Eating Disorders and Nutrition News

Labs say you're fine, doctor says you're sick: What's going on?

Dear Readers,

                What are parents to do when they're pretty sure their child has an eating disorder yet all lab tests and the usual medical markers of health come back within normal ranges?

                This is a situation that Marcia sees a lot, most recently in the case of a young college-aged patient. The student reported that although she knew she had an eating disorder, she was told by her doctor that her labs, weight, blood pressure and heart rate were all fine. The girl and her parents were left baffled and confused.

                The same thing happened to Marcia as a young girl of 15 struggling with anorexia. In our book, we relate the story of the time when Marcia's grandmother, who was worried about Marcia's plummeting weight, took her to see their family doctor. He found no cause for alarm, despite the fact that Marcia was five-foot-six inches and 100 pounds. "He recommended that I put olive oil in my dry and brittle hair," recalls Marcia, "when he should have told me to add the olive oil to my food."

                Even though doctors are far more educated today about the hazards of eating disorders than they were when Marcia was a teen (an extreme case like hers would most likely be noticed by even an obtuse doctor now), eating disorders are still often missed. Patient and family are eager to accept this poor but reassuring advice; after all they don't really want to admit that there is a problem. The professional in the white lab coat is giving them permission to look the other way, and it's just too convenient sometimes.

                The reason this scenario -- normal lab results despite clear-cut anorexia – occurs so often­ is that the body works very hard and very effectively to compensate for starvation. The ups and downs of human evolution have ensured that the body is well-adapted to surviving famine. Usually labs will stay normal until the patient is in very serious medical trouble, and then things go downhill so fast families have no time to process what is happening.

      In the recent case of the young college-aged girl, Marcia advised her and her parents that it was vitally important to treat her eating-disordered behaviors regardless of her normal lab results. Marcia also referred the patient to a doctor who specializes in eating disorders, someone she knew would use the misleading lab results to educate their patient about the dire consequences of an untreated eating disorders.

 

Take care, and for parents, stay vigilant,

Marcia and Nancy

Intensive short-term family treatment for anorexia: a solution to inadequate medical coverage?

Dear Readers:

The Los Angeles Times published a story and audio slide show recently, Starved for Normality about a 39-year-old man living in Orange County, CA who has suffered from anorexia for the past 12 years. At 5'- 9" and 82 pounds, he is at high risk for dying of starvation, yet he is unable to get the kind of long-term residential care he and his doctors believe he needs to get well from the state Medicaid program that he depends on.

Unfortunately, the story does not touch on the equally grim travails of eating disorder patients with private health insurance, or the growing body of scientific evidence detailing the genetic and neurobiologic causes of anorexia and other eating disorders. It does not challenge the common misperception that eating disorders are the consequence of a frivilous susceptibility to America's diet-obsessed culture. Based on what we know today, refusing to treat eating disorders is equivalent to refusing to treat schizophrenia or cancer, diseases that patients were unfortunate enough to be genetically susceptible to, through no fault of their own.

Still, I noticed the story because I recently spoke with Dr. Walter Kaye and advanced doctoral candidate Roxanne Rockwell at UCSD's Eating Disorder Research and Treatment Program . They described the very high rate of success they were having with a five-day intensive family outpatient therapy program for adolescents with anorexia. Since November 2006, the program has treated 25 families, with patients ranging from ages 10 to 18. These patients had body-mass indexes (BMI) ranging from 13 to 21, meaning that on average they were severely underweight. The amazing thing is that followup checks, ranging from three months to two years after treatment, have been very positive, with patients maintaining a BMI of 19.5. And this is with little to no followup treatment. 

The program consists of a mix of family based techniques, such as coached family meals (where therapists show parents how to suport their anorexic child during mealtimes, invariably the most difficult time of day for an anorexic); psychoeducational sessions (where families learn about what causes eating disorders, why they should not blame each other or themselves for the illness, and how to separate their child from the anorexia that is controlling them), and behavior modification techniques.

One of the best indicators of the program's early success is that the last patient to enter the program, according to Rockwell, was referred by the family's health insurer. The child had been hospitalized once to no avail, and her insurer had paid for four other hospitalizations of patients who did not improve until attending the UCSD five-day intensive program. From the insurer's point of view, if a five-day intensive outpatient program could turn around what much longer inpatient programs had not been able to, they were willing to foot the bill.

Sadly, Bryan Bixler, the subject of the L.A. Times article, who lives within driving distance of UCSD and has a degree from that institution, is so far ineligible for this program, although the staff there would like to one day be able to treat older patients. Yet the work of Dr. Kaye and his team may show the way to a shorter, less costly and highly effective type of treatment that would prevent tragic insurance stories like Bryan's, or the story of Janell Smith, which we wrote about in this Los Angeles Times op-ed piece. 

Marcia and I will be writing a longer piece on the topic of the latest in family based therapy techniques in an upcoming issue of  the newsletter Eating Disorders Recovery Today ,  so stay tuned.

Take care,

Nancy