Portraits

• Lindsay had binged a few times during middle school and early high school. She didn’t like vomiting, so she used laxatives afterward and exercised a lot.
  
• Madeline and Maggie were twelve-year-old twins whose anorexia got started in part because of their intense competition with each other. They obsessed over who ate the least and exercised the most.
  
• Don was a seminary student who found that he was very good at keeping track of food intake. After he graduated, his food obsession went with him to his job as a youth pastor.
  
• Jennifer would binge and purge for weeks every time she started dating someone new or broke up with a boyfriend. After getting married in her early 20s, her bingeing stopped for a while. When it returned, she started getting cavities from the vomiting, and she finally decided she had to tell her husband 

Definitions and Key Thoughts

• Persons with eating disorders are characterized by a primary obsession with food (either eating a lot or not eating enough) and compulsive behaviors related to eating. Often these behaviors are attempts to gain control and deal with anxiety and stress.
  
• Compulsive overeating and milder forms of obsession with food or weight can also be considered eating disorders if they produce unhealthy and obsessive behaviors and/or altered thought processes or body image.

Anorexia Nervosa

• Anorexics (those with anorexia nervosa) starve themselves in order to feel thin.
  
  
• Even when weighing 20-30 pounds below the lowest recommended weight for their age and height, anorexics still believe they are fat. Body image is extremely distorted.
  
• Anorexics consider hunger pangs to be good—evidence of their success at weight loss. They obsess over what they eat and how much they exercise.
  
• Some estimates indicate that as many as 20 percent of anorexics may die of starvation.

• Most anorexics are girls between the ages of 14 and 18. A symptom of the disease is that they stop menstruating or never start.
  
• Many anorexics come from overcontrolling homes where parents held them to high or perfectionistic standards. Conflict with a same sex parent is also common. When standards become unclear or when a child feels out of control, often the only thing they have any power over is food. Unfortunately, even their control over food begins to control them.
  
• The attempt at perfection is fueled by several fears:
  
  – Fear of fat
  – Fear of failure
  – Fear of being less than perfect
  – Fear of rejection
  – Fear of losing control
  

Bulimia Nervosa

♦ Bulimics (those with bulimia nervosa) binge on high-calorie, fatty, and/or sweet foods, secretively eating hundreds or thousands of calories at a sitting. Afterward, to counteract the effect of this eating, they self-induce vomiting, overdose on laxatives, or exercise excessively.

♦ Bulimia tends to occur in girls in late adolescence, such as the last years of high school and early college.
♦ Bulimia can lead to complications related to electrolyte imbalances and destruction of tooth enamel.

♦ Bulimics are often of normal weight. While they are worried about fat, they do not suffer from the severe distortion of body image that plagues anorexics.

♦ Unlike anorexics, bulimics are often not particularly thin, yet they are similarly obsessed with food and fat.

♦ While anorexics feel they are right in their extreme diets, bulimics know that their bingeing and purging is not normal.



Common Barriers to Treatment

There are often multiple barriers that keep a person from receiving proper treatment for an eating disorder.

Access: Sometimes finding treatment from someone who specializes in eating
disorders is difficult.

Considering It an Act of Will: There are emotional, spiritual, and interpersonal complexities involved in the healing of eating disorders. Persons with an eating disorder cannot simply “will themselves” out of it.

Denial: Persons with eating disorders can have distorted body images and may deny the level of harm they inflict on themselves.

Fear of Treatment: Treatment involves discomfort, facing pain and hurt, and can be a difficult and frightful process. This prevents some persons with eating disorders from seeking treatment.

Financial Barriers: Unfortunately, many treatments for eating disorders are expensive.

Idols: With eating disorders, food is not about sustenance; it is a preoccupation and obsession.

Lack of Faith: Persons with eating disorders may not believe any person or treatment can help with their affliction.

Minimizing the Problem: Many delay treatment because they minimize the grasp the problem has on their lives, and they believe it might go away on its own.

Pride: It’s not easy to admit to self, others, and God that something is out of control.

Shame and Guilt: Secrecy and shame may shroud eating disorders for long periods of time. It is very hard for persons to admit there is a problem. It is embarrassing to admit to not eating, or bingeing and vomiting.

Warning Signs

Secretive behavior coupled with trips to the bathroom after eating

Laxative or diuretic abuse

Heart palpitations

Depression

Social withdrawal

Restrictive dieting

Frequent and obvious weight fluctuations

Preoccupation with body weight and appearance

Assessment of Eating Disorders

*We have used female pronouns since some 90 percent of people with eating disorders are girls or women

Rule Outs

Q1 How long have you (your loved one) been starving yourself (herself)?

Q2 What do you (does she) weigh? (If your / her weight is 10 percent or more below the recommended weight for your / her age/height, you / she should be taken to a doctor for a thorough medical exam. Medical conditions are always a significant concern for those with eating disorders.)

Q3 If you (your loved one) purge(s) by vomiting, how long has this been going on? (If you / she has done this frequently, you / she should have medical and dental exams to rule out medical conditions caused by vomiting.)

Questions for the Caring Adult

Q4 What sorts of statements does this person express related to body image and fat?

Q5 Does this person view herself as fat, even if she is very thin?

Q6 Has she been asked to gain weight? If so, how did she respond?

Q7 How long has she been starving herself/bingeing or purging/overeating?

Q8 What was childhood like for her? Are there issues in the home regarding control or perfectionism?

Q9 Is she facing a transition? (Such as, from middle school to high school, from high school to college, or moving from one place to another.)

Q10 How has she been influenced by social norms related to beauty?

Q11 Have you noticed her being particularly sensitive to such expectations?

Questions for the Girl

Q4 Do you ever feel helpless? If so, when?

