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HOUSE CALL WITH DR. SANJAY GUPTA
Eating Disorders In Older People; Binge Or Compulsive Eating Disorder Most Prevalent In U.S.; More Adults Doing Gymnastics; Schools Changing Food As Childhood Obesity Rises
Aired February 4, 2006 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
BETTY NGUYEN, CNN ANCHOR: I want to give you some pictures out of Atlanta this morning, where the body of 78-year-old Coretta Scott King is about to be moved to the Georgia Capitol, where she will lie in state. Public viewing is scheduled for noon Eastern until 8:00 p.m. this evening. The wife of Dr. Martin Luther King, Junior died on Monday at a clinic where she had sought treatment for ovarian cancer.
The diplomatic divide between Iran and the world's nuclear community grew wider overnight. The U.N.'s nuclear watchdog agency has voted to refer Iran to the Security Council. Iran responded by saying all their nuclear activities will resume and they will deny U.N. inspections.
Well, the wedding bells will not be ringing for Lance Armstrong and Sheryl Crow. The seven time Tour de France winner and award winning singer have broken off their planned wedding. The couple met in 2003 and announced their engagement back in September. It would have been Armstrong's second marriage and Crow's first.
Those are the headlines. HOUSE CALL begins right now.
SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Good morning and welcome to HOUSE CALL. I'm Dr. Sanjay Gupta.
You know, we talk a lot on this show about losing weight. And for good reason. The government says 60 percent of Americans are overweight or obese.
But on the other end of the spectrum, millions of Americans are starving or purging themselves, desperate to be thin. And while these disorders primarily affect the young, Randi Kaye reports on a troubling trend.
RANDI KAYE, CNN CORRESPONDENT (voice-over): At 46, Becky Marsella is severely anorexic, one of a growing number of women over 35 who suffer from the illness.
Although she had never done so before she says, she began starving herself six years ago as she turned 40 and depression suddenly set in.
BECKY MARSELLA, BATTLING ANOREXIA: This kind of just a senseless, hopelessness, that my life wasn't going anywhere, that I had just reach a point in my life where I couldn't get any -- any more satisfaction out of just day-to-day living. It's like I needed something else, something that would just make me happy, something that I could be successful at.
KAYE: Becky was searching to take control of her life. The only thing she thought she could control was food and the amount she ate.
If you look at yourself now, you have to wonder who is really controlling who? Are you controlling the food or is the food controlling you?
B. MARSELLA: The food and the disease has total control over me. I don't have control.
KAYE: When her depression kicked in, Becky started exercising excessively. She only takes walks now. But back then, she'd sneak out in the middle of the night and run. She'd run again before work and when she got home.
In spite of her husband's desperate efforts to help her, the weight of this 5'5" Florida woman dropped to just 58 pounds.
What do you remember about weighing 58 pounds? Do you remember?
B. MARSELLA: I remember being weak. I remember my skin just ripping off, and my hair falling out.
KAYE: But even that wasn't enough to shock Becky back into regular eating habits. Becky got so sick, she could barely hold herself up.
B. MARSELLA: I remember standing in the shower. And I got very light headed. The next thing I remember is waking up, laying on the bathroom floor with my husband over me. And my daughter was on the phone calling 911 for an ambulance.
KAYE (on camera): Back in October of 2003, Becky checked herself in here to the Hyde Park Counseling Center in Tampa. She was treated by a counselor and a nutritionist. She wasn't allowed to take regular exercise classes with other eating disorder patients because her condition was so severe, but she was weighed every week.
(voice-over): Becky's no longer getting treatment, but her weight is up to more than 71 pounds.
What is it like when you go out in public?
B. MARSELLA: It's hard. It's real hard. People stare, people talk. The hardest part for me is when the little kids see me.
KAYE: And what will they say?
B. MARSELLA: Oh, mommy, what's wrong with her? Look at her. What's wrong with her? Why does she look that way?
KAYE: That must break your heart. MARSELLA: It's very hard.
