Question: I am a 32 year old binge eating male. I have been binging for 6 years. I do not purge. I am dangerously overweight. I am sick of living like this. I want to get treatment. Diets do not work for me. Nutrition plans do not work for me. I have a compulsion that is beyond my control. I understand this now. I have never had any kind of therapy or psychiatric treatment before but I suspect I also have borderline clinical anxiety and depression on top of the BED although I think that much of my anxiety and depression gets mixed up with the tension and shame of the eating. I feel like I want to really get away at a rehab type place but most of these places seem to be for people who already have a treatment team and all that. How do I get started with treatment? Is a residential facility going to be an appropriate place for a male of my age? Can you recommend a good facility for someone with my types of problems?

Katie Brooks Says...:

Hi there-

I'm glad you have decided to take the step to get treatment.  It sounds to me like you have an unhealthy coping skill rather than a dieting problem.  It seems like a weight loss program would have worked if dieting was the issue.  You do not have to have a treatment team to go to a residential facility.  Because I do not know appropriate details like where you live or the severity of your disorder, it is very difficult for me to refer you to a specific treatment center.  It would probably be a good idea for you to see a therapist in your area so that you can be properly evaluated.  You may not need to go to such a high level of care in order to effectively treat the BED.  Once the therapist evaluates you, he or she can then refer you to a local treatment center that treats men and fits your needs.  If you have any further questions please don't hesitate to contact me at goodtherapysandiego.com. 

Question: My wife has had a history of anorexia. She is stable now but 5 years ago she was hospitalized for it. We had our first child 18 months ago. My daughter is having a lot of feeding problems and our pediatrician is concerned that she is falling behind on her growth curve. She is too small. She wouldn’t go to solid foods and she is really picky about what she will eat. I am at work and my wife is a stay at home mom. I am worried that my wife’s history of anorexia is causing her to underfeed. I don’t think she does it consciously but she sort of sabotages feeding time because she is basically against weight gain, even by an infant. Like one thing she does is she wipes her mouth after every bite and asks her ‘are you done yet’ starting after like the second or third bite. I have to stress I do not think she is doing this on purpose! My wife doesn’t see the problem. She doesn’t think the lack of weight gain is a big deal and she does not see how she contributes to the problem, and when I suggested getting my mom to come in and help with feeding she got really angry and upset, accusing me of accusing her of being a bad mom. So now I do not know what to do? Can you give me any advice?

Rob Danzman Says...:

Dear Anonymous, 

This definitely is a complicated situation. You have your wife's history and dignity to respect yet, at the same time, you are concerned her current behavior is impacting your daughter's development. Bare with me as I dissect this to answer your questions. Obviously, all I have to go on is what you have shared with me but, I'll try and give you some things to consider that may or may not be helpful. Let's jump right in to some things to try:

1. Pediatrician: Get regular appointments set up (more than you would typically have for an 18 month old). I'm sure you pediatrician already recommends healthy eating habits for your daughter but it might be a good idea for you to have them get more specific (meal plans, calories, etc.) so you have concrete numbers. I would also ask the pediatrician at what BMI or weight does it become a safety issue. You may also want to, if possible, be home for at least either breakfast or dinner so you can help feed your daughter. I'm concerned that the pediatrician may not really understand what's going on. Lastly - Pediatricians like many other healthcare providers are what are called mandated reporters. If they suspect neglect or abuse of a child, they are required to contact the local department of health and human service to file a report. They do not have to tell you they are doing it. The more contact you have with them, the less likely they will surprise you with reporting. I'm certainly not saying that they will definitely report you and your wife - I just want to make you aware of a possibility if your daughter's weight does not pick up and they suspect your wife is restricting her food. 

2. Couples Counseling: Addressing this with her is important but you may want to use a neutral third party to help facilitate this. Your wife may be defensive but she may also need help hearing you are not attacking her but concerned for your daughter. A really good counselor that specializes in couples work would be able to help tremendously with this. This is a good space for you to ask what she likes and dislikes about being a new mother. What are some things she wishes she could do if she had more time or support. Questions like these help disarm someone who is prone to being defensive. 

