Hunger pangs

Mary Howden


Mary Howden, pictured, is the clinical supervisor at Center for Hope of the Sierras, a residential treatment center in Reno for girls and women with eating disorders. Learn more at,

Tell me a bit about the center.

We have two houses. It is a residential home that’s been turned into an eating disorder facility. Each one has six beds in it. They come here for a variety of things. With eating disorders, you sometimes have dual diagnosis—some come with just an eating disorder, some come with diabetes and an eating disorder, which is also something we specialize in. I think there’s two or three places in the country that can do that. Girls stay anywhere from a minimum of 45 days to three months, six months, depending on what they’re working on and the severity of their issues.

Are there certain criteria for someone to come to your center?

Yes and no. There’s a criteria where if their weight is too low, we can’t take them because they need to be in a hospital setting because they are in such great risk of heart failure. Somebody has to be medically cleared to be here. As far as the level or severity of their eating disorder, that’s an issue with many women. A lot of women feel like throwing up their food three times a day is normal, because they’ve done it so long. There’s no real criteria—if this is hampering your life, it’s taking control of your work life. There’s a questionnaire, and if you answer so many out of 10, there’s a strong chance you need to get help. People will come to us because they say they really need to do something different because “this is something that’s ruining my life.”

Some people think you have to look like Karen Carpenter to be anorexic when someone who looks perfectly normal could have an eating disorder.

For somebody with bulimia, they probably have a normal body weight—it’s not always based on that. Somebody could be purging 12 to 15 times a day and still have a normal body weight, but purging 12 to 15 times a day is not normal.

What are some common reasons people develop eating disorders?

There’s no one thing we can pinpoint, but from a family systems perspective, certain things will stick with a child early on about her weight—if someone else in the family is concerned about her weight. And more often than not, if a girl has bulimia, she probably comes from a family with more judgment and criticism. And I’ll put that another way: There’s a propensity for some of these girls—they kind of absorb some of the problems of the family. They want to fix everything. They have a lot of compassion, they’re caretakers, they tend to want to help everybody else. That, plus society, all the things we have on TV, the things we read in magazines being promoted as the ideal body. And usually, these girls, we talk a lot about the food—and people with eating disorders tend to have body issues right off the bat—but there’s something beneath that. They’re not communicating what they’re thinking, what they’re feeling, the judgment and criticism they might feel from family members, high school peers, anything like that. It’s hard to wrap up in one article, it’s such a massive topic.

What are we now learning about diabetes and eating disorders?

We’re finding out a little bit more. For instance, a girl will come in with diabetes, and maybe she already had some issues with an eating disorder, or maybe there was some judgment issues where she felt she had to be perfect, and then she’s diagnosed with diabetes. That adds another element to it. A lot of times they’ll learn this from other diabetics early on, like “Oh, if you want to control your weight, I can show you how to do that.” They can manipulate their insulin to lose weight. If they’re dosing for carbs, they have to calculate how many carbs they have, and they have to give themselves so many units of insulin to account for that because their pancreas doesn’t work the same as ours does. So when they don’t take their insulin, the glucose just builds up in the blood. When the blood glucose levels get too high, the kidneys can’t handle it, and the glucose spills over into the urine. So instead of being used by the body, all of the calories in the glucose are excreted in the urine.

Why are we seeing this more?

It’s not that it’s necessarily new, it’s that we’re all talking about it now and realizing that this is a form of an eating disorder.

What can parents and friends do if they think someone has an eating disorder?

If you suspect someone is binging, purging or restricting their food, I would absolutely have that conversation with that person. I think more often than not, families are nervous or scared and don’t want to say the wrong thing, so it goes unnoticed. They’ll say, “I noticed you’re starting to lose weight, but I didn’t know what to say.” But if I were a parent with a child I suspected had an eating disorder, I’d get online and start reading.

What are some signs of eating disorders or ways people hide them?

There’s lots of different ways. With binging, someone will eat an inordinate amount of food and either hide their food in their room or a cupboard somewhere behind boxes, and if you’re the parent paying for the food, you’ll notice you’re buying food a lot. Somebody with bulimia can spend up to $300 a day, maybe more, that’s the worst-case scenario I’ve heard. It’s an expensive habit. If you suspect they’re purging, you can lift up the toilet seat. That sounds gross, but if they’re purging, they might not be cleaning the toilet seat; you can check that. It can feel sneaky, and I don’t really want parents running around being sneaky. I think being upfront saying, “You’re in your room, you don’t talk a lot, you don’t eat with the family anymore …” Someone with an eating disorder will often come up with excuses for why they won’t eat with the family, like “I already ate with my friends; I’m going to eat later.” Then there’s the social isolation piece—they don’t go out with their friends anymore, they don’t do anything.

So much of going out with friends is about eating, like going for pizza or ice cream. So they’ll say, “Oh, I’m a vegan now, so I don’t eat milk or cheese.”


How can new parents help prevent eating disorders in their children who are babies or young now?

How you feel about your body is really important. I have two girls and a boy, and they’re grown now. But how you feel about yourself and talk about yourself—a lot of women will look in the mirror and go, “Oh, I look so fat today,” not thinking about it, but that little girl is sitting a couple of feet away and listening to everything you say. If everything in the house is diet, if there are never cookies in the house or good-food, bad-food, where parents say that’s not healthy …

So we should have cookies in the house?

Oh yeah! I think we should be teaching them moderation, not “That’s bad, that’s bad.” … We do follow the intuitive eating philosophy. We’re all born intuitive. Babies cry when they’re hungry. Something gets crossed at some point, and we stop being intuitive because the rules start to get too rigid—like “I can’t eat that,” and all the sudden they’re eating lettuce and mustard, and that’s all they’re allowing themselves to eat. So we teach moderation and balance, not just with food but in life.