# Eating disorders and EMS



## bigbaldguy (Apr 12, 2012)

A recent post here has brought up some discussions about body image. I've had several discussions with several members lately about body image and attitudes toward people who don't fit the "perfect body" stereotype. I suggested that one of our members who has experience with eating disorders put together an informational post on it. They didn't feel comfortable posting it themselves so I'm posting it on their behalf. I urge you to read this post as it has some excellent info in it. Some of the info in it might shock you. This is both something we may deal with when treating a patient and something we may run into in our family and coworkers.

Eating Disorder PSA
Do you know someone with an eating disorder? You probably do, but you don't even know it.


Here are some facts about eating disorders:

    An estimated 7 million women and 1 million men suffer from eating disorders in America alone.

    Of those, only 1 in 10 will seek treatment.

    Inpatient treatment costs, on average, $30,000 per month. Treatment time ranges anywhere from 3-6 months.

    Outpatient treatment costs, on average, $100,000 per year.

    With treatment, only about 60% of sufferers recover, 20% make partial recoveries and 20% make no improvement.

    20% of those who do not receive treatment will die from complications of their eating disorder.

    Anorexia has the highest premature mortality rate of any psychiatric disorder, and is the leading cause of death in women 15 to 24 years old.

    The leading cause of death in those who suffer from eating disorders is suicide, the second leading cause of death is heart failure.



Society places heavy emphasis on physical beauty and often associates physical beauty with thinness. This creates a dangerous mentality, often leaving those who suffer with eating disorders feeling that if they gain weight, the will be unloved and that it is better to be dead than to be overweight.


Thinspo/Thinspiration/Pro Ana/Pro Mia are becoming internet epidemics, cluttering the pages of Facebook, Tumblr, Pintrest and other social media sites. Thinspiration refers to phrases and pictures used to motivate those who suffer with eating disorders. Pro Ana/Pro Mia sites are places where people with eating disorders go to find like minded people who are proud of their eating disorders.


A few very disturbing examples of these sites: 


http://manianofood.xanga.com/

http://proanalifestyle.blogspot.com/...ot-to-eat.html

http://youhavetoeatlesstoweighless.t...com/ProAnaTips

http://www.whyeat.net/

http://www.skinnygossip.com/category/thinspo/

*Signs and Symptoms of Eating Disorders You May Encounter As A Health Care Professional:*

Menstrual Irregularities

Hair Thinning and Loss

Preoccupation with calories and food

Dry skin, brittle hair and nails.

Edema, especially in the hands, feet and abdomen

Calloused or bruised fingers

Easily bruised

Ketoacidosis

Complaints of fatigue, nausea, weakness, dizziness

Abnormal blood glucose readings.

Muscle atrophy

Lanugo (http://en.wikipedia.org/wiki/Lanugo)


So what does this mean for you as a health care provider?

*Possible Complications to Keep in Mind When You're Treating a Patient:*

Esophageal reflux

Decrease in gastric motility

Esophageal ulcers

Peptic ulcers

Paralysis

Mallory-Weiss tear 
(http://en.wikipedia.org/wiki/Mallory–Weiss_syndrome)

Gastric Rupture

GI Bleeding

Electrolyte Imbalances

Heart Failure

Kidney Failure

Liver Failure

Polycystic Ovarian Syndrome

Osteoporosis

Dehydration

Refeeding Syndrome (http://en.wikipedia.org/wiki/Refeeding_syndrome)

Swollen glands

Sallow complexion

Tooth decay/tooth loss

Severe halitosis

Syncope




Resources if you suspect someone you know is suffering an eating disorder.


www.ANRED.com
http://www.something-fishy.org/
http://www.nationaleatingdisorders.org/


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## EpiEMS (Apr 12, 2012)

That is some truly frightening stuff.


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## Aidey (Apr 12, 2012)

I'm not trying to be a pain in the arse, but binge eating disorder is also a recognized eating disorder, and that isn't addressed here at all. Frankly, the list of negative affects from being overweight is even longer. I'm going to get a little preachy here, but NEITHER END OF THE FARKING SPECTRUM IS HEALTHY!!!!


