"We need effective prevention campaigns to curb the rise in eating disorders."

"I think there are several factors contributing to this continued increase in cases and the decrease in age. The pandemic and lockdown period meant that many people lost some mechanisms of social control, such as school or contact with peers, and it may also have led to increased use of social media and exposure to unfavorable messages or messages that encourage the development of eating disorders or other risky situations. The lockdown , clearly, and the pandemic in general, have negatively impacted young people , and this has been reflected in the increase not only in eating disorders but also in other problems such as depression and suicide attempts."

But from a broader perspective, it's striking that despite the extensive discussion about eating disorders and the efforts to prevent them, as well as the increased awareness in schools and families, the numbers don't seem to be decreasing ; in fact, they continue to rise, and there's a decline in the age at which these problems begin. This is likely related to more general social trends that point to a kind of "adultification," or rather, an earlier onset of adolescence . It seems we have children, especially girls, who are already adolescents at ten years old and are beginning to worry about their body image and weight, which is inappropriate for their age. This early preoccupation with these issues, along with the exposure to diverse influences on social media and the limited parental involvement in all of this, I believe—and other authors agree—is making children and pre-adolescents more vulnerable. And that's why we're seeing ongoing eating problems in nine, ten, and eleven-year-old boys and girls, when not long ago it was normal for them to appear at fourteen, fifteen, and sixteen years old. I think these are sociological changes that are contributing to these problems not decreasing."

"Perhaps talking about new models can be misleading, in the sense that treatments for eating disorders have been known for some time, and what we probably need to do is implement them as effectively as possible. And we must always keep in mind that the best treatment is good prevention of these disorders, because even the best treatments don't guarantee a person's recovery. But alongside the more common treatments for these eating disorders, there has been recent discussion about home-based care models or programs for less severe cases. These would involve working at home with the help of family or other people the affected person lives with. We can also talk about group interventions , where new psychotherapeutic techniques such as mindfulness or third-generation therapies are being implemented, which also seem to contribute to better treatment outcomes."

The treatment of eating disorders, an interdisciplinary work

Read more

But the core principle of treatment remains the same: working on the physiological or physical aspects of the person , taking into account the body and the recovery of a normal weight, body mass index, and nutrition, and also the psychological aspect , addressing the misconceptions these individuals hold. And then there's the environment, working with their support group, which is usually the family, to help them regain healthy habits that can then be maintained. Because in many cases, the challenge isn't just acute treatment, getting the person back on their feet and eating, but ensuring that this recovery is maintained over time and that there's a recovery in all aspects—social, academic, and so on. The approach is complex and multidisciplinary.

"We must keep in mind that this person is usually part of a family unit, and that even if they are hospitalized or undergoing some type of individual treatment, they eventually return to the family unit where the eating disorder originated. On the one hand, we need to explore whether there are aspects of family dynamics that may have contributed to the onset of the disorder, such as poor dietary habits or eating customs that are not entirely appropriate, and try to correct them (the more psychoeducational aspect). But then we also need to study family interactions and see if they are in any way contributing to elements that are important in the development and maintenance of the eating disorder, such as perfectionism or obsessive tendencies: wanting a perfect son or daughter, maximum demands, peak performance… We can also help change these patterns of family interactions, which can later contribute to a more complete recovery."

Family intervention in an eating disorders unit

Ir al artículo

The family can certainly be a significant driver of change. Some families feel powerless and say they don't know what to do, but they usually have resources, and these systemic interventions seek out those resources and help them find a way to move forward and overcome the eating disorder. It's not always easy, and sometimes it sadly drags on, with professionals spending several years helping people emerge from these situations. Involving families is an added value to the treatment.

"The involvement of families in treatment is becoming increasingly important in most centers, but this involvement varies depending on the resources available at each center. Sometimes it's limited to providing recommendations and guidelines, which feels inadequate. When resources are available, it's possible to work more intensively and on a longer-term basis with these families. If you have the time and staff, you can even create multi-family groups , bringing together several families to support each other through this often long and painful process , where emotions and feelings aren't always positive." There are cases where you find desperate parents, who almost throw in the towel, who may even reject the son or daughter with an eating disorder that doesn't seem to resolve itself over time and who, just like with drug addiction problems, sometimes don't quite understand and think that the person stops eating or eats excessively because they want to, blaming them, when in reality they are a victim and not a perpetrator and are not guilty of anything, but have simply fallen into this problem and need help to get out of it.

