Eating Disorders 101 Guide:

A Summary of Issues, Statistics and Resources

About Renfrew: The Renfrew Center Foundation (RCF) is a national nonprofit organization working to advance the education, prevention, research and treatment of eating disorders. The RCF is unique ecause we are an eating disorder nonprofit linked to treatment centers, allowing an on!going connection etween patients, families and professionals. To learn more a out The Renfrew Center Foundation or to download other Renfrew Action Guides, visit www.renfrew.org or call "!#$$!R%&FR%'. About The Action Guide: (ne wa) The RCF helps accomplish our mission is ) educating people in recover) and their families on how the) can affect change on oth a local and national level. (ur staff mem ers compiled this document as a resource for reporters, pu lic officials, students and others who are interested in learning more a out eating disorders. 'e turned to national mental health groups for information. Calls to *ction are posted on our we site under the +&ews, section- please look there for an) action need. *dditionall), we have a Renfrew *ction &etwork which people in recover), families, friends and professionals are encouraged to .oin (visit our we site to .oin). 'e hope this guide will help )ou understand the issue and serves as a guide for action. Suggested Citation: The Renfrew Center Foundation for %ating /isorders, 0%ating /isorders "$" 1uide2 * 3ummar) of 4ssues, 3tatistics and Resources,0 pu lished 3eptem er 5$$5, revised (cto er 5$$6, http277www.renfrew.org.

STATISTICS
Prevalence": " in 8 women struggle with an eating disorder or disordered eating.5 9p to 5: million people suffer from an eating disorder in the 9nited 3tates.6 9p to ;$ million people world wide struggle with an eating disorder.:
1 <revalence and mortalit) rates of eating disorders are not tracked ) the 93 government. Therefore, all estimates are ased on studies conducted ) private researchers. 'e have listed sources in this particular footnote that reference prevalence rates in their studies7articles2 Cul erg,=., > %ngstrom! ?ind erg,@. <revalence and incidence of eating disorders in a su ur an area. *cta <)schiatricia 3candinavica, "AA#, ;#, 6":!6"A. Fisher @, 1olden &B, Catzman /C, et al. %ating disorders in adolescents2 * ackground paper. =ournal of *dolescent Bealth, Dol. "E, "AA8. 1arner, /@, 1arfinkel, <% (%ds). Band ook for treatment of eating disorders. "AA;. &ew Fork2 1uilford <ress. Boek, B'. Review of the epidemiological studies of eating disorders. 4nternational Review of <s)chiatr), "AA", 8, E"!;:. The 93 /ept. of Bealth > Buman 3erviceGs (ffice on 'omenGs Bealth, www.:women.gov > The 93 /ept. of Bealth > Buman 3erviceGs &ational 4nstitute of Bealth www.nimh.nih.gov Fager =, *ndersen *, /evin @, @itchell =, <owers <, Fates *. *merican <s)chiatric *ssociation practice guidelines for eating disorders. *merican =ournal of <s)chiatr) "AA6- "8$25$;!5#. 5 %ating disorders include anoreHia, ulimia and inge eating disorders (classified as mental illnesses in the /3@ 4D). /isordered eating is not a classified mental illness. /isordered eating is characterized ) at)pical ehaviors such as continuous restrictive dieting, inging and purging, )et the individual does not fit all the criteria to have a diagnosa le eating disorder. 4t has een estimated that up to 58 million men and women in the 93 struggle with disordered eating or su !clinical eating disorders. 6 This estimated figure was created ) utilizing current 93 Census num ers and statistics from the &ational 4nstitute of @ental BealthIs (&4@B) guide, Eating Disorders: Facts About Eating Disorders and t e Searc for Solutions (i.e. 6.;J females suffer from *noreHia, :.5 females suffer from Kulimia and 8J of males and females suffer from Kinge %ating /isorder. The 5: million figure com ines all three eating disorders, anoreHia, ulimia and inge eating disorder. The figure of #!"$ million people suffering from an eating disorder is a common figure used, however this underestimates ) not including all ages, oth genders and all three eating disorders. : http277www.eatingdisorderinfo.org7menu.html:

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*lmost 8$J of people with eating disorders meet the criteria for depression.8 &earl) half of all *mericans personall) know someone with an eating disorder.E

