Breaking the Shackles of an Eating Disorder with Denise Fair, RD – EP032

 In Podcast

“It’s very scary. We make light of an eating disorder. I hear it all the time, ‘Oh, just give them a chocolate bar.’ It’s about food, but it’s not about food. It’s really about this intense, intense fear.”




Denise Fair is a registered dietician from Canada who specialized in pediatric nutrition at The Hospital for Sick Children in Toronto and Winnipeg Children’s Hospital. She moved to Hong Kong in 2009, where she has served as an RD with Central Health Medical Practice. Denise does private consultations in all areas of dietetics, continuing to focus on pediatrics and adding an expertise in eating disorders.

Today Denise discusses the most common eating disorders she encounters, the demographics of her patients with anorexia and bulimia, and the personality traits common to these patients. She addresses the steps you can take as the parent of a child with a potential eating disorder and when to pursue a live-in intensive program in a hospital setting versus a weekly consult with a nutritionist. Listen and learn how an eating disorder develops into a phobia of food and how we can prevent eating disorders from manifesting in the first place.

Topics Covered

[0:59] The most common eating disorders Denise encounters

  • All center around fear of food, getting fat
  • 4:5 patients have anorexia (restrict diet)
  • 1:5 patients have bulimia (binge/purge)
  • Orthorexia means eat volume, but only ‘safe foods’

 [2:34] The demographics of eating disorders

  • Majority of patients are teenage girls
  • As young as ten, as old as 43
  • Most develop disorder in teen years
  • #1 nationality = French
  • High prevalence in girls with one Asian, one Western parent
[4:05] Eating disorders by the numbers

  • Only 4% of anorexics, 6% of bulimics diagnosed/treated
  • 1:4 teens in US either have eating disorder or know someone who does
  • Prevalence much higher than realize
[4:40] The personality traits common to individuals with eating disorders

  • Overachievers (good grades)
  • People pleasers
  • Helpful, nice
  • Low self-esteem, insecurity
  • Anxiety
  • 1:4 have OCD
  • Think in extremes (black or white)
  • Afraid to disappoint, fail parents
[5:56] What parents of at-risk kids can do

  • Watch anxiety levels
  • Encourage communication
  • Don’t try to force feed
  • Ensure variety in diet
  • Sit down to family meals
  • Discuss importance of nutrition
[9:45] The effectiveness of a weekly consult with a nutritionist

  • Depends on severity of illness
  • Denise will admit if outside scope of ability
  • Early detection key in reversing patterns
  • Full-time therapy necessary if patterns entrenched
  • Straight to inpatient if weight too low, heart issues
[11:54] What a live-in intensive program looks like

  • No comprehensive option in Hong Kong
  • Most countries offer 24-hour programs in hospital-like settings
  • Options include day, evening programs
  • Clients have traveled to UK, Australia, US, South Africa
[13:42] Denise’s success stories

  • Many phenomenal girls
  • Editor of college newspaper
  • Girls in law, med school
[15:03] How intensive programs work

  • Patients literally can’t help themselves (puppets)
  • So malnourished that brain, body don’t work
  • Must be force fed or given nutrition supplement
  • Psychiatrist, counseling to address drastic phobia
  • Very difficult to do at home
  • Typical stay of two to six months
[18:15] The pros and cons of recovering in a group setting

  • No longer feel alone, isolated
  • Talk through different stages
  • Can backfire (teach each other nasty tricks)
  • Mediator guides group discussion
  • Need individual therapy as well
[19:12] An ‘early detection’ success story

  • Patient from Macau
  • View on food ‘not right,’ mom worried
  • Denise challenged thinking
  • Got balanced, better variety in diet
[21:05] Denise’s experience with manipulative patients

  • Many are secretive, try to manipulate
  • Experienced nutritionist knows ‘how eating disorder hides’
  • Brain is starving, patient not thinking straight
  • Malnourishment affects way brain thinks
  • May not be aware, have no recollection of actions
[24:43] How an eating disorder gradually develops into fear over time

  • Starts as insecurity, patient goes ‘healthy’
  • Snacking stops, portions limited
  • Gets emotional around food, stops going out with friends
  • Body image issues feed into anxiety
  • Skewed logic (one potato chip = overweight)
  • Binge/purge in social situations
[25:56] Denise’s advice around addressing eating disorders with adult friends

  • Depends on level of relationship
  • Start a conversation, speak to your worry
  • Education doesn’t work (‘it won’t happen to me’)
  • Brain is hardwired to think, ‘I’m fine’
[28:32] Athletics and eating disorders

  • Sport and illness often entangled
  • Start eating well, may exercise more to compensate
[29:53] The prevention of eating disorders

  • Tough because don’t talk about selves, ask for help
  • Starts with global awareness of disease
  • Often dismissed as non-issue (‘just eat’)
  • Address society, advertising image of ‘ideal woman’
  • Love our bodies, stop buying into hype
  • Educate that food is not good or bad
  • Teach schools, parents what to watch for
[34:39] The value of balance in combatting eating disorders

  • Figure out what’s important, fit into plan
  • Don’t fear one or two bites of cupcake
[36:14] Denise’s best advice for parents

  • Be aware, talk to kids
  • If worried, see registered dietician

Learn More About Denise Fair

Island Health




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