Eating Disorders: Anorexia and Bulimia

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Overcoming Eating Disorders: Kelly Brownell, PhD

Discuss prevention and treatment of eating disorders with our weight disorder expert. 

By Kelly Brownell
WebMD Live Events Transcript

The opinions expressed in this transcript are those of the health professional and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician.

In the United States, conservative estimates indicate that after puberty, 5-10 million girls and women and 1 million boys and men are struggling with eating disorders including anorexia, bulimia, binge eating disorder, or borderline conditions. We discussed how you can recognize and overcome these eating disorders when WebMD's eating and weight disorders expert, Kelly Brownell, PhD, joined us on WebMD Live.

Moderator: Hello, Dr. Brownell. Welcome back to WebMD Live. We have so many questions for you -- let's begin.

In the United States, conservative estimates indicate that after puberty, 5-10 million girls and women and 1 million boys and men are struggling with eating disorders including anorexia, bulimia, binge eating disorder, or borderline conditions. We discussed how you can recognize and overcome these eating disorders when WebMD's eating and weight disorders expert, Kelly Brownell, PhD, joined us on WebMD Live.

Member: I've suffered from anorexia in the past and received intense inpatient and outpatient treatment for several years. I stopped restricting and returned to a normal weight, but now suffer from binge eating, which in my experience is far more emotionally damaging and harder to behaviorally affect change. I still see a professional therapist, but I feel like my so-called recovery from anorexia has been a lie -- I've just replaced one eating disorder with another. Has my therapy failed me? Though I know it differs from individual to individual, what are the most effective approaches to the treatment of food addiction and binge disorder?

Brownell: If you believe that current therapy is not helping, don't hesitate to shop around for different help. There are many therapists who advertise themselves as specialists in eating disorders who may not be using proven techniques. For binge eating, cognitive-behavioral approaches appear to work best. It's completely within your right to ask the therapists if they use this approach or whether science supports the approach they do use. There is an excellent book by Dr. Christopher Fairburn called Overcoming Binge Eating. This book might very well be of help to you. Keep trying, as with the right help you might very well be free of eating disorders some day.

Member: I don't know if I have an eating disorder. I'll eat at school and with my friends and not vomit. And I don't think about it and don't feel guilty. But when I'm home I either don't eat or vomit after eating. Is that borderline?

Brownell: If you are vomiting after eating, you have a problem. While you may know other people who do this, it can be a troubling condition that could get worse over time. The best approach is to normalize eating. That means to eat regular meals, to not restrict, not to binge. If you feel you cannot control this on your own, it's important to seek help from a professional who understands eating problems. This way, they might catch the problem early and prevent it from growing worse.

Good luck!

Member: I'm a 15-year-old female. I weigh about 125 and I'm 5'6 and lately I have been kind of on a diet where I can only eat at certain times of day and if I do otherwise I take laxative tablets. None of my friends know about this. Well, I don't think they do because I'm really good at hiding things. I'm not sure if this is even a problem.

Brownell: This is a problem. It is not normal to eat at a certain time of day only, and laxative use can be a trap like quicksand. Once you start being preoccupied with eating and weight, it's easy for other aspects of your life to be crowded out. As I mentioned to the previous chatter, it is best to eat regular meals, avoid extremes of restriction and overeating. It is essential to young people to protect themselves from the toxic messages received in the media. The "perfect body" one sees in models and actresses is unobtainable for most of us and is probably unhealthy. The best weight for an individual is what they attain when they eat a healthy diet and get regular activity. Just like people vary in hair color and eye color, people vary in body shape and weight.

Trying to squeeze yourself into the arbitrary ideal is unfair and shackles you with worries you don't deserve and can lead to bad behavior like laxative use. If you find you cannot solve this problem on your own, please discuss this with your parents or with someone you trust at school immediately. I hope this is helpful.

Member comment: That's how I started -- diet and laxatives. Most important is to find out why [you have] the preoccupation [with weight and food]. Only 13 years later have I started to really get a handle on that!

Brownell: I am glad you raised this point. Most people focus on the behaviors of an eating disorder, but what's important is what underlies the behavior. The obvious pressure again is only part of the picture. Other psychological issues such as perfectionism, low self-esteem, and family problems can also play a role. Good therapists will help a person understand these matters.

