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Eating disorders have been around for a very long time, but they have skyrocketed in recent years. A recent report from the Centers for Disease Control and Prevention found that emergency room visits for mental health issues have increased at an alarming rate for kids aged 5 and up just since 2020. This is not just for anxiety and depression, but it seems that eating disorders are also increasing, especially among teen girls.
Why Eating Disorders are Increasing in Children

Why? Researchers who are studying the trends think that lack of structure in the daily routines of teens, emotional distress, and even fluctuations in whether families had food available or not, all contributed to the increase.

Eating disorders can develop at any time, but we see it most often in teens and more likely to be girls than boys. The National Eating Disorders Association reports that the rate of eating disorders has risen by 119% in kids under 12 just in the last few years, and anorexia is now the third most common chronic illness in teens only behind asthma and obesity.

Kids who are predisposed to anxiety, such as having a strong family history of anxiety or depression, seem to be more prone to eating disorders. Some clinical studies by psychologists also indicate that teens who spend more time on social media may be more at risk because they can exacerbate poor body image and constantly bombard kids with diet trends, and those can trigger eating disorders.

Teens with eating disorders often compare their bodies to peers and can feel bad about themselves if they don't have what they believe to be the perfect body.
How to Know if Your Child Has an Eating Disorder

So what are some signs to look out for if you think that your child may be at risk for an eating disorder? Well, look for behavioral changes. Kids, when they are struggling with body image issues, will often isolate themselves, withdrawal from social activities or seem overly sad or angry.

Some big behavior changes that parents should watch out for according to the National Alliance for Eating Disorders is hiding food, eating in secret, starting a new diet, obsessing over physical activity, or going to the bathroom every time after eating a meal.
Next Steps if You Think Your Child Has an Eating Disorder

The first step, if you think your child might have an eating disorder, is to make an appointment with your child's pediatrician. We can check their height, weight, and body mass index and look for any alarming trends. If there are concerns, we can do labs and possibly an EKG.

If the labs and EKG are reassuring, then the next step is to get a psychiatrist involved. If the labs or EKG are not okay, then your child may be admitted to the hospital to medically stabilize them while they start working on treatment options for their eating disorder.

A psychiatrist needs to be involved because these are brain-based illnesses with biological, psychological, and social components, not just something your child chooses to do usually.

Parents need to educate themselves too. Some good resources are the National Eating Disorder Association, Project HEAL, and the National Association of Anorexia Nervosa and Associated Disorders, also FEAST.

Your child needs their feelings and struggles supported, and with the stigma of shame around eating disorders that can make the problem worse. This is a disease that affects entire families. There is help out there. Your pediatrician is the first place to start. But be aware this is not something your pediatrician will manage. It involves a lot of therapy and work with a mental health provider.

Dr. Gellner: If your child has been diagnosed with an eating disorder, you will need to know how your child's health will be affected. I'll tell you what you need to know on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering The Healthy Kid's Zone, with Dr. Cindy Gellner on The Scope.

Dr. Gellner: No one is really sure what causes eating disorders, but they are very real problems and they show up usually when kids are between ages 13 to 17 years old. And this is when there's a lot of physical and emotional changes, not to mention academic and peer pressures. Athletes and dancers are particularly vulnerable to eating disorders as they try to maintain a certain weight.

Eating disorders are serious medical illnesses. They often go along with other problems, such as stress, anxiety, depression, and substance use. Eating disorders can lead to the development of serious physical health problems. The body goes into starvation mode when someone has anorexia. This causes hair loss, periods may stop in girls, soft hair called lanugo can grow all over the skin (it's the same kind of soft hair that's seen on newborn babies), teens may have concentration problems, anemia, and brittle bones.

For a person with bulimia, the constant vomiting and lack of certain nutrients can cause damage to the stomach and kidneys. Tooth decay, especially on the molars, from recurrent exposure to stomach acids, can happen too. And so can swollen cheeks from the salivary glands permanently expanding from throwing up so often. They can have loss of periods in girls and loss of potassium, which can lead to heart problems and even death.

It's not only a teen's physical health that will be affected. It's their mental health as well. Kids that become so obsessed with their weight, monitoring their food intake and exercise, it's so hard to focus on anything else. They're in a constant state of stress about food and what their body looks like. They start withdrawing from friends and family, and their whole world starts to fall apart.

