Behavioral Health

Eating and Weight Disorders

COVID-19 Clinical Services Update

In response to the social distancing precautions required by the current COVID-19 pandemic, the Eating and Weight Disorders program is offering all outpatient services via telehealth at this time. To make an appointment, please call 212-659-8724.

The Center of Excellence in Eating and Weight Disorders at Mount Sinai provides the expert care you or your loved one needs. We have more than a decade and a half of experience helping children, adolescents, and adults with eating disorders. Our psychotherapists and psychiatrists work as a team to diagnose and treat anorexia nervosa, bulimia nervosa, binge eating disorder, obesity, and other conditions. These conditions can affect your physical and emotional health as well as your relationships with others. Anyone can develop an eating disorder, regardless of age.

Eating and weight disorders are complex mental health disorders. They are influenced by psychological, biological, and social factors. Eating disorders often lead to physical illness with acute and chronic symptoms that are life threatening. For this reason, it is very important to get a proper diagnosis and treatment as early as possible.

Determining whether someone has a problem with food or weight is complicated. Often, the condition has been going on for a while before it is noticeable. Early intervention is very important and improves chances of long-term recovery. Most eating disorders can go undetected until the resulting health issue is severe enough to require urgent treatment. The longer the condition has been going on, the greater chance of lasting damage.

There is no one cause of eating disorders, nor is there a single best treatment. We offer one-on-one treatment, therapy groups, and an innovative family-based Intensive Program.

About Us

The Center of Excellence in Eating and Weight Disorders provides diagnosis and treatment on East 96th Street, near The Mount Sinai Hospital. This lets us provide interventions that are evidence-based, effective, and tailored to your individual needs.

At our Center, we offer effective treatments for all stages of illness. We are committed to providing the personalized care that you and your family need.

Our program is integrated with the Hildebrandt Lab in the Department of Psychiatry at the Icahn School of Medicine at Mount Sinai. This means our doctors are up to date on the latest research about the biological, psychological, and environmental factors that can lead to an eating disorder or obesity. We use this research to develop modern evidence-based, effective approaches within our regular and intensive outpatient programs. Additionally, we offer a bariatric surgery evaluation program.  

Treatments are tailored to specific needs, focusing on you and your family. Our goal is to provide personalized treatment and the tools to prevent relapse.

Conditions

Anorexia Nervosa

People who have anorexia nervosa have a body weight that is low for their age and gender. It is generally caused by severely restricted eating associated with an intense fear of gaining weight or becoming overweight. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes two types of anorexia nervosa: restrictive anorexia nervosa and binge-purge anorexia nervosa.

Typically, anorexia nervosa begins in adolescence or earlier when the bodies of young people are changing. Youth are especially vulnerable to developing a distorted body image and self-esteem. Girls are about six times more likely than boys to be diagnosed with anorexia. However, this may be partly because it can be more difficult to identify eating disorders in boys.

Common symptoms and complications
If you or a loved one has anorexia, you may also have a related psychological problems such as depression, anxiety, and/or obsessive-compulsive disorder. You may tend to withdraw from social situations, show signs of irritability, or experience insomnia.

If you have anorexia nervosa, we may see some or all of these symptoms:

  • Distorted beliefs about body shape and weight
  • Excessive exercise
  • Restricting food intake, specific foods, and/or overall calorie consumption
  • Self-inducing vomiting
  • Use of laxatives, diuretics, or diet pills

Extreme weight loss in people with anorexia nervosa can lead to dangerous health problems, including:

  • Slow growth in children
  • Heart and kidney dysfunction
  • Infertility
  • Osteoporosis

Anorexia nervosa is a serious psychiatric condition and like other eating disorders, has a high mortality rate.

At the Center of Excellence in Eating and Weight Disorders at Mount Sinai, we offer a variety of effective interventions for anorexia nervosa. Most of these are family-based treatments, however we tailor our treatments to suit our patients’ needs. No one form of treatment works for all patients. For some, a single course of treatment is effective. Others may gain weight and recover—and then lose weight and relapse. We are here for you as long as you need us.

Bulimia Nervosa

People with bulimia nervosa alternate between restricting food intake and overeating or binge eating. If you have bulimia, you may feel you are out of control and you may take extreme measures to prevent weight gain.

Bulimia usually begins in late adolescence or early adulthood. While between one to three percent of adolescents and young adults develop the condition, between 60 to 70 percent are female. As with anorexia, people who have bulimia suffer from concerns with body image, although they are often within a healthy weight range. For a diagnosis of bulimia, bingeing and purging is occurring at least once a week for three months.

Common symptoms and complications
If you have bulimia, you may experience some or all of the following:

  • Consuming large amounts of food while experiencing a sense of loss of control over eating
  • Excessive exercise
  • Intermittent fasting
  • Laxative and diuretic misuse
  • Self-induced vomiting

Bulimia nervosa can contribute to a variety of other conditions. Some of them are severe, though treatable. These include:

  • Anxiety, depression, and other psychological problems
  • Cardiac abnormalities
  • Dehydration and electrolyte imbalances
  • Dental erosion and deterioration
  • Gastrointestinal disturbances, such as esophageal reflux
  • Menstrual irregularities
  • Swollen salivary glands

We use several approaches to treat bulimia nervosa, notably cognitive behavioral therapy and medication, and outcomes vary from person to person. You may suffer from bulimia for a long time, or you may alternate between recovery and intermittent binge eating and purging. While many adolescents display symptoms, most do not seek treatment until adulthood.

Binge Eating Disorder

Binge eating disorders involve recurrent episodes of loss of control—or binge—eating. Unlike with bulimia, people who binge eat do not compensate for their behavior by exercising excessively or inducing vomiting. Binge eating disorder affects approximately one to four percent of the population, of all ages, and is evenly split between males and females.  Most binge eaters carry extra weight. 

