Eating disorders have the second-highest mortality rate of any mental illness, only surpassing opioid addiction. As the nation grapples a pandemic and individuals are experiencing unprecedented isolation, many are forced to deal head-on with their unhealthy relationships with food. People are in increasing need of accessible eating disorder treatment and resources in the Philadelphia area.
Kristin Szostak is the site director at The Renfrew Center in Center City, one of the eating disorder treatment center’s two locations in Philadelphia. In this interview, she talked about how treatment methods have shifted throughout the pandemic, how the unpredictable circumstances have affected people and their relationships with food, and where people can seek help if they or someone they know may be battling an eating disorder.
How prevalent are eating disorders in Philadelphia?
Well, the stigma around eating disorders is certainly dissipating, which is a wonderful thing because it’s allowing more people to come forward and say, “I’m challenged with this, whatever this may be.” Additionally, the scope of eating disorder challenges is being more recognized; it’s not just the anorexic person or the bulimic person that’s often portrayed in cinematic form and other sorts of media. There’s attention being drawn to all forms of eating disorders, including binge eating disorder and avoidant-restrictive food intake disorder, and that in itself is providing more education and more awareness.
The prevalence within any area is difficult to pinpoint, just because more and more people are coming forward. As far as for our region, we have seen a multitude of patients come through both Philadelphia sites. And since Renfrew opened in 1985, we’ve treated over 85,000 adolescent girls and women nationwide.
Are there any in-person treatment options still available during the pandemic?
Starting last March of 2020, when we were just at the beginning of this global crisis, the national network of eating disorder treatment centers did remain open and have remained open through the COVID-19 crisis to serve adolescent girls and women. Renfrew has two residential facilities: one in Philadelphia just on the very edge of the county that remains in-person, and we have a residential facility also in Coconut Creek, Florida that remains in-person.
All of the nonresidential programming was temporarily shifted to a virtual platform where they are able to offer virtual day treatment and virtual intensive outpatient programming that doesn’t mirror the programming that was offered prior to the pandemic when they were in person. So, it still consists of therapy groups, supported meals with clinicians and registered dietitians, individual support services such as therapy nutrition psychiatric consultations, and connections with families both through family therapy and support of the families that are supporting the person seeking recovery.
How do you think the switch to online has been for patients in treatment?
Ultimately, it allows those at risk to see professional care that they need from the safety and comfort of their own home. So, that does mitigate the risk of becoming infected with COVID-19, which is a very real concern for everyone right now. It also allows patients to maintain a sense of order because everything is so unpredictable and changing constantly, and none of us have ever been through this. It gives them an opportunity to rely on the treatment team and rely on this routine professional care to maintain some sort of order.
Some of the challenges we’ve seen have been primarily around what’s been coined Zoom dysmorphia because we don’t live our daily lives walking into spaces that are surrounded by mirrors. We’re not accustomed to being in a world where we’re looking at ourselves pretty much all day, so that has been a challenge that we’ve seen with a handful of our patients is just that constant focus on looking at themselves and looking at their faces. And then this being exacerbated by the multitude of filters that you can pull down from social media to look different. Even if it’s something silly, like funny ears or something like that, there still is filtering across the face that kind of gives more of a cosmetic change to it. And so we’re seeing more distress around that sort of body image, body acceptance, even if it is just from the shoulders up.
For those who may not even have a diagnosed eating disorder, how do you think the pandemic and isolation from lockdowns has affected their thoughts about and relationships with food?
It used to be the freshman 15 that was geared toward college populations. Now, a lot of the jokes on social media are about gaining the “quarantine 15” and ultimately, it gives the implication that a person should be worried about gaining weight during a crisis. It’s harmful to everyone, but especially those struggling with disordered eating, and the jokes reflect the fat-phobic idea that gaining weight is inherently a bad thing and that you are inherently a bad worthless person, which is definitely not true.
This whole concept of this forced isolation and self-quarantining that we had all been pushed into may have caused individuals, either with clinical criteria eating disorder or someone with just disordered eating challenges, to respond in a variety of not-so-helpful ways. Those that are in recovery from eating disorders may often find themselves in a survival mode, and they feel like they’re in this constant freeze, fight, or flight. So that in turn is decreasing the chance for them to have flexible thinking and be able to respond in helpful and healthful ways to any situation.
People may identify with old eating disorder thoughts, where they may have used binge-eating a certain type of food as a source of comfort, a source of relief, and they may be reverting to that. … It’s not always because bodies change through the sedentary lifestyles that we’ve all been forced into. It could be driven solely by the emotions that are surrounding the Coronavirus and the social distancing and everything that’s come along with it that is leading people to feel so out of control that they’re yearning for anything familiar to grasp onto. Even if rationally they know “this is not the best option for me,” it’s all they have in that moment.
Are there resources and treatment options that are accessible to low-income families and individuals, or those without health insurance?
Absolutely. One of the options is always to either go on the Renfrew website or call 1-800-RENFREW, so even if we are not able to work with a family that may not have insurance, we do have a team of professionals in the program information department that always has additional information about resources. So even if someone doesn’t even know where to begin looking, that could be a start. And while the person may not land with us, we may be able to help them land somewhere that is appropriate to them. I would also recommend the National Eating Disorder Awareness website. If a person has difficulty accessing Wi-Fi and the internet, which I know is also a very real challenge, there is a phone number for NEDA (1-800-931-2237), and that’s another option for resources. Even if it’s just something that is a phone-in or Zoom-in support meeting, not necessarily something treatment-based, but just group peer support options.
When do you think it’s necessary for someone to seek treatment if they think they might be struggling with an eating disorder?
It’s often hard to find the right time for treatment because it’s kind of like, “But I have so many things that I need to be focusing on,” whether it’s schoolwork, family demands, etc. However, the recent changes in those structures have opened the door for more opportunities for individuals to engage in treatment.
If a person is noticing within themselves and realizing that they’re forgetting to eat certain meals, their depression has gotten severe enough to the point that they’re sleeping through breakfast and lunch, they realize they’re only eating one meal a day and they’re starting to feel the physical changes of that, or they’re finding that at night they’re just binge-eating on food over and over and over to the point that they feel that they’re losing control of their own behaviors around foods. These are all reasons to come in [or call] and just get a free assessment to determine, do you need more support and help from where you are now, and if so, how can we help you get there?
Where can someone in Philadelphia go for help if they themselves are struggling, or they have suspicions that a family member or friend may be struggling with an eating disorder?
More often than not, the social network of that person, whether it’s family, friends, whatever the case, will pick up on something that’s just not right before the individual. So, if a family member or friends at college or a coach is saying, “Hey we’re kind of concerned because we’re seeing this,” there’s absolutely no shame in just calling for an assessment and saying, you know, “I was recommended to do this by someone.” Assessments are free, and it doesn’t necessarily mean that, you know, the next day we’re going to say, “Well, you got to pack up, we’re shipping you off to residential because you really need this.” Sometimes it could just be that there seems to be a negative relationship with food. It’s not a full-fledged eating disorder, but it’s something to be aware of. So we’ll provide support options for you to explore to kind of stop it where it is. If there is a situation where the person does need more support, then we would make that recommendation for an appropriate level of care for them to come into.
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