Q&A: Update on eating disorders

Key takeaways:

• Signs of eating disorders can include repetitive dieting, hiding food or changes in mood.
• Girls as young as age 6 years have started to express concern about their weight or shape, an expert said.

This year, Eating Disorders Awareness Week is being held from Feb. 26 to March 4.

According to previous research, eating disorder claims rose 65% as a percentage of all medical claims between 2018 to 2022, while there were increases in all eating disorder subtypes.

The findings also showed that 72% of patients with eating disorders were also diagnosed with one or more concurrent mental health disorders.

Melissa Spann, PhD, MBA, CEDS-C, chief clinical officer of Monte Nido & Affiliates — an eating disorder treatment center based in Miami — spoke to Healio about the common signs of eating disorders, the impact social media has on eating disorders and more.

Healio: What are some signs and symptoms of eating disorders?

Spann: There’s a lot of different signs and symptoms of eating disorders. Sometimes it can be hard to tell because there are different types of eating disorders that people aren't necessarily attuned to.

Some signs may include constant or repetitive dieting, evidence of somebody running to the restroom after a meal, hiding or stealing food, excessive exercise patterns and rituals around food.

But more than that, signs can include changes in mood as well. Other signs include depression and anxiety, withdrawing from family or friends or social activities, and certainly an increased preoccupation with body, weight and shape.

Healio: What are the current trends regarding eating disorders, especially among women and girls, who are disproportionately affected?

Spann: Although that is true, I very much believe that those trends are changing. I think it's a pretty significant myth to consider that eating disorders are affecting just women and girls, particularly white women and girls. We know more and more research is coming out that eating disorders affect marginalized communities and populations just as much, there’s just less research and less information in those areas.

In the research that we do have, one of the studies that's most cited is that girls as young as age 6 years start to express concern about their weight or shape, and that in elementary school, there's some staggering numbers — like 40% to 60% — of elementary school girls who are concerned about their weight. Certainly, that continues and is pretty pervasive throughout their lifetime.

Healio: What kind of impact does social media have on eating disorders?

Spann: Social media has significant impact on eating disorders. I think that we can look at the surgeon general's report and consider what's happening as it impacts depression and extend that to the eating disorder population.

In particular, social media perpetuates those unrealistic and ideal images of beauty or fitness or thinness, and really favors diet culture, which is a true sort of challenge within the eating disorder community, which is working against all of “thinspiration,” “fitspiration” or whatever the trendy term of the day is. Our culture is saturated with those messages, but social media is just pushing it into people's faces at a much higher and more pervasive rate than anything we've ever seen before.

Healio: Do you have any recommendations for primary care providers when it comes to identifying and treating patients with eating disorders?

Spann: Oftentimes, the first person who someone's going to see is going to be their PCP. I would urge PCPs to remember BMI is an arbitrary number. Instead of praising people for weight loss, ask questions when you see changes in weight and fluctuations overall, particularly for adolescents. The goal is to see someone continue on their growth curve, not drop on their growth curve because they're losing weight. Typically, if that happens, it's from some unrealistic way that someone's losing weight.

The other take-home message for me is... to consider all populations as ones who could potentially have a struggle with an eating disorder. So, if you see someone who in your mind is not the picture of an eating disorder, it could still be present.