Host: Abigail Trafford

Stefanie Gilbert, a licensed clinical psychologist, was our guest for "Health Talk," a weekly discussion with Abigail Trafford, The Post's Health editor on Tuesday, April 13, from 2 to 3 p.m. EDT.

Gilbert works with the Metropolitan Psychiatric Group in Bethesda, Md., specializing in the treatment of eating disorders. She is a board member of the Washington Society for the Study of Eating Disorders and Obesity and has written articles on eating disorders and body image for professional and lay publications.

Note: Her responses to questions on this Web site are not a substitute for psychotherapy or other professional medical consultation.

Abigail Trafford: Hello and welcome to Health Talk. We want to talk about eating disorders and body image. Why are so many people, especially women, preoccupied with their weight? Stefanie Gilbert, a clinical psychologist, is our guest.

Abigail Trafford: Stefanie. What are the main eating disorders in the U.S. Is the incidence increasing?

Stefanie Gilbert: The two primary eating disorders are anorexia nervosa and bulimia nervosa. Anorexia nervosa is characterized by a refusal to eat enough to maintain a normal weight for an individual's age and height, an intense fear of becoming fat, and a distorted body image whereby the individual views herself as fat despite her thin or emaciated appearance. Bulimia nervosa is characterized by eating episodes in which an individual consumes huge quantities of food and then, in an effort to prevent herself from gaining weight, uses a variety of methods to "purge" herself of the food she has just eaten. The incidence of eating disorders has risen during the last thirty years or so.

Abigail Trafford: Stefanie.I have two daughters. In their teenage years, body image was a prime concern. They worried about being too fat. How does our culture encourage this obsession with weight?

Stefanie Gilbert: Most of the images of female beauty we see in the media depict women who are white, tall, and extremely thin, women who have bodily proportions that, for most people, are impossible to attain. These svelte television, print, and movie stars are depicted as happy and successful. The message that young girls and women receive is loud and clear. In order to be happy and successful, we must be thin.

Cleveland, OH: At 28, I have suffered from both anorexia and bulemia over the 15 years. Retaining my anonymity, how can I seek answers on how to overcome the disorders via self-help, etc. I do not wish to be identified or have my disorder documented on any medical record, though would like to live free of these disorders.

Abigail Trafford: Stafanie, how can people get started? Where can they go for help?

Stefanie Gilbert: Because you have been battling eating disorders for such a long time, it seems clear that working on your problems without outside help is not the answer. With regard to your concern about maintaining your anonymity, you need not be concerned about medical records if you do not use insurance for payment for therapy sessions. Discuss your concerns about medical records with a therapist and ask whether she would agree not to keep any.

Rockville, MD: What is the youngest age that a child has been diagnosed with an eating disorder? My 4-year old daughter has on two occasions completely shut down eating and drinking, to the point where she had to be hospitalized, and rehydrated through an IV. Could this be an early sign of a future anorexic?

Abigail Trafford: Stefanie. Is it possible that an eating disorder could start so young? What accounts for this?

Stefanie Gilbert: Since your daughter has been hospitalized, I would assume that she has had a thorough physical examination in order to rule out any physical causes of her refusal to eat and drink. If this is the case, then it appears that she may be trying to express herself through her abstinence. Although you are very concerned about your daughter, resist the urge to pressure her to eat and drink. Try to remain as neutral as possible at mealtimes, offering her a few food choices and a drink, but if she refuses to eat, don't make a big deal about it. You're responsible for deciding what food gets put on the table; her responsibility is deciding whether or not she wants to eat, and, if she does, how much.

McLean, VA: I have been bulimic for 10 years and just recently began therapy. I was told at my first consultation that I can be given medication. I chose to do therapy. What would be the criteria you would use to decide if a client should use medication for bulimia?

Abigail Trafford: Stefanie, are drugs part of the treatment for eating disorders? Which drugs and for what kind of patients? Are there risks associated with these drugs?

Stefanie Gilbert: My first choice with people who are battling bulimia is therapy. Therapy can help an individual determine the triggers for binging an purging and the underlying purpose and meaning of the eating disordered behavior. If medication alone is used, I am concerned that once the individual stops taking the medication, eating disordered symptoms or other symptoms may return. Medication has been shown to be an effective treatment for bulimia, however there are side effects with all medications. The most common medication used in the treatment of bulimia is the antidepressant.

washington, DC: My partner has a history of bulimia and ceased the behaviors when we got together a year ago; however, she has gained a significant amount of weight and moved into an overweight state. Is this cycling common?

Abigail Trafford: This is so confusing. Can you suffer from bulimia and become overweight? Is it common? Are special kinds of therapy needed in this scenario?

Stefanie Gilbert: Cycling from one type of eating disorder to another is very common, particularly if the issues underlying the eating disorder have not been addressed. The specific symptoms of an eating disorder (abstaining from food, overeating, binging, purging) are merely different ways of expressing emotions and getting needs met. If a person eliminates the symptoms (for an obese person, by losing weight, or for an anorexic person, by gaining weight), that doesn't necessarily mean that she has resolved the issues that led her to develop those symptoms in the first place. If she hasn't, then it's likely she'll take on some new symptoms or revert back to old ones.

McLean, VA: I have an eating disorder. I have an 18 month old baby girl. I already find myself thinking about what I give her to eat so that she does not get fat. I am so afraid that I will pass on my problem to her through my behavior. How do I balance making sure she learns healthy eating habits and not being obsessive about her weight? Do you have any literature to recommend?

Abigail Trafford: What parents do is so important. What's your advice, Stefanie?