!ortality Rate;: %ating disorders have the highest mortalit) rate of an) mental illness. The mortalit) rate associated with anoreHia nervosa is "5 times higher than the death rate of *?? causes of death for females "8!5: )ears old. 5$J of people suffering from anoreHia will prematurel) die from complications related to their eating disorder, including suicide and heart pro lems. Access to "reatment: (nl) " in "$ men and women with eating disorders receive treatment # and onl) 68J of people with eating disorders that receive treatment get treatment at a specialized facilit) for eating disorders.A * out #$J of the girls and women who have accessed care for their eating disorders do not get the intensit) of treatment the) need to sta) in recover)Lthe) are often sent home weeks earlier than the recommended sta)."$ The more important factor is that onl) once weight is restored to within A$!A8J of the normal range, can counseling and medications make a lasting impact. /ischarging a patient efore than increases chances of relapse. 4n fact, a patientIs relapse rate is 8$J if released while her weight is still elow #8J. "" This high relapse rate, during the weight gaining phase of treatment, ma) e due to patients generalizing that all eating leads to weight gain and ecome fearful and egin restricting once home."5 AEJ of eating disorder professionals elieve their anoreHic patients are put in life!threatening situations ecause their health insurance policies mandate earl) discharge."6 #oung Peo$le: *noreHia is the 6rd most common chronic illness among adolescents.": %ating disorders are higher among )oung women with t)pe " dia etes than among )oung women in the general population."8 A8J of those who have eating disorders are etween the ages of "5 and 58."E 5#J of high school males attempt to gain weight through weight lifting. 58J of college!aged women engage in ingeing and purging as a weight!management technique.
8 The mortalit) rates are all from the following stud), 3ullivan<F. !ortality in Anore%ia &ervosa. *merican=ournal of <s)chiatr), "AA8- "85(;)2 "$;6!:. E Mog ) *merica poll, 5$$5.

; *merican =ournal of <s)chiatr), Dol. "85 (;), =ul) "AA8, pp "$;6!"$;:, 3ullivan, <atrick F.
# Ruth 3triegel!@oore, et al., 'ne year (se and )ost of In$atient and 'ut$atient Services Among Female and !ale Patients wit
an Eating Disorder: Evidence from a &ational Database of Insurance )laims, 4nternational =ournal of %ating disorders 5; (5$$$). A Characteristics and Treatment of <atients with Chronic %ating /isorders, ) /r. 1reta &oorden oH, 4nternational =ournal of %ating /isorders, Dolume "$2"8!5A, 5$$5. "$ The Renfrew Center FoundationIs o servations of trends over the last "; )ears. "" Research conducted ) /r. 'illiam Boward at =ohn Bopkins 9niversit) 3chool. "5 3tructured %ating %Hpereinces in the 4npatient Treatment of *noreHia &ervosa, ) =. 3parnon and ?. Born)ak. "6 /avid France, +Anore%ics Sentenced to Deat ,, 1lamour @agazine, "AAA. ": <u lic Bealth 3erviceIs (ffice in 'omenIs Bealth, Eating Disorders Information S eet, 5$$$. "8 Cited in the federal ill, BR Con. Res. "#E2 &ational <u lic Bealth 4nitiative on /ia etes and 'omenGs Bealth "E 3u stance * use and @ental Bealth 3ervices *dministration (3*@B3*), The Center for @ental Bealth 3ervices (C@B3), offices of the 93 /epartment of Bealth and Buman 3ervices.

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8$J of girls etween the ages of "" and "6 see themselves as overweight. #$J of "6!)ear!olds have attempted to lose weight. "8J of )oung women in the 93 who are not diagnosed with an eating disorder displa) su stantiall) disordered eating attitudes and ehaviors."; * out ;5J of alcoholic women )ounger than 6$ also have an eating disorder."#

*esbian, Gay, +ise%ual, "ransgender )ommunity: @en and women with higher levels of femininit) have greater levels of dieting ehaviors. * ma.or risk factor that places transgendered individuals at risk for developing an eating disorder ma) e the +o session, with gender roles and intense discordance with the od) and anatomical seH."A ?es ians are at greater risk of inge eating disorder than heteroseHual women.5$ *mong ga) men, nearl) ":J appeared to suffer from ulimia and over 5$J appeared to e anoreHic.5" *mong men suffering from eating disorders, "$!:5J have identified themselves as homoseHual or iseHual (which is higher than the overall ase rate of homoseHualit) in the male population, which is EJ).55 !ales: *n estimated "$ to "8J of people with anoreHia or ulimia are male.56 %Hercise status and seHual orientation are two risk factors for eating disorders in males.5: @en are not immune to outside od) image influences. @edia images can affect menIs views of their odies.58 Racial and Et nic !inorities: * stud) presented at the 5$$5 4nternational Conference on %ating /isorders shows that women of color have man) of the same a normal eating patterns as white females. Bispanic women were once thought to e immune to these disorders ecause the) had etter od) images and different cultural eHpectations than white women. Kut with the high visi ilit) of Bispanic cele rities like <enelope Cruz and =ennifer ?opez, their cultural eHpectations are changing.5E 4n "AA: a stud) ) Essence !aga,ine, ased on 5$$$ women, concluded that *frican *merican women were at risk and suffer from eating disorders in at least the same proportion as white women.
"; 1irl <owerN, a pu
lic education program of the 93 /epartment of Bealth and Buman 3ervices. 5$$5

