text: [Themes: edutainment, socially important, serious]
  
  Welcome!
  
  This game is designed to be a first player simulation that centers around eating disorder awareness. Thus, the following links will provide information on symptoms, medical consequences, treatments, etc. in relation to eating disorders. Please note that the information provided is general, describing known observations and in no way is direct representation of a patient suffering from an eating disorder. That being said, the progression through the game should be taken as a virtual simulation to discover the processes and choices that someone with an eating disorder could possibly encounter.
  
  [Author's Note: This is an interactive game that is meant to spread awareness of eating disorders by educating players of the symptoms, treatments, and consequences associated with an eating disorder. Players will play as a generalized schematic of a patient.]
  
  > What do you believe your diagnosis to be?
  Before you go on you should learn a bit more about eating disorders. Please select the first choice.
  
  If you have already done so, proceed with the rest of the simulation.
  
  > Don't have an eating disorder
  Although not always the case, sometimes individuals will deny that they exhibit symptoms that align with a diagnosis for an eating disorder. Beliefs may arise that one's dietary habits may not produce any serious consequences, but this thought process can prove to be fatal.
  
  The next page will cover the medical complications and consequences that can come from having an eating disorder. When one is under the effects of an eating disorder, not only are physical appearances in relation to weight reflected (ie. looking thin, large, etc.), the entire body suffers from the consequences of improper dietary health.
  
  > Medical Complications
  Most medical complications of eating disorders can be helped, but there are some complication that can't be fixed.
  
  Skin:
  
  Signs of irregularity in the dermatology of someone suffering from an eating disorder includes: "xerosis (dry, scaly skin), lanugo-like body hair (fine, downy dark hair on the back, abdomen, and forearms), telogen effluvium (hair loss and a positive 'hair pull test'), acne, carotenoderma (carotene deposition in the tissues and yellowing of the skin because of excess ingestion of carotenoid-rich vegtables), acrocyanosis (circulatory changes resulting in cold, blue, and occasionally sweaty hands or feet), pruritis, purpura (caused by thrombocytopenia), stomatitis, and nail dystrophy."
  
  Cardiovascular system:
  
  The heart is noticeably affected as well, causing problems such as poor circulation, slowing of heart rate, and thinning of the heart's walls. Other problems concerning that heart that may occur include poor circulation of the cardiovascular system, abnormal electric rhythm of the heart, and difficulty in accommodating changes in position (sitting up to lying down). As one of the most important organs in the body, the complications of the heart are quite serious and knowing these medical consequences is imperative that the first step in treatment is getting the patient to eat and back to a target weight.
  
  Skeletal System:
  
  Individuals who are affected by an eating disorder experience nutritional and hormonal problems that negatively impact bone density. Particularly in females, having a low body weight causes the body to stop producing estrogen, resulting in a condition known as amenorrhea (absent menstrual period). Low estrogen levels also play a factor in bone density loss. As well, individuals with anorexia can produce excessive amounts of adrenal hormone cortisol, which is known to cause bone loss. Other issues that may occur include calcium deficiency, malnutrition, and osteoporosis.
  
  Source: (http://www.niams.nih.gov/health_info/bone/osteoporosis/conditions_behaviors/anorexia_nervosa.asp)
  
  Metabolism:
  
  Eating disorder medical complications affect the composition of the body's regulation and alters the individual's ability to properly process normal bodily functions. For example, individuals suffering from anorexia often have body temperatures that are much lower than normal. Other complications that are associated include increased blood pressure, insulin resistance, and reduction of the metabolic rate.
  
  The reality of the situation is this: Eating disorders are fatal if not taken seriously and/or treated. The following statistics highlight this fact.
  
  Anorexia Nervosa (AN): 20% attempt suicide; up to 4% commit suicide
  
  Bulimia Nervosa: 35% attempt suicide; Actual suicide rates are no higher than non-BN population
  
  AN has the highest mortality rate of any psychiatric disorder
  
  For females 15-24 years old with AN, mortality rate is 12x higher than death rate of all causes of death.
  
  5.1 deaths per 1000 people with AN per year; 1.7 deaths per 1000 with BN
  
  Alcohol and other substance abuse disorders 4x more common in ED than in general population
  
  AN and BN have high rates of disability and tend to be a significant burden to carers, and healthcare funders.
  
