Eating Disorders with Dr. Robbie Campbell

Eating Disorders week is held every February 1st - 7th. This episode features Dr. Robbie Campbell, a Psychiatrist, who has worked with the treatment, recovery/relapse and research of anorexia, bulimia and binge eating disorders for over 40 years.

Transcript

OMA Podcast Episode 10: Eating Disorders with Dr. Robbie Campbell

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Voice-over: In this podcast, the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us. 

This episode explores eating disorders.

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Dr. Robbie Campbell: I'm Dr. Robbie Campbell. I'm formerly professor emeritus at Western University, and consultant psychiatrist at Fanshawe College with the Fowler Kennedy Clinic, and I'm also the consultant psychiatrist with the family medical team at St. Joe's in London, Ontario. 

Eating disorder has the highest mortality rate of any psychiatric illness by far. The earlier the intervention, the better the prevention. 

Well, an eating disorder is something that's very, very hard to define. It's a complex body image disturbance when a person struggles with eating, but primarily we're trying to deal with a distorted view of a body shape and body size. 

Anorexia primarily is restricting food, and you take your weight down at an uncomfortably low weight. What happens there is, more often, it is restricting food severely, over-exercising, and oftentimes there's a binge eating disorder component to it, but it's called binging and purging. 

Now bulimia, on the other hand, is: you eat until you're uncomfortably full, you're doing this on a regular basis. And what happens is that you are often involved with either exercising or vomiting to try to manage your weight, to the fact of disturbing your lifestyle.

Binge eating disorder, on the other hand, has just been given the classification of a bonafide eating disorder, although we've recognized it all along, but it is compulsive eating until you're uncomfortably full. 

Oftentimes people do become very overweight —they can't stop their eating, and they feel very disturbed after that they've done something wrong. They feel a sense of guilt, and it cramps their lifestyle as well. 

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Dr. Campbell: Traditionally the way that we view women with anorexia, bulimia, men—it's only 10% of men—but men have it as well. But I see them with a different form. 

Men have a tendency to focus on their body image; it's kind of like “big-orexia.” "I got to be tougher, stronger. I got to have steroids, I got to build myself up, I got to be the Olympic champion."  So it's a big problem in athletics. 

I feel that when you bring the body part up, when you bring the binge eating disorder part up, it equalizes out. We're seeing men just as frequently as women in this category. The problem is men don't want to come forward. 

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Dr. Campbell: The mental, the physical go hand in hand. It's not that necessarily one thing causes it more than another. You have the emotional component things and physical side of things. Eating disorders, more frequently, are associated with co-morbid psychiatric factors. 

If we look at eating disorders, approximately 80 to 97 percent, depending on what study you're looking at, has a co-morbid factor. We're looking at anxiety, we're looking at depression, we're looking at OCD, we're looking at PTSD, and we're looking at personality disorders that go along with them. 

This is just the psychiatric co-morbid factor. Oftentimes there are physical factors that go along with them, and this makes it so, so complex. If you leave one of those things off the table, invariably, there can't be recovery. 

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Dr. Campbell: If we look at what triggers an eating disorder, when does it start? Oftentimes it's in adolescence. I see those folks that have been traumatized. They've been either emotionally, physically or sexually abused, even at a younger age. 

So sometimes we see an eating disorder start—say at four or five or six, traditionally it's in adolescence and young adulthood is when they are—but most of the people I see, you can take it back and start and deal with it in childhood. 

An eating disorder can actually present at any age. You can be a child, or I've seen them also present at 60 or 70. 

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Dr. Campbell: You can tell if they're not eating properly. The problem is, how do we approach them when we see it? So not only can you tell by their weight, either underweight or overweight, you have to be able to observe eating habits and take note of them. 

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Dr. Campbell: There are some coping strategies for families that I think are really important. And just to mention a few, you got to be patient. You can't rush in and say, "Well, let's get this fixed." You got to encourage them to seek help with your support. Without your support, they're not going to do it. You have to prepare yourself that they're going to deny that they have a problem, and you can't be laying blame. 

Sometimes parents will have their children and compare one with another. You can't be comparing them all the time. It just is a trigger. And avoid making body comments. 

So be aware of the control issues. Above all, you got to learn what you can, because understanding is the key to coping.

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Dr. Campbell: You need help getting past this because, in fact, it is a serious mental illness. So it's vital, I think, to be able to get someone to the table. 

To me, it's really important to connect with your family doc. If you don't have one, you've got to get one. So they have other people on the team, i.e., it's the family doc, or the nurse practitioner, you have psychologists, you have dieticians, you have social workers, you have recreational therapists. You have a host of people that are all important. And I think one of the first places to go is to ensure that you have an assessment with your family physician.

The focus can't be just on the food. It has to be focused on, yes, healthy eating, but healthy lifestyle. 

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Dr. Campbell: There's a huge gap in service right now, as I see it. Once you're discharged from hospital, you don't have the support that you had in hospital. We must do a better job at ensuring that there are support teams out in the community. 

The Eating Disorders Foundation of Canada has as this project right now, our home that we are calling "Charlotte's Hope." A home, or a transition house, for girls with an eating disorder who have been through treatment, but who are being discharged back to their community. 

We want to get it off the ground in the spring. You would have a treatment team that manages you, and you would have a support team that's in part of the house. 

The reason it's so important is because more often when people complete a program, often there's no place to go where they feel safe, where they feel comfortable. This will offer them that opportunity and some breathing space to look at really where they want to go. And if this works successfully, we plan to roll it out across the country. 

It's long overdue.

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Voice-over: Don't miss our next episode all about technology in medicine. 

This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.

For more information, please visit our website at oma.org.

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