Member comment: It might be helpful to explain the health consequences of laxative abuse, and it doesn't even "get rid" of the food -- only water!

Brownell: Both laxative use and vomiting are not as effective as people believe in helping a person get rid of calories. This, of course, enhances the need to restrict even more, and the cycle continues. It's also important to recognize that laxative use and vomiting can have negative health consequences, not to mention psychological fallout from having disordered eating.

Member: I have two friends who are obsessed with staying thin. They eat, but very little, with astonishing self-control. If they gain one-half pound, you would think it was 20. Their self-image, even though they are rail thin, is that they are fat. I don't think either of them purge or over-exercise, though one used to. Now she just controls it through selective eating. It maddens me, though neither would admit they are anorexic. What do you think? And, are there any support groups for friends and family of anorexics? For my own role, I am disheartened by the energy they spend on the issue of thinness, and angry at the vanity that goes with it, all unacknowledged and therefore taboo to speak of. What do you think about the issues that a friend of an anorexic has to deal with? It is as if by being silent, we are enabling this destructive disease. And this destructive disease is not only fashionable to practice, but the sickly thin image, as promoted by all our media, has also become a national standard. We are all ill, if you look at the social support for this behavior.

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Brownell: This is a very important issue you raised. Friends often recognize eating disorders but are uncertain about how to deal with the problem. Many people may not meet the criteria or a diagnosis of an eating disorder, but still have a real problem. Your friends may fall into this category. It is hard to break through and connect with such people because they believe they are engaging in behavior that's socially acceptable and done in pursuit of a widely accepted goal, that is, to be thin. If your friends will listen, it is fine to express your concern and to offer to be of help should they wish to take advantage of it and your friendship for them.

If you believe the problems in your friends are serious, contacting the parents or school authorities can sometimes get through to them to help. There are several national organizations with excellent web sites that provide information on eating disorders and helping those who have them. One such group is the American Anorexia and Bulimia Association. I hope this is helpful.

Member comment: Express concern, not judgment!

Brownell: This is correct. Sometimes people with eating disorders erect a wall around themselves that can be hard to penetrate. Expressing concern, support and caring, is more likely to be helpful than trying to help a person out of the disorder by expressing a negative attitude about specific behaviors.

Member comment: I am in my 20s and can attest to the long-term damages -- major dental problems is the least of my worries. I spent a summer wondering if I would wake up the next day. I had chest pains and heart problems, headaches, throat and stomach problems. It catches up. Luckily I have a good therapist and a loving, supportive family that hasn't given up. I am happy to say that there is light at the end of the tunnel.

Brownell: What you say is common in young people who have eating disorders. I am very happy that you are willing to share this with others. Some people often believe that they are invulnerable to health problems. But as your words indicate so powerfully, an eating disorder can have many negative health consequences, and must get the attention they deserve. Thank goodness for your loving family and a caring, competent therapist. I hope the future for you is very bright.

Member: I am 25 and recently started recovery for an eight-year problem with anorexia and bulimia. I have been debating telling my nonsupportive parents about my problem. But I was wondering if that will hurt my recovery if they don't support me. Should I just keep it to myself?

Brownell: Good question. This is a tough call. If you are seeing a professional for help with this problem, perhaps the two of you could discuss this and decide what's best for your situation. You are in the best position to know whether discussing the problem with your family would be helpful. As a default, it makes sense to have the family involved. Some people are surprised when the family reacts with more support than the person expects. On the other hand, some families are very harsh and critical, and are not likely to provide anything in the way of help. Without knowing you and your family I cannot make a specific recommendation. I can, however, tell you it is a judgment call and that no one way is necessarily better than the other. Good luck!

Member comment: Tell them! You have already made the decision to get help and you will feel better just getting it off your chest.

Member comment: Prepare yourself for the good and bad. What will you do if they don't support you? Have a plan.

Member comment: I have been through this with my own family. Some of them are very supportive and others are not. You have to be prepared to accept the feelings, etc., when you tell them.

Brownell: I thank these three people for responding. Their comments suggest that different approaches work for different people. It's true that telling the family can be a great relief for some, and in these cases, the families and the individual sometimes grow closer. This is not always the case, and sometimes people tell families and it hurts rather than helps. The person who suggested having a plan is sharing a wise comment. If you decide to speak with your family, it makes sense to have a plan as to how you will respond to whatever they do.

