By Steven Karp, DO, FACN
One of the first questions people struggling with eating disorders ask is how to get these crazy thoughts about food, weight and body image out of their head. What is the best treatment to stop these obsessive thoughts and the compulsive nature of the eating disorder behaviors? The answer is simple, FOOD, in an adequate variety, quantity and quality so it can restore the body and brain to a healthy nutritional state.
The nutrients in the foods you consume affect your body’s ability to make neurotransmitters, the chemicals in the brain that influence your moods, thoughts and actions. Most people who suffer from an eating disorder are deficient in nutrients in their diet that are the building blocks so they aren’t producing enough of these neurotransmitters, which can play a role in their abnormal response to food, mood and anxiety.
We know that many women and men with anorexia, binge eating, bulimia and other atypical eating disorders also experience depression, anxiety and/or a substance use disorder. For example, a 2004 study by the Price Foundation, an international team of researchers, found that two-thirds of people with eating disorders will suffer from an anxiety disorder in their lifetime. Research has also shown that a significant number of people with an eating disorder also abuse alcohol or other drugs.
Symptoms Settle Down With Good Nutrition
When an individual with an eating disorder comes into treatment, it is important to appreciate how their state of malnutrition is affecting their mental state. A nutritional assessment is done immediately. They must meet with a registered dietician, one who is a specialist in eating disorders, to assess the state of nutrition and begin a meal plan that starts the restoration process for the body and brain.
Once they have the nutritional building blocks for neurotransmitters and the obsessive thinking is reduced with food intake, you can assess for comorbid psychiatric conditions. Diagnosing a cluster of symptoms too soon may result in patients who may be diagnosed with a psychiatric disorder when the symptoms are a direct result of the state of malnutrition. What is clear is that after two to four weeks of nutrition restoration, a patient’s symptoms of depression, anxiety and other psychological symptoms may improve if they are caused by malnutrition. If the symptoms persist, they are likely to have an independent psychiatric disorder that requires treatment with medication, therapy or both.
A Two-Pronged Approach
At the same time the malnutrition is being addressed, treatment must also focus on elimination of the eating disorder behaviors. These behaviors include binging, purging and restricting. Working with a therapist, patients begin to deal with emotional stressors like trauma that may be driving the behavior. Cognitive behavioral therapy can be very effective in bulimia. Experiential therapies such as psychodrama are helpful in getting through the emotional defensiveness that may exist. In addition, individual, group and family therapy, as well as holistic treatments like equine-assisted therapy and art and music therapy help support the recovery process.
Medications for Eating Disorders
The antidepressant Prozac has been approved by the Food and Drug Administration for years to help with the binging and purging seen in bulimia, but no medication has proven to be effective in treating anorexia, the most deadly of all psychiatric disorders.
It wasn’t until very recently that we had a drug to treat binge eating disorder. In 2015, the FDA approved the expanded use of Vyvanse, a medication originally developed to help people with ADHD. It must be kept in mind that this is an addictive drug and must be monitored carefully.
Several drugs that can alter appetite cues may be best to stay away from. The dietitians work with patients during the recovery process to help them get back in touch with their hunger and fullness cues in order to feed themselves normally. It is important for patients to learn to eat when hungry and stop when they are no longer hungry. Drugs that reduce appetite can interfere with long-term recovery. A medication called Topamax has a powerful effect on appetite by decreasing the desire to eat and increasing the fullness sensation. That is why some people have dramatic weight loss as a side effect. Stimulants such as Adderall and Ritalin will reduce appetite and eating disorder patients often abuse these drugs to drop their weight.
Following a Meal Plan
The key to long-term and sustained recovery is following the meal plan given by the registered dietitian while continuing therapy. Once the person stops following the meal plan or starts using the eating disorder behaviors again, the focus needs to go back to nutrition and behavior. Underlying therapy may take a backseat during these periods. Psychodynamic therapy is less effective when the patients are acting in their eating disorders, similar to addicts who start using again. All members of the treatment team should be focusing on those foundational issues, meal plan and eliminating the behaviors.
The not-so-simple truth is that if the body is fed adequately, it will find its genetic set point for weight and appearance. It is also likely that some mental health and physical issues are often directly related to malnutrition and may respond by returning to normal nutritional status. It must be noted that normal weight and overweight individuals can be severely malnourished. You can’t assume normal weight means normal nutritional status. If the person is eating poorly and not eating 100% of daily dietary requirements, the body can be sick at a “normal” weight.
Dr. Steven Karp, DO, FACN, is the medical director of Promises Scottsdale. Dr. Karp is a diplomat of the American Board of Psychiatry and Neurology, the National Board of Examiners for Osteopathic Physicians and Surgeons, and the American Osteopathic Board of Neurology and Psychiatry.