Eating disorders can be treated, but the process is long and hard. Counseling is a very important part of getting better. Doctors, mental health professionals, and dietitians will all be involved. The first step to recovery, though, is for a teen to reach out to someone they trust. If they're not ready to talk to a parent, they may reach out to a friend or a teacher. Remember that eating disorders are very common among teens, and support from those they trust most will be needed to help them survive.

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Dr. Gellner: Eating disorders are quite common, but they're sort of a taboo subject to talk about with teens. How can parents recognize the signs of an eating disorder in their teen? I'll help you figure that out on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: First, I need to define just what an eating disorder is. Eating disorders aren't picky eaters or teens trying to change their eating habits or exercise daily to become more healthy. Eating disorders are extremes in how teens think about food, eating, and being active to the point where it becomes all-consuming.

One or 2 out of every 100 teens in America will struggle with an eating disorder. Every year, thousands of teens start down the path of having an eating disorder because of how they perceive their bodies. The most common eating disorders are anorexia and bulimia.

Teens with anorexia have a true fear of weight gain and a distorted view of their body. They think they are overweight, when, in fact, they can be dangerously underweight. They eat very little and exercise excessively. Counting calories becomes almost an obsession as they try to eat as little as possible.

Bulimia is similar to anorexia in that calorie restriction is the main goal. But these teens may eat and eat and then try to compensate by throwing up or exercising all the time to prevent gaining any weight. This is different from having a day where you pig out and then work extra hard at the gym the next day. For someone to be diagnosed with bulimia, they need to be doing this regularly at least once a month.

For several months, bulimics often eat large amounts of food in secret, even taking food out of the trash to eat it. They feel powerless to stop eating until they are so full and then they will go vomit everything back up. Some bulimics use excessive amounts of laxatives to make everything go right through them so the calories don't stick.

Although anorexia and bulimia are very similar, teens with anorexia are usually very thin, but those with bulimia may be normal or even overweight. Teens who have these conditions often have intense fear that they are or will become fat even though they are normal-sized.

There are some signs to look for in someone who has a true eating disorder. Anorexics may look very frail, be obsessed with weight and portion control, and only eat certain foods and not because of a medical issue like a food allergy. They also may exercise excessively. And they may also water load, which is where they drink a lot of water before going to a doctor's appointment so they seem heavier than they are when they're weighed.

Bulimics will make excuses to go to the bathroom right after eating, regularly buy laxatives, only eat diet foods unless they're binging, and spend most of their time working out.

Both anorexics and bulimics often withdraw from social activities which involve food. These are tough diseases to diagnose and treat. If you think your teen may have an eating disorder, talk to your child's pediatrician to investigate further.

Announcer: Have a question about a medical procedure, want to learn more about a health condition, with over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Jones: There are some conditions that are more common in women, medical problems that can lead to problems with oral health. Today we're going to talk about eating behaviors and eating disorders and oral health in women on The Scope.

Announcer: Covering all aspects of women's health. This is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Well, I have a disclosure here on The Scope. My mother's pregnancy with me was diagnosed by a dentist. My mother was a dental hygienist, had perfect oral health, she brushed and flossed, and her teeth got all puffy and they bled. The dentist that she went to see said, "Oh, madam. I think it's not me that you should be seeing, but my partner down the hall who's the obstetrician." She didn't even know she was pregnant.

There are conditions more common in women in pregnancy, and today we're talking about eating disorders, which are more common in women that can change oral health. In the studio today, we have Dr. Lea Erickson, who's the Associate Dean for Student Life at our dental school. She has been an expert on the consequences of eating disorders in primarily women because women have more eating disorders than men, and their oral health. Welcome to the studio, Dr. Erickson.

Dr. Erickson: Thank you for the invitation.

Dr. Jones: So let's talk a little bit about eating disorders in women. I think of eating disorders in two forms, which are sometimes combined. There's anorexia where people just don't eat, and then there's bulimia where women make themselves throw up, and sometimes women have both. Can you talk about anorexia and oral health?

Dr. Erickson: So there aren't really any clearly defined links between oral health and anorexia in the absence of bulimia. It's logical to assume that the lack of adequate intake is going to have an impact on the quality . . . I mean, we know it has an impact on the quality of the bone and certainly it's reasonable to assume that it has an impact on the quality of the bone that's supporting the teeth. There's really no long-term evidence showing that.

Dr. Jones: But sometimes women, when they have an eating disorder, eat certain kinds of foods exclusively. So they'll eat more sour things or they may choose to drink more sodas that are sugar-free and not so much other things. Are there any kinds of foods that might be habitually used in people who are trying to decrease their calories that might be bad for your mouth?

