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Offhand Comments Can Serve As Triggers
Feb 3.2008
by Anne-Marie Tobin, THE CANADIAN PRESS

TORONTO - Shayla Gutterman received treatment for an eating disorder a few years ago, and sounds confident and wise beyond her 19 years when she offers advice to parents and other teens who might be at risk.

"One hundred per cent, I would say get rid of the scale," said Gutterman, now a second-year student at Wilfrid Laurier University in Waterloo, Ont.

"You can't really tell whether you're fat or skinny from a scale. It's about how you feel and it's about your body structure. And you can be muscular and fit, and weigh more than someone who's not. So I think the scale throws people off hugely."

Gutterman said her earliest memories of being concerned about her weight go back to when she was in Grade 1. When she was about 13, she began restricting her food intake while she was at a "sleep away" summer camp for about a month.

"And that was for me a good opportunity to, I guess, lose some weight. So I started at camp, and it got to the point where I was fainting."

Her eating habits reverted to normal when she returned home, although she would go through phases - a week here and there - when she would again limit her eating. In Grade 11, though, as her family prepared for a winter trip to Mexico, she said it served as a trigger to make her really want to lose weight.

"So I started then, and it was at that point that laxatives and diet pills, and exercise and purging entered the equation. It definitely got worse," she said.

Her mother, who knew about the dieting but didn't realize what else was going on, said Shayla eventually sought help - which often isn't the case with someone suffering from anorexia nervosa or bulimia nervosa.

"She actually came to me and said to me, 'I am really unhappy,"' said Anita Gutterman, who lives in Thornhill, Ont. "She was hiding it and it wasn't overt, and it usually isn't. And she said, 'I'm not just losing weight, I'm really not eating, and it's escalated into a problem, and I need you to help me."'

"And I am so fortunate that she did that because many girls - they don't want to get better, they don't want the help. They don't admit it."

After seeking help from a family doctor and other health care professionals, Shayla said she was "very lucky" to get into a day treatment program at Southlake Regional Health Centre in Newmarket, Ont.

"There you are really forced to have three meals and two snacks a day, and that was intervention for me," she said, adding that she had to stop taking laxatives and diet pills, and limit exercise.

Dr. Ahmed Boachie, director of the eating disorder program at Southlake, said society is so slim-obsessed that some young people wrongly believe they're overweight, and worry about becoming obese. "And what has happened, some of them can actually be so preoccupied with food and food-related issues, and in their fight to avoid being obese some of them are actually starting off as normal weight, and some of them are actually underweight," he said. "In trying to avoid being obese, they stop eating and they can develop eating disorders - anorexia or bulimia, which are two of the most devastating chronic illnesses."

Up to 20 per cent of people with these illnesses will die if they don't receive proper treatment, he said.

There isn't one particular thing that causes an eating disorder, said Boachie, a child psychiatrist who has been at the centre for six years. Sometimes a casual comment by a friend, such as "It looks like you've gained weight," will act as a trigger. "If you say that to the majority of young people, they may probably be able to brush this off," Boachie said. "But there are always a lot of people who have vulnerabilities. And this statement, which may seem innocent, may send them spiralling."

Those who inherit perfectionistic tendencies are at greater risk, he noted. And only one boy for every 10 girls develops an eating disorder. Parents who diet frequently could be a factor, he said, along with not having good friends or having bad days at school.

Kate Lum, volunteer co-ordinator at Sheena's Place, a support centre in downtown Toronto, said they're hearing about more younger and older females with the condition "due to the cultural insanity around expectations about how women should look." It's very difficult for a teenager to resist the onslaught of perfect-looking and "unhelpful" images shown on television and elsewhere, she said.

Shayla Gutterman said magazine photos can affect her. "Even still, I try to stay away from magazines because I know, looking at them, it's not going to make me feel good," she said.

And when she hears anyone make a comment about someone else's weight: "I hate it. I can't stand it."

In terms of treatment, Lum, a survivor of anorexia, said the person really does need to want to get better, and when friends say something like "Why don't you just eat? You're too thin," it doesn't help. Lum said those sorts of comments made her think "You're just jealous" or "You're not my friend. You're trying to sabotage this."

The incidence of eating disorders in North American teens is between 0.5 and one per cent, said Boachie.

At Southlake, teens aged 13 to 18 who are in the day program are reintroduced to food with the encouragement of dietitians and a team of trained professionals. "We are not only looking for them to finish their meals, it's how they eat, the behaviours around food, what food represents," Boachie explained. "They attempt to cut it into pieces. Sometimes you can watch somebody eating, and they can tell you how difficult the eating disorder is by watching their behaviour."

"Food is their medication," he said. "We make sure they finish everything on their plate. Every meal is measured so that they can finish it."

Talking helps, too. Besides nutritional intake, the family-focused program includes an ongoing medical assessment, and discussions about body image, self-esteem and anxiety issues.

"Up to about 70 per cent of them will get really well," Boachie said. "And then the other 30 per cent, a few of them will come back again and revisit the program."

There are waiting lists for many programs across Canada, according to Lum, but Sheena's Place will put people into a support group right away so they can "stabilize a little" until treatment is available. Some people make use of private clinics in Canada and the U.S. because they can't wait for a spot at a place like Southlake, she said.

Shayla Gutterman recommended that parents focus on balanced diet and health, rather than make comments like "Don't eat this, it's bad for you" or "This is fattening."

"Do what makes you feel good."

"I think it's always going to be a struggle," she said of her own battle with an eating disorder. "I'm OK now, though. I do what I can to stay happy."
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