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Adolescent Eating Disorders Podcast

  • SARA LOMAX-REESE: I want to welcome our Einstein docs, Dr. Donee Patterson, who is a Family Medicine physician with Einstein Department of Medicine. Welcome.

    DONEE PATTERSON, MD: Thank you.

    LOMAX-REESE: And Dr. Kelly Bethea, a pediatrician and the director of the Teen Clinic at Einstein. Welcome.

    KELLY BETHEA, MD: Thank you.

    LOMAX-REESE: Happy New Year to you both.

    PATTERSON: Happy New Year to you.

    BETHEA: Happy New Year.

    LOMAX-REESE: Why don't we start?  I think that this topic of eating disorders, a lot of times we talk about overweight and obesity when it comes to the African American community and that has so many implications across the spectrum, in terms of health issues, whether it's diabetes or heart disease or certain cancers, all of those things, but we seem to feel like eating disorders are not a part of our cultural experience or our medical or healthcare experience. I am going to start with you, Dr. Donee. Can you define eating disorders and what it might look like in the African American community?

    PATTERSON: Sure. We wanted to talk today about this topic because a lot of times teens are coming home from college and they're on Spring Break or they're on their Christmas break or come back from Spring Break and a lot of times it is a key time for parents to pick up that something might be going on and in our community there is a big focus now, as you said, on weight loss and childhood obesity, but in everything in medicine there are two extremes. So we want to talk about the other extreme, which is too much weight loss or disordered eating. Disordered eating can be overeating, but it also can be under eating or binging and purging and that's what we want to talk about today. Dr. Bethea, she works in the Teen Clinic at Einstein, and so she sees a lot of this and I wanted her to come and kind of help explain exactly what anorexia and bulimia is. They have very strict definitions and so that's why a lot of times it is missed because people think that African Americans don’t have eating disorders. Initially we were thought to just have great self body images and we were not predisposed to that, but because of the pictures that people see in magazines and on TV, it really is common in African Americans and Latino women and Asian women and Native American. So we definitely wanted to talk about that today. Dr. Bethea, did you want to explain about exactly what's going on with anorexia and bulimia?

    BETHEA: Well, anorexia and bulimia in the patient population is basically defined for anorexia it is weight loss by restriction or really decreasing the amount of calories that you take in, where bulimia is a type of eating pattern where you would eat an exorbitant amount of food, let's say a turkey dinner all by yourself. I mean the whole turkey, all the sides, the trimmings and really in a short period of time consume the entire meal and then purge it out, either by excessive exercising, throwing it up or using a laxative. The problem in the community is that people don’t really notice that kids are doing these things or that adults are doing these things. So some of the things that parents can be wary of or looking for is the activity or what the child is doing after they eat. If they're eating family meals and suddenly they always have to go to the bathroom right after the meal or they come home during Spring Break, college break, or even during high school where they just come home and they seem to be losing a lot of weight, looking at grades, how are their grades in school? If they are decreasing that's because they could have decreased concentration. It is just a various many things that go along with eating disorders, but the main point is that they shouldn’t wait until the weight is so low that they look emaciated or like the Calvin Klein commercial models. That's one of the takeaway points we do want to emphasize. 

    LOMAX-REESE: Cause I think that, I know that growing up I would see certain TV shows and things about anorexia and that was kind of the quintessential, classic eating disorder and I was reading some of the research and it says that recurrent binge eating, which is both bulimia and binge eating disorder, is actually more common in black women then in white women. My question is if you are eating that much can you possibly purge enough to actually lose weight? If you are talking about eating an entire turkey dinner, an entire, you know, an exorbitant amount of calories, so how would you even know necessarily, unless you are really watching the behaviors, because they might not actually be losing weight. It might just be more of a mental and emotional struggle. Dr. Donee?

    PATTERSON: Right, that's what we want to emphasize today. We want to emphasize that it is not just the teens or the women that are 90 pounds or smaller. These women are often normal-sized women or sometimes they are even above their ideal body mass index. You don’t know just by looking at them. We want to tell people please, pay attention to what your teen is doing. Pay attention to what they're eating, have conversations out of the blue. Just say, "Well, what did you eat today?" Have conversations out of the blue. Know what's in your cabinet. Know what they're eating and pay attention to what they do after a meal. Do they even eat meals with you and do they disappear after the meal? I know that one teen, well, actually she wasn’t a teen, she was like 21, 22, and what she would do, she was living at home, she would come and she would eat massive amounts of foods, whole containers of ice cream with cookies and snacks and a whole loaf of bread and she would feel so horrible about it afterwards she would purge and then she would know that people would miss that food in her house and so she would go and she would replace the food. It's something that you really need to pay attention to, but the reason why we are bringing it up is it tells us that a person probably has some depression going on. About 50, 55 percent of people have associated depression and also that binging can tear the esophageal lining and it can rupture a peptic ulcer, a stomach ulcer and it can destroy teeth. It can destroy the enamel on the teeth and it can have long-term consequences. In the later stages you can go into organ failure and it is hard to recover from those things, but it's a wake-up sign for people to say there is something more going on with this child, I need to pay attention. 

