Ask Us Anything About… Eating Disorders

The video begins inside one of the meeting rooms within Penn State Health Children’s Hospital’s Eating Disorders clinic. Two individuals are standing in front of a wall that has a hand crafted 3-D art mural showing collaboration. The two individuals are looking at the camera. Standing from left to right is Scott Gilbert and Division Chief of Adolescent Medicine and Eating Disorders at Penn State Health Children’s Hospital

Scott Gilbert – 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 Health Children’s Hospital. Dr. Ornstein, thanks for your time today.

Dr. Rollyn Ornstein – Thanks for having me.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – It’s not something that’s just going to pass if it’s for real.

Dr. Rollyn Ornstein – It is not just going to pass. These are not phases. These are not things that kids just dabble in. These are serious disorders.

Scott Gilbert – What about peers? If I’m a teenager and I suspect this in a friend, can they take action, too?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – You’re watching Asked Us Anything About Eating Disorders from Penn State Health 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – There some other symptoms, maybe not directly related to eating, such as, say, mood disorders, things like that?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – Let’s talk about some of the most common eating disorders. We’ve heard a lot about anorexia nervosa. What is that?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – Compare that to bulimia nervosa.

Dr. Rollyn Ornstein – 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.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – You’ve heard of situations, I’m sure there must be, where the teenager says, simply, “I’m not going.”

Dr. Rollyn Ornstein – 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.

Scott Gilbert – I’m sure that happens.

Dr. Rollyn Ornstein – That can be challenging, yes.

Scott Gilbert – I imagine, and then they realize where they are. But they’re there for their own good, though.

Dr. Rollyn Ornstein – Yes.

Scott Gilbert – 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 Health Children’s Hospital. There are both inpatient and outpatient components, correct?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – When you say a partial hospitalization. That means they go home each night?

Dr. Rollyn Ornstein – Yes, they either go home each night, or they could also stay at the Ronald McDonald House, if they live farther away.

Scott Gilbert – 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?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – And if people want to get in touch with your program, obviously, I’m sure they can do so through the Penn State Health Children’s Hospital website, right?

Dr. Rollyn Ornstein – 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.

Scott Gilbert – 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 Pennstatehealthnews.org, 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.

Dr. Rollyn Ornstein – Thanks for having me.

Scott Gilbert – And thank you very much for watching, Ask Us Anything About Eating Disorders from Penn State Health.