Editor's Note: In conjunction with the University Counseling Center, Scene presents a series of five columns this week that highlight eating concerns in recognition of National Eating Disorders Awareness Week.

Many individuals with eating concerns are highly successful people in many areas of their lives. They are often among the brightest students, hold positions of leadership and authority, and no one on campus would initially suspect that anything was wrong. The shame of admitting that they are not perfect, that they are out of control with food and that they need assistance, prevent many people from coming forward and seeking help.

Help is available both at Notre Dame and in the South Bend community. Depending on the type of eating concern, the length of time the individual has been struggling and other issues that may also be factors in a person's life (e.g. depression, anxiety, family concerns, death of a loved one, relationship break-up, transitions to college or the real world, etc.) a number of professionals may be involved to provide assistance. At Notre Dame, the Counseling Center and Health Services work collaboratively to determine on a case-by-case basis what would be appropriate.

Typically, a psychological evaluation by a therapist and a medical evaluation by a physician are important first steps. Additional referrals to a psychiatrist and dietician may be warranted as well. During the assessment phase, professionals involved determine whether resources on campus are adequate to provide assistance or if the student would benefit from more intensive treatment. In that case, a referral would be made to South Bend community resources or a program near the student's home if this was more desirable.

Therapists at the University Counseling Center (UCC) provide assistance to students who have their own eating concerns as well as to family, friends, coaches and residence hall staff who are concerned about someone's eating behavior.

Frequently, concerned others seek assistance at UCC much more readily than someone who is struggling. UCC therapists assist these individuals in determining the best way to talk to the person they are worried about. It is very important to remember that an occasional skipped meal, weight loss or weight gain, overeating at brunch or hearing someone vomiting in the bathroom does not automatically mean someone has an eating concern.

Before discussing a concern about eating behavior with an individual, it is helpful to have multiple pieces of information that appear to indicate that this might be a pattern of behavior that has developed over a period of time. For example, concerns about increased depression, anxiety, social withdrawal, missing meals, multiple examples that suggest self-induced vomiting or laxative abuse might warrant a discussion with the individual.

It is important to focus on the reasons one is concerned about the person and expressing care for the person rather than diagnosing the problem or telling the person what she/he should do. Many individuals, when confronted, deny the problem or get angry. Remember that a great deal of shame is involved as well as a sense of being out of control.

For most individuals, admitting the problem is difficult. In most cases, treatment only works when the individual wants it. Making people who struggle with their eating get help usually backfires in pushing the person to isolate more and feel worse.

The best-case scenario is when the individual recognizes that she/he deserves better and that their eating behavior is interfering with his/her happiness and the life he/she should be having as a college student. In those cases, the individual benefits from treatment.

Treatment at UCC could consist of some or all of the following: individual counseling, group counseling, and consultation with a psychiatrist and/or meetings with a dietician. Each case is different just like each eating-disordered person is different. Providing a safe place to admit the problem and learn new ways of coping, thinking and responding allow many people to move on to happier, healthier lives.

The registered dietician disseminates nutritional information and helps the student learn how to eat normally again. This entails being free of guilt, of anger, of obsessive thoughts about food and of the fear associated with eating. The educational process also involves teaching the client how to achieve a healthy food intake while balancing classes, exercise and socializing with friends. It is important to help dispel the disordered thoughts and behaviors while developing healthy habits that meet nutritional needs.

Many students with eating disorders know a great deal about nutrition. The challenge of the registered dietician is to educate the student to think differently about food and the role it plays in his/her body. The treatment role involves more than calories, fat and protein. It includes education on metabolism and the health dangers of continued disordered eating. This process includes collecting detailed information on behavior, nutrient intake and eating patterns. The student is provided with information on food intake necessary to stabilize weight and metabolism including optimal food intake, how metabolism and weight are affected by dieting, understanding body shape and size for overall acceptance and how the body processes nutrients to function normally.

It is important to discuss how the student's body reacts to binging and purging or starvation and hydration. The long-term goal is to teach the student how to properly nourish his/her body so that it reaches a natural weight. The first steps include making changes that will eventually add up to a healthy way of eating.

Medical evaluation of a person with eating concerns is aimed at: 1) identifying signs and symptoms; 2) screening for complications of disordered eating behaviors; 3) making a plan for stabilization of the person based on abnormal findings; and 4) giving the person objective evidence of how his/her disordered eating behaviors are adversely affecting his/her health. Medical and dental history, family history and psychiatric and social history are obtained to look for past problems with weight or body image, yo-yo dieting, depression or obsessive compulsive disorder, medical conditions such as diabetes, thyroid disease, inflammatory bowel disease, history of sexual or alcohol/drug abuse or history of family members with eating disorders.

Height and weight are measured on the initial exam so as to determine the person's body mass index. A physical exam is done looking for signs of low blood pressure and slow heart rate, low body temperature, sallow skin, enlarged glands in the cheeks and below the jaw, dental erosion, heart rhythm disturbances, abdominal distention and neurologic abnormalities including troubles concentrating and signs of depression due to the disordered eating behaviors.

Laboratory data are gathered as indicated by the physical exam findings. Most eating-disordered patients have low platelet and white blood cell counts, abnormal kidney function, abnormal glucose, cholesterol, electrolyte, protein, iron and hormone levels. Women who have stopped menstruating often have estrogen levels below those of postmenopausal females and even below that of males! Men with eating disorders have been found to have low testosterone levels.

Bone density studies indicate bone loss due to imbalances hormonally and chemically in both anorexics and bulimics. This predisposes them to stress fractures and problems associated with osteoporosis. Electrolyte abnormalities put the eating disordered person at risk for cardiac rhythm disturbances so an electrocardiogram (EKG) may also be part of the medical evaluation.

The above evaluation then leads the physician to a discussion with the patient or his/her results in order to make a plan for correction of abnormalities and prevention of further complications. This plan always involves the collaborative efforts of the multidisciplinary team of professionals who provide treatment.

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