An eating disorder is a disease, not a decision

Restaurants, dinner parties, celebrity chefs and food television networks; eating is a way of life. Other than we ate too much, or we didn’t eat enough, most of us don’t give it a second thought.

Of the approximate 30 million Americans (9.4 percent of the population) that are affected with the disease of Eating Disorder (E.D.), as many as 5.2 percent will die as a result of their disease. It is one of the most often misdiagnosed or completely missed diseases in medicine today.

Just to clarify, the majority of the general population and surprisingly, the majority of physicians and other health care professionals don’t know that it is a disease, either.

In the United States, approximately 20 million women and 10 million men are victims of eating disorders, including anorexia, bulimia, binge eating disorder, or other specified feeding or eating disorder (OSFED). E.D. is specifically classified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). It also has been assigned a variety of diagnostic codes.

Multiple studies have discovered that people suffering from the disease of E.D. actually have genetic coding and predisposition for the eating disorder and that it is closely associated with the gene of addiction. There is an intensified dopamine reward response with E.D., just as there is in addiction.

Also just like the disease of addiction, the disease of E.D. must be “triggered” or “switched on” within the individual in order to become active. Anorexia, bulimia, or any of the other eating disorders develop as the person’s response and coping mechanism to some type of underlying issue. It may be depression, relationship problems, physical, mental or sexual abuse, lack of positive self-image or lack of self-esteem, bullying or many other things.

Often the victim is unable to change the situation they are in, so they use their control of food (which no one can make them eat or not eat) to pacify and comfort themselves. The persistence of this food control further comforts the patient resulting in a ritual or routine, including extreme exercise, obsessive calorie counting, cutting food so small it is almost non-existent, etc., that is so satisfying and euphoric (E.D. triggered) that if not caught and intercepted becomes a path of lifelong devastation potentially ending in death.

In anorexia for example, the victim’s “euphoria” from not eating becomes their primary mission. The underlying issue that started the entire cycle is persistent, but no longer important to the victim, thus “dealing with their problem”; Much as an addict or alcoholic uses substances to “take away and cover-up their psychological pain and make it go away”.

The majority of patients with excessive weight loss or weight gain frequently present to the physician’s office with somatic complaints and sleeping problems. It can be viewed as “politically incorrect” to question adolescents, young adults, or anyone for that matter about why they look so thin and why they are losing so much weight. Many physicians and other health care providers may not bring it up or include it in their discussion with the patient, particularly young adolescents so as to not hurt feelings or make the patient feel inadequate.

This is a huge mistake that as physicians we need to become more aware of. It is our often times early questioning and intervention with these sensitive topics, particularly in the adolescent or young adult age group that can prevent the patient from triggering the full blown eating disorder.

By asking about excessive weight loss or weight gain, unusual changes in dentition (acid from purging classically erodes teeth), we can investigate all potential causes such as thyroid, diabetes, cancer, and malabsorption but most importantly we can initiate the conversation that will hopefully put the patient at ease with us and help us expose any underlying problems that the patient is crying out for help.

As an educator of medical students and our future physicians at Touro University Nevada College of Osteopathic Medicine, I have made it a priority to integrate the disease of eating disorder and how to recognize the early signs and symptoms of it into our medical school curriculum. It is important that we stress to students the all too common initial presenting symptoms of patients that may be developing an eating disorder and the ability to recognize it. They must feel confident initiating conversation about weight rather than ignoring it and shying away from it. By focusing particular attention on adolescents and young adults that present to a physician’s office with recurring somatic complaints, stomach aches, and sleeping problems, I hope to train our future physicians in early recognition and intervention to help control this devastating disease.

Ronald Hedger, D.O. is associate dean/director of the Center of Professional Practice Simulation and Associate Professor Family Medicine at the College of Osteopathic Medicine at Touro University Nevada.

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