When your Au Pair has an eating disorder

by cv harquail on March 25, 2010

Every au pair we’ve ever had (all 11 of them) went on some weird kind of diet. These diets included protein drinks, Slimfast shakes, grapefruits, Diet Cokes for breakfast & lunch and — my personal favorite —  rice and bread. (Going without butter was where ya really saved on calories!)

Thankfully, most of these diets were short-lived.

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I understand where the impulse to try these weird diets comes from– many au pairs put on a few extra pounds as they get adjusted to the American diet and to the size of a Mocha Frappucino.

These diets have raised some issues for me as a host mom, worrying that our au pairs aren’t getting proper nutrition and are developing unhealthy eating habits. I have also worried about the role model this might set for my kids, I’ve felt that my fabulous cooking was being spurned, and I’ve resisted buying strange foodstuffs for strange diets — but all of those are issues for another post.

What I’d like your thoughts on is when the food situation turns from weird to grim — when you suspect or discover that your Au Pair has a bona fide eating disorder such as bulimia or anorexia.

We got an email from a host mom who is very concerned about her au pair. She writes:

We have a terrific au pair. I’m concerned that she may have an eating disorder. Her eating disorder is not affecting her work (as far as I can tell). And it is not affecting her energy level or overall health– yet.

Because of our living situation (and since I buy the food) I’ve noticed how little she eats at real meals, how she gorges on items like ice cream, and how some foods just disappear from the cabinet. Also, she seems to be getting unhealthily skinny.

Our au pair is a rather private girl, and she’s never talked at all about her weight, or about dieting. I have been trying not to make a big deal about it (I don’t tell her to ‘eat her vegetables’) but I do think I should be doing something.

Any ideas how to respect her privacy but still address the concern?

If this were my au pair, I think the first place I’d turn would be to our LCC. I’d hope that she would have some training from her Agency on how to help an au pair get help. (Perhaps she would also have some experience and information about local treatment options.)

I’m assuming that other host parents have been in similar situations because eating disorders are more common among young women of au pairing age.

Has anyone got some experience they can share?

Photo: Alas / Hope is the thing with…from Celeste

{ 22 comments }

momto2 March 25, 2010 at 9:49 pm

We have seen this with one of our girls. In her home country, there seemed to be such an emphasis on physical appearance, but not on healthy eating and exercise. She felt she must be thin, but back home a few extra pounds are rectified with plastic surgery–cheap. We typically buy healthy food items, and we cook healthy, but she was addicted to the junk which she bought herself and stashed in her room. With a counseling background, I recognized signs of bulimia (quick exits to the bathroom after meals, returning with bloodshot/watery eyes, she kept a spoon in her toothbrush holder–to avoid scars forming on the backs of her fingers–, frequent mouthwash user/teeth brusher to cover up the foul acidic breath, discolored front teeth from the stomach acid, etc.,). This is a delicate situation to take on, with or without an MSW. We tried to model the benefits of exercise and enjoying moderate indulgences, but this did no good. She didn’t like to sweat, and the girl couldn’t get enough ice-cream. We made it to the end, but as expected, she returned home and immediately underwent liposuction to take off the few extra Haagen Daas pounds she picked up in the US. After that experience, we added interview questions that addressed frequency of physical activity, typical meals, favorite foods, etc, self image/confidence, etc. This helped us to avoid picking another candidate who would present this type of an eating disorder.

I would caution against a confrontation with the au pair about her eating disorder. She will probably deny it, and will likely become more withdrawn, and distrusting. I do not know what type of therapy the au pair insurance covers, but our last au pair’s plan wouldn’t even cover all expenses for her bladder infection, so I’m none too confident that it would pay for counseling.

The LCC is likely the best place to start. He/She may be aware of low cost counseling options and resources since they likely see this issue more frequently. Good luck.

HRHM March 26, 2010 at 4:55 am

First, don’t be too quick to judge. Calculate her BMI, if you can and make sure that you aren’t assessing her with American eyes (we’re all overweight and very quick to feel that thin people are underweight when they are not). Next, don’t assume that just because she has a horrible diet that she has an eating d/o. AP2 who just left ate ice cream, snickers, chips or bread with cream cheese. That’s it. She was also pretty thin and rarely worked out. She did not have an eating disorder, she just ate one big bowl of ice cream each day and not much else. Is this a healthy was to eat? No. But it’s not an eating disorder either. AP1 however, ate apples and vegetables and modeled great eating behavior. She also would eat in secret and kept a big box of laxatives in her room. So while she appeared to be fine, she definitely had an eating d/o. I didn’t find out about the laxatives until she was leaving, but even if I had, I’m not sure I would have said anything unless it was affecting her work, or she asked. It’s very personal and it’s a psychiatric disorder, so unless you want to rematch, there’s not much you are going to do for her. Encouraging good eating and exercise are useless. It’s a disease and you can’t cure a disease by modeling healthy behavior.