"# Bealth magazine, =an7Fe

"A 3urgenor, ?ois and =ennifer Fear. Eating Disorder in a "ransgendered Patient: A )ase Re$ort, 4nternational =ournal of %ating /isorders, Dol. 5:, &o.
:, "AA#. 5$ Beffernan, Caren. Eating Disorders and weig t concerns among lesbians. 4nternational =ournal of %ating /isorders, Dol. "A, &o. 5, "5;!"6# ("AAE). 5" 4nternational =ournal of %ating /isorders 5$$5-6"26$$!6$E. 55 Carlat, /.=., Camargo, C* > Berzog, /K. Eating disorders in males: a re$ort of -./ $atients. *merican =ournal of <s)chiatr), ":#, "AA". 56 Carlat, /.=., Camargo. Review of bulimia nervosa in males. *merican =ournal of <s)chiatr), "8:, "AA;. 5: *nderson, *%. !ales wit Eating Disorders0 "AA$. 58 ?eit, R*, 1ra) == > <ope, B1. " e media1s re$resentation of t e ideal male body: a cause for muscle dysmor$ ia20 4nternational =ournal of %ating /isorders. 5$$5. 5E Eating Disorders on Rise in 3is$anics, *ssociated <ress *rticle, =une 6$th, 5$$6.

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;:J of *merican 4ndian girls reported dieting and purging with diet pills.5; 4n Chile, it is estimated that ;$,$$$ women etween ": and 6$ )ears suffer from anoreHia nervosa and that 68$,$$$ Chilean women suffer from ulimia nervosa. /espite these alarming num ers, no specialized treatment centers for eating disorders eHist in Chile at this present time. 5# * poll ) the *rgentine *ssociation to Fight Kulimia and *noreHia (*?9K*) indicated that of the A$,$$$ teenage girls etween the ages ":!"# who participated, " in "$ suffer from an eating disorder. 4t is also estimated that eating disorder rates in *rgentina are 6 times the amount in the 9nited 3tates. %ating disorders are one of the most common ps)chological pro lems facing )oung women in =apan. 9nfortunatel), there is still great shame in seeking treatment in =apan- so man) people are going undiagnosed.5A Communit) studies in Bong Cong have indicated that 6!"$J of )oung women suffer from disordered eating to a degree that warrants concern.6$

Dieting and 'besity: A8!A#J of people on diets gain the weight ack (and more) within 6 )earsL/iets /onIt 'orkN There is now a O:$ illion diet industr) which was non!eHistent 5$ )ears ago. @an) people suffering from an eating disorder state the) were on a diet efore the) developed an eating disorder. @ore than E"J of adults and ":J of adolescents are affected ) o esit) and some 6$$,$$$ die each )ear from health pro lems directl) related to o esit).6" ( esit) is not .ust something that affects the individual, o esit) costs the 93 O";$ illion per )ear, which includes health care costs and lost productivit). 65 !edia The od) t)pe portra)ed in advertising as the ideal is possessed naturall) ) onl) 8J of the *merican females. The average model weighs 56J less than the average woman. A$J of all girls ages 6!"" have a Kar ie doll, an earl) role model with a figure that is unattaina le in real life.66 :;J of girls in 8th!"5th grade reported wanting to lose weight ecause of magazine pictures.6: EAJ of girls in 8th!"5th grade reported that magazine pictures influenced their idea of a perfect od) shape.68

5; Rosen et al. 5# The &eurosiquiatrico Centre of 3antiago. 5A Renfrew Center resource document. 6$ /isordered eating in three communities in China, a comparative stud) of female high school students in Bong Cong, 3henzhen, and rural Bunan.
4nternational =ournal of %ating /isorders 5$$$- 6";!5;. 6" C&& interview with /r. 3atcher, 3urgeon 1eneral, 5$$". 65 93 /epartment of Bealth and Buman 3ervices Fact 3heet. 66 Facts on t e !edia, /r. ?iz /ittrich for * out!Face. *lthough Kar ie or the media is not to lame for the development of eating disorders, the media and to)s do send messages a out unrealistic odies and reinforce negative od) image. 6: Prevention of Eating Problems wit Elementary ) ildren, @ichael ?evine, 93* Toda), =ul) "AA#. Recent studies cite the negative feelings rought on ) the magazines disappear for health) girls and o)s after 6 hours, however in individuals that are at!risk of an eating disorder, the feeling sta)s with them and ma) trigger eating disordered ehavior (e.g. restricting food, inging, purging through eHercise, pills, etc.). 68 4 id.

