Integrative Pediatric and Adolescent Health: Educational Web Column

April 2009: Eating Disorders

"The doctor of the future will no longer treat the human frame with drugs, but rather will cure and prevent disease with nutrition." - Thomas Edison

"Let they food be thy medicine, and let thy medicine be food." - Hippocrates

Our bodies come in a wide variety of shapes and sizes. Most of this variety is an example of a healthy range of our unique qualities as human beings. Sometimes, however, how we see our bodies in our minds, or how we think about food, interferes with a healthy relationship with eating. Most of us have times when we wonder about our bodies and ask ourselves whether we could be healthier in some way. These are normal feelings. But in the extreme, anorexia, binge eating patterns, bulimia, or over-eating can threaten our health and well-being. For the person struggling with these issues the severity of the problem is not often clear to them in the moment.

Our most recent speaker for the Pritzker Lecture Series was Dr. Carolyn Ross, a nationally-recognized expert in eating disorders. She has written and taught extensively about an integrative approach to helping children and families address disordered eating patterns. In her talk, Dr. Ross noted some sobering statistics: 7 million women and 1 million men have an eating disorder, and 35% of the population is obese. Eating disorders are particularly devastating because they are so often associated with depression, anxiety disorders, and substance use.

Recognizing the Signs of an Eating Disorder
How do we know when natural periods of self-doubt or body-image questions have become pervasive enough to be harmful? Physicians and mental health professionals often use specific criteria for the diagnosis of disordered eating patterns. Excessive pre-occupation with weight and/or body image, excessive weight gain or loss, and unrealistic notions of body weight or shape each raises concern.

If you think you, or a family member, may have an eating disorder, you can ask yourself a series of questions. These may be questions you ask yourself, or information you gather from casual conversation with a family member*:

How many diets have you been on in the past year?
Do you think you should be dieting?
Are you dissatisfied with your body size?
Does your weight affect the way you think about yourself?

A positive response to any of these questions should be addressed with your doctor.

Getting Help and Treatment
There are a number a ways to seek help for teenagers struggling with eating disorders. At UCSF, our Adolescent Medicine team has experts in eating disorders, including Dr. Sara Buckelew who runs a number of clinics in the Bay Area. Because of the nature of eating disorders and their dangers, treatment should be taken seriously. A multidisciplinary team approach is most likely to be of greatest benefit. Many complementary medicine techniques can be helpful, such as mind-body approaches, acupuncture, art therapy, and others, but none alone is adequate or safe. This is a time for an truly integrative approach. Get your primary care provider involved. Have them help coordinate specialty referrals when appropriate, and keep them informed about complementary approaches you are interested in or are already trying. An integrative and well-coordinated approach to eating disorders is most beneficial.

What You Can do at Home
Prevention and wellness care are important tenants of integrative medicine. One of the best ways to establish a healthy relationship with food before problems arise is for the family to set the tone of the relationship early on. Talk with your children about healthy food and healthy habits. Eat at least one meal a day together as a family, because associating food with positive social engagements establishes a healthy and positive tone with meals. Encourage children to try and to enjoy a range of foods. Teach them that bodies come in all different shapes and sizes, not just the ones we see in the media around us.

References
*Information from Anstine D, Grinenko D. Rapid screening for disordered eating in college-aged females in the primary care setting. J Adolesc Health 2000;26:338-42.

Resources (courtesy Dr. Sara Buckelew)
http://www.something-fishy.org/ Dedicated to raising awareness and providing support to people with Eating Disorders, and their loved-ones

http://www.feast-ed.org/ is an organization of and for parents and caregivers to help loved ones recover from eating disorders

http://www.aedweb.org/ The Academy for Eating Disorders is a global professional association committed to leadership in eating disorders research, education, treatment, and prevention.

http://www.nationaleatingdisorders.org/ non profit organization directed at supporting individuals struggling with eating disorders and their families and providers.

http://www.aptedsf.com/ This website lists local (greater bay area) available resources, such as therapists, psychiatrists, MDs who have a particular self proclaimed interest in the treatment of eating disorders.

http://knol.google.com/k/sara-buckelew/anorexia-nervosa/3695bxw3f9mgj/2#
http://knol.google.com/k/sara-buckelew/bulimia-nervosa/3695bxw3f9mgj/3#
Links to detailed medical descriptions of these conditions, their causes, diagnosis, and treatment plans. Written by Dr. Buckelew.

Neumark-Sztainer Dianne. I’m Like So Fat: Helping your teen make healthy choices about eating and exercise in a weight obsessed world. Guilford Press, New York, 2005

About the Column

This column presents an integrative medicine view on a range of topics relevant to children, teens and early adolescents including: nutrition, herbs & supplements, mind-body and self-regulation skills, and general health and wellness.

If you’re new to the concept of integrative medicine, take a few minutes to browse the UCSF Osher Center web site, particularly the page what is integrative medicine?

Broadly speaking, integrative medicine is practicing good medicine. It is an approach to a child’s health that:

places illness in the context of the child, rather than the child in the context of illness;
takes into account family and environmental factors;
neither rejects conventional medicine nor accepts complementary or alternative medicine (CAM) uncritically.

Integrative pediatric consultations are available at the Osher Center with Kevin Barrows, MD, Rick McKinney, MD, and Priscilla Abercrombie, RN, NP, PhD, AHN-BC. To make an appointment, please call the main clinic line at 415.353.7720.

David Becker, MD, MPH is an Assistant Clinical Professor in the Department of Pediatrics at the University of California, San Francisco, and Affiliate Faculty at the Osher Center for Integrative Medicine at UCSF. He is starting the Pediatric Integrative Pain Clinic in July 2008. This is a referral-based service for children and adolescents with chronic pain. For questions about referrals, please contact the main Mt. Zion Pediatric number: 415.885.7478.

In addition, we offer two healthy parenting stress reduction classes: Mind in Labor and Mindfulness-Based Childbirth and Parenting.