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## Anjel (Apr 12, 2012)

When people are made to feel so bad about themselves, and have to read and hear how people are disgusted to even look at them. This is what happens.

You don't have to be attracted to everyone you see, but you don't need to be disgusted either. 

It is so very sad to see what some people resort to, to cope.


And Aidey is right. Binge eating is an eating disorder as well. Are there treatment programs for that as well?


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## Aidey (Apr 13, 2012)

The psychology behind eating disorders is much more complicated than that.* For a huge percent of anorexic and bulimic pts it starts off as a control thing, and it goes downhill from there. Eventually they become addicted their own neurotransmitters, displaying patterns very similar to those addicted to cocaine and meth (see dopamine and reward center of the brain for more info). That is part of the reason why so many continue to lose weight even after they start suffering serious health problems. Seeing the scale go down, or fitting into a certain clothing item provides a type of high. 

Obviously different people develop EDs for different reasons. Models, ballerinas, jockeys and wrestlers come to mind as people whose environment and weight restrictions instigate the disease rather than an internal psychological issue. 

As far as I know there are treatment programs for BED but they aren't as common as those for other EDs. There has been resistance to mixing them in with anorexic and bulimic pts because of issues of them triggering each other and whatnot. 

* Sorry, this is a pet peeve of mine. I hate the excuse that society shouldn't encourage people to be a healthy weight because it will cause eating disorders. There is definitely a right way and wrong way to do that encouraging, and the wrong way can be very psychologically unhealthy. But the overall idea is inaccurate.


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## Anjel (Apr 13, 2012)

I understand that isn't the only reason. I should of clarified. But society doesn't need to treat fat people like they are disgusting either.


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## Aidey (Apr 13, 2012)

Everyone should be treated with respect, but that obviously doesn't happen, and not just in regards to fat people. 

Want to know something interesting? I get more harassment now than when I weighed 100lbs more. I learned very quickly I could not talk about what size I am, how I eat or how I workout without being accused of being anti fat people. I posted some after pictures on FB and the next day several female friends liked pages like "real women have curves" and stuff like that. I have friends who post all sorts of stuff about how size 6 or lower is unhealthy, bad, not feminine etc. It is really depressing. I love being healthy, and I feel like I can't talk about it at all because it will hurt someone's feelings and make them feel bad about themselves. 

There is a model named Crystal Renn. She started out super small and developed anorexia, then gained a bunch of weight and started plus size modeling at a size 14. Recently she lost enough weight to be a size 6. She looked good, although lacking muscle. She said she was eating way more food than she wanted to just to maintain her weight, and she got sick of it. 

She was slaughtered online. Women called for a boycott of her because she betrayed "real" women and all sorts of other insane things. It was downright scary how hateful people were towards her. 

People have got to understand that it isn't just about looks, but health too. There is such a strong movement to accept everyone for exactly how they are that we(society) can't talk about how being overweight is bad for you because it is seen as being discriminatory against fat people.


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## Anjel (Apr 13, 2012)

Very good point. 

I am overweight. But I am healthy. Not one health problem. Not even HTN. But I know that could change as things catch up to me. And I know this is not the norm.

I really don't care how someone looks as long as they are healthy.

Those suffering from eating disorders need help. Plain and simple. It's sad that it cost so much money to get the help you need. Instead of standing around and judging everyone. There should be programs in place to help those who can't afford fancy tx resorts. 

There is a toll free suicide hotline, and free community mental health programs. Are the resources for those suffering from eating disorders?


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## medichopeful (Apr 13, 2012)

bigbaldguy said:


> http://www.whyeat.net/



Excellent post.  I know a few people who deal with eating disorders unfortunately, and it's truly a sad thing. 

That being said, I think this website is actually for people trying to get OVER eating disorders, not trying to continue them.  I could be wrong, but that's what I got when I took a glance at it!


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## bigbaldguy (Apr 13, 2012)

medichopeful said:


> Excellent post.  I know a few people who deal with eating disorders unfortunately, and it's truly a sad thing.
> 
> That being said, I think this website is actually for people trying to get OVER eating disorders, not trying to continue them.  I could be wrong, but that's what I got when I took a glance at it!



