Eating Disorders and Nutrition News

Hear Dr. Marcia Herrin on the Maudsley Method for Eating Disorders

2008-08-14T20:25:03-07:00

Dr. Herrin has been invited to discuss Maudsley-inspired techniques for putting parents in charge of their eating disordered child’s food behavior at several upcoming conferences.

Sept. 18-20, 2008 in Austin, Texas @ National NEDA Conference. This conference is designed for individuals living with an eating disorder, a family members or friends looking to offer support to a loved one, or treatment professionals looking to help others.

Nov. 13-16, 2008, Renfrew Center Conference for Professionals. @ Philadelphia Airport Marriott. This conference also features Jane Fonda!

Sending Your Recovering Child To College

2008-08-07T16:06:09-07:00

This is that time of year when parents call me for advice on sending their eating-disordered child off to college for the first time. I’m always reminded how important it is that parents make sure that a good tight system is in place for their recovering young college students. As much as we would like to turn treatment and monitoring over to the college, the truth is that colleges rarely get involved until students are in serious enough trouble to worry roommates, professors, and residential life staff.

I just got off the phone with Leigh. She is the mother of Simone, who is going off to her freshman year in college in a few weeks. Leigh called the school last week, leaving a message saying that she wanted to know what resources the college had on campus that would support Simone’s continued recovery from purging anorexia. Leigh had called me because she was frustrated she hadn’t heard back from the health center and worried the college would not be aggressive enough with treatment to keep Simone’s recovery on track.
I told Leigh that most colleges are not going to insist on treatment for incoming students, but they can do weight checks and many have counseling departments and even nutritionists. As Simone’s parent, Leigh will have to be the one to insist that Simone arrange for the weekly weight checks and check out the counseling and nutrition resources. In Simone’s case, Leigh is going to have the health center fax weekly weights to me. Simone and I have planned to continue treatment over videocam unless she finds a nutritionist to work with on campus.
It’s a good idea to talk over the transition to college with your child’s nutritionist or doctor and coordinate ongoing care with your child’s college health care center. Your goal is to not have anything fall between the cracks where treatment is concerned. Starting college is stressful under any circumstances, so try to make the transition in treatment as seamless and well-planned out as possible.
Marcia

Eating disorders and the Olympics

2008-08-01T10:45:08-07:00

As the 2008 Summer Olympics are about to begin in Beijing, it’s a good time to reflect on the role eating disorders have played among Olympians and other elite athletes.

Perfectionism, the desire to please, and a fierce work ethic are among those traits essential to the making of an Olympian. They are also among the most common characteristics of the classic anorexic. It’s no surprise, then, that elite athletes are especially vulnerable to eating disorders, especially when the athlete’s specialty falls into the category of so-called “thinness-demand sports,” which call for maintaining a low weight. Included among these high-risk sports are gymnastics, wrestling, rowing and cycling, all of which are summer Olympic sports.

The link between athletics and eating disorders was underscored in a study published this month in the International Journal of Eating Disorders, which found that university undergraduate women who actively participate in sports are more vulnerable to eating disorders than those who don’t regularly exercise. The higher the anxiety about sports or exercise-related performance, the more likely these women were to experience eating disorder symptoms and body dissatisfaction.

Nadia Comaneci and Kathy Rigby both suffered from eating disorders, as did USA tennis player and two-time Olympic medalist Zina Garrison. German Olympic rower Bahne Rabe’s eating disorder reportedly killed him at age 37 in 2001.

In her recently published memoir Chalked Up: Inside Elite Gymnastics, Merciless Coaching, Overzealous Parents, Eating Disorders, and Elusive Olympics Dreams (William Morrow), author Jennifer Sey describes her path to becoming the 1986 U.S. national gymnastics champion. Comments from coaches such as “I don’t coach fat gymnasts” turned her into a self-punishing anorexic who kept her weight down through a steady diet of laxatives. Sey didn’t make it to the 1988 Olympic team even though her mother, whose whole life had been devoted to grooming a champion, promised, “I won’t let you eat, I’ll lock the cabinets,” and said, “You’re not going to throw this away after all the time and money we’ve spent.”

