>> From Penn State health, Milton S. Hershey Medical Center, this is Ask Us Anything About
Eating Disorders.
I'm Scott Gilbert.
This is National Eating Disorders Awareness Week, and the theme this year is It's Time
to Talk About It.
Here to talk about this important issue with us is Dr. Rollyn Ornstein.
She is Division Chief of Adolescent Medicine and Eating Disorders at Penn State Children's
Hospital.
Dr. Ornstein, thanks for your time today.
>> Thanks for having me.
>> So this seems like it's a tough discussion to have.
If an adult suspects and eating disorder with someone who they love, isn't that a tough
discussion, a tough topic to broach?
>> It's definitely a tough topic to broach.
There's a lot of denial in kids and adolescents, and even adults who have eating disorders.
>> So what's some of the best advice you can give, first of all to parents, who might see
some of the warning signs, which we'll talk about in just a moment.
But what's some advice you have for parents?
>> I would say just like any other thing that might concern the parent, they just need to
sit down and have an open, honest conversation with their child.
Just like if they were concerned about their grades, possible drug use, or anything else,
ignoring it is not the way to go.
>> It's not something that's just going to pass if it's for real.
>> It is not just going to pass.
These are not phases.
These are not things that kids just dabble in.
These are serious disorders.
>> What about peers?
If I'm a teenager and I suspect this in a friend, can they take action, too?
>> Definitely.
I often find that it's the peers who bring it either to the school's attention or the
parents' attention, and I think is a friend, being a good friend is really important.
If you feel that your friend is not going to be your friend anymore if you act for them,
I understand that.
But really, the best thing to do for your friend is to try to take action and maybe
get an adult involved.
>> You're watching Asked Us Anything About Eating Disorders from Penn State Children's
Hospital.
I'm Scott Gilbert alongside Dr. Rollyn Ornstein, and we welcome your questions over the course
of this video.
Whether you're watching it live, we can pose those questions to her live, or even if you're
watching it on playback after the fact.
We'd be happy to share the questions with Dr. Ornstein and track down an answer for
you that we'd share in the comments section, as well.
And if you like the content you're seeing right now, feel free to share us and help
us get the word out about this important topic.
We talked briefly about warning signs.
What are some of the most common warning signs of -- we'll speak generally about eating disorders?
>> Certainly, if one notices that their child is not coming to meals anymore, making excuses
to not eat, such as I ate when I came home.
I ate at someone else's house.
Disappearing after meals or just not coming down to the table.
Cutting their food up into small pieces.
Pushing food around on their plate.
Those are some of the behavioral signs that might tip someone off that there may be an
eating disorder going on.
>> As you mention those, I'm thinking, I can think of times that my kids have done that.
It seems like every kid does that at some point.
Place with their food, pokes it around.
When does it cross that line?
Maybe when you see a pattern?
>> Well certainly, picky eating is common in much younger kids.
Certainly, in toddlers.
Picky eating really shouldn't extend significantly beyond into school-age.
If this is a new behavior, a change in behavior, I think is what I'm talking about.
>> Sure, and of course, back when we went to school, we took what $1.25 or whatever
in cash, and we paid.
So if a child wasn't going to eat lunch that day, they could hide that money from their
parents.
Today, it's a much more digital process in most schools.
So that can be another warning sign, right?
If you see it not being used?
>> Actually, that's true.
I just had a patient come in whose parents said they noticed that she was not using her
lunch account money.
Now a kid could use their lunch account and not eat to food, of course, but usually, they
won't do that.
By not buying food at lunchtime, that could be another warning sign.
>> There some other symptoms, maybe not directly related to eating, such as, say, mood disorders,
things like that?
>> A lot of kids who have eating disorders have other things like anxiety and mood disorders.
Some of them started before the eating disorder, and some of them may be the result of the
eating disorder.
>> Let's talk about some of the most common eating disorders.
We've heard a lot about anorexia nervosa.
What is that?
>> Anorexia nervosa is a disorder where the patient restricts the intake significantly,
such that they either lose a significant amount of weight, or if it's a younger person, they
may not just make the weight gains that are appropriate developmentally.
They often will have some over exercising, as well as part of that disorder.
But the caloric intake is highly restrictive, and there's a lot of weight and shape concerns.
Concerns about becoming fat or overweight, despite not being fat or overweight.
>> Compare that to bulimia nervosa.
>> Bulimia nervosa is characterized by binge eating, which is eating a large quantity of
food in a relatively short period of time, usually in secret, associated with a lot of
guilt and shame, and then there is a compensatory behavior.
Meeting, something to get rid of the calories that were consumed.
Most commonly, this could be self-induced vomiting.
However, it can also consist of laxative use, diet pills and diuretics, excessive exercise,
or severe restriction in between the binge episodes.
>> Sounds like there are you know, at the root of a lot of these, are some body image
questions that arise in someone's head.
Can you talk about that and how they may have a distorted view of how they actually look?
>> Oh absolutely.
Both anorexia nervosa and bulimia nervosa have body image disturbance, weight and shape
concerns at the core of the disorders for both of those, despite, you know, not ever
being overweight, perhaps, or maybe being a little bit overweight.
We are seeing increased eating disorders in kids who were formerly overweight becoming
anorexic.
>> And we hear a lot about the pressures, especially on women, to, you know, look good,
to be as thin as possible, and to what extent do you think that kind of more public pressure
weighs in?
