Wickenburg’s Remuda Ranch has treated women and girls for eating and anxiety disorders since 1990. Psychologist Dena Cabrera, Psy.D., director of educational outreach, talks about the connection between bullying and eating disorders, bargaining with kids about food and why every family should have a “no diet” policy.
Talk about what led you to the work that you do.
I went to UCLA and had two roommates who had eating disorders. One had anorexia and the other one had anorexia but also binge and purge—bulimia—at the same time. I found it fascinating that they treated food like this.
What did you notice about their behavior?
One friend would restrict and exercise compulsively; another friend would go on yo-yo diets and exercise, and not eat for a week. One friend went on to recover and had a healthy, beautiful family. One friend died. She was very, very low weight and she actually went into cardiac arrest. That led me to think, why would anyone hurt their body in that way?
You began a self-discovery process after your friend’s death and you made some personal changes.
I have had body image issues since I was 16. I dieted, I compulsively exercised, and I did not like my body. And it wasn’t till about age 30 when I thought, this is ridiculous that I treat my body this way. Because of my work with patients, seeing the devastation, I really started to change my outlook and my relationship with food and my body.
What do people still not understand about anorexia, bulimia and overeating?
Anorexia and bulimia are mental illnesses. It’s not just about someone who doesn’t want to eat for the purposes of getting attention, or wanting to fit into that dress, or wanting to avoid life. The same thing with binge-eating disorder and eating emotionally for those struggling with being overweight. These eating disorders take individuals hostage, and really hold on.
You say that kids are ridiculed by their peers for being just a bit overweight and often that has become a component of what leads to anorexia or bulimia. Why do we ostracize people who carry extra pounds?
It’s the last socially acceptable prejudice, or “weightism.” Sixty percent of all parents tease their children about their weight in the guise of wanting them to lose weight, not to be malicious or mean, but to help them. That’s the wrong approach to take with children.
It’s tricky to talk to a child who appears to be putting on too much weight. Thoughts?
Buy the vegetables, the fruits, and put them out, make them readily available. Plan meals ahead, include the children, get them involved in the cooking process and teach them about portion control. Stay off those numbers, because that gets them obsessed. We want it to be about health.
Many parents make bargains with food, insisting a child “eat all your burger or you won’t get any ice cream”—that type of thing. Does this set up control issues?
We as parents are responsible for providing the meal, giving healthy choices. And you have to help children to understand their bodies’ cues when it comes to food. As a parent, you decide what and when they’ll eat. And as a child, they’ll decide how much, and if, they’ll eat.
Some people live by the idea that “dieting” is the way to reach their desired weight. Do you agree?
In our house, we have a “no diet” policy. We don’t even talk about diets. And I recommend that to all families. Some families do need to change their lifestyle—they do need to change their way of eating.
Some teens decide to “put themselves on diets.” How should a parent react?
Stay focused on healthy behaviors. Don’t calorie count, don’t weigh them, don’t focus on the number. Change the lifestyle and change the approach to food. You want to get clarification, too, and have the conversation, “Why are you interesting in dieting? What’s going on?” Maybe there is a real concern about weight and they feel fat, and are being teased.
How do you know when a child or teen needs professional help?
Children will exhibit anxiety prior to being diagnosed with an eating disorder, so that’s the first sign. A mood change—if they’re feeling low, or sad, or disparaging themselves, or skipping out on meals. When you start seeing these emotional ramifications, that’s when you really want to get some help.