Another example: On July 28, world women’s cycling champion Marta Bastianelli tested positive for a banned stimulant during a qualifying competition for the Olympic Games. Bastianelli claimed that the substance identified was not a performance-enhancing drug but part of a mix of herbs a naturopath had prescribed to help her lose weight. After a bit of unplanned weight gain, Bastianelli had been advised by her Italian cycling team coaches that she needed to lose weight.

The takeaway lesson for parents here is that sports, especially when practiced in a highly competitive and pressured environment, put a child or adult (especially one who is genetically susceptible) at risk for an eating disorder. Be vigilant and make sure your child’s coach is not making overt comments about weight, shape or size. As Jennifer Sey, who now suffers from the physical effects of her long-term eating disorder, found out, pursuing a sport at the risk of your health is just not worth it.

Take care,

Marcia & Nancy

Check out Our Los Angeles Times Op-Ed: “Starved for Adequate Care”

2008-06-28T21:21:03-07:00

Dear Readers,

There is an interesting court case about to start in Los Angeles involving the parents of a 26-year-old anorexic, Janell Smith, who committed suicide after her insurance company cut off coverage for her hospitalization. It’s amazing how this is still happening, and how insurance companies are still getting away with it.

Marcia and I, along with the esteemed David Herzog, M.D., who besides teaching psychiatry at Harvard Medical School, heads the Harris Center for Advocacy in Eating Disorders at Massachusetts General Hospital, wrote this op-ed piece on the court case, published in today’s Los Angeles Times.

We’d love to hear any of your eating disorder-related health insurance stories.

Take care,

Nancy

At What Age Should You Start Worrying About Your Child's Weight?

2008-06-17T06:47:31-07:00

Dear Readers,

The issue of rising obesity among young children has been a difficult one for those in the eating disorder field. Yes, the increase has been frightening, and something should be done about it. But the fear is that approaching the problem too zealously, or without giving a child the right information and tools to manage weight, well-meaning parents and health care professionals could be putting the child at risk for an eating disorder as she or he grows up.

I saw this issue addressed again recently in a June 10 article in The Wall Street Journal, “The War on Obesity Targets Toddlers.” The article discussed parents of mere 3-year-olds who were informed their toddler was overweight and told something needed to be done. Hospitals and clinics, in turn, have duly responded to this “crisis.”

The Cincinnati Children’s Hospital Medical Center, for instance, reports the Journal, now has a weight-management group for 2- to 5-year-olds, and there are a number of pre-school programs across the nation aimed at increasing physical activity for both overweight and normal-weight kids.

Here’s Marcia’s reaction to this trend of labeling younger and younger kids as obese and trying to teach them better eating and exercise habits: “These kinds of programs do make me nervous, but I am aware that research has been done showing that good weight loss programs for children and teens don’t cause eating disorders.”

One counter-argument comes from a University of Minnesota study published this year that found that when parents correctly realized that their child was overweight they tended to simply put their kids on a diet. We know that this strategy does not work, especially for girls, who are more likely to develop body image problems and/or an eating disorder. Of course this Minnesota study targeted adolescents, not 3- and 4-year-olds. Still, the finding that parents tended not to react in a constructive way – offering more fruits and vegetables, fewer high-sugar drinks, snacks and fast foods; cutting down on tv viewing; increasing family meals and exercise, and teaching kids how to make healthful food choices – is likely true for parents of toddlers who are overweight as well.

The key seems to be to make sure that if you are working with a toddler or an older child, you have the proper nutritional supervision as you embark on a weight-loss program. It’s important to remember that your child is still growing, and needs a variety of foods: protein, fats, carbohydrates, fruits and vegetables. The Journal article points out that kids up to about age 5 need a higher percentage of fat in their diet than adults do, as well.

Marcia herself has worked with many overweight children with good success. “What I’ve found is that my patients end up protected from eating disorders because they have learned healthy ways to manage their weight,” she says. “I also talk to kids about body image and genetics AND the dangers of eating disorders.”

Marcia’s advice to parents: “Make sure any weight loss program you enroll your children in addresses these important issues.” A child who knows that weight and size are largely genetically determined, that body acceptance is important to maintaining a stable weight, and that starving oneself can lead to an eating disorder is a child who has a better chance at healthy weight management.