  For more on statistics visit --> http://www.nationaleatingdisorders.org/mortality-and-eating-disorders
  
  Source: Medical Complications of Anorexia Nervosa and Bulimia Nervosa
  
  > understand, but you don't have an eating disorder
  One of the concepts that was constantly emphasized in the lectures was that overcoming an eating disorder was not a matter of using one's "will power" because the changes that occur when one is affected by an eating disorder are on a biological level as well. Thus, there are some individuals that choose not to acknowledge that they may be suffering from a disorder due to fear or stigma or because they believe that they are in control of the situation.
  
  As a result, these individuals may choose to resort to secretive behavior, hiding their eating disorder routines in order to evade treatment or alarming those who care about them. Understanding this mindset is important to not only health care providers, but also to close family and friends who are concerned that someone close to them is affected by an eating disorder. This next section will cover some indicators of this behavior and how to approach the situation.
  
  > Secrecy and Eating Disorders
  Individuals affected by an eating disorder often attempt to keep their thoughts and behaviors a secret from others. There are a number of reasons why an individual would choose to do including:
  
  Not realising that they have a problem
  
  Being worried about what other people will think
  
  Being concerned that others will try to stop them
  
  People may think that they are protecting other people's feelings by not telling them.
  
  How to talk to someone about their eating disorder
  
  Be careful to avoid critical or accusatory statements, as this will only make your friend or family member defensive. Instead, focus on the specific behaviors that worry you.
  
  Focus on feelings and relationships, not on weight and food. Share your memories of specific times when you felt concerned about the person's eating behavior. Explain that you think these things may indicate that there could be a problem that needs professional help.
  
  Tell them you are concerned about their health, but respect their privacy. Eating disorders are often a cry for help, and the individual will appreciate knowing that you are concerned.
  
  Do not comment on how they look. The person is already too aware of their body. Even if you are trying to compliment them, comments about weight or appearance only reinforce their obsession with body image and weight.
  
  Make sure you do not convey any fat prejudice, or reinforce their desire to be thin. If they say they feel fat or want to lose weight, don't say "You're not fat." Instead, suggest they explore their fears about being fat, and what they think they can achieve by being thin.
  
  Avoid power struggles about eating. Do not demand that they change. Do not criticize their eating habits. People with eating disorders are trying to be in control. They don't feel in control of their life. Trying to trick or force them to eat can make things worse.
  
  Avoid placing shame, blame, or guilt on the person regarding their actions or attitudes. Do not use accusatory "you" statements like, "You just need to eat." Or, "You are acting irresponsibly." Instead, use "I" statements. For example: "I'm concerned about you because you refuse to eat breakfast or lunch." Or, "It makes me afraid to hear you vomiting."
  
  Avoid giving simple solutions. For example, "If you'd just stop, then everything would be fine!"
  
  [Adapted from: National Eating Disorder Information Center and National Eating Disorders Association]
  
  Sources: http://www.healthtalk.org/young-peoples-experiences/eating-disorders/secrecy-and-eating-disorders
  
  http://www.helpguide.org/articles/eating-disorders/helping-someone-with-an-eating-disorder.htm
  
  > No really, you're fine.
  Even though you may not be affected by an eating disorder, you may encounter someone close to you that may suffer from an eating disorder.
  
  ED stats: A public health crisis
  
  AN affects ~1% of women and BN affects ~1-3% of women
  
  Up to 24 million people in the U.S. suffer from an ED (AN, BN, BED)
  
  AN and BN have substantial and costly medical morbidity
  
  ED receives inadequate research funding. Research dollars spent per affected ED individual was $0.93 (NIH, 2011) compared to $88/Alzheimer's disease patient, $81/Schizophrenia patient, and $44/Autism patient
  
  Sources: Week 2
  
  > The Bigger Picture
  By now you've either gone through two paths to come to this page.
  
  1) You've gone through the simulation as someone who has not experienced an eating disorder
  
  2) You've gone through the simulation as someone who's gone through treatment for an eating disorder
  
  Learning about eating disorders is important, not only because of the medical complications (which you may have learned about if you attempted to leave treatment) but because of the neurobiology chemistry and social effects that affect both people with eating disorders and people without eating disorders.
  
  > You've learned a lot about eating disorders, what do you do now?
  For more information please check out sites such as:
  
  http://www.nationaleatingdisorders.org/find-help-support
  
  Thanks for doing this simulation.