    LOMAX-REESE: This is really something and I saw from the statistics that most of the people who have, 95 percent of people who have eating disorders are between the ages of 12 and 25 or 26, but I am still grappling with the definition a little bit because I see a lot of obese older women in particular and older people so why isn't that considered an eating disorder? Why isn't obesity considered an eating disorder in a classic sense?

    PATTERSON: I think a lot of people use food as a coping mechanism for stress and many people overeat. In a sense, that's its own eating disorder, but then some people restrict. When people restrict their diet, they're restricting what they eat, they will only eat under 200 calories in a day or when they binge and then they purge. That's a true psychiatric definition of an eating disorder so it is on both sides. 

    LOMAX-REESE: Let me just ask you this, Dr. Bethea, because if we are talking about treatment and it sounds like I think what Dr. Donee is saying is that there's a psychological, there's like a real psychological dimension to classic eating disorders, as opposed to just eating too much and not exercising enough and getting overweight or obese. So what are some of the treatment options for these eating disorders?

    BETHEA: So to just kind of back up just a little bit, obesity is an eating disorder. The DSM-4 criteria, as it evolved, have added binge eating as a part of the criteria for an eating disorder, which is basically eating too much food and not having and not having a compensatory mechanism to get rid of the weight. We know that bulimia usually they're normal or overweight because they don’t compensate enough for the amount of calories that they take in. So when we approach eating disorders, anorexia, bulimia and obesity, it has to be approached in a multi-disciplinary fashion. The medical physician is a part of the team because, especially in under-weight patients, you have a tendency to have low blood pressure, low heart rate and other medical instability, whereas with obesity you are not going to have those kinds of acute signs of body failure. It's long-term effects on the body of laying down the fat in your cells and increasing your risk of stroke and hypertension and diabetes in the long run. The next person on the team should be a nutritionist, someone who really is adept in not only giving you how many calories you should take in, how much you need to lose weight, how much you need to gain weight, but also someone who is adept in making sure that the amount of calories that you are taking in, for someone who is underweight, is in a smaller portion so that it is not overwhelming or figuring out how to satisfy those who eat large portions with a smaller amount of food and really teaching them how to substitute in and out the good for the bad. The third person that should be on the team is a psychiatrist and/or psychologist to deal with the depression, post-traumatic stress. A lot of these young people have problems with abuse, sexual, physical, emotional abuse. When you look at males, who are much underdiagnosed with eating disorders…

    LOMAX-REESE: I was going to ask you about that.

    BETHEA: Yeah, males, I have a real big passion for the male patient, but about one percent of eating disorder patients are males and a lot of times they are struggling with identity. So their sexual identity is one of the problems with eating disorders and when you think of eating disorders it makes a whole lot of sense why it is in the 12 - 25 year old age group when developmentally these are the persons who are trying to become an adult, who are trying to find their own being and their meaning and purpose in life and so what is one thing that children can control in their life. The only thing they really can control is what they can't do or don't put in their mouth. So eating disorder in this age group makes a lot of sense because they can't control where they live because their parents usually tell them where they need to live. They can't control what foods come in the house unless they go to the supermarket, which a lot of times they don’t pay attention, but they can control within themselves how much they consume or not consume in their body. You really need that full team of persons to really get to the crux of why they are having these eating problems and then the bottom line is that the family support has to be there. A lot of times the families are, the mother or the father has struggled with eating issues in their life and they too need to be involved into the treatment of the eating disorder. 

    LOMAX-REESE: That's Dr. Kelly Bethea and she is a pediatrician and the Director of the Teen Clinic at Einstein and we are talking with also Dr. Donee Patterson, family medicine physician in the Einstein Department of Medicine. We are talking about eating disorders, particularly in the African American community today as we launch into 2013 and the New Year. If you have a comment or a question give us a call, 215-634-8065 or toll-free, 866-361-0900. You can also listen to us live online at Dr. Bethea, when you mentioned the boys or the young men and their struggles, I am curious what would the symptoms or what would it look like in a boy? Would it look very different then what you might see in a girl in terms of how you might identify this as an issue?

