Eating Disorder Treatment - Professor Michael Kohn - Sydney Australia
A person has an eating disorder when their attitudes to food, weight, body size or shape lead to marked changes in their eating or exercise behaviours, which later affect physical health and interfere with their life and relationships.
Eating and exercise behaviours include: restricting intake of food and fluids, overexercising, or purging by use of pills, such as diuretics and laxatives, vomiting, or binge eating (consumption of an unusually large amount of food accompanied by a sense of loss of control). Eating disorders are serious and potentially life threatening mental illnesses, in which a person experiences distortions in thoughts and emotions, especially those relating to body image or feelings of self-worth.
People of all ages, genders and socio-economic and cultural backgrounds are affected by eating disorders. A person with an eating disorder can be underweight, within a healthy weight range, or overweight.
Assistance to diagnose and care for someone with an eating disorder is available . Centres such as Total Health Care have a multidisciplinary team of health professionals who can assist.
There are four different types of eating disorders: anorexia nervosa, bulimia nervosa, binge eating disorder and ‘eating disorders not otherwise specified’ (EDNOS). If the person you are helping is underweight and continuing to use weight-loss strategies, they may have anorexia. If the person is engaging in binge eating followed by purging strategies, they may have bulimia. A person with bulimia can be slightly underweight, within a healthy weight range, or overweight. If the person regularly eats an unusually large amount of food in a short period of time, accompanied by a sense of loss of control over their eating, but does not use extreme weight-loss strategies to compensate, they may have binge eating disorder.
People with binge eating disorder may be within a healthy weight range, though are typically overweight. If the person does not fit the description of anorexia, bulimia or binge eating disorder, but their attitude to food, weight, body size or shape is seriously interfering with their life, they may have EDNOS. Some examples of EDNOS include when the person is using extreme weight-loss strategies but does not have the very low body weight of a person with anorexia, or when the person has infrequent episodes of binge eating or vomiting.
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How can I tell if someone has an eating disorder – a person may be suspected of having an eating disorder if there is significant change in weight associated with any of the following:
- Dieting behaviours (e.g. fasting, counting calories/kilojoules, avoidance of food groups or types) are early warning signs an eating disorder may be developing • Evidence of binge eating (e.g. such as disappearance or hoarding of food)
- Evidence of purging includes vomiting or laxative use (e.g. taking trips to the bathroom during or immediately after meals)
- Excessive, obsessive or ritualistic exercise patterns (e.g. exercising when injured or in bad weather, feeling compelled to perform a certain number of repetitions of exercises or experiencing distress if unable to exercise)
- Increasing restriction of food choices and amounts (e.g. refusing to eat certain ‘fatty’ or ‘bad’ foods, cutting out whole food groups such as meat or dairy, claiming to dislike foods previously enjoyed, a sudden concern with ‘healthy eating’, or replacing meals with fluids)
- Development of rigid patterns around food selection, preparation and eating (e.g. cutting food into small pieces or eating very slowly)
- Eating alone or avoidance of eating meals, especially when in a social setting (e.g. skipping meals by claiming they have already eaten or have an intolerance/allergy to particular foods)
- Lying about amount or type of food consumed or evading questions about eating and weight
- Developing a preoccupation with food (e.g. planning, buying, preparing and cooking meals for others but not actually consuming; interest in cookbooks, recipes and nutrition)
- Behaviours focused on body shape and weight (e.g. interest in weight-loss websites, books and magazines, or images of thin people) • Development of repetitive or obsessive behaviours relating to body shape and weight (e.g. body-checking such as pinching waist or wrists, repeated weighing of self, excessive time spent looking in mirrors)
- Social withdrawal or avoidance of previously enjoyed activities
Physical warning signs relate to weight loss, and include:
- Sensitivity to the cold or feeling cold most of the time, even in warm temperatures
- Changes in or loss of menstrual patterns
- Swelling around the cheeks or jaw, calluses on knuckles, or damage to teeth from vomiting
Psychological warning signs, include:
- Pre-occupation with food, body shape and weight
- Extreme body dissatisfaction
- Distorted body image (e.g. complaining of being/feeling/looking fat when a healthy weight or underweight)
- Sensitivity to comments or criticism about exercise, food, body shape or weight
- Heightened anxiety around meal times
- Depression, anxiety or irritability
- Low self-esteem (e.g. negative opinions of self, feelings of shame, guilt or self-loathing)
- Rigid ‘black and white’ thinking (e.g. labelling of food as either ‘good’ or ‘bad’
Professor Michael Kohn, MBBS, FRACP, FACPM, PhD, is a paediatrician with over 30 years experience in the assessment and management of conditions affecting the health and development of children, adolescents and young adults.
Professor Kohn has contributed to a number of major textbooks and written over 150 scientific articles around the assessment and management of eating disorders (anorexia, bulemia, obesity), nutrition (cholesterol).
Areas of specialty include:
Eating disorders, obesity and hypercholesterolaemia
In addition to the “obesity epidemic”, young people are increasingly experiencing weight loss during their growing years from restrictive dietary changes. These affect the capacity of the young person to grow and thrive and place increasing strain on families.
Total Health Care is located in Bondi Junction. We serve patients from all over NSW and have a strong presence in the Eastern Suburbs of Sydney. Our practitioners include paediatricians, psychiatrists, psychologists, counsellors and dieticians. Total Health Care professionals work closely with families and each other, taking a holistic and family-centred approach to treatment.
The Clinic provides standardised neuropsychological assessments using clinical and computer based technologies. Treatment strategies include non-medication approaches (neurofeedback and cognitive training) as well as medication support with both stimulant and nonstimulant medication.