Athletes and Eating Disorders; what parents and coaches need to know…

Elizabeth Hunkins is a therapist at Aurora Behavioral Health Center in Summit

Elizabeth Hunkins is a therapist at Aurora Behavioral Health Center in Summit

Sport activities offer such an array of benefits for individuals from improved confidence, self-esteem, social skills and healthy activity.  But when does having “fun” cross the line that places an individual at risk for possible eating disorder?

Competition in athletics can be a factor that leads to psychological stress, which increases risk factors for disordered eating patterns in males and females.  A study in 1992 found that 62 percent of females in sports suffered from eating disorders (  It is believed that since that study was completed that eating disorders among athletes continue to be on the rise.  Many parents, coaches and even physicians fail to recognize the signs of eating disorders in these individuals.  Athletes are at a greater risk of medical complication due to the demands they place on their body.

There are too many stories of athletes that have suffered from this disease. In July of 1994, top US gymnast, Christy Henrich died of multiple organ failure after a US judge told her she was “too fat and needed to lose weight to make the team”, and subsequently dropped to 47 pounds. She resorted to anorexia and bulimia, which eventually took her life.  Cathy Rigby, another Olympian suffered with this disease for 12 years and went into cardiac arrest two different times (  Not only is this happening on the elite level, it is happening on every level of competition in sports.

What are some early warning signs of an eating disorder in an athlete?

  • Rapid weight loss
  • Going to bathroom after meals
  • No breaks in weekly training (should have 1-2 days off per week)
  • Increased concern about body fat/calorie intake
  • Rigid behavior around food (refuses food groups, eating fat free/eating in isolation)
  • Social withdrawal from family and peers
  • Preoccupied with training/exercise and becomes upset if unable to workout
  • Will continue to workout even when ill/sick
  • Other areas in life becomes unmanageable (relationships, work, school)
  • Loss or irregular menses

Coaches need to educate themselves on the dangers of eating disorders and recognize early warning signs and intervene.  Education needs to be provided on healthy nutrition, and proper refueling.  Coaches need to be positive, encouraging and motivating; not harsh, negative and critical to athletes.  Parents should attend a training session to observe their child and the coach’s training.  A parent should not witness a coach pressuring their child to “WIN at any cost”.

Coaches should encourage athletes to develop a healthy routine with adequate emphasis on eating, hydration and life balance. Coaches should praise their efforts and their achievements.  If there are negative comments about an athlete’s appearance/weight and performance, then it is time to change coaches/programs for the well-being of the individual and seek assistance from a professional.

Liz Hunkins, LCSW is a therapist at Aurora Behavioral Health Center in Summit

If you or someone you know may be struggling with an eating disorder, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services


What does “eating well” mean to a person with an eating disorder?

The Academy of Nutrition and Dietetics recognizes March 9, 2016 as Registered Dietitian Day. This event, started in 2008, was created to increase the awareness of the vital part registered dietitians provide for patients regarding food and nutrition services and to recognize RDs for their commitment to helping people enjoy healthy lives.

The importance of the registered dietitian is extremely evident in the area of Eating Disorder treatment.

Blaies, Sandy 04a

Sandy Blaies

“Dietitians are an essential part of our program at Aurora Psychiatric Hospital” says Sandy Blaies, Eating Disorders program supervisor. “Eating disorders have both psychological and physiological elements and require treatment providers with expertise in both.

“The extreme dieting behaviors, severe weight loss and symptoms of semi-starvation, binge-eating behaviors, and the patient’s distorted beliefs about nutrition and dietary requirements all support the need for the expertise provided by dietitians.”

“Dietitians have an essential role within the multidisciplinary assessment and treatment programs for all three major eating disorders.”

The main aim is to provide sound nutritional knowledge for the patient, the caregivers and other members of the treatment team. The focus of treatment should be on the establishment of a balanced dietary intake which will restore nutritional status and body weight.

Anne Sprenger

Anne Sprenger

Ann Sprenger, RD, a registered dietitian in the Aurora Psychiatric Hospital Eating Disorder Program describes how she works with patients. “I meet with every patient to provide nutrition information, describe how nutrition affects their mental and physical health, and to develop a diet plan in partnership with the patient.

“We monitor food intake every day and identify barriers to healthy eating habits. It is important for the patients to practice healthy eating habits while in the treatment program.”

Dr. Dinshah Gagrat, MD is the Medical Director of the Aurora Psychiatric Hospital Eating Disorder Program. “Professionals who treat patients with an eating disorder need to have knowledge of the nutritional effects and physiological consequences of the illness. This is rare within a predominantly mental health setting and this is the importance of including a registered dietitian in the treatment team.”