Families should not succumb to despair and helplessness, nor engage in arguments between parents about how to handle the situation, so they can help the person with the eating disorder as effectively as possible. Sometimes we find families who are very capable and already know how to do it, but this is not the norm. Families usually need a lot of support.

The best treatment is prevention, because even the best treatments don't guarantee recovery.

"The figures usually cited refer to the 14-20 age group, which is when cases are most prevalent, because it's the period of greatest risk. But it's true that many adults have eating problems , and the figures there aren't as clear; some studies point to one set of data, and others report different numbers. But what these studies do suggest is that eating disorders in adults are on the rise. There's a kind of contagion effect of expressing distress, often anxiety or depression, through the body, through weight-loss diets, and through loss of control over food. And that's why there are more and more eating disorders in adults . And there's a disorder that now has its own distinct status: binge eating disorder , which is like a form of bulimia without compensatory mechanisms, and its prevalence is often associated with obesity or being overweight." Many of these cases of obesity, an increasingly serious problem in our society, somewhat similar to what happens in American society, are underpinned by binge eating disorder.

There are more and more eating disorders in adults, because there is a certain contagion phenomenon of showing discomfort through the body, through slimming diets and lack of control with food.

Regarding the differences between eating disorders in adults and adolescents , an adult who develops this disorder has usually already completed some studies or a phase of their education, and is sometimes even employed, so the impact on them may be somewhat less severe. In an adolescent, an eating disorder can interrupt their studies at a very early stage and hinder their educational development; in many cases, they may even miss out on adolescence altogether. These factors can affect the formation of their personality more than in an adult. An adolescent can be much more affected by a disorder that can last for years and can cut short many opportunities for development and for achieving many things in life.

"Traditionally, it was said that up to 20% of cases could become chronic. With so much concern about the issue and with improvements in treatments, these chronicity rates have decreased, and currently, we're dealing with a percentage closer to 10% of cases . It seems low, but for someone who starts with the disorder in adolescence, it's heartbreaking to think that the problem could become chronic. Although it seems almost impossible for eating disorders to disappear completely through prevention, we must strive to reduce this percentage. But we must convey to all those affected and their families the hope that they can recover from this problem , even if it takes years, even if they've been dealing with it for five years. You can start at 14, and at 20, you can't be labeled as an unrecoverable patient; instead, we must continue working and applying treatments to achieve the maximum possible recovery."

According to WHO criteria, a disease is considered chronic after two years of progression. However, we don't use these numbers when dealing with eating disorders, because an eating disorder can last three, five, or eight years, and while it could be considered chronic, it's not necessarily irreversible . Chronic conditions in medicine are generally considered irreversible, but in the case of eating disorders like anorexia and bulimia, the problem is always treatable, except in some very severe cases where physical damage has occurred. But in general, a case of bulimia or anorexia, even after a very long period, is treatable. So we can talk about chronicity, but not irreversibility.

"Generally, these are people who come of their own volition and request help. This depends on their level of awareness of their problem. There are adults who realize they aren't functioning well with their eating habits and come seeking help. I believe they are the majority, although some adults accept help from family, partners, or friends, who accompany them, and we also rely on them for treatment. With adults, it's also important to include them, because although the fundamental thing is the person's desire for change, saying 'I don't want to continue like this,' having external support is always helpful ; it's an added benefit to the treatment."

"Yes, it varies quite a bit. With minors, parental authority rests (something questionable in the case of some teenagers), and guidelines or recommendations are easier to follow. With adults, it requires more negotiation; you have to make them understand that the help their partner or family can offer isn't a loss of power or something that will continue indefinitely, but rather a temporary situation in which they need to accept help and advice in certain areas. This is because the affected person can, at a given moment, lose perspective on what portion sizes are appropriate, or whether they need to stop eating at certain times. Having external support is very useful. In hospitals or eating disorder day centers, it's easy to provide because we're there to support them, but many adults later tell us they don't know what to do at home and feel lost." That's why it's important to have someone to help them, not only in the area of food , but also in other matters, because the inner world of a person with an eating disorder has all kinds of demons, ghosts and fears, and there is a lot of anxiety, and having someone by your side who helps you manage these fears can be very useful."