3. Additional Stuff Going On: From the little you described, I wonder if there is more going on with her. She may have some dormant obsessive compulsive-like symptoms that popped up during her pregnancy or during the first few months of your daughter's life. She may also be secretly concerned about her mommy-figure. She may be experiencing some post-partum. If she does not like the idea that she may have regressed, she may deny and bury how she's actually feeling and what she's actually thinking. Depending on what your relationship is like with her, you may want to address your concerns in therapy. It may take awhile for her to feel comfortable enough to bring it up. We often have this fantasy that once an issue in counseling is dealt with, it's fixed forever. More than likely she has psychological programming for diet and behavior restriction that may pop up now and again. Stress can definitely trigger new episodes and catch her off-guard.

4. Your Mother: If she is hypersensitive to judgement right now (which it sounds like she is) having your mother or anyone come in to 'help out' while you're at work will only entrench her position. It has to come from her and be her idea. I also find it interesting that you did not mention her family at all.

5. You: Get involved with the child-rearing as much as possible right now. I suspect there is alot going on with your wife and your involvement will provide oversight as well as support. It might also be a good thing to talk about her going back to work or looking for work (ie. or finding time for herself since she may feel consumed by care for your daughter). It might cost you more money on the front end to find day care or babysitters but malnutrition and an unhappy wife/mother is WAY more expensive in the long run. 

Best of luck. The professionals will be the most helpful support for this issue. If you do not know how to find competent therapists or pediatricians, contact our office and we'll help you out. www.fonthillcounseling.com/contact

Question: I have been trying to lose weight for 2 years. I have lost 40 pounds, so obviously I was very unhealthy and overweight before and everyone tells me how great I look now. I am still 10 pounds above my goal weight so obviously it is not as easy to drop pounds as it was in the beginning. The closer I get the harder it is. I understand this intellectually, but when I weigh myself each morning and I see I have not lost any weight or if I have gained weight I feel really panicked and terrible and I try to eat as little as possible all day. When I was losing weight in the beginning it felt great all the time but now I only feel OK if I am losing and to lose I have to be pretty vigilant and when I am not losing I feel like crap and I feel so guilty about everything I eat. I am not sure what to do now. I thought I would feel really happy when I got skinny but I don’t (:

William Anderson Says...:

Have no fear. You will be OK. Even though you lost weight, you never really learned what the problem is and how to solve it. It was the same for me for 25 years. Eventually, I learned a psychological solution to the problem few people understand, lost 140 pounds 30 years ago, and I have maintained that success without trouble. It was great to lose the weight but what I had to learn has helped me in far more important ways. 

The problem is an unhealthy habitual way of thinking and behaving that is so very difficult to change because it is part of an addiction disorder. What's worse is that so many have it that it is not seen as something that needs to be changed. What's even worse, when people want to change it, they don't know how. They think you should just make up your mind to be different, but it doesn't work that way. 

Read my book The Anderson Method and it will give you a much better understanding of the problem and what needs to be done. I also have trained therapists all over the country who teach my program and you can find them at my website.

You have done well and you are getting closer to feeling good about things. Here is a preview to things you'll need to learn about and incorporate: 1) Weight loss is the wrong thing to work for. Winning at weight is something that we do everyday, measured by our behavior, not the scale. 2) The scale is the worst way to measure how you are doing. It measures mainly your water content, which changes all the time, as much as 5 pounds a day even when you are perfectly successful. When you believe in the scale, you'll feel lousy even when you are perfectly successful. It's a formula for misery. 3) Success in weight control, just like success in life, is not a goal we reach and then we are done. Success is a matter of finding a way of living each day that we love that also produces the results that we want. You will have to work at your good health every day the rest of your life. You will have to work at your success and happiness everyday the rest of your life. The key to satisfaction in all of those realms is finding work that you love doing everyday that coincidently creates the byproduct result that you want, whether it is a good weight, financial security, peace of mind, good relationships or anything else. 

You are on the right track. Keep going. Write again.

