The season is in full swing and holiday messages about indulgent eating are pulsing from every imaginable source. And while most kama’aina look forward to a hui with family and friends for lavish meals that take center stage, for individuals coping with an eating disorder (ED), this time of year can be rough waters.

Dr. Adam Coles, medical director at ‘Ai Pono, a treatment center located on Maui, has seen it all.

“It can range from those for whom the sheer quantity of food can be intimidating if they’re struggling with restriction to those for whom trying to reduce out-of-control eating becomes a Herculean task in this season of culturally endorsed over-indulgence,” Coles said. “Add to this mix the cultural and social pressure to project the appearance of stability, success, joy and happiness in the season and the effort to seek help can become much more difficult at this time of year.”

Desiree McGunagle, an ED patient in recovery, formerly in treatment at ‘Ai Pono, says that “having an eating disorder during the holidays, in my personal experience, was a major challenge.”

“Food is such an integral part of the holiday season, especially that span of time between Halloween and New Year’s,” McGunagle said. “I know now that ‘holiday food’ in and of itself isn’t why it was challenging. Food was the red herring. The real challenges were not quite so obvious, but lingering in the distant background. It was anxiety caused by nebulous things, like the anticipation of family gatherings, finances, work stress, etc. The holidays are stressful regardless of whether or not you have an eating disorder, but if you do, there are more opportunities to engage in a negative behavior with the increase in food-related activities.”

According to Saundra Moriyasu, registered dietitian/nutritionist, such behaviors can include restriction, binging and/or purging among others. These behaviors can be accompanied by powerful feelings including overwhelming guilt and desire for control. Moriyasu is currently a board member of ‘Ai Pono Foundation and previously was on staff at ‘Ai Pono.

Eating disorders are definitely present on Maui and have been exacerbated by the isolation caused by the pandemic. While statistics are not available for the entire population, Maui County had one of the highest rates of disordered eating among ninth through 12th graders in the entire state at 22.4 percent in 2019, according to Hawai’i Health Matters. Statistics show that emergency room visits for eating disorders among female adolescents doubled during the pandemic in the United States, according to the Centers for Disease Control and Prevention.

So what can you do to support someone you love with an eating disorder during this challenging season?

A few tips to help yourself and your loved ones enjoy the holiday season:

Do:

• Give plenty or unconditional love and support.

• Give your loved one space — emotional and physical — to process their emotions and space to deal with their food and feelings without someone watching their every bite.

• Provide a variety of options for food.

• Encourage and provide regular meals and snacks. Skipping meals and snacks will most likely lead to a binge later.

• Endeavor to be nonjudgmental, empathetic and understanding of difficulties during the holidays.

• Help them to not isolate. Encourage spending time with friends and family.

Don’t:

• Watch them like a hawk.

• Pressure them to eat or not eat.

• Give rules surrounding food and meals. It may actually lead to more disordered eating.

• Do not cater to their eating disorder by providing special foods. This will just “feed” their ED and lead to more disordered behavior. Instead provide a variety of foods that are full of nutrients. Having a bounty of “low calorie options” and little to none of the traditional cookies and carbohydrate-rich foods may backfire — your loved one may restrict more and/or may binge when these foods do become available.

• Pressure them to engage in all social events/activities.

• Make comments (good or bad) around appearance or looks.

As a reminder, this season can be a triggering and difficult time of year for many individuals struggling with mental health issues, including eating disorders. So let’s support those we love who might be challenged during this holiday season.

* Cathy Meyer-Uyehara, FACHE, NHA, is the CEO and co-founder of ‘Ai Pono Hawaii. Meyer-Uyehara has worked in health care for 40 years and in the field of eating disorders for 12 years. She can be reached at cathy@aipono.com.