Eating Disorder Specialist: What I Wish Others Knew

Someone dies from an eating disorder every hour. They are among the most lethal psychiatric illnesses that seem to be affecting people younger and younger. Elle Weese is an Adult-Gerontology Acute Care Nurse Practitioner (AGACNP-BC) with a special interest in eating disorders. She unpacks the silent symptoms and reasons behind eating disorders and what she wishes others knew about this disorder.

What is an eating disorder?

“An eating disorder, or ED is a combination of two things: Diet and extreme emotions,” says Elle. Eating disorders can be very serious conditions affecting physical, psychological, and social function.

Types of eating disorders include anorexia (self-starvation), bulimia (diet altering and compensatory behaviors like vomiting or extreme exercise), binge eating disorder, avoidant restrictive food intake disorder (ARFID), PIKA (eating non-food items without nutritional value), orthorexia (a hyperfixation on “healthy” food), and rumination disorder (repeated food regurgitation).

Most people with eating disorders—up to 95%—have at least one other psychiatric illness such as anxiety disorders, obsessive-compulsive disorder, or alcohol/substance misuse.

“I see a lot of trauma surrounding the behavior, such as someone who got food poisoning and vomited for days and now avoids entire food groups. Or someone who was bullied at summer camp and began restricting her food intake ever since then,” says Elle.

Why are eating disorders dangerous?

Beyond the daily mental toll of living with an eating disorder, certain types can damage the body well into adulthood and even cut a life short. “I see issues with osteoporosis, trouble maintaining enough electrolytes, heart palpitations, and many other chronic issues,” says Elle. Unfortunately, people who do not seek treatment face a sharp risk of premature death. “EDs take a huge toll, some patients might not live to see their 70s or 80s.”

Who is at-risk of developing an ED?

Eating disorders can affect people of all ages, racial/ethnic backgrounds, body weights, and genders. Although eating disorders often appear during the teen years or young adulthood, they may also develop during childhood or later in life.

“I most often see females between ages 16 and 34,” says Elle. It was previously believed that adolescents between 13 and 19 were typically at-risk, but specialists are now seeing patients as young as 9 and 10.

What do you wish more people knew about eating disorders?

You can’t tell someone with anorexia to 'Just eat something' any more than you can tell someone in a wheelchair to 'Just get up and walk.' Having an eating disorder is not a choice, it’s a mental illness that can stick with people their entire lives. “Something always precedes it, no one wakes up with an eating disorder out of nowhere.”

For someone with an ED, triggers are ubiquitous. “Things like getting weighed at the doctor’s office or even walking past your reflection can be triggering.” And just like OCD or substance abuse disorders, EDs are part of the patient’s everyday life, requiring them to manage intrusive thoughts and triggers every day.

How can friends or family support someone with an ED?

Elle calls out the National Eating Disorders Association (NEDA) website as the best place to find every type of resource. “It has guidance for people who have a child, sibling, or friend with an eating disorder. If you suspect you may have one, you can take an online analysis—it’s the perfect place to start.”

What do you wish doctors knew about EDs?

“There’s a book called Sick Enough by Jennifer Gaudiani that drew me into this population. It sheds light on how these patients fly under-the-radar because they’re not quite sick enough, but they are still damaging their organs, mental health, and lifestyle.”

Anorexia is an example of a disease with undetected symptoms. "The older DSM-IV guidance states that anorexia is defined by 3+ missed menstrual periods in a row. It's since been updated but the old guidance is more well-known than the update," Elle says. Anorexic people can still menstruate; Elle encourages providers to always look at other indicators, like a BMI under 19, yellowing skin, brittle nails, and lethargy when diagnosing an ED.

How are EDs best treated?

Since eating disorders touch so many parts of a person’s life, a collaborative approach is the best possible way to manage them. Ideally, ED patients would have access to:

• A Psychiatrist who could assess brain health and regulate medication, if necessary,
• An ED Specialist who advocates for the nuanced nature of these symptoms and triggers,
• A Registered Dietitian who could address nutrient deficiencies and food aversions,
• And a Therapist who could help regulate depression, anxiety around food, and intrusive thoughts.

Elle Weese is an Adult Adult-Gerontology Acute Care Nurse Practitioner with special training in Eating Disorders. She works with our Neuropsychology team, taking a multipronged approach at the Ogden Clinic Neurocare Center. Elle sees patients age 15 and older; learn more or schedule a visit here.