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Treatment program for young people focuses on family

May 08, 2012 - Dallas Morning News | By Nancy Churnin

Then they heard the last diagnosis they expected for their 11-year-old daughter: anorexia nervosa. Hearing that her life was becoming “medically unstable,” Cynthia Rinehart and Thetis LeMaistre quickly packed what they needed from their San Antonio home and drove to the Center for Pediatric Eating Disorders at Children’s Medical Center, which offers the only inpatient eating disorder program in North Texas for those 18 and younger.

The center, which has been treating children for more than 20 years, expanded its focus on the family’s role in recovery when it moved to a new location at Children’s at Legacy in Plano in November. Intensive family therapy, including separate sessions for parents and children and sessions together, trains parents to become their children’s coaches as they eat together at the facility’s cafeteria.

The holistic approach also integrates art, music, pet and outdoor therapy, cooking workshops, peer support and, for the first time this spring, an opportunity to grow and harvest vegetables and herbs in an outdoor garden with the aim of fostering a healthier regard for food.

The number of people with eating disorders, including anorexia and bulimia, is hard to assess because anorexics hide food they pretend they’ve eaten, and bulimics hide the fact that they’re purging.

Still, it’s estimated that at least 10 million females and 1 million males in the United States suffer from anorexia and bulimia, with millions more struggling with binge eating, according to Lynn Grefe, president and CEO of the National Eating Disorders Association. NEDA also reports that more than half of teenage girls and one-third of teenage boys use unhealthy means of weight control.

Anorexia has the highest premature fatality rate of any mental illness, according to a1995 study in the American Journal of Psychiatry, the most recent statistics backed by NEDA and Children’s Medical Center. The risk of death from suicide or medical complications is markedly higher for people with eating disorders, according to a study published in 2009 in the same journal.

Suicide is a concern of the Elisa Project, a Dallas nonprofit dedicated to raising awareness and providing resources for those with eating disorders. It’s named in honor of Elisa McCall of Dallas, who committed suicide at 20 after a battle with bulimia, which was revealed in journal entries after her death.

While people associate the disease with teen girls, experts say they see it at all ages in both genders, starting as young as 6.

“The incidence of boys is definitely on the rise,” says Dr. Stephanie Setliff, a psychiatrist and assistant professor at UT Southwestern Medical Center who directs the Children’s Medical Center program.  

“Boys are under increasing pressure to look a certain way, to perform in sports, to get into college. It’s very common for coaches to make remarks such as, ‘You would be a faster runner if you lost weight,’ or ‘You would wrestle better at this weight.’ ”

Setliff attributes the overall rise in eating disorders to the increased stress children face — from the financial and resulting emotional pressures of the recession to peer pressure and bullying in social media.

Dr. Craig Johnson, an author, researcher, clinical professor of psychiatry at the University of Oklahoma Medical School and chief clinical officer of the Eating Recovery Center, which offers inpatient treatment in Denver, says he also sees a correlation with the recent push for everyone to diet and exercise.

While that’s a laudable goal, he estimates that 5 percent of the population takes it to an unhealthy extreme.

“The two strategies to combat obesity are diet and exercise, but these are the gateway behaviors to eating disorders,” Johnson says.

That may have been the case for Eric G. Torres of Garland. His stepfather, Juan Renteria, says Eric was 14 when he started talking about wanting to be healthier. Renteria noticed Eric eating less, eating more slowly, going on the Internet to check on calories and spending increasing time studying the ingredients on food boxes. When Eric was 15, Renteria saw him without his shirt and gasped.

“My first impression was, ‘Man, you are going to die. Your body is bones everywhere. Tell me what is wrong.’ He said, ‘I feel all right.’ ”

Eventually Renteria convinced Eric that he needed help and got him into the program at Children’s, where Eric, now 16, spent months learning a better approach to food.

Johnson urges parents to be aware that there can be a physiological as well as a psychological component to the disorder. “Dieting and exercise alter brain chemistry. Everyone doesn’t have the same vulnerability to these neurochemical events in the brain. But for some, particularly families that have histories of eating disorders, these changes can trigger anorexia and bulimia.”

Caitlin’s parents have had their own struggles with food over the years, but she says she began her journey to anorexia after a checkup in the fall when her doctor told her she was 2 pounds overweight.

She started out restricting certain types and amounts of foods. By January, she was suffering from dizzy spells, but didn’t know how to reverse the process. “People said I looked skinny. I started trying to eat more, but it wasn’t making a big difference.”

The experts at Children’s Medical Center examine contributing psychological factors in individual and family therapy. At the same time, they maintain a steady re-education about food.

Caitlin worked with her parents to create a list of foods in three categories — red for the ones she does not want to eat, yellow for the ones she will eat but doesn’t want to and green for the ones she will eat.  

She picks something from the red and yellow lists to try at each meal with the goal of moving foods to the green category. She takes off her hoodie as required, so she does not have long sleeves or pockets in which to hide food, and eats with a timer, knowing that she must finish everything on her plate in 30 minutes. When she finishes, she pulls out a “Re-Think Sheet” from her folder and writes down her “Automatic Thoughts.”

For a breakfast in March, she wrote: “It went good. I feel guilty because I know sausage is a fatty kind of meat and the buttermilk biscuit just leaves me with a guilty feeling. Feeling full also makes me feel guilty.”

In another category, called “Alternative Thought,” she writes: “Your brain is made up of fat so the fat in the sausage patty will help with that. So will the protein in it. The biscuit can be converted to glucose.”

Cynthia Rinehart, a middle school science teacher, smiles as she reads this.  

Caitlin, she says proudly, wants to be a marine biologist.

But first, this fifth-grader, who loves music and reading and science, wants to get well. Speaking in a whispery voice, Caitlin says she’s learning “to talk to people more,” referring to other patients. She appreciates, too, the encouragement to share more with her parents.

“The best thing is getting closer with my family,” she says.


 
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