Dr. Erickson: So all of the sugar-free sodas, all the diet sodas, really any fruit that's highly acidic, vegetables that are acidic are going to dissolve tooth structure. So potentially, those who have such a limited diet that their diet coke all day long, diet soda all day long are probably dissolving tooth structure.

Dr. Jones: Right. Well, in women with eating disorders, bulimia or forced vomiting is actually often associated with anorexia, and there are people who don't lose a lot of weight but have bulimia alone. Let's talk about forced vomiting and how that might affect oral health.

Dr. Erickson: The acid in the stomach that they're vomiting is constantly bathing the teeth and will dissolve the enamel and ultimately the dentin. So the teeth will become thinner and thinner from usually on the pallet side and these eventually dissolve away.

Dr. Jones: The pallet side, meaning on the inside where the tongue is . . .

Dr. Erickson: Correct.

Dr. Jones: . . . or sort of like that. Well, how about the way people make themselves throw up? Some women can just make themselves throw up by thinking about it. But quite often, young women are sticking their fingers down their throat. Does that affect their oral health?

Dr. Erickson: Sticking the fingers down the throat probably doesn't affect the oral health, although there can be some scarring on the pallet from it. Very often there's scarring on the fingers where the teeth are impacting them.

Dr. Jones: Oh, okay. Well, the other thing is that women who have bulimia are not often forthcoming about their problem. They're addicted to their vomiting. They realize that they have a problem. But they're often not telling either their parents, their family, their friends and certainly not their dentist. What might be the first sign that someone might have this problem?

Dr. Erickson: Very often, the dentist is going to be the first one to see evidence of this and it will be the thinning of the teeth. Usually the upper front teeth on the inside, they'll become thinner. The enamel will dissolve away. The teeth will become shortened. So really, the dentist can play an important role in identifying the problem.

Dr. Jones: I think the issue for women who are suffering with bulimia is recognizing that this is a disease. There are medical interventions that can help, as well as psychological interventions, and there are consequences whether or not it has to do with weight loss or whether women are just vomiting to try to maintain their weight. But there are significant consequences to their health and their oral health.

Dr. Erickson: The consequences can be phenomenal. I saw cases where the teeth were literally dissolved almost to the gum line.

Dr. Jones: Oh, no.

Dr. Erickson: So a disease that started with a teenager who wanted to be a cheerleader and so she started vomiting in an attempt to control her weight, and as you mentioned it is an addiction and continued until literally the teeth were short and black in the front. So devastating effects.

Dr. Jones: It's devastating, particularly for a young woman whose self-image was already in jeopardy leading to the efforts to maintain her weight and becoming bulimic, and now having a lifelong teeth presentation problem.

Dr. Erickson: Yeah. Then, she really does have a lifelong dental disability as a result of the bulimia.

Dr. Jones: When we're talking about bulimics, I think about something that starts young as kind of a fad. Girls do it together. You're talking about long-term effects on the teeth. Is this something that you might see if a young woman goes through kind of a fad stage where she's bulimic for maybe six months or a year? Or is this something, the kinds of changes that you've described, do they take a really long time?

Dr. Erickson: We're not going to see this, usually, until somebody's been vomiting, usually multiple times a day for a significant period of time.

Dr. Jones: Does that mean a year? Or how long is a significant period of time?

Dr. Erickson: The patients that I saw that had a substantial amount of damage had, most of them, been vomiting four or five times a day for seven to 10 years.

Dr. Jones: Right. Being honest and helping your clinician take the best care of you and your dentist take the best care of you is going to help you, if you suffer from these issues, when you finally recover, have the mouth that you want when this is all over.

Dr. Erickson: And certainly, talking with your dentist frankly and asking your dentist to help you find the resources to get the help that you need.

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Interviewer: People with eating disorders experience severe disturbance in their eating patterns. It's important to remember that eating disorders are mental illnesses and the physical effects are the symptoms. That's coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Three percent of Americans suffer from binge eating disorder. We're talking with Dr. Jason Hunziker, a psychiatrist at the University of Utah. Dr. Hunziker, what mental conditions can cause an eating disorder?

Dr. Jason Hunziker: There are lots of mental illnesses that are associated with eating disruption or eating disorder for different reasons. An example would be somebody with schizophrenia gets very paranoid often, so they won't eat their food because they're afraid it's been poisoned. We have other people who are so anxious about allergies in food that they just won't eat, so they have a specific phobia about certain foods. Some recent studies have shown that people with bipolar disorder and/or depression also struggle with eating disorder of a different type in which they binge eat.