I was just informed that it is indeed a recovery site now but had started as a  pro ana site at inception. Good catch, obviously someone is actually reading


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## TheLocalMedic (Apr 13, 2012)

medichopeful said:


> Excellent post.  I know a few people who deal with eating disorders unfortunately, and it's truly a sad thing.
> 
> That being said, I think this website is actually for people trying to get OVER eating disorders, not trying to continue them.  I could be wrong, but that's what I got when I took a glance at it!



Yeah, I got that too.  Although all of the other sites were absolutely disgusting.  Giving tips on how to hide the food you aren't eating?  WTF?  The anorexia and bulimia thing in this country is a little scary.  Not that the overeating issue isn't a problem, but the idea of people starving themselves to death speaks to a more intense psychological indoctrination than the obesity issue does.


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## Agent Cooper (Apr 13, 2012)

OP - Thanks for posting this. I was reading the skinnygossip one and it was pretty disturbing. It makes me sad that a lot of the people posting there seemed to be in high school or younger. There was a lot of self-hatred and shame coming from those posts. But I think it's important that we know that websites like this exist, and I agree that it's important for EMS providers to be aware of this growing problem.


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## bigbaldguy (Apr 14, 2012)

medichopeful said:


> Excellent post.  I know a few people who deal with eating disorders unfortunately, and it's truly a sad thing.
> 
> That being said, I think this website is actually for people trying to get OVER eating disorders, not trying to continue them.  I could be wrong, but that's what I got when I took a glance at it!



Just something another member asked me to post for them. Again they did not feel comfortable sharing this themselves. They wanted to give some insight into what might be motivating people who join sites like these. I've edited the quote slightly for clarity. I am posting it because I think it ties in nicely with this thread. I think the member is basically saying the reason people join this type of site is because there are not many alternatives. This is true in many areas of both mental health and addiction problems. People feel isolated and alone and because there are no good options to turn to they turn to bad ones.


*I just want to pop in and explain pro ana for a bit.

It is truly a horrible thing but at their inception there were not many pro recovery sites. They serve their purpose. For women who are not ready to recover, it gives them a feeling that they aren't alone and that there are others who think and feel just like them.

Personally when I was active, I felt so alone and isolated. The night I was at my lowest point, was the night I found my first pro ana forum and the isolation lessened a bit. 

They're still harmful but they do serve a purpose.

*


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## mycrofft (Apr 15, 2012)

Clustering eating disorders as a _*spectrum*_ from overeating to _anorexia nervosa _has some philosophic value but not when it comes to interventions or recognitions medically. They are not opposites, they are not coaxial, they are distinct issues and each person experiencing any of them is a distinct person. Eating disorders can be the expression of female subjugation by a Madison Avenue driven society, but they can also be expressions of underlying OCD...or both. Or other causes. The physical and the cognitive are both involved.

Philosphically, though, if there is recognition that it is a disorder and not a big brand on your forehead, it might be easier to self-recognize and start modifying one's life.

Some classmates and I watched the most classy and beautiful young woman among us drop from 125 to 68 lbs one summer, fall behind in class, but claw back and graduate with the rest of us two years later. It was among the most frustrating and saddening experiences for us, and still very inspiring.


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## emt_abby_a (Dec 22, 2013)

Anjel said:


> There is a toll free suicide hotline, and free community mental health programs. Are the resources for those suffering from eating disorders?




Go to the NEDA site for more info but there is a hotline number 1-800-931-2237. Hope that helps. Also I am receptive to questions if anyone wants to ask any.


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## mycrofft (Dec 22, 2013)

A timely revival.

Sidebar: over 10,000 patients per year are undergoing bariatric surgery. According to one NIH source setting up their lateral study, many if not most of these regain and maybe surpass their original weight; all who survive the original procedure long enough experience initial drastic weight loss, then regain SOME, usually a significant percentage, of their lost weight. These people have important medical issues for the rest of their lives and no one is advocating for research and teaching about these issues.


http://www.edc.gsph.pitt.edu/labs/Public/aboutus.htm
A graph from another source, it reflects the Australian national health system's findings. RYGB is Roux-en-Y gastric bypass, and LAGB is laparascopic gastric banding.


