Asking the right questions can prevent the progression of eating disorders, experts say

Sasha Guerra (Photo courtesy of Sasha Guerra)

Anchorage high school student Sasha Guerra is proud of her heritage. Her mother is Russian and her father Mexican. She is fluent in Russian and says she is so into Spanish. She loves her sister, her dogs, singing classical music and being outside with her friends.

But when Guerra was in middle school, she worried a lot about her fitting in. People commented on her body, which affirmed her thoughts about herself.

“I wasn’t beautiful,” she said, thinking to herself. “I was not interesting. I was not funny and I was not liked.

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These feelings stayed with her for years. Then, in the summer of 2020, she started restricting her food intake and following an extremely rigid eating plan.

At first, her family supported her.

“They were like, ‘Oh, you’re eating more vegetables. That’s great. You’re taking control of your health. That’s great,’” she said. “They didn’t know what it was rooted in. and they didn’t necessarily understand why I started this quote-unquote health journey.”

Guerra’s family didn’t realize she had an eating disorder until she was already experiencing severe physical symptoms, such as hair loss and her period.

This is a common problem, according to doctors. People don’t know enough about eating disorders to spot the signs early, and doctors usually don’t screen for them.

“One of the most important things is to identify an eating disorder early before you have complications,” said Dr. Rachel Lescher, pediatric endocrinologist at the Alaska Native Tribal Health Consortium.

By the time Lescher sees young people with eating disorders, they have already started having serious medical issues. The number of eating disorder diagnoses is increasing nationally, but there is no good data showing trends in Alaska.

“We know that eating disorders are all far more prevalent than what is diagnosed and recognized,” Lescher said. “We know that eating disorders can affect people of all genders, all races, all income brackets, all levels of education. It’s not the type of stereotypical after-school special that some people think of.

Lescher said it’s possible to catch problems earlier if medical providers ask basic questions such as “Have you restricted what you eat in the last six months in order to lose weight?” or “Have you done anything to change your body image?” The answers may be signs that providers need to dig deeper, especially with teens who generally shouldn’t diet.

Family members and friends can also learn to notice signs of potential eating disorders, said Beth Rose, co-founder of the Alaska Eating Disorder Alliance. Rose has both recovered from an eating disorder and supported people seeking help. His organization helps educate people on the issue. She said if you see someone’s relationship with food taking over their daily life, it’s important to gently start a conversation about their actions without being judgmental.

For example, you can say things like, “I noticed a lot of food is missing from the pantry, or I noticed you’re missing these meals,” Rose suggested. “And I noticed that you weren’t seeing your friends either or you were having trouble with school or you weren’t turning in your homework and things were happening. How can we talk about this?

In Alaska, there are very few medical providers who specialize in eating disorders. For intensive treatment, people have to go out of state. Lescher said that’s part of the reason it’s so important to research the prevalence of the problem in Alaska. The data can motivate hospital administrators to invest in providing these services here.

Rose said providers also seek training opportunities from her organization, and while they don’t become specialists, they have the training to start helping patients.

“Often doctors and therapists are told, ‘Don’t work with patients with eating disorders because they take too long and they don’t recover,'” Rose said. But if medical providers have the skills to assess the problem, they can help people, she said.

“The majority of people with eating disorders recover,” she said. And if the disorder is detected within the first three years of the onset of symptoms, she said, there is a greater likelihood of full recovery.

When Guerra began to look unhealthy, her family noticed and helped her get support from a dietitian and therapist. She said she still struggles, but looks at food and the role it plays in her life very differently now. She is aware but not rigid.

“I will try to cook it in a new way,” she said. “And then just enjoying the food that’s on my plate, and then thinking, ‘Do I feel satisfied? Could I go further?’ Usually the answer is, ‘Yes, I could go get some ice cream right now.’ »

The Alaska Eating Disorder Alliance offers free training opportunities with an eating disorder specialist in May and June. Some are for family members, others for medical providers.

This story is part an ongoing solutions journalism project to Alaska Public Media on the destigmatization of mental health. The project is funded by a grant from the Alaska Mental Health Trust but is editorially independent.

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