DOUG BUNNELL, CLINICAL PSYCHOLOGIST: We are seeing an increase in the number of women again for the most part coming into treatment in their 30s, 40s, 50s and even 60s.
KAYE: Psychologist Doug Bunnell works at a Renfrew Center for Eating Disorders. He's been treating eating disorder patients for 20 years. The center recently started a program to treat women over 35.
BUNNELL: When you think about other developmental shifts that go on in midlife, often kids are growing up and leaving the house, often well we know when that happens marriages have to be renegotiated. There's a sort of a quantum shift in how the relationship works. That can be upsetting or a risky transition for a lot of people.
KAYE: Have you ever thought to yourself this could kill me?
B. MARSELLA: Mm-hmm. At night, my breath would be so shallow that I would just pray, you know, please let me wake up in the morning, because I don't feel like I can.
KAYE: Do you ever worry about losing her?
RACHEL MARSELLA, BECKY'S DAUGHTER: All the time, all the time, yes. It's terrifying to think that I might lose her. It's just -- I can't bear to even think about it.
KAYE: Becky's daughter Rachel understands what her mom is going through. Rachel used to work out and diet with her mom. Her own weight became dangerously low. At 5'11", she weighed only 100 pounds
R. MARSELLA: I was starving every day, so hungry, so weak and tired. And I just - I had to stop. I just quit it.
KAYE: Rachel is frustrated she can't help her mom. Becky still averaging only about 200 calories a day.
B. MARSELLA: I normally don't eat breakfast and lunch. I may have a handful of grapes, or a couple carrots, or a cracker. And at dinner time, I may have something like an egg white and maybe some sauteed mushrooms.
People have good intentions. They're like just eat. Just pick up, you know, go, get a milk shake. You know, go get hamburgers and french fries. And you know, just eat. Just sit down and put the food in front of you and eat it. And you just - you can't.
KAYE: So what happens if you try to do that? What happens if you bring home a Whopper and cheese?
B. MARSELLA: It'll go in the garbage.
KAYE: You just can't eat it.
B. MARSELLA: Can't eat it. It's like a little voice inside your head that will say, if you give in, if you eat that food, if people see you eating that food, they're going to think she's getting better. And to get better would be a sense of losing the control over denying myself the food.
KAYE: Becky's family is seeing small improvements. She's trying to dine out once a week and struggling to stand up more often to the voice in her head telling her not to eat.
Randi Kaye, CNN, Tampa, Florida.
GUPTA: Randi, thanks.
And since this story originally aired on "PAULA ZAHN" now about six months ago, Becky has improved. We just talked with her a few days ago.
She credits her daughter's wedding this past fall for helping her begin another phase in her recovery. Now while she's still struggling with restricting her food, she says she has gained some weight. She doesn't know how much, though, because the scale is taboo. Really interesting story.
Coming up on HOUSE CALL, an expert is going to join us. Nicole Posner is going to answer your questions about eating disorders. Stay with us.
UNIDENTIFIED FEMALE: From restricting to compulsive eating, how do you know if you have a problem? Signs, symptoms and help after the break.
First, take today's quiz. Which eating disorder affects men the most? A, anorexia; B, bulimia or; C, binge eating. That answer just ahead.
UNIDENTIFIED FEMALE: Before the break we asked, which eating disorder affects men the most? A, anorexia; B, bulimia; or C, binge eating? The answer is C. Approximately 40 percent of people with binge eating disorder are men.
GUPTA: And binge eating or compulsive eating is the most prevalent eating disorder with 25 million sufferers overall in the United States. Now people with this disorder generally eat much more food at a single sitting than is normal for a regular meal. Thousands of calories more, in fact. They also eat alone and quickly, often feeling guilty and shameful once they're finished.
Here to answer our questions on binge eating and all the other eating disorders as well is Dr. Nicole Posner. She's a psychiatrist specializing in eating disorders at the Renfrew Center.
Thank you very much for joining us.
NICOLE POSNER, DR., EATING DISORDER SPECIALIST: My pleasure.