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## unleashedfury (Dec 25, 2013)

alot of the blame is society 

We label people morbidly obese, which is true americans are quite heavier than most other developed countries. 

But eating disorders usually stem from some sort of psychological aspect. poor self esteem, poor self image, and peer pressure to look like the models on the swim suit magazine. most commonly affecting female teenagers. 

I used to date a girl many years ago, who was very slim, after high school she went into the starving herself to death kick to aim for the whole Size 0 hero. She eventually overcame the problem but the health problems exsist to this day, She has a ton of fillings from her teeth decaying, her bones are brittle and similar to those of a 60 yr old. and all kinds of metabolic imbalances 

In the end I doubt any teenage girl will listen, but myself and other guys I know will tell you, not a fan of bones. its nice to have something to grab onto


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## MyCatTigger (Dec 25, 2013)

I can say, as a woman who has struggled with my weight all my life (I was 200 lbs in the 5th grade, started Weight Watchers at 9 y/o) its not easy being overweight.  A few years back, I was "officially" dx'd with Binge Eating Disorder.  I went to a treatment program in OK that did absolutely nothing for me.  Oh, I lost weight while I was there.  Being on a strict 1400 cal/day diet in triple-digit temperatures will do that.  But I learned _nothing_.  It was 21 days and that was it.  On day 21 they (essentially) said, "Don't let the doorknob hit ya where the Good Lord split ya!!"  There were no outings to grocery stores or restaurants, nor were there any simulations where we could practice what "skills" we learned.  At meals, it was basically a choice between two options.  "Do you want pancakes or hot cereal for your carbohydrate?" "Do you want green salad or broccoli for your vegetable?"  "Do you want pork or chicken (vegetarian options were also available) for your protein?"  Etc.  It was not very helpful.  They told me I could always return for a "tune up," but why would I?  The program didn't help the first time, why would I go back?

I have friends who are at the opposite end of the spectrum.  They eat similar items (though not the same amounts) as I do, and they are thin.  Very high metabolisms.  They are labeled as anorexic by the layperson on the street.  Once, I was out with a very slender friend of mine at Dairy Queen.  We both had hamburgers and sodas.  I overheard one young man (I'd guess in his 20's) say to his friend something to the effect of, "That cow needs to give her burger to the toothpick! hahaha" It took a LOT of self-restraint to just ignore him.  I really wanted to say (and do!) something, but I didn't.

I had a doctor tell me I should think about undergoing Gastric Bypass, and I had thought about it for a while.  But I saw my friend and her mother both go thru the Roux-en-Y procedure, and her mum gained back all the weight she lost, plus some.  And I knew that would be me.  I know that my eating habits are not conducive to bypass surgery.  And now, about 10 years out from their surgeries, the mother is still having issues losing weight.  And my friend has had SO MANY gastric problems.  She lost 7 inches of small intestine because it constricted and developed necrosis.  She had to have emergency gall bladder surgery to remove it.  She's been in and out of GI offices for 10 years.  And she's severely anemic.   All of this, and she still is considered "obese."  Not worth it to me.  I'll work on it the old-fashioned way.

Okay, I'll get off my soapbox now.


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## mycrofft (Dec 25, 2013)

Some stray shots.

My wife underwent Roux-en-Y and it reworked very well, she was able then to have knee replacements  she had needed for a decade. You cannot depend soley upon surgery to create health, only continued diet control exercise etc can do that. And maybe plastic surgery.

Our family friend underwent it and died.

People may be _labeled_ as morbidly obese, but it also a _specific medical diagnosis_.


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## Carlos Danger (Dec 25, 2013)

mycrofft said:


> A timely revival.
> 
> Sidebar: over 10,000 patients per year are undergoing bariatric surgery. According to one NIH source setting up their lateral study, *many if not most of these regain and maybe surpass their original weight*; all who survive the original procedure long enough experience initial drastic weight loss, then regain SOME, usually a significant percentage, of their lost weight. These people have important medical issues for the rest of their lives and no one is advocating for research and teaching about these issues.



At the facility I just spent some time at, one surgeon told me a "successful" gastric bypass is one where the patient lost at least 50% of their _excess_ weight - and still had 50% _of that weight_ loss 5 years later.

Not an overly effective procedure, by any means.


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