    BETHEA: With young men it is difficult because a lot of times men who are thin aren’t looked at as being unhealthy and then men who are larger aren’t looked at as unhealthy. So it is really getting them to really understand what heathy weight for height is and then when you look at the typical eating disorder in a female it is usually a body image problem. They feel that they are too fat. With males, it is not really a body image, although they might think they are a little overweight, but it might be about fitness. I want to be fit. It might be about if they are an athlete who participate in sports that require weight classification, such as wresting or body building. As they grow and get older and get taller they become heavier so when they become the best in their weight class and now they have grown five inches over the last year, their weight class has to go up, but they don’t want to move up their weight class because they want to maintain their prowess in their sport. It's about educating them and making sure that they understand that weight gain with height is normal and expected and then they get overlooked because physicians - I had a patient once who had an eating disorder and I was not the primary, but I was doing sports physicals for a high school, and we kept sending him back to his doctor and doctors in the community don’t really appreciate eating disorders so he kept coming back. "I gained five pounds the last time." But it came to light that he was being weighed in his boots, in his coat, everything was still on so they weren't really getting accurate weights, where we were making sure he was in a gown getting accurate weights and then he just disengaged from even seeing us. 

    LOMAX-REESE: I am just curious. How widespread in this understood within the medical community? Because there is such a focus on overweight and obesity, particularly in the African American community, that if a child comes in and they are underweight, I don’t know if that is going to raise a major red flag. Dr. Donee?

    PATTERSON: I wanted to encourage parents who are maybe listening and saying, well, what can I do, I am not sure what's going on. We want to encourage them to bring their child in for a well child check and encourage and just make sure that the doctor is checking their height and their weight on the scales that we have, they're actually graphs that we have, and it is a testament to following up with the same doctor year after year because then they'll have a chart and we will be able to see if a child is dropping below their body weight. So if they drop two lines below their body weight, then we get concerned, or if they jump too high above their body weight. Normally a child will trend on a normal curve, they will continue to grow, but if they go too high or too low then that is something that would be a red flag and I would encourage parents to make sure that their doctor is checking their height and their weight as well.

    LOMAX-REESE: I am curious like family dynamics. You mentioned that it is important for the parents to be engaged and observant, but anyone who has every had siblings knows that they can be cruel. They can be very pivotal in shaping how you see yourself, your self-esteem, your self-image, all of those things and I know that I am one of six, and that's a huge family in today's standards. I think most people are only children now it seems, but what role and how do you shape and make sure that the family dynamic is supportive and nurturing beyond the parents who might have the maturity to be supportive, but what about siblings and their role in this whole process? Dr. Bethea?

    BETHEA: Well, I think it definitely has to be a family-based approach and we know that family intervention usually has the best outcome, but it is really getting the family to understand what it means to be an eating disorder because a lot of times, especially for the eating disorders that are low weight or underweight, the focus becomes greatly on that child who is underweight. So then the other children feel that no one pays attention to them so they may have their own issues or acting out. It is just really trying to get the whole family to understand and then engage them all into the therapeutic treatment of the patient. So making sure that if family therapy is necessary, that they all are engaged in therapy to help the patient in their eating issues.

    LOMAX-REESE: Dr. Donee?

    PATTERSON: I think we have to be careful because we have to recognize that eating disorders start somewhere. Often for teen girls it may be sports, like cheerleading, where they have to be thinner or gymnastics, but often they may be a little pudgy and people are constantly saying to them, "You're pudgy." "You are overweight." "You're fat." Or the kids at school may be saying that to them. So you will find girls very young, 10, 11,12, they'll want to be on diets and so in my particular family, I have four children, and one of my children happens to be a little bit, just a little bit, heavier then the other children and I think that she notices that. So we constantly have to give her self-esteem and constantly have to remind her how awesome and how beautiful she is. We want to keep her in healthy sports, sports that she enjoys, that she can continue to run around and play and exercise 60 minutes of the day and when she does that she is fine, but if we back off on that then maybe she would have a problem later. Keep your kids active. Keep them in whatever sport or activity is important for them. Encourage them to hula hoop or just go outside and play. Put down the tablet and the iPod and go outside to play and just continue to remind them that they're beautiful because it does start somewhere and it may even be at school, but you have to remind them that we don't want kids to be dieting alone, at home, be dieting at 9, 10, 11 years old. So if they are overweight, it should be done in the context of their doctor.

