AUAA… Episode 11 Eating Disorders – Penn State Health Milton S. Hershey Medical Center
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AUAA… Episode 11 Eating Disorders – Penn State Health Milton S. Hershey Medical Center

August 23, 2019

>>From Penn State health, Milton S. Hershey
Medical Center, this is Ask Us Anything About Eating Disorders. I’m Scott Gilbert. This is National Eating Disorders Awareness
Week, and the theme this year is It’s Time to Talk About It. Here to talk about this important issue with
us is Dr. Rollyn Ornstein. She is Division Chief of Adolescent Medicine
and Eating Disorders at Penn State Children’s Hospital. Dr. Ornstein, thanks for your time today.>>Thanks for having me.>>So this seems like it’s a tough discussion
to have. If an adult suspects and eating disorder with
someone who they love, isn’t that a tough discussion, a tough topic to broach?>>It’s definitely a tough topic to broach. There’s a lot of denial in kids and adolescents,
and even adults who have eating disorders.>>So what’s some of the best advice you can
give, first of all to parents, who might see some of the warning signs, which we’ll talk
about in just a moment. But what’s some advice you have for parents?>>I would say just like any other thing that
might concern the parent, they just need to sit down and have an open, honest conversation
with their child. Just like if they were concerned about their
grades, possible drug use, or anything else, ignoring it is not the way to go.>>It’s not something that’s just going to
pass if it’s for real.>>It is not just going to pass. These are not phases. These are not things that kids just dabble
in. These are serious disorders.>>What about peers? If I’m a teenager and I suspect this in a
friend, can they take action, too?>>Definitely. I often find that it’s the peers who bring
it either to the school’s attention or the parents’ attention, and I think is a friend,
being a good friend is really important. If you feel that your friend is not going
to be your friend anymore if you act for them, I understand that. But really, the best thing to do for your
friend is to try to take action and maybe get an adult involved.>>You’re watching Asked Us Anything About
Eating Disorders from Penn State Children’s Hospital. I’m Scott Gilbert alongside Dr. Rollyn Ornstein,
and we welcome your questions over the course of this video. Whether you’re watching it live, we can pose
those questions to her live, or even if you’re watching it on playback after the fact. We’d be happy to share the questions with
Dr. Ornstein and track down an answer for you that we’d share in the comments section,
as well. And if you like the content you’re seeing
right now, feel free to share us and help us get the word out about this important topic. We talked briefly about warning signs. What are some of the most common warning signs
of — we’ll speak generally about eating disorders?>>Certainly, if one notices that their child
is not coming to meals anymore, making excuses to not eat, such as I ate when I came home. I ate at someone else’s house. Disappearing after meals or just not coming
down to the table. Cutting their food up into small pieces. Pushing food around on their plate. Those are some of the behavioral signs that
might tip someone off that there may be an eating disorder going on.>>As you mention those, I’m thinking, I can
think of times that my kids have done that. It seems like every kid does that at some
point. Place with their food, pokes it around. When does it cross that line? Maybe when you see a pattern?>>Well certainly, picky eating is common
in much younger kids. Certainly, in toddlers. Picky eating really shouldn’t extend significantly
beyond into school-age. If this is a new behavior, a change in behavior,
I think is what I’m talking about.>>Sure, and of course, back when we went
to school, we took what $1.25 or whatever in cash, and we paid. So if a child wasn’t going to eat lunch that
day, they could hide that money from their parents. Today, it’s a much more digital process in
most schools. So that can be another warning sign, right? If you see it not being used?>>Actually, that’s true. I just had a patient come in whose parents
said they noticed that she was not using her lunch account money. Now a kid could use their lunch account and
not eat to food, of course, but usually, they won’t do that. By not buying food at lunchtime, that could
be another warning sign.>>There some other symptoms, maybe not directly
related to eating, such as, say, mood disorders, things like that?>>A lot of kids who have eating disorders
have other things like anxiety and mood disorders. Some of them started before the eating disorder,
and some of them may be the result of the eating disorder.>>Let’s talk about some of the most common
eating disorders. We’ve heard a lot about anorexia nervosa. What is that?>>Anorexia nervosa is a disorder where the
patient restricts the intake significantly, such that they either lose a significant amount
of weight, or if it’s a younger person, they may not just make the weight gains that are
appropriate developmentally. They often will have some over exercising,
as well as part of that disorder. But the caloric intake is highly restrictive,
and there’s a lot of weight and shape concerns. Concerns about becoming fat or overweight,
despite not being fat or overweight.>>Compare that to bulimia nervosa.>>Bulimia nervosa is characterized by binge
eating, which is eating a large quantity of food in a relatively short period of time,
usually in secret, associated with a lot of guilt and shame, and then there is a compensatory
behavior. Meeting, something to get rid of the calories
that were consumed. Most commonly, this could be self-induced
vomiting. However, it can also consist of laxative use,
diet pills and diuretics, excessive exercise, or severe restriction in between the binge
episodes.>>Sounds like there are you know, at the
root of a lot of these, are some body image questions that arise in someone’s head. Can you talk about that and how they may have
a distorted view of how they actually look?>>Oh absolutely. Both anorexia nervosa and bulimia nervosa
have body image disturbance, weight and shape concerns at the core of the disorders for
both of those, despite, you know, not ever being overweight, perhaps, or maybe being
a little bit overweight. We are seeing increased eating disorders in
kids who were formerly overweight becoming anorexic.>>And we hear a lot about the pressures,
especially on women, to, you know, look good, to be as thin as possible, and to what extent
do you think that kind of more public pressure weighs in?>>I personally think that we have seen an