GUPTA: First of all, you know, you've seen what we've been talking about here. Do we know what causes these disorders, Dr. Posner?
POSNER: We don't have the exact cause of eating disorders, but we know that it's a combination of biological, psychological and social factors.
We believe that there - that some people are genetically predisposed to eating disorders. We also know that there's some brain chemicals that are likely involved, dopamine and serotonin, which affect appetite, reward, mood, and anxiety as well.
And then there are psychological reasons that people have eating disorders. We know that some people, as we saw with Becky, feel that they are losing control of their lives and try to get control through eating or not eating.
We also know that there are other psychological factors that can predispose people to eating disorders like anxiety, depression, perfectionism. And then there are social factors. All of the barrage we have, pressuring us to diet and to have certain body types.
GUPTA: It's interesting. We seem to be a nation of extremes. On the one hand, you know, we have this incredible obesity epidemic. On the other hand, these eating disorders.
Let's get to some of the e-mail so we can really drill down. Our first one comes from Sherry in Alaska, who wants to know this. "How do you know if you are an emotional eater and if counseling will help your eating problem?"
And doctor, we went over some of the symptoms. What advice can you give Sherry?
POSNER: Well, if you find that you're eating, not in response to hunger, but in response to emotional distress, anxiety, depression, or you know, stress in your life, then you may be emotionally overeating. And the best thing you can do is to find a therapist to help to work through some of these underlying issues.
GUPTA: Do we all do that to some extent? I mean, people talk about comfort foods, and eating when you're stressed out. I mean, everyone does that to some extent, don't they?
POSNER: Absolutely. Everyone does eat, sometimes in response to emotional stress at some times in their life. But, you know, if you find that it's affecting your health, your weight, or if you're feeling a lot of guilt or shame around this behavior, if you find that you're eating alone because you feel so uncomfortable behavior, then it's time to get some help for that.
GUPTA: All right, let's get going with binge eating here. Moving on to another question. It can lead to some destructive behavior, as we found out from Tina in Saskatchewan, who wrote us this.
"What can we do to help a teenage girl who compulsively overeats? She hides, sneaks, and steals food. She wants to stop and doesn't like her size, but doesn't know what to do."
So you know, you talk about people, parents in the case. What can they do to help a compulsive eater, their child in this case?
POSNER: Well, people who are compulsively overeating are eating large quantities of food in response to depression, anxiety, low self- esteem. And they often follow these episodes with depression, guilt, and shame. So I'm not surprised that this young woman is hiding her behavior.
But what the parents can do is help their daughter or their child to get into treatment, so that she can discover what sort of underlying issues she has that's leading her to this behavior.
GUPTA: Is the treatment pretty effective?
POSNER: Yes, there are very good treatments. And recovery is certainly possible for most people.
GUPTA: All right, we're talking with Dr. Nicole Posner about eating disorders. Taking your questions, more of them after the break.
UNIDENTIFIED FEMALE: The abusive cycle of bingeing and purging, what parents and girls need to know about the long-term effects.
And later, we head to one school where dealing coke has taken on a whole new meaning.
But first, this week's medical headlines in "The Pulse".
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): When it comes to women, heart disease may not be playing by the rules. According to a new government report, as many as three million American women don't know they have heart disease because of the way cholesterol builds up in their arteries. Traditional tests show these women have clear arteries. And in fact, they have a high risk for heart attacks.
That wonderful new car smell could be toxic. According to a study done by The Ecology Center, a Michigan based environmental group, the interior of a new vehicle may contain dangerous levels of chemicals used in fire retardants and plastics. The study claims those chemicals have been linked to birth defects and other health problems.
But an industry group said the chemicals used in cars are safe and necessary.
Christy Feig, CNN.
GUPTA: That is just a remarkable number. Almost half of first to third graders wanting to be thinner. In the United States, it seems that dieting has just become a way of life. And for some, it's gone to extremes. Nearly 10 million women and one million men struggle with anorexia or bulimia.