Interviewer: First of all, what is binge eating?

Dr. Jason Hunziker: Binge eating is when you're going along fine and you eat normal foods, then you have an episode in which you just can't get enough food. You binge on whatever's in front of you. Most often it's not stuff that's good for you.

Interviewer: Always.

Dr. Jason Hunziker: You eat lots of it. Then, you eat to the point that you almost feel like you're going to burst. That leads to some people then going in and purging and getting rid of the food that they just ate.

Interviewer: So, it's different than, say, on a Saturday night I'm in front of a movie and I'm eating everything that's in my kitchen. That's different. It's those people that do that but then feel guilty, and then they throw up afterwards. Is that correct?

Dr. Jason Hunziker: That's correct. Usually, with binge eating there is a number of times you need to participate in that event before it even gets classified as a binge eating disorder. That has to be several times a week or month. Then, you qualify for a binge eating disorder.

Interviewer: What exactly causes someone mentally to think okay, I need to throw up? Because when I eat too much and I'm full I just wait for the food to settle down.

Dr. Jason Hunziker: Not everybody does throw up when they have the binge eating. What they'll do, though, is they use that food as some way to help comfort them for whatever's going on in their life. Often, as I said, it is associated with depression. When people are sad and they're down they...

Interviewer: They eat.

Dr. Jason Hunziker: ...feel like eating. And, the same with bipolar disorder - when you're sad and you're down, you eat. That somehow gives them some comfort, while at the same time it induces shame, and guilt, and other aspects of well, now I'm gaining weight, and now I'm not thin. It's a vicious cycle for them.

Interviewer: We obviously know that we classify binge eating as an eating disorder which is a mental illness. What other physical health conditions can it cause?

Dr. Jason Hunziker: It depends on how long this goes. Clearly, binge eating is going to increase your weight. As your weight increases we know that affects all aspects of your body including your lungs, and your heart, and then the cardiovascular system and other physiologic effects that it can bring on. Type-2 diabetes in this country now is really expanding because of the obesity problem, and this would be another way to contribute to that problem.

Interviewer: That's interesting. There are all these sorts of more severe diseases that can come from just binge eating.

Dr. Jason Hunziker: That's correct.

Interviewer: Obviously, you know that's going to happen. You want to treat it. Is it something that you physically and emotionally are maybe aware of, or do you need somebody to tell you I think there's a problem you need to go see a specialist?

Dr. Jason Hunziker: I think that some people are aware and some aren't. I think if it's associated with your mood disorder that would be a time to get into your doctor and get on some medication for your depression, which often will help take care of those binge eating episodes. Sometimes the medication itself will help take care of that compulsion or drive to eat which some people just have. They just feel compelled to do it and they can't feel good unless they do it. Then, they feel bad after they do it. It's a really vicious cycle. The medicine often will help with that.
There are good therapies that can help with eating disorder as well. It's really important to understand the underlying cause, and if it's caused by another illness to make sure that you treat that illness so that you can then treat the binge eating.

Interviewer: Any final thoughts on binge eating?

Dr. Jason Hunziker: I think that the important thing to do is for the patients and/or their families to recognize that the binge eating is a disruption to them, and that they get into talk to their doctor as soon as possible about what could be done to help them...

Interviewer: Because it can be treated.

Dr. Jason Hunziker: ...because it can be treated.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.

Interviewer: Thirty million Americans suffer from eating disorders at some time in their life, and those are only the reported cases. But what identifies an eating disorder and why do people suffer from them to begin with? Could you have an eating disorder and not be aware of it? Ask today on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier, healthier life. You're listening to The Scope.
We're with Dr. Nick Galli, Assistant Professor of Department of Health Promotions and Education. There are so many types of eating disorders; you hear it all the time, but what is it?

Dr. Nick Galli: There are actually four major types of eating disorders identified in the DSM, the Diagnostic Statistical Manual, which a new version just came out, so the standards are changing.
The two classic eating disorders that most people know about and think of are anorexia nervosa and bulimia nervosa. In either case the underlying theme is being dissatisfied with one's body weight, and making an attempt to in some way or another control the diet. Anorexia without going into every single diagnostic criteria, one of the big indicators is extremely low body weight, and intense fear of gaining weight. Those are kind of the two hallmarks, and the person may look to restrict their food intake.
Bulimia nervosa is characterized by binging, so eating a high quantity of calories and purging those calories in one way or another. So that's the characteristic of bulimia. Individuals with bulimia may be a normal weight. And then binging disorder is the binging without the purging.