Stefanie Gilbert: Children do model their behavior after their parents', so it's very important that you get the help you need for your eating disorder so that you don't pass it along to your daughter. I encourage you to see a counselor, not only so that you can prevent your daughter from inheriting your eating problems, but more importantly so that you can lead a normal, healthy life. In the meantime, try to stay as neutral as possible at mealtimes, offering your daughter a variety of foods, but letting her decide how much she eats. Trying to control her eating will make eating an issue for her--exactly what you're trying to prevent.

Durham, NC: I have had several friends in high school and in college who suffer from poor body image and-or eating disorders. It seems to me that the biggest determining factor in whether or not a young woman develops an eating disorder is her mother's behavior towards food and weight. Those mothers who made incessant comments about dieting, exercising, etc, invariably raised daughters who have extremely low self-esteem, poor body image, and are most susceptible to eating disorders. One mother even sent her daughter a string of pig lights to hang up in her dorm room to remind her not to eat. Not surprisingly, the daughter is now a compulsive exerciser, alternately deprives herself of and binges on food, and has worn several different clothes sizes since we met 4 years ago.

We tend to lay most of the blame for the rise in eating disorders with society and the media, but don't you think we should focus more on supportive parenting as a way to combat this contagious disease?

Abigail Trafford: What's your advice to parents?

Stefanie Gilbert: Parents play a critical role in shaping their children's attitudes towards their bodies. Mothers' self-deprecating behavior is often emulated by their daughters. Then, too, fathers should be careful not to comment negatively on the mother's weight or body shape. Parents also can play a role in helping their children to evaluate all of the media hype that surrounds us. The media may offer us certain images and ideals, but we don't have to buy into them.

MD: I compulsively overeat through out the day. I eat for reasons other than hunger. I don't really binge and I never purge but I still feel as if I have a problem. I am also very over weight. Is that "normal" and should I just watch what I eat or do I need help?

Abigail Trafford: Is this problem similar to bulimia--though the results are very different?

Stefanie Gilbert: The fact that you feel as though you have a problem is a good indication that you do. Eating throughout the day "for reasons other than hunger" suggests that you may be eating for other reasons. Some people eat when they are stressed, others when they are angry. At any rate, eating when you are not hungry is not a kind way to treat yourself, just as pushing food on a child who isn't hungry isn't a kind way to treat a child. Determining the purpose for your overeating could help you to find a way to meet your needs in a healthier, more self-nurturing way.

Wash, DC: Hi Stefanie. What is your take on male eating disorders? My boyfriend, in my opinion, shows signs of having one. He goes to the gym everyday, then runs several miles each night, after a full 8 hours of work. He eats the bare minimum, like egg whites and canned tuna. He is always hungry but says this is the way it has to be if he is going to lose weight. The thing is, he is losing weight! He steps on the scale a few times a day and stands in front of the mirror and says he is so fat and out of shape. I mean, teenage girls do this. It's starting to scare me because he is so relentless about this and is never satisfied with the results. The fact that he has trouble sleeping due to hunger at night is also an issue. I know that many men are disciplined when it comes to weight loss, but this to me, is not the same. Any advice?

Thank you.

Abigail Trafford: We always think of eating disorders as women's diseases, but they affect men, too.

Stefanie Gilbert: Men do develop eating disorders, particularly men who are involved in sports that place a high priority on maintaining a low body weight (rowing, gymnastics, ballet, wrestling). Although men tend not to develop eating disorders as frequently as do women, it is also possible that eating disorders among men are underreported, since men may be less likely to seek help. Your boyfriend's symptoms are consistent with an eating disorder diagnosis. Share your concern with him, and encourage him to get help.

Richmond, VA: I'm 43 years old. Four years ago I lost weight and went from a size 16 to a size 8 or 10. I've kept the weight off for four years now. What I don't understand is why when I look in the mirror I still see myself as fat or heavy. Rationally I know a size 8-10 is slim but I just can't see my body this way. Is there anything I can do to change this? I was heavy most of my adult life. Am I always going to see myself this way?

Abigail Trafford: This is such a common experience. Stefanie, why do people THINK they are fat when they are obviously not fat?

Stefanie Gilbert: This is not an uncommon experience for people who lose weight. Many of us dream of attaining a certain goal weight, believing that if only we can do so, we will like the way we look. The sad truth is this doesn't happen. It is for precisely this reason that I don't advocate going on diets. A healthier approach is learning to respond to one's internal hunger and satiety cues and developing a caring, nurturing relationship with one's body that includes moderate exercise, a healthy lifestyle, and a positive body image. Counseling or self-help books on improving body image can help.

Reston, VA: My sister is in her 30s and we thought that she had "outgrown" anorexia -she was never officially diagnosed-. She does aerobic exercise 7 nights a week -and has done so for 10 years-. She is withdrawn from society and is often angry. Her job is very stressful but she is addicted to it. She is very emaciated and recently told me that she was writing a will. She eats very little and cries all night if somthing prevents her from exercising.

She is an adult, and we don't know how to help her. She has never wanted to go to counseling. What should her family members do? We are very afraid for her health and her behavior makes us sad and unable to enjoy our own lives.

Thanks.

Abigail Trafford: How do you get through to someone who doesn't want you to? At a certain point, do you have to accept this and move on?

Stefanie Gilbert: It is very painful to see a loved one destroying herself in the manner you describe. The most you can do is express you concern about her behavior and maintain a supportive stance by listening to her rather than being judgmental. If you have encouraged her to seek counseling before, and she has refused, a different approach might be to ask her if she would join you in counseling, since you yourself are having such a difficult time coping.

Abigail Trafford: I hate to stop this discussion, but our time is up. Stefanie Gilbert, thank you very much. And to everyone on the web, thanks for joining us. See you next week.