Member: How do I help my daughter with bulimia, when I also suffer with it? I feel responsible and helpless. I have had this problem on and off for over 30 years.

Brownell: Getting help yourself, perhaps at the same time your daughter gets help, is an obvious way to proceed. Research suggests that daughters of mothers with an eating disorder tend to be at higher risk for having an eating disorder themselves. This does not mean mothers should be blamed, but rather that they realize that they and their daughters share genes, an environment, and ways of looking at the world that might predispose both of them to the disorder. You can be a very good model for your daughter by acknowledging the problem, admitting you need help, and by being a thoughtful consumer in seeking out the best help for both her and you.

Member: Doctor, I am bulimic and after my last purge developed a dull, frequent pain in my chest, my doctor thinks it could be related to my [esophagus], what do you think?

Brownell: I hope that you told the doctor about the disordered eating. Physicians are often at a disadvantage when people with eating disorders describe symptoms but not the disorder. If your physician knows about the disorder but is still uncertain about your symptoms, you might find an eating disorders center near you and ask if they can recommend the name of a physician who works with people with these disorders. I am very happy to hear you have discussed the physical problems with your physician. Many people have serious medical issues but are unwilling to speak with physicians, which can lead, of course, to the problems becoming very severe.

Member: I was anorexic in high school, and even though I eat three meals a day now, I remain obsessed with food. The obsession takes the form of intense concern about food quality (fresh, organic), and way too much time spent planning meals, shopping for meals, etc. Is this just another form of an eating disorder? What is a healthy interest in food/cooking compared with an obsessive interest?

Brownell: If your feelings about food, weight, and your body are interfering with your life, or go beyond what most people experience, by definition there is a problem. Stated another way, ask yourself if you would be better off if you were not this way. It is very good news indeed that you have made such progress with the anorexia symptoms you experienced earlier. You deserve to be a happy person, so it makes sense to get counseling so you better understand the reasons you feel as you do, and to develop strategies for having a more healthy relationship with food.

Member: I am using Dr. Fairburn's book for my two-year binge eating problem. It's great, but I wonder if it is ever possible to not be preoccupied with eating and weight. I believe I will always be tempted and have to fight a desire to binge and/or overeat. Do you ever see people who win this battle and are not preoccupied with food and weight anymore?

Brownell: Yes. I am pleased to hear the Fairburn book is helpful. The book deals more with methods for stopping binge eating than it does with psychological reasons for weight concern. Some people stop binge eating and the body concerns fade with time. For others, the body concerns persist. It makes sense, given that this applies to you, to get some help to understand the origin of these concerns. And then you can find different ways of dealing with food and can place eating into a healthier context.

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Member: After years of struggling with anorexia, I have kept a healthy weight and BMI for 10 years now. However, I still have a distorted body concept. I am a size 4 and will always pick size 10 women if asked to pick someone my size. What can I do to normalize my self-perception?

Brownell: This is a major problem for some who have recovered from an eating disorder. If a person feels they are much heavier than they are, the reality does not line up with perception, and unhappiness can be the result. Help from a professional may uncover some answers to your questions. It would be a shame if you had to struggle with this perception of yourself for even more months or years. You can repeatedly remind yourself you are the size you are, but if this does not get the job done, professional help may be worthwhile.

Member: I have been struggling with anorexia and bulimia for 12 years now. I have learned everything about nutrition, the physical consequences of eating disorders, what causes them, etc. I have been hospitalized four times in eating disorder psychiatric units. I have been on several different medications as well, and I even had to have abdominal surgery requiring a bowel resection. Yet, I still can't seem to take control over this "addiction." I know it has to do with my low self-esteem and lack of support. I am disabled as a result of these illnesses (along with chronic depression) so I do not work, and I have no friends, so I am quite isolated. My family is getting tired of dealing with me. I have tried volunteer work, and even ran a support group, but the stress caused my eating disorder to worsen. I know I use the anorexia and bulimia as a "coping mechanism," but I can't seem to find a suitable replacement!