Interviewer: Okay.

Dr. Nick Galli: And then there are criteria regarding the amount of time the person has been exhibiting certain symptoms.

Interviewer: So with all these different signs and symptoms of these eating disorders, it almost sounds like it's just I don't like food. And so in a way could some people have eating disorders and not know that they have an eating disorder? Or is it just an illness that you just know you have?

Dr. Nick Galli: I don't know that it's that simple. I'm sure there are people who might be diagnosed as having an eating disorder who don't know; maybe they don't have very great self awareness; or maybe they've just been living like this for awhile. There may be people who know there's something not quite right going on with the way they feel; it's possible. That's why we rely on people to help us recognize that there's something going on, because sometimes you get into a habit of how you live your life.

Interviewer: Exactly.

Dr. Nick Galli: And maybe if you're surrounding yourself with people who also have these dysfunctional eating patterns I would say it is quite possible that someone could at least be eating dysfunctionally and having disordered eating and maybe not a full blown clinical eating disorder.

Interviewer: What factors into someone developing an eating disorder? Does age play into all this, physical form?

Dr. Nick Galli: Yes, we've sort of identified different clusters of factors that contribute to an eating disorder. You mentioned age; I wouldn't say that age is a contributing factor, but we do tend to see the age of onset as around that adolescent period.

Interviewer: Someone who needs to find myself age?

Dr. Nick Galli: Exactly, but we're also seeing eating disorders linger into adulthood, and even in adults developing eating disorders it's less about age and more about sort of this inner play of the person and their environment. So personality does play into it; also who you are surrounded with. Did you have parents who modeled dysfunctional eating? Was your mom or dad always on a diet? That plays into it. Biological factors; they are still trying, and they think there might be something there, in a level of the brain.

Interviewer: So it's not just somebody just looking at a cover magazine and saying I want to look like that, the cover of the magazine?

Dr. Nick Galli: Well it's probably an interaction of where we see people who might be predisposed because of their personality and their genetics and what not. If they're exposed to these images of men and women in the media, it might be more likely to feel the urge to have to look like that. As any psychological issue it's usually not just one thing.

Interviewer: So how do you prevent then that bad eating habit into becoming an eating disorder? Is there that line, is there a gray line or is there kind of like I know this is...

Dr. Nick Galli: I'd say there's a gray line. If someone who's a typical college student is a good example, as they tend to maybe be not eat as many meals as they should, or they pack them all into one meal. We consider that disordered eating.

Interviewer: Okay. So I could have an eating disorder and wouldn't even know it.

Dr. Nick Galli: Maybe not an eating disorder but maybe you have a disordered eating pattern.

Interviewer: Bad eating habits.

Dr. Nick Galli: Yes. Maybe not developing into a full blown eating disorder, because maybe you've got some other good things going on in your life. Maybe you don't necessarily feel bad about your body, you just don't have the greatest eating patterns; the same with a lot of us are like that. We don't eat when we should, and the different nutrients that we should.

Interviewer: Do you see many cases where, like you said the typical college student, do you see that transitioning into an eating disorder?

Dr. Nick Galli: It could.

Interviewer: It could, okay.

Dr. Nick Galli: It could with some people, but not with all people.

Interviewer: Okay.

Dr. Nick Galli: They'll have multiple identities, you know, don't define yourself by how you look. So I think it's important for parents, and of course you want your parents to be on the lookout for signs, but even in the younger children you want to set the stage. You want to be proactive in helping your kids have a healthy self esteem and not define themselves based on how they look.

Announcer: We're your daily dose of science, conversation, medicine. This is the Scope; University of Utah Health Sciences Radio.

Interviewer: You've just recovered from an eating disorder. Life is good and you're getting healthier. The question is can relapse happen? And what might trigger it? We're talking about the steps to take after you've recovered from an eating disorder today on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier, healthier life. You're listening to The Scope.

Interviewer: We're talking to Dr. Nick Galli, assistant professor of the Department of Health Promotion and Education about the steps you take after recovering from an eating disorder. Dr Galli what are the steps? Can relapse happen?