How do registered dietitians help people live well? Check out the top 10 ways from the Academy of Nutrition and Dietetics.

Dr. Dinshah Gagrat

Dr. Dinshah Gagrat

If you or someone you know may be experiencing an eating disorder please contact us at 877-666-7223 or visit our web site at Aurora Behavioral Health Services or check out these resources:

Would you recognize the signs of an eating disorder?

Whether you’re a professional caregiver, a friend, or a family member, you could be the first person to recognize and offer assistance regarding a patient’s eating and weight concerns. Identifying the problem early is important.  Early detection and treatment improves the prognosis.

PosterFlyerSCOFF is a screening tool developed to identify patients who may be experiencing an eating disorder.

The SCOFF questionnaire is effective as a screening instrument because it is simple, memorable, easily applied and scored.

One point is assigned for every “yes”; a score greater than two (≥2) indicates a possible case of anorexia nervosa or bulimia nervosa.

The SCOFF questions

  • Do you make yourself Sick because you feel uncomfortably full?
  • Do you worry that you have lost Control over how much you eat?
  • Have you recently lost more than One stone (14 lb) in a 3-month period?
  • Do you believe yourself to be Fat when others say you are too thin?
  • Would you say that Food dominates your life?

Read more information about What every Primary Care Physician should know about eating disorders.

NEDAwareness Week is February 24-March 2, 2013. This is the largest education and outreach effort on eating disorders in the United States.The aim of NEDAwareness Week is to increase awareness and education about eating disorders and body image issues for effective recognition, early intervention and direction to care.

If you or someone you know may be struggling with an eating disorder, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services. Access an Eating Disorders Screening Tool, or learn about the Eating Disorder Program at Aurora Psychiatric Hospital.


Everybody knows somebody with an eating disorder

NEDAwarenesweekNational Eating Disorders Awareness Week is the largest education and outreach effort on eating disorders in the United States, taking place from February 24 to March 2, 2013.

The aim of NEDAwareness Week is to increase awareness and education about eating disorders and body image issues for effective recognition, early intervention and direction to care. This year’s theme is EVERYBODY KNOWS SOMEBODY.

Do you know somebody affected by an eating disorder?


Melissa Arvin

Judy Arvin knew somebody. Her daughter, Melissa, lost her life to an eating disorder. Following Melissa’s death, Judy formed Someday Melissa – a 501(c)3 nonprofit organization, that was established to promote awareness of the dangers of eating disorders.

Click here to read Melissa’s story or watch the full movie trailer.

You can also access an Eating Disorders Screening Tool, or learn about the Eating Disorder Program at Aurora Psychiatric Hospital.

If you or someone you know may be struggling with an eating disorder, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services.  


Want to lose holiday weight? Lose the diet first!

The Twelve Days of Christmas, or “How to have your plum pudding and eat it too!”

anne sprenger

Anne Sprenger is a registered dietician working in the eating disorders program at Aurora Psychiatric Hospital.

Right after the holidays there is a noticeable increase in advertising for weight loss programs. This is no doubt an effort to take advantage of the fact that many people will gain an average of seven pounds over the holidays!

Current research shows the whole concept of “dieting” doesn’t really work for anyone to lose weight or even stay at a healthy weight.

According to Psychology Today, about 95% of people who lose weight by dieting will regain it in 1-5 years. The temporary nature of dieting means it won’t work in the long run. One reason is that cutting out calories changes your metabolism and brain, so your body hoards fat and your mind magnifies food cravings into an obsession.

Dieting raises levels of hormones that stimulate appetite — and lowers levels of hormones that suppress it. For more information about why diets don’t work, click here.

In the true non-diet spirit, follow these recommendations from Anne Sprenger, registered dietician at Aurora Psychiatric Hospital.

Day 1 (Christmas Day): Throw out every calorie-counting book on the shelf. We know dieting doesn’t work.

Day 2: There is not one food you cannot have today. It is human nature telling ourselves we can’t have something makes us want more. If we eat a forbidden food, we feel guilty. Permission allows us to eat without guilt and to eat less in the long run.

Day 3: Don’t skip breakfast and lunch because you are going out for dinner tonight. You will just set yourself up to overeat the entire evening. If dinner is late, have a snack before you go. Once you are full at dinner, set aside the reset of the food and ask for a “doggie bag” to take home.

Day 4: Take time for yourself by taking a walk. If you don’t have an hour, then 15 minutes will do.

