Asking the right questions can stop eating disorders from progressing, experts say

A portrait of a woman outside
Sasha Guerra (Photo courtesy Sasha Guerra)

Anchorage high school senior Sasha Guerra takes pride in her heritage. Her mom is from Russia, and her dad is from Mexico. She’s fluent in Russian and said she’s so-so in Spanish. She loves her sister, her dogs, singing classical music and being outdoors with her friends.

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

“I was not beautiful,” she said she thought about herself. “I was not interesting. I was not funny, and I was not loved.”

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

At first, her family was supportive. 

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

Guerra’s family didn’t realize she had an eating disorder until she already had serious physical symptoms, like losing her hair and her period.

That’s a common problem, according to doctors. People don’t know enough about eating disorders to detect signs of them early, and doctors don’t usually screen for them.

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

By the time Lescher sees young people with eating disorders, they’ve already started having serious medical problems. The number of eating disorder diagnoses is rising nationally, but there isn’t good data showing trends in Alaska. 

“We know that eating disorders are all a lot more prevalent than is being diagnosed and that is being recognized,” Lescher said. “We know that eating disorders can affect people of all genders, all races, all income brackets, all education levels.  It’s not kind of the stereotypical afterschool special that some people think of.”

Lescher said it is possible to detect problems earlier if medical providers ask some basic questions like, “Have you restricted what you eat in the last six months in order to lose weight?” or “Have you done something to change your body image?” The answers can be signs that providers need to dig deeper, especially with adolescents who typically shouldn’t be on diets. 

Family members and friends can also learn to notice signs of potential eating disorders, said Beth Rose, co-founder of Alaska Eating Disorder Alliance (Rose is also vice chair of the Alaska Public Media Board of Directors). Rose has both recovered from an eating disorder herself and supported people seeking help. Her organization is helping educate people about the issue. She said if you see that someone’s relationship with food is taking over their daily lives, it’s important to gently start a conversation about their actions in a nonjudgmental way.

For example, you can say things like, “I noticed there’s a lot of food missing from the pantry, or I noticed you’re missing these meals,” Rose suggested. “And I noticed you’re also not seeing your friends or that you’re having problems with school or you’re not turning in assignments and there’s some things going on. 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 sway hospital administrators to invest in providing those services here.

Rose said that providers are seeking out educational opportunities from her organization as well, and though they don’t become specialists they do have the training to start helping patients.

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

“A 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, the likelihood is greater for full recovery.

When Guerra started looking unhealthy, her family noticed, and they helped her get support from a dietician and a therapist. She said she still struggles some, but she looks at food and the role it plays in her life much differently now. She’s mindful but not rigid. 

“I’ll try cooking it in a new way,” she said. “And then just enjoying the food that’s on my plate, and afterwards thinking, ‘Do I feel satisfied? Could I go for more?’ Usually the answer is, ‘Yeah, I could go for ice cream right now.’”

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

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

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Anne Hillman covers mental health as part of a special solutions journalism project at Alaska Public Media. She also runs Mental Health Mosaics, a project of Out North that uses art, podcasts, poetry, and creativity to explore mental health and foster deeper conversations around the topic. Reach her at anne@outnorth.org.

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