    LOMAX-REESE: I guess I am going to ask kind of an anti-health question because I am wondering if, I feel like there is a major kind of movement a foot in terms of the medicalization of life, of everything, and I wonder if it could potentially be as traumatizing to label or identify your child as having a disorder, as opposed to figuring out, identifying it, and working to make a corrective action without putting them within kind of a clinical health care setting. You have to be observant. You have to be mindful no matter what as a parent, but I am just wondering do you ever see a backlash, a flip side of having a child who might be struggling, but once they go into kind of a therapeutic, go down that avenue, that they might actually progress further into the problem, as opposed to be able to help themselves out?

    PATTERSON: I see where you are going with that, but often, especially in the African American community, people think that they're by themselves. They think no one understands this. My family, my friends, these are not the pictures that I see on the magazines. They think that they're alone and sometimes when you get them into treatments they realize, oh, I am not the only one that's suffering from this. There is a fine line between staying at home and encouraging your child, but sometimes those children aren't getting that at home and eating disorders can be very dangerous. The obesity part of it, like Dr. Bethea said, yes, they have more long-term consequences of clogging arteries and risk of diabetes and heart attack and stroke, but the under eating, the restricting, can have pretty immediate and real consequences and a lot of times it is actually the most common, it is one of the most common chronic diseases in adolescents and it is a really high cause of mortality in adolescents. People don’t realize that teens are actually dying of eating disorders because their electrolytes change so their sodium potassium is thrown off. They can go into organ failure and it is associated with depression. Yes, there is a line between, I see some red flags, let me intervene for my child and noticing, ok, this is getting overboard. I really need some help because it definitely is a multidisciplinary type disorder and when the teen doesn't get the multidisciplinary approach they often struggle for years and years with it.

    LOMAX-REESE: The long-term, you have outlined a number of the long-term consequences. Are there, I would imagine there are psychological long-term consequences as well. Is this something if you are diagnosed and you're 17, 16, whatever, is this something that you essentially are struggling with or coping with for the rest of your life or you're cured so to speak?

    BETHEA: Well eating disorder treatment you go into remission, that's how I usually put it because any new stress, life stress events, can relapse you into your eating disorder. The greatest part about a multidisciplinary approach is the earlier we intervene the more likely you are to put them in remission forever then when you catch them at 16, 17, 18, 19, 20, they've been living within their eating disorder for a much longer period of time. The key is to get them into treatment earlier. Does treatment also cause a worsening of eating disorder symptoms? Absolutely it can. It can have an effect, if they get hospitalized they're with kids with the same disorders, they teach each other the tricks of the trade, so it is a double-edged sword, but you have to start somewhere.

    LOMAX-REESE: We have been talking with Dr. Kelly Bethea and she is a pediatrician and Director of the Teen Clinic at Einstein and Dr. Donee Patterson, a family medicine physician with Einstein Department of Medicine. We are going to take a quick break and when we come back we are going to wrap it up. Don't go away. And we are back. You are listening to HealthQuest Live on 900AM WURD and today we are talking about eating disorders in the black community. It is much more complex, much more contextualized then I would have considered initially. We are talking with Dr. Donee Patterson from Einstein and Dr. Kelly Bethea about teens, boys, girls, men, women and what eating disorders look like specifically in the African American community. While we were on break we were talking a little bit about denial and the fact that in the African American community, we tend to have a lot of denial around mental health issues across the board and so when you layer on something that is much more specific and unique it probably gets us a little bit deeper into denial, particularly something around food. I wanted to see, Dr. Bethea, if you could talk to us a little bit about how you intervene, how you find some way to break through this level of denial to allow a family, a parent, to really provide and step outside of their own kind of denial and help their child.

    BETHEA: Yeah, we know that anorexia, bulimia, even some forms of obesity have, well most obesity, have a psychological component, and in the minority community mental health, there is a stigma around mental health. No one wants to believe that there is something that they cannot control. So what we try to do is to really engage the family into a discussion. It is kind of a barter system. How do you get them to engage in a mental health system? We are not always successful, but when we are, really the rewards really are great. One way we do that is we try to at least get them to agree to an assessment. So, come on, let's get an assessment. If I am wrong then that's fine, but really trying to capitalize on their assets on the positive attributes that they have and to really, one of the things, especially with teenagers is, trying to take that guilt off of the parent because a lot of times they feel guilty because it is something that they can't control and of course as a parent we always want to be in control and making sure that our children are well, but really taking off of the parent, the stigma that this is their fault, really encouraging them, telling them that they've done a wonderful job as parents and this is no reflection on them as a parent, but we really need to understand the psychological backlash of whatever is going on in their life. It could’ve been a life event, they were teased by, a coach might have said, I had a patient where a coach said, "Oh, you are a little fat today" and just really try not to…

    LOMAX-REESE: Cell phones should be silenced during the radio show. No worries. No worries. Continue telling us about this coach.

