By Dr. Juanaelena Garcia, Medical Director, Horizon Blue Cross Blue Shield of New Jersey

About 30 million Americans have had an eating disorder at some point in their lives. Roughly half of the girls between the ages of 6 and 12 in America say that they have concerns about their weight or becoming too fat, and nearly one in five women experience an eating disorder by age 40.

But it is not just women who are at risk. From 1999 to 2009, the number of men hospitalized for an eating disorder-related cause increased by 53%.

Society’s apparent worship of thinness makes it the best-known environmental contributor to the development of eating disorders. But reading magazines or watching movies that glorify certain body shapes is hardly the only reason behind a person’s unhealthy focus on weight and food.

A range of genetic, biological, behavioral, psychological and social factors can lead someone to develop an eating disorder – which is characterized by dangerous eating behaviors that make this mental illness among the deadliest, second only to opioid overdose.

How can you tell when a loved one’s eating behaviors indicate a potentially fatal condition? Here’s an overview of common eating disorders and how to get help.

How eating disorders develop

Many eating disorders start during the teen years or young adulthood. While rates of these conditions are higher among women than men, it’s important to know that men can suffer from distorted body images too.

Signs and symptoms of eating disorders can include:

• Frequent dieting
• Binge eating
• Chronic weight fluctuations
• Rigid or excessive exercise routine
• Obsessive calorie counting
• Purging (by using diet pills or laxatives or self-induced vomiting)
• Anxiety about certain foods, or feelings of guilt and shame associated with eating
• Self-worth highly dependent on body shape and weight

When these behaviors become frequent and severe, a person can be diagnosed with a full-blown eating disorder. The three most common eating disorders are:

• Anorexia nervosa: People restrict the number of calories and the types of food they eat, sometimes using extreme measures like excessive exercise or vomiting after eating because they see themselves as overweight even when they’re underweight.
• Bulimia nervosa: People have recurring episodes of eating large amounts of food (bingeing), followed by efforts to rid themselves of extra calories through unhealthy means (purging), such as vomiting or using laxatives.
• Binge eating disorder: People lose control over their eating and regularly eat too much, even when they’re uncomfortably full or not hungry. Binge eating disorder is the most common eating disorder in the U.S.

It’s not always possible to know if someone has an eating disorder just by looking at them. You may think that people with eating disorders appear thin or emaciated, but, in reality, people with eating disorders come in all body shapes and sizes.

Getting treatment – and learning to develop healthy behaviors

Early treatment for eating disorders, especially life-threatening cases, is critical. People with eating disorders can develop heart and brain damage, blood pressure problems and even organ failure. They also often have other mental health conditions such as depression or obsessive-compulsive disorder and are at greater risk of suicide and substance use disorder.

While eating disorders can take a long time to treat, recovery and remission are possible. Treatment typically involves psychiatrists, psychologists or counselors, dieticians and primary care providers (PCPs). Pediatricians and PCPs have the first opportunity to notice the signs of eating disorders, especially in teenagers. Unfortunately, physicians who have not been trained to recognize the signs and symptoms of eating disorders may overlook them.

People with eating disorders need to unlearn the behaviors that have contributed to their eating disorder, understand the psychological problems underlying their disorder, and then learn new coping skills and develop a healthy relationship with food. This can be accomplished through nutritionist-led meal planning and psychotherapy.

Family-based therapy is another important component of eating disorder recovery. Family and friends can provide important support for someone in early recovery. Oftentimes, because eating disorders are diseases that involve hiding things, lying and deceiving the people closest to them, family and friends need help re-establishing a trusting relationship with a person who has the eating disorder.

There is no medication that can cure eating disorders. However, certain medications, such as antidepressants or mood stabilizers, can help with underlying anxiety or depression.

It’s important to find therapists and doctors who specialize in eating disorder treatment. Horizon Blue Cross Blue Shield of New Jersey members can always contact us for a referral. In addition, you can find a behavioral health professional or check out our guide to accessing mental health resources during the pandemic.

While a qualified health professional should treat people with eating disorders, there are strategies parents can use to help children develop healthy eating behaviors:

• Avoid dieting or speaking about dieting around your child to encourage them to eat a wide variety of foods in moderation.
• Reinforce healthy body image by talking to your child about social depictions of thinness and beauty and reassuring them that varying body shapes should be accepted and respected.
• Work with your child's doctor to identify any risky eating behaviors early on and encourage your child to ask questions about their appearance.