Q5 How do you handle such feelings?

Q6 Describe a time when you felt angry, frustrated, or afraid. How did you express those feelings?

Q7 What were meals like in your family of origin?

Q8 In your home, was there much focus on food while you were growing up?

Q9 Has anyone ever told you that you’re beautiful? Who and when?

Q10 How did that make you feel?

Q11 Why do you think that person said that?

Q12 Describe your relationship with your parents and siblings. What kind of a child were you?

Q13 Do you sometimes feel like you aren’t good enough?

Q14 What advantage does weight loss (or purging) afford you? How does it make you feel about yourself?

Q15 What disadvantages have you seen from those actions?

Wise Counsel

Anyone whose eating disorder is endangering her life or well-being should be in the hospital or an inpatient treatment program.

Remember that God is always working and there is always hope for recovery. Eating disorders are very difficult, but not impossible to overcome.

Watch for evidence of suicidal feelings (see section on Suicide) and get help immediately if you see or experience the signs.

If the behavior has gone on for some time, you will do best to seek the assistance of a professional who is a specialist in eating disorders. Your health or this young woman’s health will continue to be compromised until you / she gets help.

Action Steps

 1. Identify a Target Weight

• It is important to identify an ideal weight and target weight. Ideal weight refers to the best weight for the person when the person’s height and body type are taken into account. The body mass index (often abbreviated as BMI) is the most accurate measure of ideal weight, but few persons can easily work with this index.
  
• A target weight is the lowest safe weight; it is the bare minimum you want someone with an eating disorder to be at. Target weight is calculated as 90 percent of midpoint of the ideal weight. It is best to have agreement on a target weight with a doctor or dietician because persons with eating disorders often try to negotiate this number.
  

2. Focus on Relationships

• Seek support from friends and also from a professional counselor. People with eating disorders tend to have a very hard time being open and accepting help. You will need to be willing to speak and hear the truth. 
  
• Ask family members to be careful not to criticize or compare or ask questions in a manner that causes you or the person to feel condemned.
  
• Healing relationships with people and with God are essential to the recovery process.

3. Take the Focus Off of Food

• Unless you / she is in immediate danger from starvation or electrolyte problems, examine what weight loss means to this person, what eating stands for, and what she most fears about eating.
  
• Help the family to take the focus off food at home. They need to see that focusing on food is part of the problem, not the solution.

4. Watch for Triggers

• Identify what triggers your / her bingeing behaviors and try to identify situations that aggravate it.
  
• Try to identify what is behind your / her actions. Chances are, some kind of anxiety and stress is driving these actions.

5. Change Thinking Patterns

• Try to discern the lies behind the behaviors that are trapping you / her.

6. Examine Perfectionism

• Examine your / her perfectionism. Chances are, you / she holds herself to standards to which you / she does not hold loved ones.
  
• Examine these standards and how they square with God’s truth revealed in Scripture
  

7. Keep a Journal

Write in a journal about your feelings and the events of each day (or encourage the person with the eating disorder to do this).

Biblical Insights

Now the mixed multitude who were among them yielded to intense craving; so the children of Israel also wept again and said: “Who will give us meat to eat? We remember the fish which we ate freely in Egypt, the cucumbers, the melons, the leeks, the onions, and the garlic; but now our whole being is dried up; there is nothing at all except this manna before our eyes!” —Numbers 11:4-6

• Preoccupation with food can indicate an eating disorder. When people become overly focused on food, their dependence on God suffers.
  
• The Israelites, while not having an eating disorder, did experience a “perspective disorder” because of their focus on food. Their preoccupation with foods they did not have caused them to lose sight of God’s miraculous and loving provision of manna.
  
• When people become preoccupied with anything other than God, they can lose their perspective of God’s care for them. People with eating disorders need to refocus on their worth in God’s eyes and be thankful for God’s provision
  

Put a knife to your throat if you are a man given to appetite. —Proverbs 23:2

• Some people attempt to fill the emptiness in their lives with drugs, alcohol, sex, money, or even hard work. Others use food, and such people find themselves trapped in emotional eating—leading to such problems as obesity and bulimia.
  
• There is nothing wrong with food. There must be a balance, however, between enjoying what God has provided, and using food to meet emotional needs and thus allowing it to control one’s life.
  
• The fruit of the Spirit called self-control applies to many areas of life, including eating. God desires to fill any emptiness, helping us to lead balanced, healthy lives.

All things are lawful for me, but all things are not helpful. All things are lawful for me, but I will not be brought under the power of any. Foods for the stomach and the stomach for foods, but God will destroy both it and them. Now the body is not for sexual immorality but for the Lord, and the Lord for the body. —1 Corinthians
6:12-13

• Some who face a difficult eating disorder—whether it be an addiction to food, or an addiction to going without food—understand the power of that addiction. God provided food for the animals and people He created in order to sustain them. Food is meant for sustenance—“foods for the stomach and the stomach for foods.”
  
• A food addiction takes the focus off God and puts it on one’s food or stomach— both of which will eventually no longer be needed.
  
• People who struggle with eating disorders should seek Christian professional guidance to gain a proper perspective and pattern for eating.
  

Recommended Resources

Bulimia/Anorexia: The Binge/Purge Cycle and Self-Starvation, by Marlene Boskind- White and William C. White, Jr.

Hope, Help, and Healing for Eating Disorders: Anorexia, Bulimia, & Overeating, by Gregory L. Jantz

“Mom, I Feel Fat!”: Becoming Your Daughter’s Alley in Developing a Healthy Body Image, by Sharon A. Hersh

Remuda Ranch in Wickenburg, AZ, provides bibically-based treatment for women and adolescents with anorexia, bulimia and related issues. Contact them at 1.800.445.1900.