Question: So I stopped drinking like 6 months ago and I have lost 30 pounds since then. I am close to rocking a 6 pack which is something I never believed I would ever see grace my portly-since-i-was-a-kid body. SO this is good. But what’s weird is now that I am all of a sudden in good shape I am feeling obsessed with counting my calories and exercising and trying to get to that body I have always wanted. I think about it all the time. All the time. I am always checking myself out in the mirror and making plans to exercise and reading about health and fitness a lot. So my best friend was anorexic in her teens and she says I am starting to scare her because I am getting weirdly obsessed. SO this worries me. But if anything was the matter I would be feeling anxious about how I look, not feeling great about it, right?

Katie Brooks Says...:

Congratulations on your
weight loss and abstinence from alcohol.  I'm sure that you feel great!
 It sounds like you are just really excited about your new body and health
status.  Word of caution though...  becoming "obsessed"
with weight, food, and exercise can turn into an eating disorder over time.
 It is progressive.  Right now you feel great, but it can easily turn
into a terrible cycle if you are not mindful about your habits.  If you
spend most of your time and thoughts on any subject it can be unhealthy.
 Getting exercise and eating healthy foods are really important for a
healthy life style, but they should not take over your life.  Focus your
energy on health rather than on appearance.  Try to limit the time you
spend on appearance and balance your life by developing other areas of
strength.  

My concern is that sometimes
weight loss can become a goal driven activity that never actually is satisfied.
 Make sure your goal weight attainable and is within the normal BMI range
for your weight and size.  I have been
witness to numerous women who will go to extreme measures to hit their “goal
weight”, only to gain it back because it is not a realistic goal for their
body.  This is how the cycle starts and
more extreme measures/ punishments are taken to reach the unattainable goal.
Once this war with the body develops numerous health risks can occur.  Be
aware if you start to engage in any of these behaviors:  restricting your
food over long periods of time, ignoring hunger signals, excessive exercise
(regardless of fatigue, injury, or weather), bingeing, purging, using diet
pills/ laxatives, obsessively checking the scale and body, avoiding social
activities associated with food, and the development of food rules and rituals.
 Please visit my website for more information on the signs and symptoms of
eating disorders:  GoodTherapySanDiego.Com .  If you have any more questions you are
welcome to schedule a phone session or visit. 
Good luck!

Question: My husband has asked me to stop exercising before bed and he is concerned that there is something unhealthy about my weight control habits. Is it wrong to keep track of everything I eat and calculate the calories and then calculate my daily resting caloric expenditure and then calculate how many calories are surplus and then make sure I do as much exercise at night before bed as is needed to make sure my intake and outtake match almost exactly? It is something I have been doing for about a year and it has helped me to control my weight very effectively, and in the past I have struggled to control my weight. This way I can eat as much as I want without guilt because I know I will work it all off before I go to bed.

William Anderson Says...:

What you are describing is a form of bulimia, where a person eats too much, binges, and then "purges", ridding the body of the calories that have been overeaten. There is a high risk that it will get out of control, where one's life gets taken over by a compulsive need to binge, followed by a compulsive need to exercise, followed by a never-ending vicious cycle of these two addictions. Some people have gotten so addicted with this that their whole life is consumed by it. They stop the other normal activities of their life, even sleep and work. Some have died as a result of it. 

Your husband's complaint is a sign that it might be getting out of control. Make an appointment with an eating disorders therapist and check it out to either confirm or discount this possibility. 

I have always discouraged this kind of "calorie balancing" strategy because it can cause so many problems. Your goal needs to be to create a healthy relationship and habits with food and a healthy relationship and habits with exercise. What you are doing does neither and risks creating a well-known, sometimes-lethal disease. 

Read my book, The Anderson Method, and read the articles at my website, www.TheAndersonMethod.com, the Table of Contents at the lower right corner of the home page. These will give you a healthier way to think about the problem and solve it.

Make good health and habits your goal, and weight control a part of that. Weight control at the expense of your health and well being in a mistake.