Take care,

Nancy

New Hope for Insurance Coverage

2008-06-05T19:19:39-07:00

Having spent a good part of the day writing reports and requests in my never-ending battle to get insurance companies to cover nutrition treatment for eating disorders, I was heartened to read the news that a lawsuit by parents against Aetna has led this insurance company to improve its coverage for eating disorders. Unfortunately, coverage for nutrition treatment was not included. I am hoping that this development in the first step towards getting decent coverage for eating disorders. I encourage parents and professionals who are fighting insurance company to reference the Aetna lawsuit. Peace, Marcia

Orthorexia revisited

2008-05-28T19:53:24-07:00

Dear Readers,

My freelance writing has taken me lately into research on orthorexia, a topic that Marcia addressed a little while back in one of her posts. Described as a “fixation on righteous eating,” orthorexia is a condition where obsession with eating healthily becomes so extreme that it leaves no room for other interests or activities and can imperil the sufferer’s health.

Sounds familiar, right? Marcia described it as a modern-day variant on anorexia. Another researcher I spoke to sees orthorexia as an amalgam of an eating disorder and its frequent partner condition, obsessive-compulsive disorder (OCD). The term "orthorexia" is not in the Bible of mental illnesses, the DSM (Diagnostic and Statistical Manual of Mental Disorders), so is not recognized by the psychiatric community as an eating disorder or any other type of mental illness. So we are relying on the definition of the man who first coined the term back in 1997, Steven Bratman, M.D., who described what he saw: people not motivated by a desire to lose weight, but by the desire to become as healthy and "pure" as possible.

But once you starting talking to eating disorders professionals who have seen these so-called "orthorexics" first hand, it appears that as Marcia surmised, things aren't so clear cut. Marcia told me, "We're seeing a lof of kids falling into this type of dangerous eating and parents are missing it because it looks like their child is interested in becoming more healthy. Almost always these kids are vegetarian. There are a number of studies about the higher risk of eating disorders among vegetarians, and declaring one is vegetarian often precedes the diagnosis of an eating disorder."

Often, Marcia sees patients like these striving to elevate their vegetarianism into veganism, an even higher level of self-denial.

So can someone who fits the orthorexic profile so clearly also want to lose weight, counter to Dr. Bratman’s definition of the condition?

“I have not seen a young teenager where there isn’t an eating disorder lurking in all this,” declares Marcia. Among adults, she adds, it can be harder to tease out the eating-disordered component in the orthorexia because the “healthy behaviors” are so ingrained in the person’s life that it has become the norm for them.

Marcia often hears the refrain “I didn’t mean to lose all this weight!” from her patients. When she hears this, she always asks herself, “Is the healthy eating/vegetarianism/veganism/raw foodism/ a cover for an eating disorder?" She explains, "It’s hard to find a woman who doesn’t feel reinforced by the culture because she is thin.” I suspect the same goes for many men who suddenly find they are thinner as a result of a new and obsessive interest in “healthy eating.”

Let us know your thoughts on this topic!

Take care,

Nancy

Where Does "I Feel Fat" Come From?

2008-05-05T10:02:47-07:00

Dear Readers,

For those of you who have helped or are helping a loved one battle an eating disorder, one of the most puzzling aspects of these diseases can be the absolute conviction of your loved one that she or he is fat, when in fact they are starving to death, or even on the thin healthy side.

There are so many other behaviors associated with eating disorders that are equally inexplicable: Why does your child feel happier and safer the more his bones stick out, the more he courts cardiac or cerebral damage? Why does she crave the ritual of stuffing herself with junk food until she feels sick and passes out? How can she continue starving and purging when she knows eventually her bones will crumble like bread sticks and her teeth will rot and fall out?

Two eating disorder specialists, Johanna Marie McShane, Ph.D., a psychotherapist, and Tony Paulson, Ph.D., a social worker, have written a book designed to explain these mystery, and in general take you inside the eating-disordered person's head. It's called "Why She Feels Fat: Understanding your Loved One's Eating Disorder and How You Can Help," and it is published by, Gürze Books, the publisher of our book.

This is a great idea. As many of you know from reading our book, family based therapy is now considered the most effective way to treat adolescent eating disorders. Yet as much as parents want to help, often they are held back from being truly effective by their absolute bafflement at how their smart, responsible and loving child has seemingly lost all reason when it comes to food, exercise, shape and size.

