Fighting Back: Winning the Struggle Against Eating Disorders

A Q and A with UB Graduate School of Education Professor Catherine Cook-Cottone

Release Date: August 14, 2008

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Catherine Cook-Cottone is working to find answers to the complex problems of eating disorders.

In eating disorders, the "battleground is the body," says University at Buffalo researcher Catherine P. Cook-Cottone, who is examining ways to win those battles using conventional as well as less-common solutions.

"The good news is that eating disorder interventions do work," says Cook-Cottone, an associate professor of counseling, school and educational psychology in UB's Graduate School of Education.

For example, research shows that children and adolescents taking part in media literacy programs often learn to reject misleading media images and cultural pressures that can make them feel deficient. Other conventional methods focus on behavioral modification.

But Cook-Cottone believes incorporating active work with the body such as breathing techniques, relaxation and yoga could also be valuable weapons for those at-risk as well as those struggling with an eating disorder. Her method focuses on helping adolescents obtain a healthy sense of their inner self in relation to their external environments.

"Through these techniques, we work on balancing the focus on others with attention to self-care," she explains. "Ultimately, the goal is to teach children and adolescents how to take care of themselves within the context of their connection to others."

Media may contact Cook-Cottone in her office at (716) 645-2484, ext. 1073, or at

How common are eating disorders among young people?

For anorexia nervosa, the average prevalence rate -- a term that describes the total number of cases divided by the number of people in a population -- is 0.3 percent in females, or 3 in every 1,000 females.

The incidence rates -- which measures those at risk of becoming anorexic -- are at 8 per 100,000 for anorexia nervosa. So over a year it is expected that 8 in 100,000 will be diagnosed with AN. These rates represent an increase over the past 50 years, especially in females ages 10 to 24.

The long-term outcomes are serious. Anorexia nervosa is associated with one of the highest risks for premature death among all the psychiatric disorders. Of those diagnosed, between 5 and 5.9 percent die of symptoms related to the disorder.

The average prevalence rates for bulimia nervosa are 1percent in females and

0.1 percent in males. Incidence rates are estimated at 12 per 100,000 for bulimia nervosa per year. Of those diagnosed with BN, 0.3 percent are believed to die of complications related to the disorder, and that could be low because of the short duration of available follow-up studies.

In the U.S. alone, as many as 10 million females and 1 million males are fighting a life and death battle with an eating disorder such as anorexia or bulimia. Millions more struggle with binge eating disorders. Many cases are not reported because people are ashamed to admit they have a problem.

In addition, many individuals struggle with body dissatisfaction and sub-clinical disordered eating attitudes and behaviors. For example, it has been shown that 80 percent of American women are dissatisfied with their appearance.

Who is at the greatest risk?

The risks are complex and involve a combination of biological, physical and cultural factors. Body dissatisfaction is the strongest risk factor. Those who diet also face a strong risk. It's important to note that dieting is qualitatively different from attention to nutritional self-care. In dieting, the child or adolescent is restricting calories or carbohydrates and setting themselves up for excessive hunger, malnutrition and slowing metabolism.

Other risk factors include an environment (family, school and/or culture) excessively focused on appearance above emotional connection with others and well-being. Struggles with emotional regulation and anxiety can also increase risks. Perfectionism is a risk factor. Athletes can also be at risk. Of note, eating disorders, depression, anxiety and substance-use difficulties can run in families.

How can you tell if someone you care about is struggling with an eating disorder?

Dieting is a risk factor and should cause concern when it is observed in children and young adolescents. Any excessively fast weigh loss should be noted (more than 1-2 pounds per week).

Skipping meals (restricting) and binge eating are also warning signs. Wearing excessively loose clothes -- sometimes used to disguise weight loss -- can be a sign. Any use of diuretics, diet pills and/or laxatives as well as vomiting should be directly addressed with a pediatrician.

Another often overlooked symptom is excessive or obligatory exercise. Some children or adolescents do not purge using laxatives or vomiting. Rather, they go for very long runs or work out for hours to "get rid of" the calories. Any workouts beyond 90 minutes should be questioned. Many times those facing the biggest risks try to keep their struggle a secret. Eating disorders can be difficult to detect.

Can communication or talking things out with anyone help? Where can people turn to for help?

Yes, communication can help. As with any behavioral disorder (like substance abuse or gambling addiction), the individual may be in denial and working hard to minimize the effects on themselves and others. Letting the child or adolescent know you are concerned and even scared can be good. Tell them that you have seen them struggling and you are worried that they are not OK. Parents should take their child to an eating disorder specialist (a medical doctor). These disorders are medically dangerous; blood work and cardiology tests should be considered immediately. College-age individuals and adults should be encouraged to get help. The most effective treatment team involves a medical specialist, a nutritionist and a psychologist.

What parts of our society promote eating disorders?

The media pressure to be thin and perfect is a critical factor. But the media alone cannot be blamed. Also, demanding coaches, perfectionist yet disengaged parents, as is a child's or adolescent's involvement in high -pressure activities such as modeling, ballet, gymnastics and wrestling. What keeps us at risk is that personal success is equated with unbalanced achievement, purchasing power and "looking good," and these things don't create well-being.

What special programs have you worked on that have produced some promising results?

Both the prevention and treatment programs have been published showing positive results. We have been published in The Journal of Eating Disorders, The International Journal of Eating Disorders and The Journal of Specialists in Group Work. The theory has been addressed in a theoretical article published in Psychology in the Schools and a chapter in Neuropsychology of Women. My biography page on the Graduate School of Education's Web site at has other publications.

Where can people go for more help and information?

Gürze Books, LLC, is a publishing company that has specialized in eating disorders. Find listings at

Media Education Foundation is a nonprofit organization devoted to media research, and the production of resources to aid educators and others in fostering analytical media literacy at And the National Eating Disorder Association (NEDA) at is also a good source of information.

The University at Buffalo is a premier research-intensive public university, a flagship institution in the State University of New York system and its largest and most comprehensive campus. UB's more than 28,000 students pursue their academic interests through more than 300 undergraduate, graduate and professional degree programs. Founded in 1846, the University at Buffalo is a member of the Association of American Universities.

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