Thursday, February 23, 2012

To Eat or Not

It's fitting-pun intended!- that the just after Fashion Week ends in New York we see the announcement of National Eating Disorders Awareness week which is coming up February 26-March 3.

So here's a little pop quiz:

True or False: Americans spend over $40 million dollars a year on dieting.  It's FALSE! It's $40 BILLION with a B!

True or False: Anorexia nervosa is the emotional illness with the highest mortality. TRUE! More patients die from AN than from major depressive disorder

True or False: Ten percent of eating disordered individuals who present for treatment are male. TRUE

True or False: Purging refers to vomiting. Not exactly.  Purging also refers to use of laxatives, enemas, diuretics, excessive exercise, supplements, diet pills, medications, or alcohol to increase calorie burning, decrease absorption of calories, burn them faster or otherwise induce feelings of thinness.

Although the Internet and institutions like the National Eating Disorders Association have extraordinarily helpful websites for patients, families, providers and educators alike, it has been my experience that most health care providers are reluctant to treat eating disorders.  These patients can be difficult to understand, are often very challenging emotionally and intellectually, can be hard to engage in treatment and remain at very high risk for a  long time, sometimes  years or a lifetime.   This is a combination of patient characteristics that many clinicians deftly learn to avoid.  However, by assembling a team of providers who are compassionate and knowledgable about the disorders, it is possible to enjoy the challenge and the long term rewards that come through a strong therapeutic relationship.  

Listed below is a short and selected list of providers in the metropolitan area who are experts at eating disorders with whom I have collaborated for many years. 
Primary Care providers with ongoing experience in managing eating disorders:

Drs Marcie Schneider and Sarah Levine,Greenwich Adolescent Medicine
 203 532 1919
Andrea Marks and associates, NYC, (212) 987-1414

Cynthia Pegler, MD, NYC (212) 517 5313

Liz Alderman, MD, Eastchester, 718 741-2450

Marcia Nackenson, MD, Westchester County Medical Center

Following are just a few Nutritionists/ Registered Dieticians with particular strength in Eating Disorders:

Wendy Sterling 917-568-9695
Erica Leon (914) 693-2174
Erica Goldstein, Greenwich, 203-863-4224

There are many, many therapists who specialize in psychotherapy of ED.  Often the best approach is to get a referral from the primary care provider or dietician so that they can work as a team. For consultation and referral a good resource is also CEdar associates, also known as Center for Eating Disorders and Recovery, in Mount Kisco and Scarsdale at (914) 472-4019 and here online

The critical element of long term success is catching the disease early, learning as much as possible about it,  and developing a therapeutic team.  Yes, the cost is steep, sometimes as much as a year of college.  But sometimes those savings set aside for academic education will be best spent on emotional education so that there will actually be a time for college in the future.

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