Eating disorders are a prominent issue in American culture—they have the highest mortality rate of any mental illness, and just 1 out of every 10 people suffering from an eating disorder receives treatment. “In our whole country we probably have less than 2,000 actual certified eating disorder specialists,” noted Therese Waterhous, president and owner of Willamette Nutrition Source in Corvallis, a private nutrition consulting business.
“Here in Linn, Benton, and Lincoln counties, we don’t have many eating disorder specialists,” said Waterhous. Which is why she’s recruited a multidisciplinary team of professionals interested in developing their knowledge of eating disorders in the tri-county area, all thanks to a health transformation grant by InterCommunity Health Network CCO.
“The grant is first of all recruiting people who have an interest.” Waterhous noted a common barrier to effective treatment being a lack of interest among a wide range of providers.
In the grant’s first phases, Waterhous has selected a “provider pool” of 50 professionals across multiple disciplines—therapists, doctors, nurses, dieticians—in the tri-county area. The provider pool will be expected to attend regular virtual trainings via webinars, audio files, and podcasts to learn about latest research and treatment practices.
Waterhous has recruited 15 of the top eating disorder researchers in the country to provide education to the provider pool. “Part of my vision is to have this pool of providers talking to each other, getting to know one another… then we can advertise to everybody else that they exist.” It is her hope that these professionals will collaborate to develop best treatment practice protocols and referral pathways for those suffering from eating disorders.
Along with her PhD in human nutrition, clinical nutrition, and nutrition biochemistry, Waterhous is a licensed and registered dietician and nutritionist. She’s studied eating disorders for the past 15 years, since encountering a client neither she nor other local professionals knew how to help.
“I found really that it’s a worldwide problem—eating disorders are under-recognized, under-diagnosed, and when they are diagnosed, often times people fall into pretty bad treatment,” she said.
What is Good Treatment?
“You need to have well-trained doctors that know what to look for, well-trained nutritionists that know how to do the nutritional restoration aspect, and bring on social support to help people eat,” Waterhous explained, “and the whole team needs to be well enough educated that they can educate families and significant others as support people.”
Waterhous explained that, with eating disorders, you can’t treat psychological deficits first. “Before someone is fully ready to engage in psychological treatment, they need to be nutritionally restored.”
Specialists such as Waterhous use rapid, aggressive treatment to break eating disorder habits―restricting calories, compulsive exercise, purging behaviors, and binging behaviors―by empowering and engaging with those closest to the client.
“Having a meal companion is very effective,” said Waterhous, explaining how clients typically struggle most when eating alone. She recommends coming from a place of calmness and compassion when interacting with someone suffering from an eating disorder, as they are likely to present with anxiety or agitated behaviors.
“If you really strongly suspect that a friend or relative has an eating disorder, approach them with compassion and let them know that you know they aren’t choosing to do this… it’s coming out of a place of anxiety and fear and worry,” said Waterhous.
Science and Stigma
In 2004, it was reported that 64% of individuals with eating disorders also possess at least one anxiety disorder; 41% of those individuals suffered from obsessive compulsive disorder specifically.
“More and more researchers and clinicians are calling eating disorders anxiety disorders,” said Waterhous, noting she’s never met a person with an eating disorder she would describe as “chill.”
“We also know from current research that genetics and neurobiology underlie eating disorders, so genetically, if you look through a family tree… you will see other people with anxiety-type disorders.” According to Waterhous, research in genetics is currently in infancy stage. She explained that fMRIs show differences in the brains of people who suffer from bulimia or anorexia nervosa.
Without early intervention, people who suffer for years with an eating disorder experience over time a “loss of gray matter [in the brain], loss of bone, [and are] usually physically weaker.” According to Waterhous, they tend to be very anxious and have “kind of underlying psychiatric things have not been dealt with.”
It isn’t always easy to spot an eating disorder either. Some people “can look healthy and still be very sick,” said Waterhous.
Waterhous also speaks to the misconception that those suffering from eating disorders have been victims of trauma. “Some people are just born stressed, right? So they don’t even need trauma or abuse to initiate anxiety, but they do need to learn in therapy how to recognize their own stress and anxiety and how to manage it in way that’s not harmful.”
A Call for Cultural Change
Body image, health, and fitness are subjects deeply ingrained in American culture. “Getting healthy” was searched so many times on Google between January and October of 2016—approximately 62,776,640 times—it was determined by digital marketing company iQuanti to be the top new year’s resolution for 2017. Similarly, statistics from December of 2016 mark “losing weight” as the main priority among resolution-makers in 2015.
Trends in dieting and exercise can, in some cases, be detrimental. For some, setting extreme expectations or adhering to unrealistic standards of health and fitness can be catalysts to eating disorder behaviors.
“I think it’s important for society in general to stop talking thin ideal and stop talking diets, because diets don’t work for one thing—they’re not healthy, mentally or physically, and negative energy balance can lead to eating disorder behaviors,” Waterhous explained.
Waterhous references trends in dieting today, such as vegan, paleo and gluten free. She says we should all loosen up a little and “talk about eating in a flexible, joyful manner, as opposed to restrictive or even the idea that there’s a perfect way to eat.”
For more information on Therese Waterhous and Willamette Nutrition Source, visit http://www.
By Stevie Beisswanger