Soul Food
Nurses caring for patients with eating disorders have to tend not only
to replenishing bodies but also rebuilding self-esteem
By
Heather Stringer
July 23, 2002
Vivian Hanson Meehan, DSC, RN, never planned on becoming an expert in eating disorders. She first encountered the illness in the 1970s, the day her daughter came home from college.
Meehan's nursing background was little help at the time because "eating disorders used to be a one-liner in a medical textbook," Meehan remembers.
She quickly discovered that nobody in the medical community could answer pressing questions about her daughter's problem.
Meehan decided to send her 19-year-old daughter to a therapist, but despite the sessions, the problems persisted. Five therapists and seven years later, her daughter cascaded into a pattern of bulimia and alcoholism, and finally was arrested for drunken driving.
The incident turned out to be the motivation her daughter needed to finally put an end to her destructive eating patterns.
For Meehan, the experience with her daughter drove her to found an advocacy group in 1976-the National Association of Anorexia Nervosa and Associated Disorders.
Nurses like Meehan are among the medical professionals who are on the frontlines, working with the growing number of people who suffer from eating disorders.
Although nurses say these patients can sometimes be among the most difficult to treat, they also agree that the victories they witness can be some of the most intensely rewarding moments in nursing.
A growing challenge
Since Meehan was thrust into the world of eating disorders in the 1970s, the illness has become more widespread, she said. Patients no longer are primarily >> Caucasian upper middle-class adolescents-eating disorders now plague all ethnic groups, Meehan said.
Between 1 percent and 2 percent of American women suffer from anorexia nervosa, according to the National Eating Disorders Association. Bulimia nervosa affects 1 percent to 3 percent of middle and high school girls and 1 percent to 4 percent of college-aged women.
Fear of being fat
According to the National Eating Disorders Association, anorexia is characterized by a refusal to maintain body weight at or above a minimally normal weight and an intense fear of being fat. People with bulimia also are extremely concerned with body weight and shape, but they eat large quantities of food and follow this with some form of purging, such as self-induced vomiting, laxative or diuretic abuse, fasting or compulsive exercise.
For Jill Shea, MSN, ARNP, eating disorder patients are some of her most challenging cases at the University of Washington's Hall Health Center.
She said these patients usually are hesitant to give up their eating patterns because the disorder serves an important purpose in their lives: It provides a sense of control.
"Trust of the therapist is critical, but it's really hard to build trust with an eating disorder patient," Shea said. "They are holding so tightly to the eating disorder and so afraid to let go, so anyone who is trying to take it away is a threat."
She explains to patients that her role is not to force them to give up their pattern of eating, but rather to help them determine how and when they are ready to give it up.
But Shea also admits that even though many patients will recover from their eating disorders, they often are at risk of relapsing during times of stress. Shea recently discovered just how chronic the disorder can be when she read an obituary of a former patient in the newspaper.
The woman had started struggling with anorexic and bulimic symptoms at age 16. As an adolescent, the girl had grown to be much taller than her peers, and she started dieting as a way to cope with her body image concerns.
At times, she'd only eat as much as a pear for an entire day.
She was 5 feet 10 inches tall and weighed about 100 pounds. The woman finally died at the age of 34 from heart failure because her body was so malnourished.
Shea acknowledges that patients like this woman challenge health professionals' own issues with control. "You think you can fix something, but with eating disorder patients you have to give that up," she said. "Otherwise, you get into a power struggle with the client and you will lose. I see people make wrong choices, and I can't let it affect me."
Tammy Taylor, RN, a charge nurse at Texas Children's Hospital in Houston, also has learned the importance of keeping a safe emotional distance. Taylor explains that patients will sometimes try to distract her to avoid eating their meals.
One time, a patient was not in her room when Taylor came in to check on her. When the patient returned to the room, Taylor asked where she had been and the girl said she had been in the restroom. The patient's mother believed the story, but Taylor was suspicious.
"It had me second-guessing myself," Taylor explained. "She was probably walking up and down the hallway exercising to lose weight."
Twana McVicker, MSN, RN, is intimately familiar with patterns like this between parents and their anorexic or bulimic children. As an outpatient nurse practitioner at Children's Medical Center of Dallas, one of her tasks is teaching parents how to handle their children's disorders.
McVicker says that parents will try to explain to their children that they won't get fat, and may even scream at them in an effort to persuade them to eat. She teaches parents instead to let their children pick what they want to eat, and not to argue about food.
"It's not important what they are eating," she said. "Just the fact that they are eating is good, and it's hard for parents to understand that. I teach them not to get into a food argument, because anorexics already have a lot of guilt, and it perpetuates the low self-esteem cycle."
Three different levels
McVicker also is in charge of evaluating new patients and determining where they should go for help. Her hospital has three different levels: an inpatient treatment program, partial hospitalization in which the patients sleep at home and spend their waking hours in the hospital, and a day treatment program in which patients come in from 8 a.m. to 4:30 p.m.
McVicker said she's seen patients as young as 9 or 10 go through the treatment program and that most patients enter feeling lonely and disconnected from their parents. For McVicker, the highlight of her job is seeing these feelings change over time.
"It's neat to see withdrawn, malnourished kids with disruptive thought
patterns actually smile and connect with parents," McVicker said.
"They can enjoy life again, and seeing that process is incredible."