The Time is Now

It's NEDA week, which means everyone who specializes in eating disorders or who participates in ED advocacy and awareness is ramping up on socials. Yes, this includes me. We all need a reason to find renewed motivation sometimes and even simple things like this can provide said motivation.

I've spent the day thinking about the theme for NEDA week this year: "The Time is Now." It means so many things. The time to recover is now. The time for advocacy is now. The time for healthcare providers to be properly educated in-depth on EDs is now. The time to stop body-shaming is now.

I could stand on my soap box for an hour talking about the failure of educators and textbook authors. Many of my peers with similar educational backgrounds to my own did not learn about eating disorders until after completing their education. I had the privilege of hearing one lecture and reading one chapter on the subject during my undergraduate degree. The reality is that this needs to be an entire course. Eating disorders are a leading cause of death among mental illnesses, surpassed only by opioid use. And until the last couple years, eating disorders were actually the leading cause. If more psychotherapist and more doctors were properly informed about eating disorders and they knew how to assess for them, maybe fewer people would die from them. Early intervention is crucial in these illnesses, however many are not detected until late in the game or after one's health has been severely harmed. It's a travesty that our society is so uninformed and our healthcare system has failed so many.

Since I came to the topic, let's focus for a moment on eating disorder-caused deaths. Eating disorders can cause death both directly and indirectly. They kill 10,200 people every year; that's 1 person dying from their ED every 52 minutes. Depending on the ED, having one of these conditions can cause an increased risk of suicide by 2-9 times the rates of those without EDs. Just think about that. An individual with anorexia or bulimia is up 800% more likely to attempt suicide. There is research showing that certain nutritional deficiencies increase suicidality. We also know that isolation and loneliness, and feelings of worthlessness all contribute to suicidality. What is as well known is that these are factors that play a massive role in most eating disorders. Trying to find worth through changing one's body, or numbing emotions through binging, restricting purging. Eating disorders are lonely and loneliness kills.

Dissemination is vital. Providers need to be educated. Doctors need to move away from weight loss as a prescription because "fat" is not a diagnosis. Health comes in all different shapes and sizes. If you have a doctor try to prescribe weight loss, please advocate for yourself and for every person who comes after you. I recently told a provider that I would not be taking any steps for intentional weight loss after she made this recommendation for helping to manage my PCOS. I told her exactly what I do for a living and informed her of my past ED and she immediately understood why weight loss medication would not be an option and I firmly believe she will never bring it up again. It's not always a battle with providers. Yes, some will challenge you and I've encountered that plenty myself, but in the end, they knew where I stood and they were pushed to be better doctors. One of my favorite lines when a provider requires a medical intervention based solely on my weight is to ask, "Could you give me an actual medical reason for needing this?" Unfortunately, they are not always able to do so and that speaks volumes about their competence, or lack thereof. Please, take my experiences and use them to motivate you to get the care you deserve!

And if you're a doctor, please read up. Learn about Health at Every Size. Question what you've been taught. Do the research and look beyond the surface with your patients. Thinness does not equate to health. Weight loss, especially at a highly rapid rate, can have dire consequences. Know your patients. Spend more than 5 minutes in the room. Answer their questions and look at all the contributing factors.

If you work in the mental health field, you need to be able to differentiate between overeating/undereating as a symptom of another disorder, such as depression or anxiety, and an eating disorder.

You need to learn how to properly administer the EDE-Q, the EDI, the SCOFF. We should have been taught to use these in grad school, but unfortunately, eating disorders are not prioritized in our education. However, that does not relieve you of the responsibility of gaining competence. At the very least, you need to be able to identify an eating disorder so that you are able to refer a client to someone who understands how to treat eating disorders. You need to learn about the harms of diet culture, and change your own language around food, bodies and exercise so that you aren't unknowingly encouraging your clients to engage in their disorder. You need to know that eating disorders are unlike any other disorder, while also incorporating symptoms of other disorders.

Eating disorders exist as a means of coping with life, much like self-harm. They are powerful and consuming, and clients will cling to their eating disorder for dear life. They can be compulsive. Clients will feel the need to eat or exercise perfectly, with rigid certainty that they are doing the right thing. Treatment resistance reaches a whole new level when you work with eating disorders. And if the client is an adolescent, parents may be complicit with the resistance. If you want to treat eating disorders, you have to be able to sit with clients through their urges.

You have to maintain firm boundaries. Eating disorders are sneaky and devising, and they will do everything they can to get you on their side. But no matter what, you have to remain on the side of your client's healthy self. You have to encourage and push them. You have to always be on your client's side, even when they aren't. It's tough. It's highly specialized. And if you want to join these ranks, you must seek out every resource to increase your competence.