Dr. Rachel Fortune, Medical Director for Newport Academy, is an expert in the treatment of eating disorders and mental health disorders, and is Board-certified in Adolescent Medicine. In this interview, she shares information about the risk factors for eating disorders and explains why involving the entire family in treatment is so essential.
What are the underlying issues and risk factors for eating disorders? Are they a product of nature, nurture, or both?
First, let me explain that different eating disorders have different profiles and specific details. When I talk about “eating disorders” as a collective, I am more specifically referring to anorexia nervosa, bulimia nervosa, and binge eating disorder. Eating disorders are multi-factorial. There is most certainly a genetic component, but not a single gene that has been identified at this time. Having a parent or sibling with an eating disorder greatly increases the risk of developing an eating disorder.
Other risk factors for developing an eating disorder are: being an adolescent; having a personal history of depression, anxiety, trauma, or OCD, or a history of significant weight loss; stressful life circumstances (times of transition, family stress); and being involved in an image-based sport or activity such as ice skating, gymnastics, or wrestling. In addition, the “ideal body images” that are presented by the media can impact the development or progression of eating disorders.
What are the most important elements of treatment for eating disorders? What are the newest evidence-based approaches to treatment?
Whether by medical complication or suicide, eating disorders as a collective are the deadliest of all mental health diagnoses; this is the most important issue to realize when treating patients with eating disorders. There is no room for delay of care, and the time to intervene is as early as possible because the single most important element of successful treatment of treating eating disorders is timing. Children and adolescents with shorter duration of illness have better prognoses overall.
The most evidence-based method for treatment of eating disorders is Family-Based Treatment (FBT), also known as the Maudsley Method. Having a cohesive treatment team is essential, and working with a therapist, nutritionist, and medical doctor who can all communicate well and be on the same page is of the utmost importance.
What role should parents play in treatment when a child is struggling with an eating disorder? Are eating disorders considered a "whole family" issue?
Eating disorders are absolutely family-systems issues. Rather than thinking about whether or not the family “caused” the eating disorder, the focus needs to be on the fact that the family can absolutely be part of moving the child or adolescent into recovery. The family is essential in supporting the adolescent and engaging with the treatment team to understand how to talk to their child in the various stages of recovery.
Families are often frustrated by their child or adolescent who is struggling with an eating disorder. Eating disorder recovery is a long process and families need to be patient with their loved one. They also need to be willing to explore how eating behaviors in the house have affected the child, and be willing to change that environment to aid in recovery.
Once someone is in treatment, what's the best way for friends and family members to address their loved one's eating disordered behaviors?
Friends and family members need to recognize that they might say the “wrong” thing to their loved one. For example, when a child or adolescent is drastically underweight due to an eating disorder and starts the process of weight restoration, people often say, “You look so much better.” The child or adolescent hears, “You look fat.”
Family and friends need to take the lead from the treatment team in understanding how to speak to their loved one in the most supportive way possible. A compassionate approach, both to one’s self and the individual suffering, is the best way to sustainable healing.
About the Author
Rachel Fortune, MD, Medical Director for Newport Academy, earned her medical degree from Wake Forest University School of Medicine, Winston-Salem, NC. After completion of her fellowship at the Children’s Hospital Colorado in Denver, CO, Dr. Fortune spent two years caring for adolescent patients at Yale University School of Medicine/Yale New Haven Hospital in New Haven, CT, where nearly 90 percent of patients in her subspecialty practice were being treated for eating disorders. Dr. Fortune currently lives near New Haven with her husband and their two daughters