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(fficials, in Fi.i, reported a sudden increase in anoreHia and ulimia with the arrival of television in their communities.6E The primar) reason for following a nutrition or fitness plan was to lose weight and to ecome more attractive rather than to improve overall health and well eing, according to mainstream nutrition and fitness magazines from "A;$!"AA$.

Pregnancy: *ctivel) restrictive pregnant anoreHics gain an average of "8.# l s. during pregnanc) compared to 58 l s. that an average woman gains. *ctive ulimics gain an average of 8.; l s. during pregnanc). The average irth weight of a a ) orn to an active purging anoreHic is :.A l s. 4n a long term /anish follow!up stud) of women with anoreHia, prenatal mortalit) was nearl) siH times greater and incidence of low! irth!weight a ies two times greater than eHpected rates.

6E &ational =ournal, 3otline: Daily +riefing on Politics, @a) "A, "AAA.

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CLASSIFICATIONS OF EATING DISORDERS

%ating disorders are classified in three areas, anoreHia nervosa, ulimia nervosa, and inge eating disorder. *ll three eating disorders can overlap with one another and share a common thread of depression. %ating disorders occur within men and women and within all economic, racial, and cultural ackgrounds. %ating disorders were first classified as a mental illness in the 9nited 3tates in "A#$.6; Anore%ia &ervosa is characterized ) an intentional loss of a su stantial amount of oneIs od) weight (loss of "8J of normal od) weight) that is accomplished through severe dieting and7or purging. *noreHics have an intense fear of fat, and their preoccupation with food and weight is often used to mask other issues. Those with anoreHia are often characterized as perfectionists and overachievers who appear to e in control. <eak times for onset of anoreHia are at ages "5!"6 and at age ";, known times of development (although signs of eating disorders in elderl) populations are rising). +ulimia &ervosa is an eating disorder where an individual engages in recurrent (an average of twice a week for 6 months) ingeing and purging. Kingeing usuall) involves a rapid consumption of large amounts of food ( inges can range from ",$$$!6$,$$$ calories). The ulimic then attempts to rid his7her od) of the food ) purging (vomiting, laHatives, eHercise, and7or fasting). The ulimic ma) not e visi l) underweight and ma) in fact e slightl) overweight due to the inge!purge c)cle. 4ndividuals with ulimia are often characterized as having a hard time dealing with and controlling impulses, stress, and anHieties. (nset for this disorder is common in the late teens and earl) 5$s. +inge Eating Disorder (K%/), more commonl) known as compulsive overeating, is the most newl) recognized among the three designated eating disorders. <eople with this condition engage in frequent inges, ut unlike the ulimic, she7he does not purge afterward. Kinges are followed ) intense feelings of shame, disgust, and guilt. The illness usuall) egins in late adolescence or in the earl) 5$s, often coming soon after significant weight loss from dieting (reason wh) dieters often sa), +4Ive gained all m) weight ack and more,). Researchers show that an)where etween "8!8$J of individuals enrolled in dieting programs suffer from K%/.6# Eating Disorder &ot 't erwise S$ecified is the categor) that a person might e diagnosed with if the) do not fit the criteria for an) specific eating disorder. For eHample2 4f a female meets all the criteria for anoreHia, ut still has regular menses. (r if all the criteria are met for anoreHia eHcept the person maintains a normal weight. For ulimia, all the criteria are met eHcept that the ingeing and purging happen less than twice a week or occur less than three months. (r if the person does not inge, ut still engages in purging (e.g. self!induced vomiting after eating two cookies). *nother characteristic is repeatedl) chewing and spitting out, ut not swallowing, large amounts of food. For more information on the clinical criteria of eating disorders diagnosis, please visit www.apa.org.

6; *merican <s)chiatric *ssociation, Diagnostic and Statistical !anual of !ental Disorders 4DS!5, " ird Edition, "A#$. 6# 93 /epartment of Bealth and Buman 3erviceIs (ffice on 'omenIs Bealth. Information S eet on Eating Disorders0 Fe

ruar) 5$$$.