Dr. Nick Galli: Relapse can certainly happen and I think if you talk to most people who have fully recovered from an eating disorder they would probably say that they had lapses certainly. You know I think a couple of things to keep in mind almost always there's a lapse. And I think the first rule is be ready for that to happen. And know that it's going to happen. And don't judge yourself based on that happening. Have a support system in place, going back to the support systems. Someone that you can call when it happens. And know that just because you have a lapse that doesn't mean that you have to fully relapse back into an eating disorder.
We call that the abstinence violation effect. When somebody is on a course of behavior and then has a slip up. Maybe if it's someone with an eating disorder they binge one time. And using that as an excuse to, "Well I can't do this. I give up." The best thing you can do for yourself is have a plan going in. Okay I know what are the situations that trigger me. Is it being around my mom when she makes comments about dieting and weight and size? Is it watching a certain program on TV? Is it looking at a certain magazine? Is it a certain website?

Host: Avoid those triggers.

Dr. Nick Galli: Plan one is avoid it. But maybe it's the holidays; you've got to be around Mom. What's my coping plan? When I feel a certain way, what am I going to do?

Interviewer: When you are aware of the problem and you want to treat it because you treated it already, you've been through this already, do you think it's harder the second time to go through the treatments?

Dr. Nick Galli: I have not had an eating disorder myself so I can't specifically speak to that. I know that there are people that are in and out of treatment their whole lives. I don't think it's ever easy. Whether it's the first time or the second time. And then there are people who went through treatment once and they never had to go back.

Interviewer: Are there different maybe levels of seriousness that are involved in these treatments to maybe help the patient not relapse again? Or is it just kind of each patient is different?

Dr. Nick Galli: I would say each person is different. There are different levels of severity. What you also have to think about is most of the time eating disorders co-occur with other psychological disorders, depression, anxiety. So making sure that the persons getting the treatment they need for those as well. And often times that will involved a combination of medication and therapy. I've known several people with an eating disorder and I mean an eating disorder is an eating disorder to an extent. But it's so personal so that makes treatment somewhat personally. We have guidelines and things we know work well but in the end it has to be personalized. But sure, there are people who are for whatever reason the level of severity is much higher. And it's going to be much more difficult.

Interviewer: So on the road to recovering from an eating disorder are there certain things to look out for? Maybe certain things to do more of that will help you in successfully recovering 100%? Or can you recover 100% from an eating disorder?

Dr. Nick Galli: Yes. I believe that you can recover 100% because I know people who believe that they are. So I take it right from the source. Have a plan. Recognize your triggers, so that you can hopefully avoid those. But if you can't what is your functional response to those triggers going to be? Stick with your course of treatment. Your therapy. If there are medications involved. Adhere to what's prescribed. I would say that if there's anything to begin doing more of it's more being physically active. Playing sports. Expanding yourself. Learning to appreciate the beauty of your body not just for how it looks but for its' functionality. I mean we use exercise and physical activity in treatment as a way of, yeah it's great for health and fitness. But also as a way to get in better touch with your body and gain a greater sense of appreciation for your body. Or for other people it could be music therapy. Or it could be art. Or different ways of expressing yourself. And that's all going to be part, hopefully, of the therapeutic process.
Who are you surrounding yourself with? Are there people that really do tend to trigger you who are just so aesthetic focused? Maybe you need to not be around those people. Are there certain health clubs that have posters up that just really trigger you? Maybe you need to not go to that health club. Certainly paying attention to what bothers you. And doing more of what makes you feel good.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Interviewer: Anorexia is an eating disorder that is more common than you would think. One out of a hundred women has struggled with anorexia at some point in their life. Has anorexia associated with mental illness? We'll find out next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use. For a happier and healthier life. You're listening to The Scope.

Interviewer: We're talking with Dr. Jason Hunziker Psychiatrist at the University of Utah. Dr. Hunziker, how is anorexia related to mental illness?

Dr. Jason Hunziker: So anorexia is an eating disorder that often has fatal consequences. The disorder itself is a disorder of people who generally will restrict the intake of food to the point that it causes significant organ damage and eventually death. The way it's related to mental illness, is that often people who struggle with anorexia, have other mental illnesses that come along with that.
So as their bodies continue to decline in nutrients and muscle mass and their organs start to slow down and they're having trouble with their bowels, they start to get more and more depressed and they start to get more and more anxious. Often these patients struggle with severe anxiety around food. Their focus on food is so great that they will even buy cookbooks and they'll cook these fabulous meals for their families and their friends and not once eat any of that food.

Interviewer: Wow that's interesting.

Dr. Jason Hunziker: They'll exercise until they pass out on the treadmill, just to get thin. And that anxiety and that perfectionist behavior leads to more and more depression, more and more anxiety. Which then, ultimately sometimes, unfortunately, these patients get to the point that they want to kill themselves.