Talking with us this morning about eating disorders is Dr. Nicole Posner. She's a psychiatrist. She specializes in eating disorders, working out of the Renfrew Center.
Doctor, there's been a lot of research, and you were talking about this, linking bulimia, for example, with depression. Depression is a disease that everyone knows about. Is treating the depression with medication a good start in terms of tackling both problems?
POSNER: Absolutely. If you have someone who is experiencing both depression and eating disorder, you've got to treat both things at the same time.
GUPTA: And medication, though, I mean, you know, the thing I'm sort of trying to get a sense of, you know, there's a lot of people out there saying, you know, maybe I am bulimic. Maybe I've had anorexia. Do you go to medications first? Or is there other things that you can try?
POSNER: You know, it really depends on the person. And it depends on the severity of their depression. If they have a mild depression, then certainly psychotherapy can address that, or family therapy, depending on the situation.
If someone has a moderate or more severe depression, in those cases, it would be appropriate to start with medication.
GUPTA: OK, let's keep going here. Our inbox, a question from Rick in Illinois asks this question. "How can you tell when your teenage daughter has bulimia? She is underweight but says she's fine. What can a single father do to help his daughter?"
And Dr. Posner, I know you get these kinds of questions all the time. How do you specifically know when your child has bulimia? And then figuring out the best way to help them?
POSNER: Right. Well, bulimia's a very secretive disorder. So it is quite difficult sometimes to tell even if your own daughter is suffering from this condition.
But you want to look for some symptoms and signs. And one thing that you want to look for is that your daughter may be obsessed with losing weight, or with food and body.
The other thing is you want to make sure that your daughter is not using any means to purge food. This could be self-induced vomiting. You want to look to see if the bathroom has signs of self- induced vomiting. Sometimes girls will even vomit into containers. You want to see if they're abusing diet pills, diuretics, laxatives, ipecac, and those sort of things.
And also sometimes there's evidence of binge eating. Someone will leave packages behind, for example.
GUPTA: Is it best for Rick, the single father who just wrote that question, to go directly to his daughter and say, look, I think you may be bulimic. Let's talk about this.
POSNER: I would recommend that he first educate himself a bit about eating disorders. For example, he could look on our Web site, renfrewcenter.com, to get information.
And then he should talk to his daughter. Find a private space and tell her that he's concerned about her. Not bring up anything specifically about food or weight, because that can make his daughter become defensive.
But more say I'm worried about you. How are you feeling? What's going on with you? And use I statements, like "I've become concerned...
POSNER: ..."when you disappear into the bathroom after every meal", things like that."
GUPTA: And it's a good point to make sure you're as educated as possible before you talk to your daughter or son.
Another question now. Cynthia from Indiana writes this. "Having recovered from Anorexia Nervosa, I am curious about what long term effects there may be in middle age."
First of all, let me say, Cynthia, congratulations on your recovery.
Doctor, anorexia's arguably the most deadly of these eating disorders. What are the health dangers for her longer term?
POSNER: There can be some long term medical effects. For example, most women who have anorexia experience bone loss, loss of bone density and minerals, which contributes to osteopenia and osteoporosis.
And then when you couple that with bone loss during aging, you can become more susceptible to fractures.
Additionally, whereas most women with anorexia will become fertile when they gain, you know, and become a normal weight, some women will not become fertile and will have problems with infertility.
GUPTA: All right. We're talking with Dr. Nicole Posner. We're going to talk a quick break. But grab a pen. When we come back, some places to find help. UNIDENTIFIED FEMALE: The images are everywhere. Thin is in. How parents can help their kids win the body image battle. Stay tuned.
GUPTA: We're back with HOUSE CALL. We've been talking with Dr. Nicole Posner. She's an eating disorder specialist at the Renfrew Center.
And we got so many questions on this. I want to try and get to one more.
Cara in Massachusetts writing this question. "What is your best advice to parents of young girls to establish a good body image, self- esteem, and confidence?"
Doctor, what can you tell Cara? I'm sure that's a common question that you get.
