“I’m fat,” says a teenager in front of the mirror, her voice full of insecurity. It’s tempting to quickly respond, “No way!” to comfort her and allay her worries. While well-intentioned, this answer doesn’t address the depth of the problem. In reality, it can invalidate her feelings and close the door to an important conversation about her emotional and physical well-being. That’s why it’s important to understand the complexity of eating disorders and how to provide appropriate support to those affected.
Eating disorders, which have seen an unprecedented rise during the COVID-19 pandemic, affect millions of people around the world of all ages, genders, races and socioeconomic classes. However, they most commonly begin in adolescence or young adulthood and tend to affect more women than men. As Dr. Teia Plana, coordinator of the Eating Disorders Team at Hospital Clínic Barcelona, notes, “girls and women often face much greater social pressure due to the beauty standards imposed by society.”
“Many people developed an irrational fear of gaining weight because they had no control over their diet and exercise during lockdown.”
It is important to recognise the symptoms of eating disorders in order to offer the right support. These can be behavioural, emotional or physical. Behavioral symptoms include an obsession with losing weight, skipping meals, hiding food, going to the bathroom after eating, excessive use of laxatives, changing eating habits and compulsive exercise. Emotionally, patients may experience fear of gaining weight, body dissatisfaction, low self-esteem, mood swings, anxiety, numbness and social isolation. Physically, they manifest as significant weight loss or gain, fatigue, dizziness, gastrointestinal problems, changes in skin, hair and nails, dental problems and, in women, amenorrhea.
Early detection and timely diagnosis are key to a better prognosis. Dr. Teia Plana explains: “The longer it takes from the onset of the disease to the start of treatment, the greater the risk that the patient will take longer to recover.” Families should pay attention to emotional changes, such as self-deprecating comments, dissatisfaction with one’s own body, food restriction, isolation or excessive interest in food. In such cases, it is advisable to address the problem to understand the situation and feelings and try to encourage the family member to open up and express what is going on. “At this point, psychological intervention is probably more effective than dieting,” adds the expert.
Food should not be a negotiable issue. A pleasant environment during and after meals and distraction to ease anxiety associated with meals can help the patient feel more comfortable and confident. Simplistic advice and discussions about food, health and appearance should be avoided as these attitudes can be triggering or counterproductive. Dr. Itziar Flamarique, child psychiatrist at Hospital Clínic Barcelona, stresses the importance of acknowledging feelings, valuing shared concerns and avoiding bias.
“The most important thing,” adds Flamarique, “is that the patient feels that someone is there to listen to her when she needs it.” Dr. Plana also explains the impact of the COVID-19 pandemic on young people’s body image. “During the lockdown, many people developed an irrational fear of gaining weight because they no longer had control over their diet and exercise. Factors such as perfectionism and the inability to manage stress played a crucial role,” she interprets. “This led to increased emotional risks such as anxiety and isolation, while protective factors such as social relationships decreased,” she recalls.
“It is crucial to acknowledge feelings, value sharing of concerns, and avoid judgment.”
Experts say that as time passes and the patient recovers, they will likely come to appreciate the presence of their loved ones. And since family members need energy and strength to provide the best support possible, they must equally take care of themselves. It is important not to blame yourself for eating disorders, as they are multifactorial disorders. Dr. Plana points out that there is no single motive; individual factors such as gender, as well as environmental factors such as societal pressures on physical appearance, especially in women, play a role. Physical changes during puberty contribute to their development. Setting a good example of healthy lifestyle habits can have a positive impact on both those around you and the patient herself.
The road to recovery is long and slow, but with love and empathy it is possible. Today there are useful resources for these disorders. Dr. Plana comments: “Within the CatSalut mental health program, a shock plan has been implemented. As for the treatments, there is a part that continues to work very well and others that we need to continue developing.” “In my opinion, the social dimension is the weakest, so all efforts must be directed in this direction to improve the situation in the coming years,” she concludes.