Interviewer: So bringing it back to the beginning, where does it all start? Like it's got to start from somewhere, right? In their teens...

Dr. Jason Hunziker: That's a good, that's a really good question. Often patients with anorexia have learned this from their environment. It's, there's really no good evidence of where exactly the anorexia comes from and why one person has anorexia and yet their sister doesn't. But what we do know is that there's a strong family history often in people with anorexia.
We do see this usually happen at puberty time so when people's bodies are changing and developing, we start to notice this illness getting more and more prominent. There is strong evidence of course in the teenage years that girls want to look like the other girls and they all feel like they need to be at a certain weight or certain height. And when they can't be that, they struggle and then they start adapting these maladaptive patterns of eating and exercise that eventually leads to anorexia.

Interviewer: So is it safe to say that maybe the root of the problem with anorexia comes from maybe... cultural norms?

Dr. Jason Hunziker: It comes from cultural norms, it comes from... we see it in things like ballet classes and gymnastics and cheerleading, in those environments where weight is put as a high priority. We also see it in young kids who have been very anxious their whole life. And so they worry that they're going to be different or look different or feel different, and so they change themselves or attempt to change themselves in the way they think.

Interviewer: When you see somebody with anorexia, you can kind of tell a little bit, can't you? But, are there other signs or symptoms that you kind of you look, and you might wonder.

Dr. Jason Hunziker: Things that you can find or see with that is that if you notice dramatic weight changes, if you notice that your significant other or your sibling or your girlfriend or boyfriend or whoever, is moving food around on the plate but doesn't really seem to eat it. Or is more interested in cooking these fantastic meals but you never really see them eating anything. Or right after meals, they're spending all this time in the bathroom. Or you start to notice laxative boxes in the garbage cans or those types of things, then you'll have those suspicions. They also tend to wear big baggy clothes to kind of hide their body.

Interviewer: But you're aware that you're thin, why would you want to hide it?

Dr. Jason Hunziker: Yeah that's a really good question and that's kind of the conflict is, they're not aware that they're thin. They feel like they're not thin enough.

Interviewer: What are some of the long term effects then? Because obviously we know that the short term effects is just weight and maybe depression...

Dr. Jason Hunziker: Depression, anxiety are really short term problems. But addiction becomes a problem. They'll start taking caffeine tablets and that'll advance to stimulants and then they're using all types of things to try to suppress their appetite, so that they can lose weight. Bone density problems are a big issue. They lose a lot of bone mass and they end up with fractures and broken hips at 25 years old because they just don't have the right bone structure. Heart problems because of changes in electrolyte balances. A lot of young women end up having heart attacks and other heart abnormalities because of the loss of nutrients.

Interviewer: Can this be treated?

Dr. Jason Hunziker: Definitely. The treatment is actually what they call re-feeding.

Interviewer: Okay.

Dr. Jason Hunziker: And so we have to give people the nutrition to get their brain functioning at a level that's high enough to actually engage in treatment. After you get them to the point that they're a little healthier, they have weight coming back, we do a lot of intensive therapy which has shown to be the most effective way to help people with anorexia. We examine their relationship with food and what it is about the food, and their thoughts about body and image and try to deflect away from weight, but some more focused on being healthy. How do we be healthy with who we are, and we often treat depression, that's associated with this. We treat the anxiety that's associated with this. We'll treat family issues that's clearly associated with this. So that everything is looked at as one big unit that we can focus on to help this person get well.

Interviewer: If the person doesn't want to get treated or they just don't come in for treatment, can that anorexia be something that is life threatening?

Dr. Jason Hunziker: Definitely, and that's usually the unfortunate part of this is that some people end up taking their own life because they get so despondent at the fact that they can't reach that goal that they've set for themselves, that they just get overwhelmed and end up harming themselves. Others unintentionally harm themselves by taking all those other supplements or stimulants or whatever else, that actually unintentionally overdose themselves. The bodies just shut down, unfortunately, with a lot of these patients. They end up being so malnourished that they just, is incompatible with life and their bodies just give up.

Interviewer: Any final thoughts?

Dr. Jason Hunziker: My final thought is I think we need to recognize this immediately. We need to provide support and not be accusatory or...

Interviewer: Don't be the police.

Dr. Jason Hunziker: Exactly. Don't make them guilty, don't be forcing food down, in their face because that's not going to help. Getting them to a professional, getting them to a therapist, there's eating disorder clinics available. If it's severe enough they need to be hospitalized and then start treatment. And just be understanding because this is a life long process that they're going to struggle with.

