When Cancer Triggers (or Hides) an Eating Disorder
Well – Tara Parker-Pope on Health
When Cancer Triggers (or Hides) an Eating Disorder
By Sophia Kercher July 27, 2015 3:41 pm July 27, 2015 3:41 pm
When Emmets was undergoing cancer treatment in New York over the past few years, her weight began to drop. Even though she was often nauseated and paralyzed by chemotherapy-induced neuropathy, she joked that thinness was the “bonus of cancer,” and found herself looking in the mirror and admiring her deep and hollow collarbone.
Ms. Emmets, now 39, filled her closet with extra-small size clothes. At night she pressed her fingers against her protruding bones, saying to herself, “I’m finally skinny.”
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But it was only when her cancer treatment changed that it became clear that the body-image issues she had been grappling with since her early 20s — when she would eat next to nothing and walk for six hours a day to deal with stress — had begun to resurface. When the new treatment didn’t make her sick, her appetite returned, and she began to gain weight. But instead of celebrating this sign of improving health, Ms. Emmets says she missed her size 2 jeans and was appalled by her round belly and full breasts. Her husband watched with concern as her body appeared stronger but she began imposing her own food restrictions and started shrinking again.
“During your cancer treatment, you have no control over your body — you give up your body to your doctor,” said Ms. Emmets, who wrote about her experiences on the website The Manifest-Station. “You are willing to do it because you want to live. Food restriction is the one thing that you can do to have some sense of control when everything is chaotic.”
While it isn’t known how often cancer triggers or reawakens an eating disorder, doctors and nutrition experts who work with cancer patients share anecdotal reports of patients who emerge from a difficult round of cancer treatment and weight loss only to begin struggling with a serious eating disorder that threatens their postcancer health.
After Ms. Emmets wrote about her experiences online, she heard from dozens of women who had experienced body issues during cancer treatment. One anonymous commenter wrote that after successful treatment for advanced cervical cancer, she could think only about her weight. “I have beat cancer, but all I care about is losing that weight and keeping it off,” she wrote.
A reader on another site, who gave her name as Doreen, said cancer treatment had created opportunities to hide her disordered eating.
“You are sharing my secret that I’ve carried around for over 15 years,” Doreen wrote. “I, too, used my cancer treatment as an excuse to practice my eating disorder. No one questioned why I wasn’t eating, why I was throwing up, why I was experiencing rapid weight loss.”
Eating disorders are so powerful, wrote Doreen, that even in the midst of cancer, she was compelled to “deprive my body of any nutrients at a time when it needed them the most.”
While eating disorders related to cancer appear to be uncommon, doctors say more study is needed to determine just how often they occur. A 2011 article in TheInternational Journal of Family Medicine reported on a 15-year-old girl who had begun showing symptoms of anorexia nervosa soon after beginning her treatment for advanced osteosarcoma. The article authors emphasized that they had found only three other case studies on the problem, and urged more attention to the issue. In the case of the 15-year-old, a family-based intervention helped her overcome her eating disorder.
“There needs to be more research in these areas so that people are aware of patients’ histories when it comes to their prior problems with eating, and finding ways to help them,” said Dr. Aminah Jatoi, an oncologist who has incorporated nutrition in her 16 years of work treating cancer patients at the Mayo Clinic in Rochester, Minn.
Dr. Michael Strober, director of the eating disorders program at the David Geffen School of Medicine at the University of California, Los Angeles, said that while it was unlikely that someone would develop anorexia after age 20, the eating disorder that Ms. Emmets had experienced in her 20s was accentuated by her illness. “Anything that affects body image, weight loss or weight gain, can return the illness to its prior level of intensity,” Dr. Strober said.
The nutritional therapist Robyn Goldberg, who spent five years as an inpatient clinical dietitian at Cedars-Sinai Medical Center in Los Angeles before opening a private practice in Beverly Hills, recalled two clients who both struggled with eating disorders and cancer. “I was working on optimizing nutrition when they were sick,” Ms. Goldberg said. “Once they were better, I was working with them on gaining weight, and they didn’t want to gain weight.”
Rachel Wong, an oncology dietitian, works mostly with head and neck cancer patients on getting comfortable with eating solid foods after their treatment, but she has worked with a few young female cancer patients suffering from eating disorders and cancer at MedStar Georgetown University Hospital. “Often I am made aware of the eating disorder by the oncologist,” Ms. Wong said, “Oftentimes individuals with eating disorders may not want to talk about it.”
Ms. Emmets, who sought therapy to deal with her cancer and eating disorder, said her oncologist never asked about her long history with body issues. While she doesn’t blame her doctor, she says doctors should be aware of potential eating disorder issues when patients lose or gain weight.
“It’s a real thing, and I’m not an anomaly,” she said. “I think that it needs not to be such a taboo topic.”