Understanding Anorexia Nervosa

In the world of misunderstood health conditions, few have a worse track record of misinformation than anorexia nervosa.
By Julianne Hale
Anorexia nervosa is defined by MEDA (Multiservice Eating Disorder Association) as, “a disorder in which preoccupation with dieting and thinness leads to excessive weight loss.” The symptoms of individuals with anorexia nervosa are listed by WebMD.com as:
• Weighs much less than is healthy or normal
• Is very afraid of gaining weight
• Refuses to stay at a normal weight
• Thinks they are overweight even when they are very thin
While many are inclined to brush off these symptoms as silly or passing, they should be taken very seriously. No one knows this better than Jan Robinson, Chairman of the Board of the Mary Cameron Robinson (MCR) Foundation for the Prevention of Eating Disorders. Jan watched her daughter, Mary Cameron Robinson (Cammy), fight three eating disorders for fourteen years, losing her battle in September of 2005 at age 26. Jan cautions parents and friends of people plagued with eating disorders not to run away from the problem. She explains, “Don’t ignore it. Take it seriously. It is not a diet. Just to say get over it is not enough. If secretive behavior becomes evident to you, you need to seek help immediately from an outside source.”
Since secrecy is part of the disorder, the friends and family of an anorexic person are at a distinct disadvantage. How can they ensure that the person gets help before the disorder takes hold?
Shelli Yoder, M.S., M. Div., Executive Director of the Eating Disorders Coalition of Tennessee (EDCT), gives some behavioral red flags for which loved ones of a possible anorexic can look:
• Skipping meals
• Making excuses for not eating
• Eating only a few certain “safe” foods, usually those low in fat and calories
• Adopting rigid meal or eating rituals, such as cutting food into tiny pieces or spitting food out after chewing
• Weighing food
• Cooking elaborate meals for others but refusing to eat
• Repeated weighing of themselves
• Frequent checking in the mirror for perceived flaws
• Wearing baggy or layered clothing
• Complaining about being fat
A profile of an anorexic is difficult, if not impossible, to create. There are, however, some specific personality types and interest groups that put people at a higher risk for the disorder. Yoder says, “Ballet dancers, gymnasts, athletes, perfectionists, and over-achievers are all at risk for anorexia. Research also suggests that a genetic predisposition to anorexia may run in families. If a girl has a sibling with anorexia, she is 10 to 20 times more likely than the general population to develop anorexia herself. Brain chemistry appears to play a significant role. People with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, and decreased levels of serotonin and norepinephrine, which are associated with feelings of well-being.”
When the typical American thinks of someone with an eating disorder like anorexia nervosa, the image of a teenage girl or young woman usually comes to mind. This is a common misconception and is not an accurate portrayal of this complex disorder. Pam Kelle, a Registered Dietician and nutrition therapist who works closely with patients in Solace and Focus, two eating disorder treatment programs in Chattanooga, cautions against trying to label what the typical anorexic person would look like. She explains, “I see more women over the age of thirty with eating disorders right now than I have ever seen before.” Kelle attributes this to the current culture and how difficult it is for women in our society to accept the natural aging process. This recent rise in the cases of middle-aged women with anorexia has been dubbed “The Desperate Housewives Effect” by some members of the media because today’s women are trying to emulate the ultra-thin cast of the popular television show.
Getting a diagnosis of anorexia nervosa is not a simple task. Yoder explains, “Diagnosing anorexia nervosa is a complex process, made more difficult by the anorexic’s refusal to accept that he or she has a problem. To the anorexic, the need for weight loss is normal, so only rarely will an anorexic voluntarily seek medical help. In some cases, the diagnosis begins when a concerned family member insists the anorexic seek medical help. Often the family has only become concerned after severe weight loss, making anorexia easier to diagnose but more difficult to treat.”
The process of this disorder and the secrecy and denial involved make it quite challenging to detect, diagnose, and treat. Catching the behavior early is one key to success. Once the disease has taken hold, it is much more difficult and time-consuming to treat. Treatment of anorexia is much more complicated than a simple change in eating habits. Yoder elaborates, “Anorexia is treatable. With the right treatment team, people with anorexia can and do get better. They can regain their health, learn to eat normally again, and develop healthier attitudes about food and their bodies. Since anorexia involves both mind and body, a team approach is often best. Those who may be involved in anorexia treatment include medical doctors, mental health professionals, and dieticians. The participation and support of family members also makes a big difference in anorexia treatment success.”
Treatment of anorexia must be viewed as an ongoing process. Kelle states, “Recovery takes time. It depends on the individual and their desire to get well. Lapses are common but do not mean the person has relapsed back into the disorder. It is not a willpower disease. It is not really about food. However, it manifests in food-related behavior that can be life threatening. A dietitian who specializes in eating disorders should be part of the treatment team to help stabilize the patient and help her or him in the recovery process while they are in therapy.”
A great resource for Chattanooga residents who struggle with anorexia nervosa, as well as for their loved ones, is the MCR Foundation. The organization is located on McCallie Avenue and strives to serve the entire Chattanooga community and surrounding areas. Jan Robinson describes the mission of the organization she founded to honor her daughter’s memory: “I hope to bring awareness and education to the Chattanooga area and beyond. I want eating disorders to come out of the closet, so to speak, for people to talk about them, to be aware. The MCR Foundation is focused on prevention, and we want to start young. We are hoping to get into the minds of third graders and start teaching them positive body image. We want to teach kids critical thinking about looking at magazines and ads and let them know that these images are neither real nor attainable. We want parents and children to get into a dialogue about the media and let children know early on what the reality is.”
Robinson and many other Chattanoogans whose lives have been affected by eating disorders will honor Cammy’s memory in the third annual “Walk for Cammy’s Cause” on August 30, 2008, at the Tennessee Riverpark. For more information or to participate, visit the Foundation’s website at www.MCRFoundation.com.