Day 5: Don’t eat those cookies sitting around at work for lunch. Eat a well-balanced lunch containing all the food groups and then see how many of those cookies you really want.

Day 6: While planning that special dinner menu, think of colorful low-fat choices to put with that prime rib you want to serve. Fresh steamed asparagus could replace broccoli with cheese sauce. Other festive options are cauliflower with red & green peppers or lime & raspberry sherbet in schaum torte cups.

Day 7: Pamper yourself with a bubble bath, a long shower or a nap. Often we turn to food as a stress-reliever, when what our body really needs is time to relax and unwind.

Day 8: Happy New Year! Make a resolution this year to take time to take care of yourself-enough time for exercise, enough time for relaxation, and enough time to enjoy food.

Day 9: Don’t suffer with your special once-a-year recipe made with fat-free sour cream. Use the tastier low-fat version that you will enjoy, and don’t fall into the trap of thinking “fat-free is calorie free”. This simply is not true.

Day 10: Go sledding with the kids

Day 11: Go buy some fresh watermelon, fresh berries, or any other non-winter fruit you can find. What a treat!

Day 12: You don’t have to finish all your plum pudding. It will save until tomorrow; you can eat it for breakfast if you like. Once it is gone, cherish the memories of a delightful treat. Or better yet, plan to make it again in July!

If you or someone you know may be struggling with an eating disorder, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services

How can art therapy be used to treat eating disorder?

Art therapy is part of the holistic treatment approach applied to treat eating disorders at Aurora Psychiatric Hospital. Patients can develop self-awareness, adopt better coping mechanisms, improve cognitive functions, and find pleasure in art making.

The purpose of art therapy is fundamentally on healing.  Art therapy helps patients creatively express emotions they may be having difficulty expressing verbally.

It is vital that patients express their emotions. Many times abusive or deadly behaviors are used to numb the pain of not speaking up and out. Obsessions with food and weight are often attempts to cope with unresolved emotional issues such as depression, rage, powerlessness, and loss.

Art therapy is a special tool that can help provide access to those hidden feelings in a safe and non-threatening way. Patients in the Eating Disorder Program at Aurora Psychiatric Hospital participate in both guided art and open art studios in an effort to strengthen and apply their inner resources towards recovery. Art therapy techniques are used to explore the issues that have led to compulsive eating, binging, purging, starving, over-exercising, laxative abuse, etc. Art Therapy is offered as a creative source and an outlet for patients to overcome blocked feelings. Emphasis is on discovering new ways to nurture oneself.

Art therapy is often intimidating to people. Many patients think they’re not artists or they can’t draw or they’re not creative. But art therapy is about the creative process, not the creative product. Patients connect with their inner experiences and find a way to express something that they may not be able to do easily with words. That’s one reason art therapy is a natural fit for eating disorders. It takes away the shame and helps people feel empowered.

A range of materials and mediums can be used, including pencils, watercolors, clay, collages and more. If someone is feeling anxious, overwhelmed, or out of control they might prefer markers or pencils, which help foster a sense of control. Someone who is feeling “stuck” or needing to break out might try a more fluid media, like watercolor paint. And someone who doesn’t want to draw at all can use collage, for example.

Looking at the visual representation of a particular issue provides helpful understanding of the emotions involved. So a person can examine how they feel and behave currently vs. how they want to feel or behave and explore what’s keeping them from functioning the way they want to in a situation or relationship. It’s a skill that can continue to be used at home after treatment as well. Art can be used as a positive coping skill to incorporate into a long term recovery plan.

If you or someone you know is struggling with an eating disorder contact Aurora Psychiatric Hospital Eating Disorders Program

Aurora Behavioral Health Services offers complete mental health treatment options, provided by highly trained professionals in a caring, confidential manner to meet individual and family needs.  If you or someone you know needs help, contact us — online or by phone at 1-877-666-7223 — as soon as possible.

What is Weight Stigma Awareness week?

How do you feel about your body shape and size? Do you judge a person by their weight?

The Binge Eating Disorder Association recognizes September 24-28 as National Weight Stigma Awareness Week. BEDA’s goal is to bring awareness to the way we judge ourselves and others based on weight.

Sandy Blaies, Manager of the Eating Disorder Program at Aurora Psychiatric Hospital says “Our society values thinness and perpetuates societal messages that obesity is the mark of a defective person.

We place a value on the size and shape of our bodies. We uphold stereotypes of body image and assume a person is healthy or unhealthy based on their weight. I am always careful of telling a young person they look thinner. Instead, focus on how the color they are wearing looks good on them, or how you love their smile. What you say matters.”