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ETIOLOG OF EATING DISORDERS ! LONG"TER# EFFECTS

* ?ondon ph)sician, 'illiam 1ull, first defined eating disorders as a medical pro lem in "#;6,6A however, eating disorders were not classified as a mental illness in the 9nited 3tates until "A#$.:$ The etiolog) of eating disorders is unknown, and the actual num er of individuals who suffer from eating disorders is unknown. 9tilizing current 93 Census num ers and figures from The &ational 4nstitute for Bealth, eating disorders affect up to 24 million Americans.:" &um ers internationall) are unknown, although recent studies detect the same percentage of eating disorder rates in the women from other countries as in the 9nited 3tates.:5 /espite the current limited amount of funding for research on iological factors and genetics of eating disorders, researchers are discovering genetic links. *dditionall), the latest imaging studies show that as people lose weight, their rain shrinks and +can manifest ehaviorall) in constricted thinking,, eHplains /avid Berzog, @./., president and founder of the Barvard %ating /isorder Center. :6 Furthermore, dieting and purging release endorphins and opioids that individuals ecomes addicted to, furthering the destructive c)cle. The misunderstanding of eating disorders often leads to the un!detection of the disorder, which places individuals at risk for long-term adverse effects. The earlier a person with an eating disorder seeks treatment, the greater the likelihood of ph)sical and emotional recover). 4f not identified earl) and treated thoroughl), eating disorders can ecome chronic, debilitating and even result in death. The long!term effects of eating disorders range from teeth erosion, lo !otassium levels" electrol#te imbalances, sterilit#, osteo!orosis, heart attac$s, heart irregularities, endocrine abnormalities, ru!tured eso!hagi, sei%ures, anemia, addiction to diet !ills, ovarian failure, and retino!ath# . This list is ) no means eHhaustive. 3ome studies indicate men suffer from more long!term effects. *n eHplanation is that men and people of color are diagnosed much later and therefore live with the disorder for a longer period of time without treatment as well as eing turned awa) from all!female treatment programs. %ating disorders have the highest mortalit) rate of an) ps)chiatric diagnosis.:: *n estimated 4&0,000 !eo!le die ever# #ear from com!lications related to eating disorders. The num er is onl) an estimate ecause eating disorders and related deaths are &(T tracked ) an) 93 governmental agenc) (unlike other mental and medical illnesses). Eating disorders are a gro ing !ublic health threat and the lac$ of an a!!ro!riate res!onse has created a lethal situation.

6A 'illiam 1ull was a ph)sician and medical advisor to Pueen Dictoria.

Be focused on anoreHia nervosa and distinguished the disease from other iomedical conditions. There is evidence of eating disorders in medieval times and in other ancient teHts. :$ *merican <s)chiatric *ssociation, Diagnostic and Statistical !anual of !ental Disorders 4DS!5, " ird Edition, "A#$. :" 3ee footnote on page " of this document for information on this figure. :5 @inoo &o akht and @ahmood /ezhkam, An E$idemiological Study of Eating Disorders, 4nternational =ournal of %ating /isorders, Dolume 5#7 &um er 6, &ovem er 5$$$. The stud) suggests the rates of eating disorders and od) dissatisfaction among western societies was the same in female adolescents in Teheran. :6 @egan @cCaffert), 3ollywood Starve 6ars, 1lamour, =ul) 5$$$. The article discuss the theor) that eating disorders, specificall) anoreHia nervosa, are dependent on who the individual surrounds themselves with, citing the shrinking odies of actresses on *ll) @cKeal. :: Council on 3ize and 'eight /iscrimination, "AAE.

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STIG#A
* ma.or stigma surrounding eating disorders is the perception of an upper7middle class white womanIs self!imposed pro lem. %ating disorders are compleH, chronic illnesses largel) misunderstood and misdiagnosed. The most common eating disorders ! anoreHia nervosa, ulimia nervosa, and inge eating disorder ! are on the rise in the 9nited 3tates and worldwide. 'o one $no s e(actl# hat causes eating disorders. Bowever, all socioeconomic, ethnic and cultural groups are at risk. :8 Researchers t)picall) utilize adolescent and )oung adult females, predominatel) white and either from an upper or middle class socio!economic ackground, which leads to pro lems with sampling, methods of assessment, and defining ke) terms. @ost of the studies and research done on eating disorders are gender iased. Therefore, the figures we have on the num ers of people suffering or surviving are not inclusive and under-re!resent diverse communities. 'o one is immune from disordered eating . Children ages ; to "6 are eing referred to eating disorder clinics in great num ers. <eople of all ethnic and cultural groups are vulnera le to developing eating disorders. *lthough rates of anoreHia are higher among Caucasian girls, recent research indicates that inge eating occurs at similar or even higher rates among girls and women of color. 4n addition, hundreds of thousands of o)s and men are also eHperiencing disordered eating. @aria Root, a clinical ps)chologist in 3eattle, 'ashington treats minorit) patients who tried to hint to a doctor that the) had an eating disorder. The doctor would tr) to e culturall) sensitive and tell them that women of their culture usuall) did not have eating disorders. The patients endure another )ear with an eating disorder. This is common among ethnic groups, even though researches show the rates of minorities with eating disorders are the same as those of white women. :E /r. Ruth 3triegel!@oore recentl) pu lished a stud) +Recurrent Kinge %ating in Klack *merican 'omen,, finding lack women eHperience inge eating .ust as much as white women.:; (n an international level, more studies are eing conducted and pu lished. China and =apan are facing a crisis with laHatives and fad diets. :# %ating disorders are one of the most common ps)chological pro lems facing )oung women in =apan. 9nfortunatel), women eHperience great shame in seeking treatment in =apan- so man) people are going undiagnosed. :A 4n Argentina, the eating disorder rates are ) times the amount in the *nited +tates ( ased on population). 3ome researchers assert that western culture infiltrated other countries through the media, thus increasing eating disorders. *side from the ethnocentric qualit) in this theor), no current research has found a correlation etween general identification with dominant white culture and the development of eating disorders.

