Monday, 08 March 2010 19:02

When Lauren Calig noticed her daughter Gillian's diminishing frame and realized she wasn't eating, the concerned mother approached the then-ninthgrader.

"She said, 'You don't know what you're talking about You're not a doctor,'" Calig recalls. But Calig recognized the signs of an eating disorder from her experience as dean of Laurel's middle school and immediately phoned Gillian's pediatrician.

The next day, Gillian was weighed and referred to a therapist and nutritionist. Diagnosed with anorexia nervosa, an eating disorder characterized by cycles of self-starvation, Gillian began several years of day and residential treatments, incorporating individual and family therapy, art therapy, cognitive behavioral therapy and other approaches.

At one point, the Shaker Heights teenager spent five months at Remuda Ranch in Arizona. Although the Caligs are Jewish, they felt the Christian facility's spiritual component and equine therapy suited Gillian, who enjoyed earlier experiences at Jewish camp. They also appreciated the good climate and the staff's willingness "to look at medications differently."

Now 18, Gillian is a college student who is doing well. But her mother knows that Gillian's relationship with food will always present challenges.

"The hardest part for me is now that she's 18,1 have very few rights,'' says Calig, currently primary learning specialist/lower school diversity ¦ coordinator at University School's Shaker campus and a strong advocate for changing Ohio's parity laws to cover eating disorders. "She has to make the decision to want to. stay with her recovery. Before, we prepared the meals for Gillian, and she had no say in it. The premise was these kids' lack of nutrition was not enabling them to think clearly"

Gillian's struggles are not unique. According to the National Eating Disorders Association (NEDA), nearly 10 million females and one million males struggle with anorexia, bulimia (recurrent binge-and-purge cycles) and binge-eating disorder. If left untreated, these conditions can lead to serious health consequences or death.

It's a topic that should concern everyone, says Dr. Mark Warren of the Cleveland Center for Eating Disorders in Beachwood.

"An eating disorder is a biological illness triggered by environment factors," he explains. "They have physical, behavioral, emotional and nutritional aspects to them and thus . are very difficult to treat in a way that addresses all the needs of those who suffer from them. They are widespread in men, women and all socioeconomic groups and are seen in every country of the world."

Although the public erroneously perceives eating disorders as exclusive to upper-middle-class white women, an increasing number of .men are seeking treatment. According to Warren; males represented about one in every 1,000 eating-disorder patients iii the 1960s, but today comprise one in every four patients.

"I don't know if they're more common in men now or if there's less of a stigma," he says. It often takes a long time for loved ones to recognize an eating disorder in men. "The most common symptom is over^xercising, and this is not always seen as an illness by others," Warren says.

"It's sometimes seen as something wonderful to be glorified, whereas starving yourself or purging - which are more common in women - are often seen and labeled more quickly as an illness."

For instance, a bulimic man may hit the gym for hours on end after overindulging in pizza. A bulimic woman will purge; Dr. Jorey Friedman Beegun is a licensed clinical psychologist at the Cleveland Center for Eating Disorders and one of 15 clinicians nationwide certified in Family Based Treatment, an empirically supported treatment for eating disorders in children and adolescents. Eating disorders are not about vanity or excessive dieting, she says.

"People don't understand why it is so hard for our patients to just eat, not understanding that these are serious psychiatric illnesses," Beegun explains. "Anorexia nervosa has the highest mortality rate of any other psychiatric disorder."

Beegun uses the Maudsley approach to treat young patients. This allows parents to "help restore their child's weight and reverse malnourishment, hand the control over eating back to the adolescent, and once the eating disorder is stabilized, encourage normal adolescent development through work on the developmental stresses as they pertain to their child."

Studies from The University of Chicago and Stanford point to a 75%90% recovery rate following treatment and at the five-year follow-up, Beegun says. "This treatment has literally saved these children's lives and has provided effective, efficient care without hospitalization for an illness for which recovery rates drop significantly based on the number of years one has struggled with the illness."

Beegun is gratified that the Jewish community is increasingly recognizing and seeking treatment for eating disorders. She has presented information to faculty and students at several day schools and local Jewish agencies.

"When we had a number of Orthodox adolescents in our partial hospitalization program at one point, one of the agencies provided our facility with a kosher microwave and paper products so (patients), could eat the food their families were providing to Eating 134 them while getting the intensive treatment they heeded," she says.

Treatment can last for years. Lauren Calig says Gillian still attends individual therapy once a week and family therapy every six weeks. That's why Calig speaks publicly about eating disorders. Familiar with the frustration of dealing with insurance companies who often transfer callers from department to department before ultimately denying claims, Calig continues to fight for eating-disorder coverage that, like alcoholism, wouldn't have a cap.

"The mortality rate for eating disorders is high, so if these kids don't get treatment, they could die," she says.