    BETHEA: Yes, so the coach had said to them that the kid was a little overweight or fat and had looked like they gained weight and the young lady was about, I think 11 or 12, and she internalized that and after she internalized it she stopped eating and then became anorexic and then was brought in and the doctor was like, oh, she is too low weight and then we got her into treatment. 

    LOMAX-REESE: I think that a lot of times we have no idea how much our words impact children and the people around us so that's a great story to let people know the ripple effect.  I am curious. I know that low birth weight is an issue, like premature babies is an issue in the African American community. I am just wondering if there is any correlation between having a low birth weight baby or premature baby and potentially having any kind of weight issue, eating disorder, as they get older.

    BETHEA: There really hasn't been a true connection between low birth weight and an eating disorder. Eating disorders really are…

    LOMAX-REESE:  …it's more psychological.

    BETHEA: …psychological impact at a young age.

    PATTERSON: You can have low birth weight when you are born and totally be normal throughout childhood if everything else being equal, you can regain your weight and people never know that you are a premie, but as you were saying, it really does have to do with body image. I think a lot of times, especially in the African American community, parents may say, just eat. They think that that's the solution, just to tell their teen, just eat, but it is so much more then that and I hope that that's one take home message that people hear today is that you can't just tell someone who has a body image because when they look in the mirror they really don’t see what other people are seeing. They don’t see that the numbers translate to them being underweight. It really is a body image and that's what the treatment that we are talking about, that's kind of what the crux is to get to the bottom of helping them to understand that it's not, that they actually are underweight and that they are hurting their bodies. We talked about that control and not many people know this, but at one point I think that I was, I don’t know, 13, 14 years old and I was doing certain things at home with my parents and I thought, well, if I stop eating it is going to make my mom mad, but I actually had a drawer in my room that had tons of food in it because I never liked to be hungry. So I would eat in my room, but I would think that she, I wanted to my mom to think that I wasn’t eating so I never went to the table with them, but I was actually eating, and actually my mom never even paid attention to that because I wasn’t losing weight or anything like that and I was still active and in school, but that lasted all of a week. I really think that had she had paid attention, that that would've been something that I could control over her so I just want to encourage people to make sure that they're giving their child some control in their lives. You know, well, do you want to go here to eat or do you want to go here? Do you want these jeans or do you want these other jeans? Well where do you want to go to buy sneakers? Kind of give them some controls in their lives so that it doesn’t feel like you are controlling everything. It is hard for parents. I know. I have four, but in some ways give children some of their control back in their lives.

    LOMAX-REESE: Some people would say kids have way too much control.

    PATTERSON: Right, right, right. Well, those aren’t the ones that we are necessarily worried about for eating disorders.

    LOMAX-REESE: But I want to invite callers. We have a few more minutes with our Einstein docs. If you have ever had an eating disorder, if you know someone or you suspect someone might have an eating disorder or if you have a food obsession, give us a call, 215-634-8065. Toll free 866-361-0900. Food is everywhere all the time. Usually the cheapest food is the most fattening and the most unhealthy and it is going to layer on the pounds. In a society that really doesn’t have very many hard and fast rules anymore around food, people don’t dine together. They don’t have dinner, family dinners, all of those things. It is eat on the go. It is fast food. Everything is add water and mix. It seems like we are losing a bit of the kind of culture that was established that created real systems and rhythms and socialization around food. That's kind of been eliminated. Is there any data, do you see any kind of increase or are there any changes, given the societal changes, that we've experienced in terms of how we come together or not come together around food now?