Common symptoms
If you binge eat, you likely consume unusually large amounts of food. You may also experience symptoms, such as:

  • Depression
  • Eating alone due to shame and embarrassment
  • Eating beyond the point of comfort
  • Eating large amounts of food when not hungry
  • Eating very rapidly
  • Feeling a loss of control while eating

We use a variety of effective treatments for binge eating disorder. These include:

  • Cognitive-behavioral therapy, treatment that focuses on negative or irrational beliefs
  • Interpersonal psychotherapy, time-limited talk therapy either one-on-one or in a group
  • Dialectical behavior therapy, treatment that teaches new approaches to manage painful emotions and decrease conflict in relationships
  • Pharmacological treatment, a medication regimen to curb symptoms

These interventions help reduce or eliminate binge eating and improve your quality of life. They can also help with symptoms such as depression and anxiety.

Obesity and Weight Management

Someone who is obese has a higher than normal body mass index (BMI). BMI is the ratio of weight in kilograms to height in meters. For adults, obesity is diagnosed as a BMI over 30. For children and adolescents healthy BMI varies by age. In general, we diagnose obesity in children when their BMI is above the 95th percentile of the healthy range for their age.

The Centers for Disease Control and Prevention reports that obesity rates have been rising among adults and young people.

No matter how old you are, obesity can lead to several serious medical conditions such as:

  • Breathing (pulmonary) problems
  • Diabetes
  • Gallbladder disease
  • Gastroesophageal reflux (GERD)
  • Gout
  • Heart disease
  • High blood pressure (hypertension)
  • Liver disease
  • Reproductive problems in women
  • Sleep apnea
  • Urinary stress incontinence
  • Osteoarthritis

Our doctors and researchers are committed to discovering new approaches to treating obesity and weight management. Studies have shown that it is important to have family—especially parents—involved in treatment. Some diabetes prevention programs can help with gradual and sustainable weight loss. Most of these programs are geared to adults.  

Avoidant/Restrictive Food Intake Disorder

People who have avoidant restrictive food intake disorder (ARFID) do not consume enough food. It results in significant weight loss. This condition used to be called selective eating disorder. It is not connected to body image issues such as fear of becoming overweight.

ARFID can occur at any age and affects both men and women. The disorder often causes significant nutritional deficiency and those with the condition may need intensive help to regain health. ARFID is often found in people who have other developmental disorders or medical conditions.

Common symptoms and complications
People with ARFID do not eat enough. This can cause a number of nutritional challenges, including:

  • Gastrointestinal issues such as bloating that contributes to a lack of appetite
  • Dizziness, fainting, and weakness
  • Dry skin, brittle nails, and thinning hair
  • Impaired immune functioning

When children have ARFID, they may not gain weight and height typically. Adults may have weight loss and may be unable to maintain their basic body functions.

We use many forms of psychotherapy to help and design a program to fit your needs. Treatment approaches include family-based therapy, cognitive behavioral therapy, or combinations of medication and therapy.

Other Specified Feeding or Eating Disorder

Some eating disorders do not fit into any of these categories. The American Psychiatric Association’s DSM-5 diagnostic criteria uses the term other specified feeding or eating disorder (OSFED) to refer to eating disorders that do not fall into another category. These disorders cause significant food-related distress and health issues.

The following are examples of OSFED:

  • Atypical anorexia nervosa — All the characteristics of anorexia nervosa, but with body weight remaining within or above the normal range
  • Limited binge-eating disorder — All of the characteristics of binge-eating disorder, but with instances occurring less often or lasting for less than three months
  • Low frequency bulimia nervosa — All of the characteristics of bulimia nervosa, but with binge eating and other inappropriate compensatory behaviors occurring less frequently or for less than three months
  • Purging disorder — Purging to control body weight or shape, but without binge eating
  • Night eating syndrome — Recurring episodes of waking to eat during sleep time or eating too much after the evening meal. The behavior causes significant distress and cannot be explained by another mental health disorder.

Our experienced doctors diagnose a range of feeding and eating disorders. We offer personalized treatment that suits your individual needs.

Pica

People with pica eat substances that are not considered food and do not contain significant nutritional value. While most people with pica continue to eat food, the most common non-food items ingested are dirt and paint. The types of non-food substances ingested tend to vary with age and availability.

Children with pica often have another mental health disorder such as schizophrenia, autism, or an intellectual disorder that may require diagnosis and treatment. Children under age two often put small objects in their mouths as part of exploring the world, this is not consider to be pica.

Common symptoms and complications
Pica may be associated with or cause other health issues, such as:

  • Anemia and other nutritional deficiencies
  • Blockage in the digestive tract
  • Poisoning, such as lead poisoning that can lead to brain damage

An essential part of treatment for pica is close observation and medical monitoring along with psychological therapies that may address behavior.

Rumination Disorder

Rumination disorder involves spitting out partially chewed food, also known as regurgitation. If you have rumination disorder, you may re-chew, re-swallow, or spit out your food. To be considered a disorder, this must occur often – usually daily, over a period of a month – and in children who were previously eating normally. Often, people with rumination disorder do not appear to be stressed or upset by the behavior.

Rumination generally affects infants and young children. Some people with rumination—but not all--also have another eating disorder. A medical condition that causes regurgitation is not considered to be rumination.

Common symptoms
Continued regurgitation may cause a number of health-related symptoms, such as:

  • Choking
  • Dehydration
  • Indigestion
  • Tooth decay
  • Weight loss

Careful attention to eating habits and treatment interventions are required in severe cases to avoid serious medical issues.