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- Dr. Monique Jericho is a psychiatrist and the medical director of the eating disorder program at Alberta Health Services in Calgary.
- Shelley Ugyan is a Vancouver eating disorder and emotional eating health coach and the author of Food Freedom. Ugyan has recovered from a long-term eating disorder.
- Kyla Fox is an eating disorder therapist and founder of The Kyla Fox Recovery Centre in Toronto, the first eating disorder treatment centre of its kind in the city. Fox suffered with, and recovered from, anorexia and an overexercising disorder.
How many canadians experience eating disorders? What is the impact?
Dr. Jericho: Among women, rates of anorexia are about 0.5 percent. Bulimia is around one percent. These numbers represent people who meet the diagnostic criteria but not those who are struggling with eating issues whose symptoms don't quite fit the same criteria. People with eating disorders are often weak, cold and lacking energy. EDs impact every organ system in the body and can cause fatal heart attacks.
Ugyan: It's starting young. Eighty-one percent of 10-year-olds are afraid of becoming fat. Almost 50 percent of people with an ED meet the criteria for depression.
Fox: Eating disorders have the highest mortality rate of any mental health issue. People think of the most extreme case, anorexia, but most who suffer with eating disorders appear to be physically "normal"—you wouldn't even know.
What are red flags to watch for?
Dr. Jericho: I become concerned any time I hear someone is becoming increasingly rigid with their diet.
Ugyan: If you've been on a diet for most of your life and you're always looking for the next fix. If you're anxious about food, shape or weight even some of the time, this isn't a good sign. Turning to food for any reason other than nourishment might be a sign of a problematic eater.
Fox: Common signs could be changes in mood; changes in social behaviour, such as isolating or an inability to easily adapt to change; and changes with food, like eliminating things from the diet, eating in private or being rigid (such as wanting to eat specific things at specific times).
What does treatment look like?
Dr. Jericho: It involves support from a care team that often includes a psychotherapist, a nutritionist and a physician who helps stabilize the patient medically and assists in the resumption of normalized eating patterns. Treatment allows for insight into the role the ED plays in one's life. Very often, that means exploring issues around self-esteem and perfectionism, as well as identifying and managing emotions.
Ugyan: The person has to make a decision to stop the quick fix. I try to help people change the black-and-white thinking behind their behaviour, such as all sugar is bad and if they eat one cookie, they'll binge on the whole box. The overeating happens with what I call highway hypnosis, which is that feeling of arriving at your destination without knowing how you got there. It comes down to being conscious.
Fox: Treatment is a very individual process that requires a long-term commitment, patience, a readiness to get well and the willingness to be honest about oneself. As part of the various intensive clinical therapies we offer to get to the root of the illness, narrative work can be helpful. We take the eating disorder and separate it from the person. When a person has an illness, they think they're the illness; separating the two creates space for that person to fight, to see themselves outside of the illness. We combine this work with holistic healing practices to manage the food and body symptoms. Some of these practices include holistic nutrition, naturopathic medicine, acupuncture, supervised mealtimes and yoga.
Orthorexia is a disputed "new" eating disorder. Why?
Dr. Jericho: Orthorexia is a rigid adherence to specific, often restrictive dietary rules to promote physical health and well-being. Some believe this problem is so pervasive that it merits status as a separate mental health disorder, while others see it as an aspect of conditions such as anorexia nervosa or obsessive-compulsive disorder. It's controversial because our society places a high value on apparent self-control. Those who are scrupulous with their intake are often seen as virtuous rather than obsessive or ill.
Are trends such as gluten-free diets, veganism, juice cleanses and alkaline diets worrisome?
Dr. Jericho: They can become extreme and may result in medical problems. People may explore these diets because they hope to control their health and longevity. Very few women have the time or ability to determine whether claims made about extreme diets or food types are accurate, making them vulnerable to extreme and sometimes harmful eating habits. In some cases, though, as with celiac disease, people do require an extreme diet.
How do you recommend anyone rein in potentially dangerous food obsessions?
Dr. Jericho: It starts with awareness. When you're not able to be flexible with your food intake, you are not in control. When you start to avoid social situations involving food, or you find it difficult to be adaptable with your eating, it's time to look at the "food rules" that are preventing you from living your life. Then, make an effort to engage in social eating and expose yourself to different foods. Challenge yourself to eat in restaurants. Ask for support from friends or family members. Try not to fall into the trap of avoiding normal social experiences related to food. And most importantly, seek the help of a professional.
Ugyan: For many, it's getting on a regular pattern of eating. That usually looks like three meals a day, plus snacks. If you're a problematic eater, don't do the detoxes or the cleanses and don't skip meals.
Fox: Test yourself. Try things you're not comfortable with. Notice what happens when you move away from certain patterns you have with food or your body. What feelings come up for you? The work of living without an eating disorder requires looking inward and challenging the limits the disorder has placed on your relationship with food, with yourself and with others. This is the stuff I call "boxes in the basement"; the work in recovery is opening up those boxes, facing what's inside them, then finally clearing them out of your basement.
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This story was originally part of "Making Friends with Food" in the October 2015 issue. Subscribe to Canadian Living today and never miss an issue!