    BETHEA: One of my interests a while ago, I never completed the work, but is the family meal. We know that the family meal has really gone by the wayside. We have both parents in the household usually work nowadays. So it is eat on the go. Mom comes in, dad comes in, everybody just eats what they can, grabs what they can and they keep going on their business. We know when we were growing up, or when I was growing up, we would come home and dinner was on the table and everybody sat down. It was a time to socialize. It was a time to discuss and a time of bonding and it was seen as something positive, where I think now meals aren’t positive anymore. It's just eat what you can and keep it moving and because of the price of foods that are nutritious being relatively expensive, people just would opt for the 99 cent taco at Taco Bell instead of buying a pound of ground meat and making tacos at home with the family and having taco night, which would actually cost probably less then buying the 99 cent taco, but it takes time and it takes effort. One of the things, or recommendations that we can give, is that families should reinstitute that family meal that time together, that's actually more then just eating, it's about bonding, it's about building self esteem and really making those connections.

    LOMAX-REESE: I would imagine technology adds a whole other layer onto it because you can all be sitting at a table, but how many people are on their phone or on their iPad or distracted? I am just curious how much more social media because I would imagine, especially for girls, that might be a whole new kind of playground for bullying for kind of you know sharing of pictures. You've got Instagram. You got all of this media that allows you to be much more exposed on so many different levels and you know how all of that plays into this as well.

    PATTERSON: We definitely, it's a whole other topic, but we definitely need to make sure we are checking our teens phones and, again, bringing them together at the table and telling them to put down the electronics. It is a big issue and then when you see your child sitting there playing with electronics for hours and hours on end you want to encourage them, go outside, get up, do something physical. I think one problem that happens in our communities is that there is a mixture of things going on. One family member might be thin and may have an issue and one family member might be overweight and so the things that you bring in the house are giving conflicting messages. I think that we need to take our children as individuals. I think that we need to make sure that we bring the family bond together and talk them out and talk about when we are being hurt and make sure that the children are seeing the adults be good role models. It is a complex thing and it does take a village. If you notice that someone else's family doesn’t have that, invite those kids in, it really does take a village and if you notice that something is going on with someone else's kids speak up. It is dangerous sometimes, but we have to do it in a positive way and take care of all the children of the community.

    LOMAX-REESE: Well, I want to really thank you. We've been talking with Dr. Donee Patterson and Dr. Kelly Bethea about eating disorders and I want to kind of, as we get ready to close up, what are some of the takeaway messages? What are some of the hard and fast things that you want to leave with our listeners around this whole topic of eating disorders? Dr. Bethea?

    BETHEA: Well one of the takeaway messages is to remember that eating disorders is not always looking very thin and underweight. Eating disorders have many, many different facets and different types. Just be mindful that if you are worried that your child is losing weight, gaining too much weight, seek medical attention for that and just always encourage your children to be the best that they can be and sit down and have a meal together. That sounds like a good idea.

    LOMAX-REESE: What about, I know that you are the Director of the Teen Clinic, but what about adults? Would you have the same advice for them?

    BETHEA: Absolutely. Absolutely. Everybody needs to feel good about themselves. One way to feel good about yourself is to surround yourself with people who are positive and who have your best interests at heart. Sitting down for a good meal with your friends is a good way to bond and to really build those social skills that we all need. 

    LOMAX-REESE: Absolutely. Dr. Donee?

    PATTERSON: One thing, I do want to encourage people to use their physician or their primary care doctor as a resource. We want to make sure that they're getting their weights checked, make sure they're getting their heights checked and talking to their doctor about healthy eating, but also to make sure you are looking in your family. Talk to your nieces and nephews. If we all did that it would be such a positive thing for us to reach out to that village of family and to just remember the red flags, extreme weight loss. We didn’t talk about this, but it is a late sign, but if a girl is losing her menses, her menstrual cycle, that's also a red flag. We want to make sure that they are not disappearing after meals and are they actually eating and coming to the table. Look for those red flags and if you are concerned, seek help. 

    LOMAX-REESE: Well, this has been great. I think that it is the New Year, we are all trying to develop a new us, a new me, and this issue of body image and self image and weight and all of those things continue to be front and center when we talk about remaking ourselves. If people want to get in touch with you, Dr. Donee, or you, Dr. Bethea, or Einstein, how would they go about doing that?

    PATTERSON: If you need a physician you can call 1-800-EINSTEIN or you can go on the web at You can also follow me on Twitter @DrDonee. As usual, we have a quiz, a very simple quiz about some eating disorder questions that is on our Facebook page, Einstein Health, and if you answer those questions, the first person who answers will get a $25 gift card to ShopRite. 

    LOMAX-REESE: All right, well, you can beat that. You can't beat that. Happy New Year to you both.

    BETHEA: Thank you.

    PATTERSON: Thank you.

    LOMAX-REESE: Thanks for staying a little bit longer to share a little bit more information and we will see you in about two weeks.