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Dying to Be Thin

By Diana Ballon | June 8, 2022

“I never could have imagined that, at age 47, I would be having the worst year of your life – that I’d be a therapist, a meal planner, a driver, a shopper, a caregiver, an advocate — that I’d be doing the most selfless things I had ever done in my life, and it still wouldn’t be enough, ,” says Angela,* the Toronto mother of a 15-year-old daughter with anorexia.

Angela’s struggles, and the struggles facing her daughter and the rest of her family, are heartbreaking. But sadly, their experience isn’t unique. The pandemic has produced an alarming spike in both the number of cases of youth eating disorders, as well as their severity. Since the onset of the COVID-19 pandemic in 2020, inpatient admissions for eating disorders at The Hospital for Sick Children (SickKids), for example, increased almost 90 per cent.

With the added limitations imposed by the pandemic, families have faced added stress to cope with their child’s eating disorder. Depending on the severity of the disorder, familial caretaking can mean anything from supervising their child’s meals to managing their caloric intake to providing constant emotional support and understanding.

In Angela’s case, her daughter Rachel* narrowly missed the cut off for inpatient admission at SickKids. As her condition deteriorated, she was moved up the priority list and is now being followed in an intensive outpatient treatment program at the hospital. As part of the SickKids Eating Disorders Program, Rachel gets medical monitoring (to assess things like weight, blood pressure and heart rate), is seen by a primary therapist and consults with a dietician as needed.

The program also offers psychological treatment through family-based therapy (FBT), an evidence-based outpatient treatment program. As part of Phase 1, family members provide emotional support to the young person during mealtimes; help them consume the food they require for their health; and foster a predictable environment, where their child can’t “negotiate” the food the consume.

As SickKids explains it, “the underlying causes of an eating disorder are often complex and multifactorial, and in most cases, it is difficult to identify an underlying cause. FBT focuses on recovery from an eating disorder by treating the symptoms directly. In the first phase of FBT this involves focusing on food, regular eating, and regulation of weight. “

For Angela, this first phase included preparing, plating and supervising her daughter to consume three nutritious meals and three nutritious snacks per day, while receiving coaching and teaching from the hospital team.  “Everything stops until food is consumed,” Angela explains. “Food is medicine is the basics of FBT.”

“We’re all up at 7:30 a.m. even on weekends because Rachel* needs to have breakfast early, so that she can then be ready for her mid-morning snack by 10:00 a.m. After that there is lunch and the mid-afternoon snack, followed by dinner at 6:00 p.m. so that the final snack can be at 8:30 pm. Food preparation often means surreptitiously adding coconut cream, flax seed oil, almond butter or other fats to reach the 400-calorie snack and 800-calorie meal requirements. And if her daughter is struggling to eat that day, one meal or snack can take up to two hours. At these times, Angela says, “it’s almost like there is a person inside of her bullying her – telling her not to eat — and she needs to be rescued from the loud eating disorder thoughts.”

Although Rachel didn’t require inpatient treatment, for those that do, the goal is for them to become medically stable and receive nutritional rehabilitation to get to a weight where they can go home and start outpatient treatment. Most young people in inpatient treatment at SickKids arrive experiencing moderate to severe malnutrition, which can negatively affect their cognitive functioning and make it challenging to engage in psychological treatments while they are medically unstable.

When serious medical-related issues have been treated, psychotherapy can help to address underlying issues.

People develop disordered eating for many reasons related to trauma, says Claire Langridge, a certified child and youth counsellor and registered social service worker at Growing Through Change Counselling and Healing Services, and a counsellor providing supervised psychological counselling under the supervision of a registered psychologist through Dalton Associates. They may be reacting to traumatic incidents (such as the loss of a pet, a parent’s divorce, a car crash or sexual assault) or a developmental trauma, such as chronic abuse or neglect in childhood, or lack of a secure attachment to their parents. “[In either case,] feeling helpless or out of control is often the overriding theme in the young people I see,” Langridge says. The “overeating, restricting food or binging are connected to soothing or avoiding difficult feelings.”.

“When difficult feelings arise around food — like helplessness, fear or sadness — I ask them, ‘Are there other times when you have also felt that way?’ I try to get them to connect to feeling their feelings by asking where they feel an emotion in their body. Most people live according to a thinking brain rather than a feeling body: healing happens when you use your thinking brain accurately and allow yourself to feel your feelings without engaging with them in harmful ways.”

Because feelings can be very painful, we all have an understandable instinct to want to avoid them. I ask Langridge how to speak to our adolescent daughters when they complain of being fat or when they make some other self-deprecating comment about their appearance. She responds, “It’s never about what you think it is about. Move away from the content and toward labelling the emotion your daughter is feeling. This could shift the conversation away from her physical appearance to how she is feeling inside.”

Langridge also emphasizes that feelings don’t always reflect reality or the truth. For example, people may not have any control over how others feel or react, but they can control many aspects of their own lives. And because the rational part of the brain is not fully developed until about age 24, young people may need help to think things through more accurately and reasonably, rather than simply relying on their emotions as guides, Langridge says.

In Rachel’s case, her mother says she has always been a “hyper feeler” or someone who is highly emotional and sensitive, and that anxiety has manifested itself in different ways throughout her life. Rachel is working hard to make a full recovery, and to get her life back — and the independence she enjoyed — before the eating disorder developed. With the help of SickKids, she is making solid progress and her mood is lightening as she regains the weight she is genetically programmed to be.

“Weight restoration could be just weeks away,” says her mother. “The brain can then begin the healing for a fully recovery.”

* Names have been changed to preserve the family’s anonymity/privacy.

For more information

F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders) is a global community of parents, and people who support parents among families affected by eating disorders.

The National Eating Disorder Information Centre provides workshops for high school students and other school-based programming, mostly for free.

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