I have had intensive therapy for several years, but I still find it extremely difficult to battle the illnesses. I know what I need to do to recover, or at least to manage the illnesses, but I don't have the courage to try new things and learn to get through the uncomfortable feelings. Where do I go from here? Any suggestions you could offer would be appreciated. I hope you can give some guidance to those of us who have all the knowledge and insight, but lack the strength to fight for a better life. Thank you so much for providing this invaluable assistance to our fellow sufferers. As an aside, you might find it interesting that I am about to celebrate my 47th birthday, and I did not have any disordered eating whatsoever until I reached my mid-30s. My 19-year-old daughter is afraid I won't live long enough to be at her wedding! This is quite a twist from the usual situation, in which the daughter has the eating disorder and the mother is the one who is concerned.

Brownell: You tell a very sad story. I am sorry to hear that you have gone through so much but that the disordered eating is so tenacious. We see this frequently in our own clinic, and it breaks my heart to know that bulimics are so tormented. Sometimes people benefit from multiple hospitalizations and intensive therapy, but may not have connected with the right professional to help them. Eating disorders programs vary in approaches, level of expertise, and adherence to the principles of using tested and proven treatments. If you believe the therapy you are receiving has taken you as far as it will, do not hesitate to seek out other help. Perhaps a fresh approach, or a therapist who works with you differently than you have experienced before, will help lead you down a new path.

Your own experience shows that knowledge alone does not always lead to resolution of the disorder. Understanding the psychological roots and finding alternative ways of coping with life is key to making progress. I hope this is helpful, and I hope your next 47 years are free of these problems.

Member follow-up: I think for me it has gotten to the point that I am "sick" of having this illness, and I want more out of life. I have to keep trying.

Brownell: This is a good attitude. It is possible to reverse this problem and to lift the burden on your life that this disorder creates. If you come to believe that you deserve to be a healthy and happy person, you have taken the first important step.

Member: My question is in regard to my boyfriend. He works intensely, 50-60 hours a week, and works in a hot environment. He has lost 15 pounds. He is 5'8 and weighs only 130 pounds. I can visibly see the difference, and he just appears unhealthy. I am a dietitian and chef by trade, so I know how to feed him well, and the proper steps for weight gain/maintenance, etc. When we eat, he takes a few bites and feels full or says that he has stomach pains. He reports that he wants to eat, he just can't. In addition to this, he has some dental problems. I do not suspect bulimia, but I wonder if something internally could be going on. Like many stubborn men he doesn't believe in going to a doctor. Any advice?

Brownell: As a dietician, you may have calculated your friend's body mass index. I just did this myself and the figure is 19.8. This is a fairly low weight, and given what you have observed with eating, may be cause for concern. Eating disorders do occur in males. I cannot say whether this applies to your friend, but if you believe that restricted eating is from concerns with shape and weight or is driven by other psychological issues, it would make sense to speak with him about it. It is possible your friend is constitutionally thin, but the sudden weight loss you described could be reflecting a problem.

If you feel you can discuss this with him in an honest and caring way, perhaps he will listen and be honest himself about whether there is a problem. Most males do not understand much about eating disorders, so the web site I mentioned earlier, of the American Anorexia and Bulimia Association, can provide him some useful background.

Member: What is the difference between overeating and binge eating?

Brownell: Binge eating is a specific term that refers to eating what others would consider as unusually large amounts of food but also feeling out of control during the eating. For practical purposes, people who chronically overeat and people who binge eat both have problems. Exactly what you call it is less important than acknowledging the problem and getting help for it.

Member: I have not yet checked with my health coverage but I'd like to see a nutritionist and possibly a therapist for my "bulimarexia." Aside from the anxiety I have about "coming out" about my problem, I am worried about the expense. What is your experience with health coverage for eating disorder therapy, if any?

Brownell: Most insurance companies provide some assistance for help with eating disorders. Please contact your insurance carrier and ask what the coverage is so there will not be any surprises. There should be a customer service phone number on your insurance card.

Moderator: Dr. Brownell, we are almost out of time. Before we wrap up for today, do you have any final comments for us?

Brownell: I am pleased to see that so many people have been honest about their own concerns and willing to share ideas to help others. Eating disorders can be very serious. The good news is that help is available and new research is occurring every day.

Moderator: We are out of time. I'm sorry we couldn't get to all of your great questions. Our thanks to Kelly Brownell, PhD, and thank you, members, for joining us today. You can visit Dr. Brownell on WebMD's Healthy Weight Loss message board. For more information, please check out our news stories, features, and archived interviews with experts.

Brownell: Thank you for chatting with me today.



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Reviewed on 10/23/2003 5:23:44 AM

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