>> I personally think that we have seen an increase in disordered eating because of the
pressures on women and men, for that matter.
However, patients who don't have as much access to media also develop eating disorders.
So we know it's not really the only cause or the, you know, the main culprit.
>> You're watching Ask Us Anything About Eating Disorders from Penn State Health.
I'm Scott Gilbert.
This is Dr. Rollyn Ornstein, and we do welcome your questions in the comment section, whether
it's live, or you're watching this video on playback.
We'll definitely get some answers for you.
Let's talk about a couple other types of eating disorders.
There's one that has been recognized as an eating disorder.
It's binge eating.
Is that separate from bulimia nervosa, as you described it, which involves binge eating
but then purging?
>> Yes, binge eating disorder is probably the most prevalent eating disorder, but it
was only formally recognized in 2013 in one of the newer diagnostic manuals for eating
disorders.
It is comprised of similar binge eating behaviors, as I described for bulimia, but without any
of the compensatory mechanisms that I described, and there is also less weight and shape concern
associated with it.
>> You know, I mentioned the pressures on women, but you also made the good point that
this is not limited to teenage girls, which is who I think we often think of with eating
disorders.
Is that a common misperception, and how broad do you see patients coming from all demographics?
>> It's said that the ratio of females to males with the typical eating disorders is
10 to 1.
So about 10% of patients are males, and I do believe that's what we see.
However, I have definitely, in my practice, seen an increasing number of males, especially
males who were formerly overweight.
>> In one of the comments that we got about, on the Facebook post, promoting this discussion,
we had someone named Kelly who posted that she had struggled with an eating disorder,
and she said, " I beat this illness, but I still have an awful perception about my weight."
So how do you define a cure?
Is there such thing as a cure from eating disorders, or is it something that, in many
cases, folks kind of learn to kind of cope with those feelings?
>> I do think that patients can be cured from eating disorders.
Recovery is possible.
I think some of the body image disturbance that goes along with the eating disorder,
may be somewhat normative.
It's just how it really affects the patient day-to-day.
How much of a percentage of their daily hours are spent thinking about their body?
I think that's one of the last things to improve would be the body image, even if the behaviors
are under control.
>> We talked a little bit about the warning signs and the fact that anybody can take action
and should take action if they see those warning signs.
At what point is it time to call on a medical provider, and how do you determine whether
it should be a primary care physician or even a specialist?
>> Certainly, if a child or adolescent has lost a significant amount of weight, it's
important to go be seen, possibly by the primary care doctor first, if that's the relationship
that one has.
You can also go see a specialist, if you're allowed, without, you know, getting a referral
if there is any concern on the parents' part.
Personally, even if they're told, don't worry, it's not a problem, I would say go seek help
if you know, as a parent, that you are concerned about your child.
>> You've heard of situations, I'm sure there must be, where the teenager says, simply,
"I'm not going."
>> All the time.
It's hard to get a kid into the office if they won't get into a car.
I realize that.
But again, to the parent.
You're worried about your kid.
You're the parent.
You take them to the doctor.
The hardest part is when I get it, who comes into the office, and they don't actually know
why they're coming to see me.
>> I'm sure that happens.
>> That can be challenging, yes.
>> I imagine, and then they realize where they are.
But they're there for their own good, though.
>> Yes.
>> Again, we welcome your questions here at the bottom, and like I mentioned earlier,
feels free to share this Facebook post on your page to help us get the word out about
this discussion and this important dialogue around eating disorders.
This is Ask Us Anything About Eating Disorders from Penn State Health, and the next question
I have for you, Dr. Ornstein, is about the program here at Penn State Children's Hospital.
There are both inpatient and outpatient components, correct?
>> We don't really have a true inpatient component.
If a patient is medically unstable, we can admit them to the Children's Hospital for
acute medical stabilization.
If we feel they need a higher level of care, such as an inpatient eating disordered mission,
then we don't have that component in our care.
However, we do have what's called a partial hospitalization program, or a day program,
which is a Monday through Friday program.
We have programs for patients 8 to 16, and another program for patients 17 and over.
>> When you say a partial hospitalization.
That means they go home each night?
>> Yes, they either go home each night, or they could also stay at the Ronald McDonald
House, if they live farther away.
>> What are the types of approaches you take as a specialist in working with someone on
the first steps of trying to help them overcome an eating disorder?
>> Well, I certainly need to know whether they agree that they have a problem.
Sort of a motivational stage of change approach.
If they don't even admit that there's a problem, then we have to first start getting them to
admit that there's a problem.
However, however, if they're unstable, we need to take action, whether or not they agree
that there's a problem.
>> And if people want to get in touch with your program, obviously, I'm sure they can
do so through the Penn State Children's Hospital website, right?
>> Yes.
There's also -- they can certainly give a call to our nurse at 717-531-2099 to set up
an appointment directly.
They don't actually need a referral, unless their insurance requires it.
>> Okay, we've got more information about eating disorders, as well.
In one of the more recent Penn State Medical Minutes, you'll find that at Pennstatehealthnews.org,
and also, Dr. Ornstein was featured in a recent column in Central Penn Parent.
It is actually the edition on newsstands right now, the March edition.
So I encourage you to check that out.
Dr. Ornstein, thanks so much for your time today on this important topic.
>> Thanks for having me.
>> And thank you very much for watching, Ask Us Anything About Eating Disorders from Penn
State Health.