By Judy Krasna, F.E.A.S.T. Executive Director
A mom from Israel reached out to me this week with a dilemma. Her daughter is in the 8th grade and her circle of friends is obsessed with thinness. They are competing with each other over who can lose the most weight. This mom’s daughter has a good head on her shoulders, feels positive about herself, and is not succumbing to the peer pressure to join this dangerous competition, because she sees the danger in it. However, her best friend is currently “winning” this weight loss game, and is showing signs of physical danger; this friend almost passed out the other day and admitted that she is barely eating.
When you are 14 years old and your best friend is making herself sick by starving herself, what do you do? Who do you tell? This girl was smart and did 2 things at the same time. She used the tried and true “either you tell your mother or I will” threat on her friend and she told her own mother about the situation, because she was worried both about her friend in particular and about her peer group as a whole.
And now the mother didn’t know what to do, so she called me. She told me that she didn’t know whether to approach the mother of her daughter’s best friend, who is an acquaintance at best–the kind the you say hello to at school functions, but nothing more. She was afraid that this mom would be resentful of a person who is essentially a stranger inserting herself into their family’s business.
I strongly assured her that bringing this potentially life-threatening situation to the attention of her daughter’s best friend’s mother was absolutely the right thing to do, and that she must do it immediately. In her heart, she knew that was the right answer, but she needed me to validate her instinct with the wisdom of my own experience, which I did. I explained that I have heard from many parents that they feel something is wrong; they notice the food restriction and the weight loss, or they see the binge eating or hear the vomiting after meals, but they are not sure exactly what they are looking at, so they hesitate to take action because they are afraid of “accusing” their child of something or they are concerned that confronting the issue may somehow damage their relationship with their child. Sometimes it takes someone from the outside to push parents into action, which is what happened in our case. I assured this mother that if she were the catalyst that brought this child into treatment, then she may very well be saving her life. And if she didn’t take action, and the parents aren’t made aware of the situation, this child will only get sicker.
I received a message around 30 minutes after our conversation that ripped my heart out and made my blood boil simultaneously. The mom who had contacted me took my advice and called the other mother. It turns out that her daughter’s “either you tell your mother or I will” threat was very effective and the friend told her mom about the weight loss competition and about how much weight she had lost and that she almost passed out a day earlier. This mother took immediate action and brought her daughter to the pediatrician’s office for an evaluation.
The pediatrician listened to the mother describe the issue, asked the girl to step on the scale, and then said (while looking her up and down), “Actually, she is 5 pounds overweight.” I cannot even really digest it, but he gave this girl the green light to go ahead restricting, thereby allowing the eating disorder to entrench itself even deeper. He went even further when he made a comment about a little hunger being okay. I swear, I couldn’t make this up if I tried. His reaction made the mother seem overreactive and off base. And to top it all off, he had no idea that he caused harm. To him, the 5 pounds overweight was a bigger health threat than a child on the brink of passing out (or worse) because she is starving herself. I am horrified to think that this is really what has the medical profession has come to. Sadly, I don’t think that this was an isolated incident. In fact, I know it wasn’t.
This has to stop. It happens in every country across the globe, and it is threatening the lives of our children.
Research has proven that early detection and intervention improves outcome. The first point of contact is likely a pediatrician or a family doctor. Every single one of those doctors must be trained in eating disorder detection. This case was a “gimme”–the mother handed the doctor the diagnosis on a silver platter. And even with that, the doctor couldn’t, or wouldn’t, diagnose an eating disorder, because of his own ignorance and bias. The girl wasn’t clinically underweight, so she can’t have an eating disorder. She isn’t emaciated. Yet. So she can’t be sick.
This week is National Eating Disorders Awareness Week in the US. Personally, I am not a big fan of the hype and ribbons that surround awareness weeks, I am a believer in awareness to drive action. This action isn’t going to happen on its own. So I am calling you all to arms, my fellow warrior parents throughout the world. Let’s take action. We are best placed to facilitate educating primary care physicians about eating disorders, and not just pediatricians. Adults, male and female, get eating disorders too.
So here is my ask: the next time you have contact with your pediatrician/primary care physician, give them some resources to educate them about eating disorders and ask them in earnest to read them. It will go a long way to making sure that the next person who walks into their office will be evaluated with an eating disorders lens and will get referred for treatment earlier. That will improve outcomes, reduce suffering, and ultimately save lives.
Here are some resources on the F.E.A.S.T. website. Ask your doctor to sign up for our FIRST30Days service using the observer track. There are screening tools out there if needed. But more often than not, patients have been “pre-screened” by their parents. This article can also be useful, as can this list.
Eating disorders present in people of all genders, races, colors, body types, cultures, etc. Just knowing that will make pediatricians more likely to diagnose an eating disorder across the board in all populations. Understanding that eating disorders cannot be diagnosed solely based on weight is critical. So is listening to parents when they tell you that they suspect that their child has an eating disorder.
Doctors are not getting this critical eating disorders training, and it’s putting our kids in danger. Let’s all do our part to fix this, to whatever degree we can.