Taking a computer lunch March 26, 2010 at 7:03 am

If you think an AP has anorexia or bulemia, then I would recommend talking to your LCC about what their guidelines are. I would be concerned about her modeling this behavior in front of your kids – especially if you have preschoolers and she’s home all day with them. I would not want my kids to think that vomiting was normal.

Most of my APs have sought quick diets, and when that didn’t work, they headed to the gym. My first 4 APs had gym memberships and while none were painfully thin, they were healthy. All enjoyed eating, and I knew what they really liked when they had seconds. In general, my APs have been on the young side, and still capable of consuming enormous quantities of food and not gaining much weight – because they were active.

My current AP has not been happy about food from day 1. Fortunately she is a good cook, so once a week, when we need her to stick around through dinner, we have her cook. That way she gets to eat something she really wants to eat (and when that happens she eats a lot). She admitted to me that it was important for her to stay thin. One day I saw her making a lunch of 2 slices of bread, and I said, “While being thin is important to you, if you eat like that in front of my son, that’s all he’ll want to eat.” (He’s a bread fiend like his dad.) “It is important to me that you be a role model in eating healthy foods, so he doesn’t argue with me when I make him eat a balanced diet.”

I think that is the bottom line. You want your AP to be a good role model for your children – especially if she is home all day and eating meals with them. If you suspect she is not, then you need to speak with her in a non-confrontational way.

Jeana March 26, 2010 at 7:41 am

This would be of great concern to me, and I’m sure I would contact our LCC. Several times aupairs have made statements about weight in the presence of my daughters, and I’ve privately told them that it is important to me that my girls focus on eating for nutrition and good health. I don’t want my girls to hear discussions of weight, which may influence their thoughts in the future.

StephinBoston March 26, 2010 at 9:05 am

I would also contact the LCC for help, I’m sure it’s very hard to see someone hurt themselves and not know what to do. I’ve not had to deal with that with my 3 au pairs, it sounds like a very difficult situation.

Anonymous March 26, 2010 at 11:25 am

I believe the agencies or their representatives abroad should screen for eating disorders. The applications I receive all have a section that ask if the candidate has ever had an eating disorder. It is pretty easy to lie, I guess. The application also asks if the candidate has ever been treated for an eating disorder. That is a more ambigouous position. I would not want to fool around with an eating disorder.
There are all sorts of emotional issues involved like mood swings which I would not want to handle. Unless someone is very ill ( super
skinny ), vomiting all the time , and so on, I think it is hard to prove.
I would be frank with my LCC and tell her that we are incompatible with the aupair. I would ask the LCC and the agency to help me out by arranging a no fault rematch. I would not get involved in giving references. I am not a physician but I am a well informed parent.
It will be the agency’s responsibility to tell the next family the truth.
I would worry that the aupair might pass out or faint from exhaustion while caring for my children or God forbid, while she was driving. Honestly, I used to see aupairs from western European countries who were shockingly thin sometimes ( the presumption is that poverty is not an issue ) but I haven’t seen anything like that in years. Of course, my experience is limited. I think this is a disease that is more of a threat in affluent societies .

Jill March 26, 2010 at 1:08 pm

I am an LCC. On our agency’s website it gives some signs to look out for an eating disorder:
Dramatic weight loss which is sometimes concealed with baggy clothing
Preoccupation with food, weight, calories, fat grams and dieting
Elimination of an entire food group
Preference to eat alone or consistent excuses to avoid mealtimes
Anxiety about being fat
Denial of hunger
Strict food rituals (ex. eating foods in a specific order, rearranging food on plate, excessive chewing)
Withdrawal from friends and activities
Irritability, mood swings and/or depressed mood
Frequent weight changes
Shower, bath or running water after meals / bathroom use after meals
Hiding food, multiple food wrappers in garbage can, or unexplained disappearances of food
Chronic complaints of sore throat, upset stomach, diarrhea or constipation
Obsessive exercising
Fluid and electrolyte imbalance

If you have an au pair who exhibits any of the above warning signs, call your LCC who can refer the au pair to the Program Counselor for assessment of the situation and recommendations for program participation.

Darthastewart March 26, 2010 at 1:37 pm

I think that you guys have now confirmed what I suspected with my previous au-pair- she had major self esteem issues, and.. Now I’m pretty sure that she had an eating disorder too.

I can check off nearly all of the items on your list above. :(

Deb Schwarz March 26, 2010 at 2:28 pm

I’ve been a host mom to 15 au pairs and had one major issue with this (beyond the fad dieting that many seem to go through). Here were the “signs” of a major issue:

1) This au pair NEVER ate with us. I found that odd, but she was a triathlete and kept saying that she was “going to the gym” – she always had an excuse for not eating with us.