Question: My 8 year old daughter is 4 foot 6 and she weighs 135 pounds. She is not interested in exercise of any kind. I have been trying to model healthy eating and exercise habits but she doesn’t seem to care. I do not want to put her on a diet because of the message that sends but when I let her choose how much to eat she eats too much and she eats too much junk food as well (even though we don’t have it at home she has an allowance and her friends and grandma also supply it). How do I get her to lose weight without putting a lot of negative pressure on her? I don’t want her hungry but something has to change.

William Anderson Says...:

Dear mom,

Keep modeling healthy behavior and teaching healthy thinking and habits. 

Do not give her an allowance if she uses it for junk food. You would not give it to her if she used it for alcohol and cigarettes, would you? 

If your mother will not stop making junk food available, do not allow your daughter to visit her. Let your mother see her only at your house. Do the same thing with the friends, if their houses make junk food available. If they gave the neighborhood kids beer and cigarettes, you would not allow your child to go there. Do the same with junk food. Actually, the junk food may be more damaging. 

Do not talk about diets. They do more harm than good. Serve reasonable portions at meals and no more. If allowed unlimited quantities, people tend to need more and more and develop habits of eating more than they need. Make it so that proper portions become the habit.

Don't be so concerned with her exercise. Model and lead, but don't lecture. The exercise plays a relatively insignificant role, relative to the food. 

Don't put pressure on her to lose weight. Just control her environment. As the parent, you are in charge of that. Limiting where she goes and what she has is your responsibility. Take a parenting class if you need help. 

Find out what the schools are doing. If they are not teaching good health habits, get on their case. Find out what they are serving for lunch and if they allow junk food sales in the school or promotion of them in the curriculum. 

We are in the midst of an obesity epidemic where the culture, family and friends, are not aware their idea of "normal", in regards to food, is lethal and needs to change. You can help them by leading the way.

Read all the articles on my website, www.TheAndersonMethod.com. Best wishes for helping your daughter. Her life will be so much better if you can help her solve this problem before it becomes devastating.

Question: I think I have compulsive eating disorder. I binge hard 3 or 4 times a week and I am trying to stop. I have not talked to a doctor or anything like this yet. I would like to know if there are any medications that will help me to deal with the urges I feel.

Rob Danzman Says...:

Here is what almost all therapists and doctors will tell you are the most effective means of controlling the issue you described. It's what our agency suggests as well:

Counseling: More specifically - Cognitive Behavioral Therapy. This is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with an eating disorder. Treatment includes practical techniques for developing healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations.

Medication: Some antidepressant medications, called selective serotonin reuptake inhibitors (SSRIs such as Prozac and Paxil), might be used to help control anxiety and depression associated with an eating disorder. The anti-seizure drug Topamax may reduce binge eating episodes, but side effects can be serious. You really need to talk with a psychiatrist rather than a general practice or family doctor. 

Nutrition Counseling: This strategy is designed to help restore normal eating patterns, and to teach facts and strategies for a nutritious and balanced diet.

Group and/or Family Counseling: Family support is very important to treatment success. It is important that family members understand the eating disorder and recognize its signs and symptoms. People with eating disorders might benefit from group therapy, where they can find support and openly discuss their feelings and concerns with others who share common experiences and problems. I would not recommend starting this counseling before the other strategies above since families can often be either the trigger or, at least a stressor. 

Question: My 11 year old daughter is a very competitive and talented ballerina. She is entering into puberty and she is struggling with her changing body shape. She is very concerned about gaining weight and changing her lithe shape. Her coaches seem to encourage her to stay slim. She is not fat at all but she has put herself on a 2100 calorie per day diet and she is very careful about writing down everything she eats and sticking to her limit. This may sound like a lot but she trains for 3 or 4 hours on an average day. I don’t know whether to applaud her determination or to worry about her obsession. Should I be concerned?

Jill Palmer Says...:

I would definitely keep watch over the situation. At 11 years old, we don't have the maturity to understand what these choices mean for us. Her body will change and evolve with puberty and you don't want her to try harder and harder to avoid it. 

There are a few things to think about in this type of situation. First, she is exercising multiple hours a day with not very many calories. Her body could potentially be starving which can cause problems with muscles and internal organs. We need nutrition to grow healthy and she may not be getting what her body needs to function and grow properly.