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Interviewer: How do you identify an eating disorder in someone else and what help can you offer if any at all? That's coming up next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for happier, healthier life. You're listening to The Scope.

Interviewer: You might not have an eating disorder but chances are you probably know someone who does. Everyone knows somebody who has an eating disorder. Here is Dr. Nick Galli, Assistant Professor of the Department of Health Promotion and Education. The question is how do you identify someone with an eating disorder?

Dr. Nick Galli: There are some signs that you can recognize somebody who has an eating disorder. I think one of the most important signs is how they talk about food and what their relationship is with food, if they seem to be orally preoccupied with food and eating at a certain time or eating a certain thing, or constantly seem to be trying a different diet. That could be an indication there's something going on.
Physically you might recognize someone as being severely underweight, somebody is having very dry hair, dry nails, and dry skin. In some cases people who are severely underweight might grow a fine layer of hair on their body called lanugo as a way to keep themselves warm since their body weight is so low. So there are some physical symptoms that you can recognize.
But to me it's more the behaviors. Food is a centerpiece often times for people with eating disorders, and so they might sort of put on a pedestal and make it more important than someone else might. It might affect their relationships and their social interactions. It's just something that people with eating disorders think a lot about, is food.

Interviewer: Is it more that food is bad or food is good? Or is it kind of it just depends on the person?

Dr. Nick Galli: Yes, it's definitely not food is good. It's not food doesn't tend to be something enjoyable. It's tied to the way the person feels they want to look and how do I need to eat in order to look a certain way. And here are the bad foods that I can't eat; maybe foods that have a lot of fat they might classify as bad and have very rigid rules about what food they can't eat. So I definitely wouldn't say that food is thought of as a good thing. There may be safe foods that, hey, I can eat carrot sticks and that's all I'm going to eat because it's low calorie and there's no fat.

Interviewer: So they don't really have a healthy relationship with food?

Dr. Nick Galli: No.

Interviewer: So when you see somebody like a close friend, a family, a relative, and you kind of see these signs and symptoms, how to you help them?

Dr. Nick Galli: It's a difficult thing to watch, absolutely. You can't help them. Like anything else they have to want to be helped. You can't be the police. You can't try and want to try to fix them. You approach them from a place of concern. You share your observations and what you're seeing. You ask them, how are you feeling? Are you okay? Can I help you? I'm concerned; I'm seeing you, you're not eating. You've lost a lot of weight. Your mood is fluctuating; what's going on? And if they want to engage with you in that conversation, then it's how can we get you connected with a professional, a doctor, or a dietician or somebody who specializes in this area. And how can I help you do that, because that can be a scary thing.
On the other hand if someone is defensive and isn't ready to have the conversation and then it's just, okay, well you can't force the person to have the conversation. It's I'm here if you need me, but I want you to know I am concerned and we should talk more about this, and maybe we should consider talking to a professional. But ultimately nothing gets better unless they want it to.

Interviewer: Okay.

Dr. Nick Galli: But the most important thing is presenting yourself as someone who's there, who cares and who wants to help.

Interviewer: What I'm hearing is just a lot of this just take charge, get some help for yourself. Does it really matter if someone tells you, hey, I see what's going on. Let's get you some help. Does it really matter in the final end, or is it just more of a self reflection thing?

Dr. Nick Galli: I do think that the person needs to decide for themselves, that they want to get better. But I don't think it's something that you do on your own, and that doesn't just mean you have your support of your medical team, but the friends and family are equally important in terms of just you're going to have some tough days, and having that person to talk to, to call, or that person to talk to.
It's about getting the right type of support from the right people. Friends and family aren't there to diagnose and to prescribe, but they are there to provide emotional support, whereas the doctors and the dieticians are there to give you the tools to actually work through. So I think someone would have a really hard time recovering if they didn't have any support. No matter how good their medical team is, if they didn't have support from their friends and family it's just going to make it a lot more difficult. You need somebody there.

Interviewer: A support system.

Dr. Nick Galli: Yes.

Interviewer: Any final thoughts?

Dr. Nick Galli: I would caution you from going in there with an attitude of what's wrong with you. Like I said before, don't be the police, resist that urge. Because I think that we come to that at some point where we're just like, oh, my gosh, why don't they just get it? Look at it as a complex problem and know that it's not your place to be the police. It's your place to be a supporter.

Announcer: We're your daily dose of science, conversation, medicine; this is The Scope, University of Utah Health Sciences Radio.