2) While we were on vacation, she continued to ride a bike 15 miles a day despite the fact that she had an injury and could barely walk.

3) She came down with pneumonia (the rest of us had a cold) and when I took her to the ER, she was discovered to be severely anemic and the doctor couldn’t believe that she could walk, let alone run. She told him that she hadn’t had a period in years (big red flag).

4) When I asked her what food I could get her while she was ill, she said “Diet Coke” and low calorie chicken noodle soup.

5) The gym also called me to say that she was on the machines for 5-6 hours at a time.

I started to research all of this on the web and then found a local eating disorder therapist who did a phone consult with me. Over the phone she told me that she was almost positive this she was suffering from “exercise bulimia”. This is a growing phenomena with young girls, who hid behind the guise of “being fit and healthy”.

After this, I scheduled a meeting with our LCC, gave her resources to out-patient clinics, and did an exit interview.

The really sad thing is that she stayed in the country and went with another host family who said they didn’t mind if she had an eating disorder and the agency said she just had to have a doctor’s clearance (which she somehow got).

I was tempted to call her mother to let her know what was going on, but didn’t (sometimes I wish that I had, but I suspect that she knew as she met with us later and thanked us for “taking care of her daughter”). The au pair admitted to having obsessive-compulsive disorder in the past (re: studying).

Here’s what I learned about au pairs with eating disorders – they are very secretive, and are very good at hiding it. They constantly live on the edge, and many know exactly how much they need to eat to keep functioning. If it’s caught early, then they have a better chance of recovery. The bottom line was that I didn’t want someone who was on the verge of functionality driving my children. She was a conscientious au pair, and I can imagine that she somehow keeps it together – but the sad part is, that the damage on their internal organs will lead to issues at some point in their lives. We have a very athletic daughter, who now seems to have eating issues – we aren’t sure if this au pair contributed to this, but I will definitely be on the look out for this in my children, and other au pairs as I learned it’s a VERY serious disease. And re: the less serious fad diets, I think the key thing is au pairs DO become role models to our children, so we have to be on alert for those behaviors that we don’t want our children to copy and unhealthy eating habits is one of them (thank you Jamie Oliver!)

Janet March 26, 2010 at 2:56 pm

One of our au pair’s had the same problem with “exercise bulimia” and sadly my oldest step daughter had the same issue. I’d add that the girls who do this are often high achievers, and they do it as a way of being in control of themselves. We intervened with my step-daughter very early, but she relapses when she is under high stress like at finals.

Some other signs we have seen include eating a lot of raw vegetables and air-popped / un-buttered popcorn for all meals.

NJM March 26, 2010 at 7:34 pm

Unfortunately, our very first au pair had a major eating disorder, and we reached out to our totally unhelpful and unresponsive LCC (and program director) several times to no avail. The situation came to a head when the AP passed out while on duty–thankfully, I was working at home at the time–and was taken by ambulance to the ER.

Even after that incident, our now former (notice I said “former”) agency refused to acknowledge that there was a massive problem. We decided to try to give the au pair a few weeks more to go see a doctor, a counselor, etc.–and she refused. She wound up going underground; she quit in the middle of a shift and was picked up by some “friend”, and apparently is still in the US. (The LCC never intervened or made any attempt to contact her after this young woman left our house.)

In retrospect, I wish we’d been more proactive in getting that AP to a professional or, frankly, in demanding a rematch. (She lasted with us 4 months.) That might sound really cold, but we signed up with the expectation of welcoming a reasonably healthy and attentive AP into our home and life, not to try to counsel a young lady with a very serious condition who was in no way ready to be part of the AP program.

I wish that all the agencies were more attentive to this very real issue–it seems as if our first agency had absolutely no experience or readiness in dealing with au pairs suffering from eating disorders.

KM March 26, 2010 at 9:04 pm

After reading the posts, I wonder how an agency could do a better job at screening applicants for eating disorders? Should they follow au pair applicants? Have them trailed by a detective? Follow them to the bathroom? Offer them a meal during the interview? If families “suspect” an eating disorder when an au pair is living in their home, it shows how difficult it is to catch.

Does the agency provide a medical/physical report signed by a physician? It should include information about health history. Not a guarantee but another piece of information for families.

Once a family expresses concern, it’s important their agency assists them toward some resolution. Some families will try to help the au pair, others may want to rematch. Agencies may have limitations as well. And hey, sometimes it’s a host mom with an eating disorder. Eating disorders should probably be handled on a case-by-case basis.

There are some great ideas posted.

formeraupair April 18, 2010 at 11:11 am

Regarding your question if applicants need a sign formed by a physician that says that do not have an eating disorder: they do need that for their aplication to be accepted.

