because the body is using the calcium that has been stored in the bones due to the fact they they aren't consuming any calcium.  Often they suffer from hormone and reproductive problems because the body senses that it is in starvation mode and doesn't want to allow conception to take place.  There is also the very dangerous situation of electrolyte imbalance.  This is what someone usually dies from when they starve to death because there is not the necessary nutrients for proper nerve impulse transmission, especially for the heart.  

The psychological piece is important as well.  Anorexia has the highest rate of suicide of any mental disorder.  Eating disorders are very serious issues.  The typical profile goes something like this:  one parent is very perfectionistic, with high expectations, and somewhat demanding.  Often, they are the "helicopter" parent always hovering around their child to make sure they are doing everything right or are doing what they are supposed to.  They are highly involved with their child.  The other parent is often somewhat emotionally unavailable.  Usually present, but a little hard to approach or difficult to get close to.  There is often the impression in the community that the family is picture perfect and image is important to the family.  There is also often a history of depression or alcoholism within the family, and the anorexic will often have depression as well.  Sometimes there is also a history of abuse, especially sexual in the anorexics' past.

Society also plays a big role with the images the media portrays as what is considered beautiful.  The images it sends daily are only a contributor to what is already going on in the anorexic's life and their need for more control in their lives.

An anorexic will often be very, very interested in food, to the point that they may be the family meal planner, shopper, or cook, but they usually never partake or find excuses why they can't.  They may complain of stomach aches (we don't expect someone to eat if they have a stomach ache right)?  They may be constantly cold due to a lack of body fat to insulate them.  This may lead to wearing layered cloths or baggy cloths wearing; to keep them warm and to hide their this appearance.  They may be getting social support from friends or teammates to be super thin as well.  

The key to all of this, is that they are doing it to change the way they FEEL.  The feeling of depravation is preferred to the out of control feeling they have in their lives, feelings of depression, or feelings they might have if they have been abused, and they refuse to maintain a normal body weight.

Hopefully i answered your questions, please let me know if there is anything else I can do.

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

QUESTION: I've got two more questions - basically the same question, but related to 2 different scenarios:

1 - 10 year old obese boy
2 - 65 year old male who was previously very active (sport and work) and is feeling depressed of late


Answer
Rozel- the 10 year old boy who is obese is part of a growing number of children who are dangerously overweight.  First, eating habits start early so he needs to be forming good ones right now.  At 10 it's not too later but much after 10 we start to form habits, personality traits, etc that last for the rest of our lives.  Second, obesity cannot exist in an environment that does not support it... that is to say that if he is not given access to "bad" food or too much food, he cannot continue to be obese.  Someone else is buying food right?  Someone is making food choices in the family right?  Once he gets much older, he will be able to buy his own food and make his own food choices so it is important to modify his environment now while it is still out of his control for the most part.  Third, exercise is so important.  Often physical education in schools is not that physical and not very educational, so we can't depend on it alone to be of much use.  He needs to find something he enjoys and do it for activity.  Any activity counts as exercise as long as you are moving the body: in-line skating, Frisbee, soccer, dancing, playing tag.  One of the best stories I heard was of a young girl who could not lose weight. her parents had taken her to doctors and nutritionists and nothing worked.  One day, they got her a dog she had always been wanting and told her that she had to walk it for 20 minutes 3-4 times per day.  She loved taking the dog on walks so much that soon the 20 minutes would turn into 30 and then 40 and sometimes she'd be gone all afternoon after school with the dog.  The weight started melting off and nobody could figure out why.  Finally, they realized that she was walking over an hour per day!

As for the 65 year old, our bodies go through so many changes as we get older.  Even at 65 which is not that old, our hormone levels are different, we may also start to see the world a little differently as we have more days behind us than in front of us, and often we start to lose those around us whom we are closest with.  Depression is very under-treated in the older populations.  Also, testosterone has gone down.  That hormone is one of the things that make you feel on top of the world when your are 19 or 20... you have a ton of it then.  So, the 65 year old should see a physician who specializes in treating older adults to see if he needs treatment for depression or hormone replacement therapy.  I cannot possibly know from just the email, but those are possible situations.

Ryan