POSNER: Sure, it is. And I would advise parents to be good role models, to have a healthy body image themselves and a healthy attitude towards eating. Don't make family meals a place where a conflicts are discussed. Make meals relaxed. And don't use food as reward or punishment.
GUPTA: You know, that's really good advice. Being the father of a new seven-month-old girl, I will certainly listen to those pieces of advice as she gets older.
Dr. Nicole Posner, thanks so much for being with us this morning. Good stuff.
Coming up though, the unintended effect of healthier foods in vending machines. We have that, after a short break.
CAROL COSTELLO, CNN ANCHOR (voice-over): This is what most people think of when someone mentions the uneven bars in tumbling. But coaches say more and more adults are doing back flips over gymnastics.
26-year-old Ashley started tumbling at the age of 3 and says the fear factor is what holds most adults back.
ASHLEY GURGANUS, ADULT GYMNAST: Everybody can do gymnastics. If you can do a forward roll when you're a little kid, you can do it when you're, you know, 45. Just got to get out there and try it.
ANTHONY DERRICO, ADULT GYMNAST: It's a lot of fun. It's real thrilling, I mean, to do something like that.
COSTELLO: Anthony, who's 18, says he enjoys the strength and flexibility he gains from doing it. Karol used her gymnastics routine to get into shape for her wedding. She loves the satisfaction of conquering new skills.
KAROL VERDONE, ADULT GYMNAST: Yes, you know, when I see these kids and I think, well I can do that. And I'm 33, it makes me feel pretty good.
COSTELLO: But don't jump too fast. Check with your doctor and give your time to develop flexibility. Adult gymnastic classes are offered in most states.
Carol Costello, CNN.
GUPTA: All right, Carol, thank you.
In our continued focus on childhood obesity, we brought you stories about some changes being made in the food served in schools.
Now CNN's Dan Simon has found an unintended side effect.
DAN SIMON, CNN CORRESPONDENT (voice-over): High school kids dealing Coke and junk, not that kind of Coke, not that kind of junk. This kind. Candy bars, chips, anything with lots of fat or sugar.
MARILYN ROBLES, STUDENT: I think the girl made like $50 just in one day.
SIMON: All that money says Hollywood High School student Marilyn Robles comes from selling junk food, which she says many junior entrepreneurs are doing these days at her school, including one girl who she says comes around all the time with a double bag bulging with chocolate.
If it's got sugar or junk, she's got it, right?
ROBLES: She's got it.
SIMON: Because the school doesn't. Hollywood High, part of the L.A. public high school system, has taken the junk food out of its vending machines. The Snickers bars have been replaced with granola bars. And the chips are now of the baked variety. Principal Fonna Bishop says it serves a much needed purpose.
FONNA BISHOP, PRINCIPAL: It's to raise the student's awareness of the importance of good diet and healthy eating habits.
SIMON: And let's face it. Kids eating habits these days are not the best. The L.A. school district estimates 50 to 60 percent of its students are overweight.
Some schools have taken action. In L.A. public schools, they got rid of soda machines, but put in Gatorade, which has plenty of sugar. And Pop Tarts aren't exactly health food either.
ASHLEY KOFF, NUTRITIONIST: When you look at the ingredients between a Snickers bar and a Pop Tart, there's no better one versus the other when you look at a soda versus a Gatorade. No better one versus the other.
SIMON: Nonetheless, nutritionist Ashley Koff says it's a good start. But the well intentioned initiative has created an unintended black market for junk food, according to students at Hollywood High.
CISCO KNESOM, STUDENT: People buy them because the school doesn't sell them, obviously. So they pay their money for it. And everybody wants candy.
SIMON: Dan Simon, CNN, Los Angeles.
GUPTA: Black market food. Thanks, Dan. Really interesting stuff.
Every Saturday and Sunday, we're going to be tracking the issues surrounding childhood obesity. And next weekend on HOUSE CALL, learn about rare disorders from a child for whom any kind of light dangerous, to a man living with constant hiccups. Interesting stuff.
Thanks for watching today. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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