OREM Jessica Setnick vividly remembers an 8-year-old patient who suffered from such anxiety about attending school that she constantly made herself throw up.
And while the girl's case of bulimia seemed less about food than fear, Setnick said the girl's father remained focused on the vomiting.
"The key is not, 'What is making her throw up?' " but, 'What feels so bad that throwing up feels better?' " said Setnick, a Texas-based dietician who spoke to health professionals Friday at Center for Change, an eating disorder treatment center in Orem.
As someone who has dealt with her own "food-related issues," Setnick said that she has come to realize that behind every eating disorder is an issue that drives someone even young children to cope by either eating or not eating.
While Setnick isn't sure if eating disorders are on the rise, she said they are appearing increasingly in children as young as six years old. And many children without serious disorders are more concerned about dieting and weight than is healthy, she said.
"Our children are confronted with this stuff so much earlier," Setnick said. "Whereas we might have heard about dieting for the first time in eighth grade, it's now second grade or kindergarten."
Setnick won't place the blame for eating disorders on any particular source, but said Americans put too much emphasis on looks and size.
"The magazine advertisements, the magazine covers, the women depicted on television, the birthday cards that joke about weight, those are not the things that create eating disorders. Those just reflect what we as a culture already believe," Setnick said.
"The bigger influence is the idea that since the outside of your body is the only thing that people see when they first meet you, then you really have to work on making that perfect."
That pressure to look good is exacerbated, she said, in stressful situations. And rather than lash out against problems, Setnick said some people, particularly women, turn inside and use food as a secret remedy.
"Everyone that I have met with an eating disorder is very smart," Setnick said. "An eating disorder is a very intelligent coping skill a very smart brain uses to protect it from pain. That's why treatment must provide patients with another solution, rather than just taking away the eating disorder."
Ken Cozzens, business director for Center for Change, said that his facility uses the same approach to eating disorders.
"A lot of treatment centers take an 'addictions' approach," Cozzens said. "But we believe that an eating disorder is a learned behavior that can be unlearned. So rather than learning to deal with it the rest of their life, we try to get to the underlying problem and solve that for good."
After 14 to 18 weeks at the center, many patients are able to overcome their eating problems, said dietician Kristi Terry, who works with patients to uncover emotions and make peace with food.
"So many (patients) don't even know any more what it feels like to be hungry or full," Terry said. "I ask them, 'Were you really full or were you feeling guilty?' "
And while not all eating disorders can be detected or prevented, Setnick said parents should consider any change in their children's behavior, especially regarding food, as a red flag."The most important tool a parent can have is to ask, 'Why?' " she said.
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