:8 The 93 /epartment of Bealth and Buman 3ervices, (ffice on 'omenIs Bealth :E*ndrea 'hite, Eating Disorders Among !inorities Are 7uite )ommon, Teen3tar, 3eptem er "AAA. :; @ashadi @ata a, Invisible 6omen, Silent Suffering: !yt &o *onger, an Increasing &umber of African8American 6omen are Develo$ing Eating
Disorders. www.n)u.edu7gsas7dept7.ournal7raceQclass7eating :# 3. ?ee, Anore%ia &ervosa in ) inese: A "ranscultural Pers$ective. <resented at the annual meeting of the *merican <s)chiatric *ssociation, "AA$. :A )ultural Roles9 It1s a Small 6orld. www.something!fish).org

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,riefing -emo .1, /ctober 2001

$RE%ENTION $ROGRA#S
<revention programs are limited in num er and do not receive the pu lic or private funding needed to address the man) issues associated with eating disorders. 4n "AAE, the 93 /epartment of Bealth and Buman 3ervices Task Force on %ating /isorders determined the prior curricula designed to promote health) od) image and prevent disordered eating proved ineffective. The increase in eating disorders, the high cost of treatment, the longevit) of these illnesses, and the high mortalit) rate make it imperative that prevention programs e implemented in schools and communit) programs. 4n the past, prevention programs failed ecause the focus was having survivors of eating disorders speak with students on how horri le the eating disorder was, how much weight she had lost, and how she had een hospitalized.8$ The students learned negative ehaviors and imitated or tried to outdo the ehaviors ) not eating as much or ) purging more than the person descri ed. 4n essence, the visits glamorized eating disorders and created competition rather than educating and empowering the students to change their ehaviors and attitudes. <revention programs cannot e targeted eHclusivel) toward females. @ales need to e educated as to the significant role the) pla) in preventing eating disorders. @ales, often without realizing it, o .ectif) females even at an earl) age ) making comments a out weight or overemphasizing looks. <eople of diverse ackgrounds suffer from eating disorders, despite the mainstream elief that the disease affects onl) women. *ccording to the &ational %ating /isorder 4nformation Center, " in "$ men suffer from ulimia, while " in 5$ suffer from anoreHia. * recent article pu lished ) a )oung male eHplains how similar the feelings and ehaviors are of females and males, :I can;t e%$lain w y or ow I started, but every time after I eat I go rig t to t e bat room and force myself to vomit,: sa)s =ason, age siHteen, <I;m overweig t, and t e first t ing $eo$le see is your a$$earance08"= The *merican *ssociation of 9niversit) 'omen found that adolescent girls elieve ph)sical appearance is a ma.or part of their self!esteem and that their od) image is a ma.or part of their sense of self.85 The age group involved in prevention programs is critical to the prevention of eating disorders ecause the average age for onset of eating disorders is during adolescence. 86 3elf!esteem tends to e strong in oth girls and o)s as children, )et when the) hit adolescence there is a significant drop in self!esteem for oth girls and o)s- a factor in the development of an eating disorder. The federal government, schools and communit) programs must colla orate to develop creative prevention and outreach programs that are culturall) and age appropriate.

8$ Costin, Carol)n. "

e Eating Disorder Source +oo>. ?owell Bouse, "AAA. *dditionall), women were the focus of prevention programs. @en were not identified as populations that were at!risk of developing the disease. 8" Kereznai, 3teven. +oy +ody +lues. www.wiretap.org 85 *merican *ssociation of 9niversit) 'omen %ducation Foundation. S ortc anging Girls, S ortc anging America. 'ashington, /C, *merican *ssociation of 9niversit) 'omen %ducational Foundation <ress, "AA". 86 3hisslak C@, Crago @, @cCnight C@, %stes ?3, 1ra) &, and <arna ) (1. Potential ris> factors associated wit weig t control be aviors in elementary and middle sc ool girls. <s)chosomatic Research "AA#.