The adult needs to understand that help from a partner or family is not a loss of power and that it will not last over time.

"It's an issue that will never have an easy answer. Where does individual freedom, the right to choose, end when faced with the potential risk to a person's life? This happens in other branches of medicine as well, and it's often a matter of debate. I believe it's essential to get to know the affected person well, try to establish a bond of trust with them, and if the responsible professionals are convinced that it's the only short-term solution—because involuntary hospitalization isn't the solution for eating disorders, but it may be necessary at a given moment—then we must do everything possible to convince the person. How far should we go and force them into involuntary hospitalization? It has to be a team decision, but we must always discuss it with the affected person ." We are at a time when people are always empowered, encouraged to participate in decisions, and in a matter as delicate as admission it should be like that, explaining and insisting that the team sees it as absolutely necessary for their life, for their physical integrity or to give them a push so that they can get out of the situation they are in."

"There are quite a few initiatives underway at the national level, in schools, to raise awareness of this problem and provide information to young people. For a long time, preventative campaigns focused more on psychoeducation and providing information about the problems and risks associated with eating disorders. But it's become clear that these more direct, psychoeducational campaigns aren't very effective, especially with young people, who aren't easily frightened by dangers and risks. That's why, recently, there's been more work being done in schools and youth groups to address issues like self-esteem and the risks of perfectionism —other aspects that underlie eating disorders. I think even more can be done in schools..."

Protecting mental health in educational settings

Read more

And then there's the family sphere , which is difficult to reach because there's such a wide diversity of families, and each family is unique and has its own particularities. Even if you send them messages about the risks of eating disorders or about the importance of eating together as a family, of taking care of their diet, and of avoiding diets, the response here is harder to measure. But we must focus heavily on working with families and schools because it truly is the only way to prevent these problems. Many treatments are available and are becoming increasingly effective, but there's no absolute guarantee that we'll be able to cure someone once they've developed an eating disorder.

We must emphasize this approach of working with families and schools , because it is the only way to prevent eating disorders.

"From a more microscopic view of what we have in the units and centers, you might think that people are still arriving affected and that, after the pandemic, we have quite serious cases, which could lead to a somewhat pessimistic outlook. But from a broader perspective, considering the entire system, seeing all the treatments being implemented and the focus on prevention, it gives me a more optimistic view . I believe that in the medium to long term, the 'epidemic' (which we can't really call an epidemic) of eating disorders will actually be controlled or at least prevented from continuing to increase. I see the continued existence of eating problems in society as almost inevitable, because food and diets have become a very important part of our society; many people are concerned about these issues, and it's difficult to prevent some people from making mistakes in their relationship with food. I think it's almost impossible to avoid that. But not to prevent this continued increase in cases among young people." I believe that if effective prevention campaigns are implemented, this will help to prevent us from continuing to have children as young as ten or eleven already presenting serious mental health problems."

For several years now, the Dialogue Table for the Prevention of Eating Disorders has been in operation, with the participation of various entities and departments of the Generalitat (Catalan Government), including the Mossos d'Esquadra (Catalan Police) and IT departments to prevent online crimes related to the promotion of anorexia and bulimia. Professionals involved in treatment and the Association Against Anorexia and Bulimia (ACAB) also participate, and we have been carrying out prevention and awareness campaigns and initiatives for years.

Furthermore, the Mental Health and Addictions Director's Plan is working to implement more resources and strengthen home-based care. But the latest initiative they want to promote is training in the treatment of eating disorders, not only for specialized units but for all mental health centers in Catalonia , so that these facilities can address eating problems. The idea is that an eating disorder in its early stages can also be treated at a mental health center, and perhaps sometimes it can be addressed at this level before it progresses to a severity requiring more intensive or specialized care. That's why I'm optimistic, because I believe that in the long run, all these initiatives will have a noticeable impact.