Eating Disorders News by Marcia Herrin and Nancy Matsumoto

Two new eating disorders films

Dear Readers,

                I’m just back from viewing two very good new films about eating disorders that I would like to recommend to you. Swept is a short film about a brother visiting his sister while she is in a residential treatment center for an eating disorder.  Beauty Mark is a documentary about former champion tri-athlete Diane Israel, whose obsessive drive for athletic perfection, eating disorder and work as a psychotherapist led her on a journey to understand the drive for physical perfection at any cost that lies at the bottom of so many eating disorders. Both of these films were part of a National Eating Disorders Awareness Week event at Pace University in New York City, sponsored by NEDA (the National Eating Disorders Association).

              Swept depicts a difficult confrontation between an anorexic and her brother. The sister, in typical anorexic fashion pushes away food, connection with others, even an expression of love and concern by her own brother. Hints of parental discord, of family problems being “swept” under the carpet (hence the title) point to possible factors in the disorder, and the sister’s distaste at becoming a ‘project” for her well-meaning brother may seem familiar to some of you.

                Some of Beauty Mark too, will make those of you battling eating-disorders cringe with recognition: the frenzied spinning class, led by a former body builder who tearfully admits she hates her body, the male tri-athlete whose obsessive exercise leads to hospitalization, where he bench-presses his bed.  Israel is a compelling guide, leading the viewer on a tour of these driven athletes, through her own lifelong quest for approval and perfection, and through interviews with various experts. She even visits a seriously burned and disfigured mother and son who have learned the hard way that beauty is more than just skin deep.

                Moderator Sondra Kronberg, a nutritionist and well-known lecturer on eating disorders, offered these insights:

·         Eating disorders are not about food, but involve food.

·         An eating disorder is a creative adaption for survival

·         “I’m not good enough,” is a feeling that is a running theme one encounters among those battling eating disorders

Take care,

Nancy

Dear Readers,

                In the past two days, two interesting diet/nutrition stories have appeared in the media that confirm what Marcia and I have been saying for years now. The first was the release yesterday of the results of a study published in The New England Journal of Medicine. Researchers found that when it comes to dieting, it’s not so much what kind of diet you choose, it’s the total number of calories consumed that determines whether or not you lose weight. Researcher put 811 people living in Boston and Baton Rouge on four different diets emphasizing various proportions of fat, protein and carbs. Each diet cut about 750 calories from participant’s normal daily intake. At the end of two years, all of them lost (and regained) similar amounts of weight.

                These finding are totally consistent our Food Plan, which does not emphasize lowering fat, carbs or protein, but includes a serving size of each in lunch and dinner, and makes carbs a must for breakfast (you need the energy to get going in the morning!) and protein and fat optional.

                The gist of the second story, What’s Eating Our Kids? Fears About ‘Bad’ Foods, which appeared in today’s New York Times, is that more and more kids are developing phobias about eating certain kinds of foods.  Usually these fears stem from parents who give them the message that certain foods are unhealthy, bad, or dangerous to their health. Examples include kids who will only eat organic foods, or won’t eat sugar or are afraid of salt. As we tell readers in The Parent’s Guide to Eating Disorders,  there are no “good” foods and no “bad” foods, and acting as though there are can set up genetically predisposed kids for an eating disorder. In fact, Marcia often gives patients the assignment of learning to eat one of their “fear foods.” If a bulimic child is petrified that eating one brownie will lead to bingeing, then she must learn to eat that one brownie for snack or dessert. It’s a scary process, but can be done, and will result in a much happier child. I see people both young and old, who are battling the effects of the good-food-bad-food thinking that is so pervasive these days.

                This story reminded me of the time my son came home telling me that according to a film he had seen at school, a cheeseburger and french fries were "whoa" foods (as opposed to “go” foods), and so maybe he had better stop eating them. You may not want to encourage your child to make these foods a daily staple, but on the other hand, do you really want your kid to go through life feeling like a criminal if he bites into a burger, or drinks a milkshake? So, bottom line: don’t demonize any food. There’s a place at the table for all of them, in proportions that you can help your child determine.

Take care,

Nancy

Fighting for better care for eating disorders

Dear Readers,

                It’s wonderful to see my inbox flooded with events across the country planned in conjunction with National Eating Disorders Awareness Week. This is the week that eating disorders advocates pull out all the stops, mount their biggest outreach campaigns of the year, and for a brief week, manage to grab a slice of the public’s fragmented attention.