Darthastewart April 18, 2010 at 2:05 pm

I still think it’s very difficult for a doctor to know that someone – anyone- has an eating disorder. The difficulty in diagnosing is mindboggling.

maleaupairmommy March 27, 2010 at 12:02 am

Well As my title states I’m an au pair mommy of males. Guess what my last au pair I had the same problem and I was dense as I was not looking for it. It wasn’t unitl we found puck rements on the toilet bowel that I become “aware”. It was pure acciden’t we found it and thought it was one of the kids and they were sick we had been out on a date. When we confronted him he ho hum around a bit than finally admitted it was him. We asked him if he was okay or sick. He say no I’m not sick and I ask him why he threw up and he didn’t answer me than I got and just let it go. Slowly I saw the signs but he was such an excellent au pair that I didn’t push it he was almost 23 and felt helpless on how to deal with. It made it hard as I felt he was part of our family but at the same time wasn’t. He could get super moody mostly on his off time so I didn’t want to push it. THe more Ipush things the quieter he would get and not answer. Same problem when I asked about going home. Don’t talk about, Dont think about it it ain’t happening I guess. I’m glad we are talking about this as I felt hopeless and since I had no absoulute proof felt I couldn’t talk with the LCC about it or him.

Anonymous March 27, 2010 at 4:58 pm

I had an aupair who seemed to me to clearly suffer from anorexia and/or bulimia. She refused to see a physician who was a psychiatrist but did go to a primary care physician who gave her a clean bill of health. She went into rematch and told folks that she was not happy with her family. When asked, I told families that I thought she had an eating disorder. It was a revelation to me how many families said frankly that they weren’t put off by that. She had people fighting over her. All addicts are very good at hiding addictions and I have yet to meet an active addict who admits to the addiction up front. I never heard one word of negative feedback on that aupair who rematched. In my mind, there is absolutely no question that she had an eating disorder and was trying the geographic cure. She may have worked harder at controlling or disguising the problem. Plenty of people practice an addiction for years and years undetected.

Darthastewart March 28, 2010 at 5:52 pm

I think that I would not match with an au-pair with a suspected eating disorder, period. After my experience with my last au-pair, I saw just how disruptive the whole thing was to my entire family, and have no desire to repeat that experience.

Angie March 29, 2010 at 4:38 am

We’ve been lucky, no eating disorders yet. The au pairs who have gained pounds here with us have lost them, we’ve helped them set realistic weight loss expectations and done education about what works and what doesn’t. Eating disorders are less about weight and more about addiction, I think, we’ve avoided them by luck more than by skill.

Calif Mom March 29, 2010 at 9:06 am

http://www.nytimes.com/2009/07/19/magazine/19bruni-t.html

Here’s an autobiographical account of NYT food critic Frank Bruni’s struggle with bulimia. As host of male APs showed, eating disorders aren’t just for girls!

This is definitely not something you can solve on your own with a couple conversations if you suspect your AP has a problem. It’s not about education or modeling better eating behavior (though those won’t hurt, they likely won’t help either). It’s a psychiatric condition that needs medical care from a team of caregivers. Honestly, I’d involve the agency — it’s not about “proof” because that makes it sound like an accusation of weakness or moral corruption, rather than an observation of a serious health issue.

Anna March 29, 2010 at 9:06 am

Eating disorder IS a mental illness.
I am suprised that it appears some agencies and LCCs are soft on that and don’t send her home immediately. Aren’t we promised a thorough health screening and psychological test that is supposed to weed out such issues? Then if the issue surfaces, it is the agency’s fault, the fault of their process (I know it is hard to catch, but still) – they should be quick to take care of it.

HRHM March 29, 2010 at 10:08 am

And, please don’t let the agency lure you beleiving that this can be treated while she is here, like a cold or something. More often than not, this requires intensive inpatient therapy or close family monitoring with VERY frequent visits if treated as an outpatient. If you choose to address it, she should likely be returning home, since I doubt the travel insurance is going to cover any of this and you sure as heck don’t want to deal with the home aspects. (monitoring meals, giving time off for appointments, etc)

Anonymous March 29, 2010 at 5:02 pm

I agree that an eating disorder is a mental illness and cannot be treated while someone is here. However, I think it is also progressive and can be disguised sometimes for quite a while. As a host parent, I would not be too interested in executing justice by sending her home. I would simply tell the agency what I suspected and state that we are incompatible and therefore want to rematch. I think there are probably legal issues involved in accusing someone of something unprovable in many cases. I had an aupair once whose friend insisted that her host mother was an alcoholic. How could anyone prove that ? Many of these things are judgement calls.
The associated behaviors in addictions are often as hard to live with as the disease itself. I suggest telling the agency what you believe to be the truth and then say ” we are incompatible. we need to rematch” . It is the agencies’ moral and legal obligation to tell the next family the truth or send her home. Suppose some aupair deceided that one of us should be dropped from the program for some reason ?

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