Disordered eating is a whole-health issue
State of disordered eating
Eating disorders are defined as biologically influenced medical illnesses marked by severe disturbances to an individual’s eating behaviors. People who experience eating disorders become fixated or obsessed with weight loss, body weight or shape, and controlling their food intake. Disordered eating has become such a common societal problem that 9% of the U.S. population will have an eating disorder in their lifetime . This issue is especially prevalent among youth, as 22% of children and adolescents worldwide show disordered eating .
“Eating disorders are a disruption in normal eating patterns and an individual’s ability to maintain a healthy diet,” says Ashok Shimoji-Krishnan, MD, Behavioral Health Medical Director, Wellpoint, a Carelon partner company. “Individuals experiencing eating disorders encounter an altered pattern of eating, unhealthy behaviors, body image, food choices, dieting, and weight management.”
“Individuals who experience eating disorders are avoidant and restrictive in their food intake,” says Jennifer Hailey, DO, Medical Director, Carelon. “Disordered eating stems from anxiety around food and body image.”
Types of eating disorders
Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating, and avoidant restrictive food intake.
Anorexia nervosa
Individuals experiencing anorexia nervosa avoid food, severely restricting their food intake, or eat very small quantities of certain foods. They may weigh themselves repeatedly, or see themselves as overweight, even when they are dangerously underweight.
Bulimia nervosa
Bulimia nervosa is a condition in which people experience recurrent, frequent episodes of binge eating, consuming unusually large amounts of food, feeling a lack of control over their eating. Individuals follow this binge eating with compensating behavior such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviors.
Binge eating
When individuals experience binge eating, they lose control over their food intake, enduring reoccurring episodes of eating unusually large amounts of food. Unlike with bulimia nervosa, people do not follow binge eating with purging, excessive exercise, or fasting. As a result, people experiencing binge eating disorder are often overweight or obese.
Avoidant restrictive food intake disorder (ARFID)
ARFID is a condition in which people limit the amount or type of food eaten. Unlike anorexia nervosa, people experiencing ARFID do not have a distorted body image or extreme fear of gaining weight.
The impact of disordered eating
Effect on physical health
“The impact that eating disorders have on an individual’s physical health is extreme ,” says Dr. Hailey. “In anorexia, the muscles lose mass, and in bulimia, the body becomes chronically depleted of fluid, causing an extreme electrolytes imbalance.”
“The longer it takes for an individual to seek treatment, the more difficult it becomes to treat the physical symptoms,” says Dr. Shimoji-Krishnan. “The body changes, enduring chemical imbalances, causing significant damage.”
Effect on mental health
Eating disorders can significantly impact mental health , as the physical strain that eating disorders cause can lead to anxiety and depressive mood disorders. Individuals who experience eating disorders may develop severe feelings of isolation, or suicidal ideation.
“Individuals who experience eating disorders often feel intense guilt and shame,” says Dr. Hailey. “They may also withdraw from activities and relationships, retreating into isolation.”
Causes and risk factors
Eating disorders may stem from several risk factors, such as biological, psychological, genetic, or societal influences. “The causes behind eating disorders vary widely,” says Dr. Hailey. “They can include unhealthy social dynamics, feelings of perfectionism, or severe anxiety.”
Addressing eating disorders with early intervention
Early intervention has a significant impact on patient outcomes, typically affecting the patient’s long-term prognosis. Early intervention for eating disorders is defined as the detection of illness at the earliest possible point, followed by initiating stage‐specific, tailored, or targeted evidence‐based treatment.
“Anorexia has high mortality rate , so early intervention and treatment provides an individual their best chance of resetting patterns and thinking,” says Dr. Hailey. “People experiencing disordered eating have a fixed belief system that is difficult to treat once the beliefs have set in, which affects their whole health. Disordered eating is a whole health issue.”
An individual’s support system also plays a vital part in their recovery. “Kids and teens often have the advantage of a family system involved, helping them to change their environment. They typically have more hands to help support,” says Dr. Shimoji-Krishnan. “This is one of the reasons why early intervention is so important. The earlier providers can intervene with treatment, the more likely providers are to help change the individual’s thinking. The longer the individual waits to seek treatment, the slower their recovery.”
Screening for disordered eating
Primary care providers can screen for eating disorders in their patients by monitoring and assessing risk factors and symptoms during primary care visits. Providers can look for changes in height, weight, BMI, and vital signs, performing a thorough medical and psychological eating disorder assessment, if appropriate. The provider can then refer the patient to eating disorder specialists, while continuing to work with the patient as part of an integrated, whole-health care team.
Trends in treatment for eating disorders
Treatment for eating disorders typically involves an interdisciplinary approach , depending on the severity of the disorder. Tactics may include cognitive behavioral therapy, psychotherapy, and dialectical behavioral therapy.
“The Maudsley method of treatment is effective for some individuals,” says Dr. Hailey. The Maudsley Approach, also known as Family Based Treatment (FBT) , is a leading evidence-based treatment for adolescents experiencing eating disorders. The method’s main approach is that the family is best suited to help the teen overcome the eating disorder, in phases. “Maudsley provides good education on symptoms and emphasizes ongoing family support.”
“Targeting specific eating disorders with different tactics is becoming more nuanced. We are using technology to leverage care, especially telebehavioral health to supplement the individual’s therapy. Peer networks can be useful, if they have the proper oversight and screening, so that the individual’s treatment progresses appropriately,” says Dr. Shimoji-Krishnan.
Treating eating disorders is a whole-health issue
Dr. Hailey emphasizes that integrated healthcare is vital in treating disordered eating. “While all mental health disorders need integrated care, integrated care is especially important in treating eating disorders. EDs have underlying mental health conditions that affect the disorder directly.”
Dr. Shimoji-Krishnan also believes that disordered eating is a whole-health issue. “To effectively treat EDs, we need true integration among all providers on the patient’s care team, communicating with one another to be successful, touching on all aspects of the individual’s life,” he says. “Patients may relapse, as disordered eating is how they cope with stress. They may need periodic intervention from time to time. Treating and managing eating disorders is a lifelong process, like treating addiction.”
How Carelon Behavioral Health is addressing disordered eating
Carelon is addressing disordered eating by building alliances with the right partners. “One of our priorities is to contract with as many eating disorder centers as possible. Our goal is to provide a comprehensive ED treatment solution network to our members,” says Dr. Shimoji-Krishnan. “We are also working on promoting better educational opportunities on the latest in ED treatments for our clinical teams and building a network that supports that.”