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LAC& OF F'NDING ! GO%ERN#ENT S'$$ORT

Bistoricall) and currentl) the federal government provides few resources for eating disorders. The &ational 4nstitute for Bealth (&4B), the national government organization that provides funds for research and prevention programs, designated no funding in "AAA!5$$$ specificall) to eating disorders.8: To show the disparit) of funding allocated here is one eHample2
There are A$$,$$$ people living with B4D infection and an estimated 65$,5#5 people in the 93 living with *4/3. That is a total of ".5 million people and &4B allocated O".6 illion dollars to research, prevention, and education of B4D7*4/3 pro.ects. *nd )et there are up to 5: million people suffering from an eating disorder and ver) few &4B dollars are allocated to eating disorders.

'h) the disparit)R (ne reason is a critical mass of !eo!le are not advocating for issues around eating disorders on a national level. 9ntil recentl), there was no central group working on uilding a coalition of interested parties to educate mem ers of Congress for increased health care enefits, and parit) laws. Bowever, the %ating /isorders Coalition for Research, <olic), and *ction has rought together man) diverse eating disorder groups to have one message on the federal level. 0egislation: 1ast ,ills There has een ver) little legislative activit) on eating disorders in the histor) of Congress. The first ill addressing eating disorders was introduced in "A#; and was a resolution designating a week as the &ational %ating /isorders *wareness 'eek. There are "; ills that have addressed eating disorders however, until the "$Eth Congress all the ills have simpl) een a rec)cling of the following 5 ills288
S Awareness 6ee>9Day0 * popular idea for a legislative initiative to address eating disorders is to esta lish an eating disorders awareness week or da). This idea was the first eating disorder initiative ever introduced in "A#; and a version of this idea was introduced as a resolution in the "$$th, "$"st, "$5nd and "$8th Congress. 4t was onl) passed into <u lic ?aw once in "A#A, which designated (cto er 56 through (cto er 5A, "A#A as %ating /isorders *wareness 'eek. S Information and Education. The second popular idea first introduced ) Representative 3chroeder in the "$6rd Congress ("AA6) was to require the 3ecretar) carr) out a program to provide information and education to the pu lic on the prevention and treatment of eating disorders, including the operation of toll!free 5:!hour hotline. * version of this ill was $artly included in the "AA# Committee Report of /epartments of ?a or, Bealth and Buman 3ervices, and %ducation, and related agencies *ppropriation Kill. This prompted the (ffice of 'omenGs Bealth in the 3ecretar)Gs (ffice to create the Kod)wise and 1irl <owerN pro.ects and including eating disorders in their womenGs health hotline.

0egislation: 2urrent ,ills *s of =ul) 5$$6, the following ills include eating diosrders in the ill language. <lease visit http277thomas.loc.gov7 to look up the complete ill and the illIs status. 3 :#E > BR A862 3enator <aul 'ellstone @ental Bealth %quita le Treatment *ct of 5$$6 BR #;62 %ating /isorders *wareness, <revention, and %ducation *ct of 5$$6 3 "";5 > BR ;"E2 4@<*CT *ct, ( esit) > %ating /isorder <revention 3 :$;2 Bigher %ducation *ct of "AE8 BR Con. Res. "#E2 &ational <u lic Bealth 4nitiative on /ia etes and 'omenGs Bealth 3 "# > BR 56E62 Right 3tart *ct of 5$$6 8: &4B did the) allocate "J of their overall research
udget for eating disorders in "AA;, however some of this mone) was supporting research on o esit) and dia etes. 88 The information in this section is from the %ating /isorders Coalition we site www.eatingdisorderscolaition.org. (f the "; ills, "5 ills are specificall) a out eating disorders and the remaining 8 ills are more omni us womenGs health or education ills, which include the language of an eating disorders ill.

www.renfrew.org *dvancing the education, prevention, research and treatment of eating disorders.

S'GGESTED C(ANGES IN LEGISLATION S$ECIFIC TO EATING DISORDERS

*s more individuals and groups advocate for changes in federal legislation related to eating disorders, it is important for the field to have suggestions for change. The Renfrew Center Foundation elieves the information elow outlines some possi ilities of federal action on ehalf of eating disorders. Together, eating disorder advocates, lawmakers and national leaders must create and pass a ill authorizing the /epartment of Bealth and Buman 3ervices (BB3), and its affiliated agencies (e.g. &ational 4nstitute of Bealth, Center for /isease Control, etc.) to work with private and pu lic organizations in efforts to prevent, detect and treat eating disorders. %Hamples of the components of a comprehensive ill would e2 %sta lish a national epidemiological stud) to track the incidence and death rate of eating disorders. O"8$ million over five )ears to train nurses and medical doctors on how to assess an eating disorder, address the medical and emotional needs of the patients and how to refer patients to adequate treatment. O58 million over 8 )ears to research tests to screen for eating disorders and then require federal health care programs and group and individual health plans to cover the tests if demonstrated to e effective. O58$ million each )ear for the neHt 8 )ears to support communit)! ased prevention and treatment programs including a requirement that The *genc) for Bealthcare Research and Pualit) (*BRP) conduct research on the qualit) of the prevention and treatment programs. O;8 million each )ear for the neHt 8 )ears to support programs that sustain recover).

