Male1: When we say eating disorders, what do you mean by eating disorder?
Male2: Eating disorders that we treat in that setting fall into two main categories, one is anorexia nervosa where somebody loses too much weight compared to what their weight should be and they are losing the weight not because of a specific medical problem or for depression or another psychiatric problem, but they are actually losing the weight because they want their weight to be lower or are afraid to gain weight and a very high percentage of the eating disorder patients that we treat fall into the category of anorexia nervosa. They are losing their calories usually by vomiting and it can also be by use of laxatives or by excessive exercise or at times fasting. The teenagers that we see with bulimia, some of them do not do the binging bite at all and they just vomit on a very regular basis. Some do both the binging and the vomiting, some do binging vomiting and also laxatives.
Bulimia is very dangerous because from the vomiting and from the laxatives, a person can end up with hypokalemia or too low a potassium and hypokalemia can lead to cardiac failure, so actually, bulimia actually is a worrisome cause of fatality for teenagers and young adults.
Male1: How can we treat these eating disorders?
Male2: Both anorexia nervosa and bulimia require three components to treatment. There are the medical aspects to check for instance the blood test to make sure that a person is not developing electrolyte abnormalities. There are nutritional components, where we have our nutritionists and our nurses to do nutritional counseling, we work with the patients with eating disorders to make sure that the nutrition levels that they are at are what is required to either in the case of anorexia nervosa to gain back the weight that is necessary or in the case of bulimia, to eat more normally so that the urge to binge or the urge to purge are not as severe.
The third part is the psychological component and so all of the patents that we see are also working with mental health persons such as social workers and psychologists.
Male1: If the child or the adolescent was diagnosed, where is that success story beginning if controlled?
Male2: Most of the patients that we see with eating disorders do well over time. It is actually a difficult disease to treat. It is complicated and it does not happen in the first few days, or the first few weeks. We work with patients for months and sometimes years, and over time, most of the patients do very well. The literature says, 50, 30, 20—fifty percent do very well, 30 percent do decently, but still have vestiges of the problem and 20 percent do poorly and go from program to program. We think that in the case of the teenagers, the number is much better than that. It is probably at least 75% who do very well and so we think that amongst the patients that we see as outpatients, a high very high percent. Seventy-five percent or more do very well and even the ones who require inpatient care overtime a good percentage of those patients who do very well.
Male1: The general rule is that if you have an eating disorder, you just cannot go to a psychiatrist to get it filled and get cured, you need a whole program around the kid usually.
Male2: The medical parts and the nutritional parts and the psychological parts all have to be handled in unison and if somebody goes just to the mental health component, then you are running the risk that there are medical and nutritional problems that are not being taken cared off, vice versa. If somebody just tries to treat it with a medical nutritional part, then you are missing the underlying psychological issues that need attention.
Male1: Around the New York area where you practice, there are very few eating disorder places, are they not?
Male2: It turns out that our program which has all the different components that are listed before is the only one in the New York metropolitan area that has that. The closest others are in Rochester or Philadelphia, but in the New York area, it is why we see so many patients in here. There are individuals who treat eating disorders and there are other programs that treat eating disorders with various components, but the combination of the medical nutrition and psychological in the way that we do it, we are unique. Just recently, New York State put out a grant for centers of excellence for treatment of eating disorders and they did do one in Rochester and one in Albany, but for the metropolitan area, the center of excellence is a combination of Schneider Children’s Hospital for the pediatric and adolescent component, along with Columbia and Cornell for the more psychiatric components and for those who are older.
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