Second, anorexia and general eating disorders is common among dancers. You can't tell yet how she will process or internalize the messages she is getting about being slim. You definitely don't want her to acquire an eating disorder and we usually can't tell it's happening until it's already happened. 

Another thing to think about is her identity. If she identifies with being slim, she could have problems in the future when her body does change or when she is no longer a dancer. Will she be able to go back to normal eating at some point in time or is she creating habits that will be difficult to break later? Will she be accepting if her body gains weight as she develops? It's hard to answer these questions with such a young girl since there isn't much life experience to use as information.

I would also take a look at how rigid she is being. Extremes aren't useful in too many areas in life, whereas the grey area and being flexible take us a long way. Is she able to be flexible, in general, or is she more rigid? People with eating disorders tend to be very rigid (black and white thinking).

I would also applaud her determination and her strength. Those are great qualities that will help her through life. I would praise her for her strengths and watch out for her attitudes on eating and her body. 

The bottom line is trust your intuition. You know her better than anybody. Good luck to you and your daughter.

Question: My 15 year old daughter is very smart and talented but she is also very driven and I worry that she cannot seem to relax very well and smile more. I am worried that she may have an eating disorder but I am not sure how to tell. First she went vegetarian and that was fine and then she went vegan and that was getting extreme but OK and now she is avoiding gluten as well and it is getting pretty hard for her to eat with the family at all. She does not mind eating alone but it bothers me. She says she is opposed to harming any kind of animal and that gluten gives her an upset stomach. I am worried she is using her dietary restrictions to mask unhealthy eating. How do I know if she is? She is quite thin but I do not think she is anorexia thin yet. Is there some way to tell for sure?

Lita Perna Says...:

You do not say how long this behavior has been going on. The best way to tell if your daughter has an eating disorder is to take her to a therapist who specializes in eating disorders. Your daughter may not have an eating disorder but both of you can still benefit by seeing someone.It can’t hurt. Gluten has been in the news. Is your daughter’s upset stomach due to gluten, something new for her? She may just be following a fad, but it also does seem that eating restrictions have become progressive with her.

Anorexia is just one of many eating disorders which are a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake. Those with anorexia become obsessed with food and thoughts of food. They think about it constantly and become compulsive about their food choices or eating rituals.

Whether or not this sounds like your daughter, please seek professional help.

Question: My son is a very good high school wrestler trying to get a scholarship this year. His coach wants him at 160 and he is very strong and competitive at that weight but it is very hard for him to maintain it and it is probably 20 pounds less than he would be normally. He will use laxatives and make himself throw up to get to weight before weigh ins and now he is obsessed with what he eats all the time. I want to see him succeed but it is starting to feel wrong to put his body through this. Is it dangerous for him to try to stay so far below his natural weight for wrestling and how will I know if he is doing himself harm. I am worried he is becoming mentally unwell about eating.

Jill Palmer Says...:

I do believe that using laxatives and throwing up to manage weight is damaging. I don't know how damaging it is for your son and how damaging it could be in the future. The biggest problem with this is you have no way of knowing if this will turn into a life long eating disorder or not. It is possible that he does what he needs to do for school sports, then goes back to "normal" afterwards with minimal damage. It is also possible that he uses his new skills for weight management and coping in the future.

It scares me that coaches push for weight loss (good reason for the sport) but don't also talk about the down side and how this is only for this short period of time. There are consequences for using too many laxatives and there are consequences for excessive throwing up. You, as the parent, will need to weight the pros and cons so you can feel good about this decision. I see how difficult this situation is for you. You want to support and encourage your son but don't want an eating disorder on your hands. 

I think it's important that you feel good about how you proceed so you don't have regrets in the future. You can only make the best decision on this situation based on the information you have today. You can do research on consequences of eating disorders so you have the information and way the facts with what you know is true about your son. You can also have him see a counselor to discuss how he feels about food and his body to get a professional opinion (who has more information from your son).

I wish you the best of luck with this. I wish there was an easy answer for you.