increase in disordered eating because of the pressures on women and men, for that matter. However, patients who don’t have as much access
to media also develop eating disorders. So we know it’s not really the only cause
or the, you know, the main culprit.>>You’re watching Ask Us Anything About Eating
Disorders from Penn State Health. I’m Scott Gilbert. This is Dr. Rollyn Ornstein, and we do welcome
your questions in the comment section, whether it’s live, or you’re watching this video on
playback. We’ll definitely get some answers for you. Let’s talk about a couple other types of eating
disorders. There’s one that has been recognized as an
eating disorder. It’s binge eating. Is that separate from bulimia nervosa, as
you described it, which involves binge eating but then purging?>>Yes, binge eating disorder is probably
the most prevalent eating disorder, but it was only formally recognized in 2013 in one
of the newer diagnostic manuals for eating disorders. It is comprised of similar binge eating behaviors,
as I described for bulimia, but without any of the compensatory mechanisms that I described,
and there is also less weight and shape concern associated with it.>>You know, I mentioned the pressures on
women, but you also made the good point that this is not limited to teenage girls, which
is who I think we often think of with eating disorders. Is that a common misperception, and how broad
do you see patients coming from all demographics?>>It’s said that the ratio of females to
males with the typical eating disorders is 10 to 1. So about 10% of patients are males, and I
do believe that’s what we see. However, I have definitely, in my practice,
seen an increasing number of males, especially males who were formerly overweight.>>In one of the comments that we got about,
on the Facebook post, promoting this discussion, we had someone named Kelly who posted that
she had struggled with an eating disorder, and she said, ” I beat this illness, but I
still have an awful perception about my weight.” So how do you define a cure? Is there such thing as a cure from eating
disorders, or is it something that, in many cases, folks kind of learn to kind of cope
with those feelings?>>I do think that patients can be cured from
eating disorders. Recovery is possible. I think some of the body image disturbance
that goes along with the eating disorder, may be somewhat normative. It’s just how it really affects the patient
day-to-day. How much of a percentage of their daily hours
are spent thinking about their body? I think that’s one of the last things to improve
would be the body image, even if the behaviors are under control.>>We talked a little bit about the warning
signs and the fact that anybody can take action and should take action if they see those warning
signs. At what point is it time to call on a medical
provider, and how do you determine whether it should be a primary care physician or even
a specialist?>>Certainly, if a child or adolescent has
lost a significant amount of weight, it’s important to go be seen, possibly by the primary
care doctor first, if that’s the relationship that one has. You can also go see a specialist, if you’re
allowed, without, you know, getting a referral if there is any concern on the parents’ part. Personally, even if they’re told, don’t worry,
it’s not a problem, I would say go seek help if you know, as a parent, that you are concerned
about your child.>>You’ve heard of situations, I’m sure there
must be, where the teenager says, simply, “I’m not going.”>>All the time. It’s hard to get a kid into the office if
they won’t get into a car. I realize that. But again, to the parent. You’re worried about your kid. You’re the parent. You take them to the doctor. The hardest part is when I get it, who comes
into the office, and they don’t actually know why they’re coming to see me.>>I’m sure that happens.>>That can be challenging, yes.>>I imagine, and then they realize where
they are. But they’re there for their own good, though.>>Yes.>>Again, we welcome your questions here at
the bottom, and like I mentioned earlier, feels free to share this Facebook post on
your page to help us get the word out about this discussion and this important dialogue
around eating disorders. This is Ask Us Anything About Eating Disorders
from Penn State Health, and the next question I have for you, Dr. Ornstein, is about the
program here at Penn State Children’s Hospital. There are both inpatient and outpatient components,
correct?>>We don’t really have a true inpatient component. If a patient is medically unstable, we can
admit them to the Children’s Hospital for acute medical stabilization. If we feel they need a higher level of care,
such as an inpatient eating disordered mission, then we don’t have that component in our care. However, we do have what’s called a partial
hospitalization program, or a day program, which is a Monday through Friday program. We have programs for patients 8 to 16, and
another program for patients 17 and over.>>When you say a partial hospitalization. That means they go home each night?>>Yes, they either go home each night, or
they could also stay at the Ronald McDonald House, if they live farther away.>>What are the types of approaches you take
as a specialist in working with someone on the first steps of trying to help them overcome
an eating disorder?>>Well, I certainly need to know whether
they agree that they have a problem. Sort of a motivational stage of change approach. If they don’t even admit that there’s a problem,
then we have to first start getting them to admit that there’s a problem. However, however, if they’re unstable, we
need to take action, whether or not they agree that there’s a problem.>>And if people want to get in touch with
your program, obviously, I’m sure they can do so through the Penn State Children’s Hospital
website, right?>>Yes. There’s also — they can certainly give a
call to our nurse at 717-531-2099 to set up an appointment directly. They don’t actually need a referral, unless
their insurance requires it.>>Okay, we’ve got more information about
eating disorders, as well. In one of the more recent Penn State Medical
Minutes, you’ll find that at, and also, Dr. Ornstein was featured in a recent
column in Central Penn Parent. It is actually the edition on newsstands right
now, the March edition. So I encourage you to check that out. Dr. Ornstein, thanks so much for your time
today on this important topic.>>Thanks for having me.>>And thank you very much for watching, Ask
Us Anything About Eating Disorders from Penn State Health.

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