                The tireless support and advocacy organization NEDA (National Eating Disorders Association), for example, has capitalized on its week in the spotlight by announcing what it calls the STAR Program, (States forTreatment Access and Research), a nationwide effort to promote patient rights and treatment access. NEDA has taken the war against eating disorders to state capitols, introducing into state legislatures a worldwide charter developed by the Academy for Eating Disorders, which advocates for eating disorder patient rights.  With the charter as a guide, the goal of the STAR program is to get local legislators on board the fight to give eating disorder patients and their families equal access to medical care and overturning unfair insurance company practices through legislative lobbying.

                So far, NEDA has signed up volunteers from 31 states. State leaders are given step-by-step training in how to wage a successful charter launch campaign. This is grass-roots activism at its best. I’ve signed on as an individual supporter of the charter, and you can too, by clicking here.

Take care,

Nancy

Deciphering the alphabet soup of E.D. treatment options

Dear Readers,

 

         Those of you who have spent any time reading self-help books or treatment guides have probably come across mention of different psychological approaches used to treat eating disorders such as CBT, DBT, or ACT. We’d like to take some time to decipher this alphabet soup of options. Before we do, however, it’s important to remember that more important than techniques or methods is that you (or your loved one) develop a rapport and a working relationship with an experienced, competent psychotherapist. What matters most is that all involved feel confident the professional can be of help.

         Cognitive Behavioral Therapy (CBT) has been the most studied of the three forms of treatment we’ll discuss here. Many CBT techniques have become part of the standard repertoire of both psychotherapists and nutritionists treating eating disorders. CBT is based on the idea that you can change negative behaviors by changing your way of thinking. By examining your negative thought processes and correcting them, or changing the cognitive errors that give rise to those thoughts, you can alter or eliminate negative behaviors. A bulimic, for example, would learn how to recognize problematic thoughts such as “I am fat,” or “I feel fat.” She would work on changing her thoughts to more reasonable ones, such as “I can’t be fat since others see me as thin.” Seems so simple, but it works.

          Using food records or diaries to record what you eat and how you feel about it is classic CBT. If you never eat breakfast, a therapist using CBT might encourage you to have breakfast every morning while paying attention to how this affects your eating, energy, or mood later in the day. The book Overcoming Your Eating Disorder: A Cognitive-Behavioral Therapy Approach for Bulimia Nervosa and Binge-Eating Disorder by W. Stuart Agras and Robin Apple is one example of a workbook that is based on CBT techniques.

         Dialectical behavioral therapy (DBT) teaches healthier ways to handle painful emotions by recognizing and accepting feelings without judging them as “good” or “bad.” A therapist would teach you mindfulness skills to help you recognize when you are hungry or when you feel full. Your therapist might teach you to use breathing or relaxation exercises, to take an emotional timeout, or find a healthy distraction to keep you from engaging in eating-disordered behaviors. One DBT exercise is the “raisin mediation.” While slowly eating one raisin, the patient is asked to pay attention to the experience of eating the raisin, to any feelings of hunger or fullness, and to thoughts or emotions about eating. These guided food meditations move on to include foods like chocolate cake, cheese, crackers, then whole meals. The DBT workbooks on the market aren’t just focused on eating-disordered behaviors but can be helpful nevertheless. One example is Dialectical Behavior Therapy Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance by Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley.

         Acceptance and Commitment Therapy (ACT) is a newer approach to treating eating disorders but lacks the solid underpinning of research that anchors CBT and DBT. In ACT, a therapist might work with you on developing a deeper sense of “what really matters in life" for you, beyond just weight control. You would be challenged to take action so that you live in a way that is consistent with your core values. For example, if you value being a good student, then eating well and maintaining a healthy weight are both necessary for you to have the energy to study hard and retain information.

          One example of an ACT-focused book is The Anorexia Workbook: How to Accept Yourself, Heal Your Suffering, and Reclaim Your Life by Michelle Heffner, Georg H. Eifert, and Steven C. Hayes.

         You will notice that these approaches have much in common. They all require open and honest collaboration between you and your clinician.  Many therapists Marcia works with draw from all of these approaches, though you may notice that therapists who work at medical institutions are more likely to use one single approach.

            If nothing else, we hope this little primer has made the alphabet soup of treatment types a little less daunting.

 

Take care,

Marcia and Nancy