3o! 3hree 1riorities for 2hanges in 0egislation in General for -ental 4ealth ". <ass mental health parit) legislation and ensure all mental illnesses are included in parit) coverage. 5. Require 4nsurance companies to adopt the guidelines of the *merican <s)chiatric *ssociation as the) relate to medical necessit) for eating disorders and all mental illnesses, to eliminate pre! eHisting condition clauses and to allow families to pa) for treatment themselves (private pa)) if the) can afford it and their insurance will not cover all necessar) treatment. 6. <rovide funds for prevention programs and school! ased ps)chologists, at all schools on a full! time asis, in efforts to detect and treat as earl) as possi le mental illness.

www.renfrew.org *dvancing the education, prevention, research and treatment of eating disorders.

)RIEFING S(EET

8E

4igh !revalence rate. *s we enter the new millennium an estimated # million people, mainl) women and girls, suffer from eating disorders. 4igh death rate. The risk of death for individuals with anoreHia is su stantial. (ne stud) reported an "#!fold increase in the risk of death for individuals with anoreHia making this the ps)chiatric disorder with the highest mortalit) rate. 3reatment can or$. Research shows that eating disorders can e successfull) overcome with adequate and appropriate treatment. Kulimia nervosa can e successfull) treated with cognitive! ehavioral, interpersonal and drug therapies. *noreHia nervosa can e successfull) treated with structured programs and therapies, which aim to reverse the malnutrition. 3uch treatments are t)picall) eHtensive and long!term. For patients with anoreHia, onl) once weight is restored to within A8J of normal can treatment t)picall) make a difference. 4ealth insurance com!anies contribute to high death rate. 4nsurance companies routinel) limit the num er of da)s the) will reim urse which force doctors to discharge patients with anoreHia nervosa too earl). *ccording to a recent surve) of eating disorder specialists, "$$J said that their patients are suffering relapses as a consequence of managed care coverage limits. *nd virtuall) all specialists elieved that patients with anoreHia are placed in life! threatening situations ecause their health insurance policies mandate earl) discharge. 5nade6uate resources for education and research. There is ver) little federal funding for eating disorder education and research on eating disorders. For eHample, according to the research office at the &4@B the) allocated "J of their overall research udget for eating disorders in "AA;, and some of this mone) was supporting research on o esit) and dia etes. 'eed for increased funding. 1iven the high rate of mortalit) associated with and the widespread pu lic misunderstanding a out eating disorders there clearl) needs to e more mone) for education and research. 2ongress can save lives. 'ith more attention and accurate information polic)makers could remove the life and death o stacles to access to care and support increased resources through sound policies.

56

The %ating /isorders Coalition for Research, <olic) and *ction, +riefing S eet, 5$$".

www.renfrew.org *dvancing the education, prevention, research and treatment of eating disorders.

ADDITIONAL RESO'RCES
Anna 7estin 8oundation, 3tarted ) a mother who lost her daughter to anoreHia, this foundation is an eHcellent resource for families > friends. www.annawestinfoundation.org Dads and Daughters, 1rassroots organization focused on strengthening the relationship etween fathers and daughters and raising their self!esteem. www.dadsanddaughters.org Eating Disorders 2oalition for 9esearch, 1olic# and Action , The onl) coalition of all ma.or eating disorder nonprofits which works on increasing federal resources dedicated to eating disorders. www.eatingdisorderscoalition.org 'ational Eating Disorders Association, *n organization that promotes %ating /isorder *wareness 'eek and other events around prevention and awareness. www.nationaleatingdisorders.org 'ational 5nstitute of -ental 4ealth, 1overnment organization which pu lishes fact sheets on eating disorders. www.nimh.nih.gov7pu licat7eatingdisorder.cfm 'ational -ental 4ealth A areness 2am!aign , * nonprofit started ) Tipper 1ore to remove the stigma associated with mental illness and metal health. www.nostigma.org 3he 9enfre 2enter 8oundation. The onl) nonprofit organization that is also connected to treatment facilities allowing an on!going connection etween treatment and recover). The Renfrew Center Foundation works on education ( oth professional and consumer), prevention, research and access to treatment. The Foundation also sponsors several national trainings, conferences and gatherings for professionals and people in recover). www.renfrew.org

www.renfrew.org *dvancing the education, prevention, research and treatment of eating disorders.