According to the RUDD Report from the Yale Rudd Center for Food Policy & Obesity, close to one of three overweight girls and one of four overweight boys report being teased by peers at school. Among the heaviest group of young people, that figure rises to three out of every five.

Peers see obese children as undesirable playmates who are lazy, stupid, ugly, mean, and unhappy. Negative attitudes begin in pre-school and may get worse as children age.

Those who are victimized because of their weight are more vulnerable to depression, low self-esteem, poor body image, unhealthy weight control practices and suicidal thoughts. Also, weight-based teasing makes people more likely to engage in unhealthy eating patterns.

Weight stigma can also lead to social isolation, poorer interpersonal relationships, and self-blame by those who are targeted. BEDA warns that many of these consequences can lead to eating disorders.

Sandy Blaies suggests “We should focus on health measurements that are more meaningful than numbers on a scale. Use an approach which is less about dieting and more about a lifestyle change that emphasizes “intuitive eating”: listening to hunger signals, eating when you’re hungry, choosing nutritious food over junk.

In addition, encourage exercise, but for its emotional and physical benefits, not as a way to lose weight. It advocates tossing out the bathroom scale and loving your body no matter what it weighs.”

If you or someone you know may be struggling with an eating disorder please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services

What is the Maudsley approach to treating anorexia?

Anorexia nervosa was initially recognized more than 125 years ago and today has one of the highest mortality rates among all the mental health disorders.  Advancements have been made to help treat this disease, but it continues to be on the rise.

Elizabeth Hunkins is a therapist with Aurora Behavioral Health Services.

Family based treatment (FBT) for anorexia nervosa (AN) is an outpatient treatment option that strives for weight restoration and addresses the adolescent’s development after weight has been restored.

This treatment model has been shown to demonstrate efficacy in numerous research studies, and consequently been a highly successful treatment alternative to higher levels of care.

One 2010 study, published in the Archives of General Psychiatry, showed 49 percent of those who had been in family therapy were in full remission, more than double the 23 percent of those who had been in individual therapy. And among patients who were in remission at the end of the treatment itself, only 10 percent of the family-therapy group had relapsed a year later, compared with 40 percent of those who had individual therapy.

In the Maudsley method of treatment, parents play an active role in the recovery process.  Parents are a key resource and essential for successful treatment for AN.  Maudsley does not believe there should be any “blame” on the family due to this illness or any hostility or criticism towards the adolescent.

Phase 1: Weight restoration:  The therapist’s focus with the family is about the dangers AN and severe malnutrition play, and assisting parents in re-feeding their child. The re-feeding stage is one of the most stressful points for the patient and also for the parents.  Therapists need to be mindful how this affects the entire family.  Helping the parents stay focused on the re-feeding and not get into power struggles with the illness is key.

The therapist helps the family understand the difference between their child and the illness, and continues to help towards the goal of weight restoration.  Usually during the beginning phase of treatment the therapist observes a family meal to provide an opportunity to assess the family’s interaction around food and then to assist/encourage parents in ways to help their child “eat a little more” as food is medicine.  Parents may need coaching that it is important to take time for themselves, as this can be stressful on a marriage.

Phase 2: Returning control over eating to the adolescent: The patient’s acceptance of the parents’ role in re-feeding, weight gain, and taking more control over the eating disorder behaviors are all positive signs that the family is entering phase 2 of treatment.  This phase encourages parents to help their child take more control over their eating and parents continue to maintain and watch over the adolescent’s physical health.  This phase will also begin to start discussing other family relationship issues that had to be postponed during the re-feeding phase.

Phase 3: Establishing health adolescent identity: This phase begins when the adolescent is able to maintain above 95% of ideal weight on his/her own.  Treatment shifts to the impact of AN and addressing other important treatment issues; identity issues, boundaries, personal autonomy, etc.

This treatment has shown great promise with those adolescents who have had AN if the family is willing to play an active role in treatment. Parents need to be aware of the time commitment this treatment will take prior to starting this treatment-as this treatment is not for every family.  The Maudsley therapist also believes in a treatment team approach, working with other medical professionals for the best successful outcome.

More information about the Maudsley approach can be found online at Maudsley Parents.

If you or someone you know may be struggling with an eating disorder, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services.

What should every doctor know about eating disorders?

Statistics from the National Eating Disorder Association indicate approximately 24 million people suffer from anorexia nervosa, bulimia nervosa and binge eating disorder in the U.S.

Yet, too many eating disorders are not caught until the illness is entrenched often to the point at which there has already been irreversible physical health damage done, making the illness much more difficult to treat. Studies have repeatedly shown that early intervention leads to better treatment outcomes.

Primary care physicians play a critical role in identifying an eating disorder in a number of ways. Physicians can reduce the potential for an eating disorder by educating patients on nutrition, body image, and risk factors. They can also be the first to identify early warning signs such as changes in weight, vital signs, or other physical complications.

If doctors are able to intervene more promptly and the illness is treated at an earlier stage, it helps alleviate the serious health consequences that accompany prolonged eating disorders; lessens emotional turmoil involved for the entire family; and reduces the financial burden of treatment significantly.

The American Medical Association’s (AMA) latest online course, Screening and Managing Eating Disorders in Primary Practice, a “first-of-its-kind” curriculum, was developed to educate physicians about eating disorders, with the goal of earlier detection and intervention.

If you or someone you know may be struggling with an eating disorder, or you would like to make a treatment referral, please contact Aurora Behavioral Health Services at 877-666-7223 or visit our web site at Aurora Behavioral Health Services

Additional NEDA resources for primary care physicians:

    WHATS UP DOC is a helpful guide for physicians. Using this handy acronym you will be sure to cover a wide array of significant topics with you patients.

If you have questions about our services or suspect someone has an eating disorder, please call 414-454-6694 or visit our website. If you would like to schedule an appointment for an assessment, please call 414-773-4312.

A New Home!

Caregivers and patients in the Eating Disorder Program at Aurora Psychiatric Hospital are enjoying a new home. Still housed within the hospital, on the 28 acre wooded campus, the program has moved to a new area, designed specifically for the patients attending the eating disorder program.

The United States, as a whole, is obsessed with weight. The National Eating Disorder Association (NEDA) reports that, on any given day, almost half of American women are on a diet and a quarter of men are also trying to lose weight. But for five to 10 million females and an additional one million males each year, the desire to be thin will turn into a more serious eating disorder where eating is no longer about feeding a physical hunger, but becomes about satisfying a psychological need.

The Eating Disorder Services at Aurora Psychiatric Hospital approaches an individual’s eating disorder from a biological, psychosocial and psychological focus. Understanding the complexity of the illness, theAuroraPsychiatric Hospital’s program helps individuals develop the skills to take better care of themselves from a nutritional, emotional and social perspective. One of the initial steps is to address the physical needs of a patient. “When someone enters the program, they are experiencing a lot of anxiety regarding food,” explains Anne Sprenger, RD, registered dietician withAuroraPsychiatric Hospital. “A dietician meets with them at the very beginning of their treatment to initiate the process of re-feeding them. We set nutritional goals and help them develop personalized steps to work toward those goals.” The program is customized to each individual. Food allergies, and religious and cultural preferences are taken into consideration. Initially the meals are planned for them, but as individuals progress they become actively involved in understanding how to select healthy choices. “Education is a vital component of our nutritional services,” continues Anne. “We need to get our patients the correct information regarding nutrition, explain how they can take care of themselves from a nutritional perspective and give them the support they need to get back on track with eating healthy, balanced meals.” As clinically indicated, patients can participate anywhere in the full continuum of inpatient, partial hospitalization or intensive outpatient programs. An individual’s needs are taken into consideration when trying to find the most cost-effective approach to deal with an oftentimes lengthy process. All options include psychiatric treatment, group and individual therapy with a general emphasis on cognitive behavioral therapy and dialectical behavioral therapy; education groups; family involvement; relapse prevention, in addition to the nutrition program. “Despite the outward physical appearance of some eating disorder sufferers, the toll taken on the inside is far more devastating,” explains Sandra Blaies, LCSW, supervisor of Eating Disorder Services atAuroraPsychiatric Hospital. “The Eating Disorders Program offers a wide variety of complementary therapies ranging from art therapy, mindful yoga and food challenge experiences to help patients learn how to identify and express their feelings or emotions.” In addition, family involvement is an integral part of a patient’s care. Family education and support groups for the family and friends of patients provides both the education they need to support their loved one, as well as gives them a channel through which they can address their own fears and frustrations. “In our program, families and friends are considered a valuable resource in the recovery program,” addsSandy. Indications that someone may have an eating disorder range from binge eating or food restriction, to self-induced vomiting, abusing laxatives or diet pills, a preoccupation with food, calories, nutrition and/or cooking, crash dieting, denial of hunger, perfectionism, extreme weight loss or low body weight.

If you have questions about our services or suspect someone has an eating disorder, please call 414-454-6694 or visit our website. If you would like to schedule an appointment for an assessment, please call 414-773-4312.