McShane and Paulson act as psychological translators, explaining the complex web of emotions that lie beneath exclamations such as “I feel fat,” or “I feel chaotic and out of control.” Eating disorders, they explain can be many, many things: A way to feel secure; a way to make life feel predictable, a means of communicating emotions. They can impart a calming sense of “being in control” for the child who feels his life is entirely out of control. And, as we saw with Dr. David Herzog’s book (see my April 20 post), eating disorders can be a way for the child to prove that she is “good enough,” even as she fears and believes that she isn’t.

Eating disorders, the authors explain, aren’t really about being thin (although the desire to be so, fed by our thin-obsessed culture, can be the launching pad for an eating disorder); they ultimately become a cherished coping mechanism.

After reading this book, I was struck anew by how similar an eating disorder is to a negative and destructive personal relationship. Your child’s world has shrunk to the point where this isolating relationship is all she has in the world. She clings to the relationship, having come to believe that without it, she is nothing.

You may have to fight the fight of your life to extract your child from this destructive relationship, but once you understand the anxieties and fears that lie below all the inexplicable food behaviors, you will have an easier time emphathizing with your child, and a better chance of winning the battle.

Good luck and take care,

Nancy

Are Eating Disorders Contagious? I Don’t Think So!

2008-04-23T18:32:38-07:00

Dear Readers,

A new study of eating disorders among high school students is getting alot of press. Researchers in a study (published in the International Journal of Eating Disorders this month, April 2008) found a small “clustering effect” in female students. This means that girls who live in the same county with girls who either starve, diet, over-exercise, binge, or use diet pills are 4 percent to 10 percent more likely to engage in eating disordered behaviors than if they lived in counties where these behaviors are rare. These results are leading some to conclude that eating disorders are contagious. I worry that too much focus on “contagion” could lead to isolation and discrimination against girls with serious eating disorders.

Let’s not forget that it is well proven in a number of studies that genetics are the strongest factor in causing eating disorders. I am not the first clinician to conclude that genetics “loads the gun;” family issues and social influences can “pull the trigger.”

I suspect that this new study is picking up on girls who are experimenting with eating disordered behaviors because researchers did not look at how many girls in the study actually had clinically significant disorders. As risky as it can be to play around with eating disordered behaviors, most girls who experiment with these behaviors won’t develop an eating disorder unless they are genetically susceptible.

To test whether eating disorders are contagious, this week I asked each of my teenaged patients whether they “caught their eating disorder from someone else.” Each and everyone of them, said absolutely not! I’d like to share some of the points these girls made:

• “My eating disorder was caused by some really serious problems at home, not from peer pressure.”
• “My eating disorder was too personal to be a ‘group thing.’”
• “My school had strong cliques, I remember thinking that being thin would make me more popular.”
• “I admired older girls in my school who had eating disorders, but they never talked about or shared what their ‘techniques’ were.”
• “I got my eating disorder really young and I still struggle in college. It was really hard for me when other parents would blame me for causing their kid’s eating disorder. I remember that I wasn’t allowed to play with some girls for fear that I would “infect them.” I also remember how sad this made me feel.”

The researchers of this new study argue that prevention and treatment efforts should be targeted not at individuals but at schools and other geographic communities. I urge us all to treat girls with eating disorders as individuals. Each of these girls has a personal story and their own particular pain. Each of them deserves individual attention and a treatment program tailored to their particular situation.
Peace, Marcia Herrin

French and British Politicians Make Eating Disorder Headlines

2008-04-20T20:54:51-07:00

Dear Readers,

This week has had interesting reports from Europe. First, France is considering legislation that would make promoting eating disorders a crime punishable by fines and imprisonment. Though it is hard to imagine how one could prove that this website or that diet caused an eating disorder, but nevertheless, it is a good sign that the French are beginning to take eating disorders seriously.

Today, I read that Britain’s former deputy prime minister has secretly struggled with bulimia for decades. What amazed me the most was how well this 69 year-old man described his bulimia. He said that his binge eating became a tactic for coping with stress from overwork. CNN at http://edition.cnn.com/2008/WORLD/europe/04/20/prescott.bulimia.ap/index.html quotes Mr. Prescott as saying “It became my main pleasure, having access to my comfort food. So what I did was stuff my face with anything around….there would be a weird kind of pleasure in vomiting and feeling relieved.”

Since eating disorders are as big of a problem in most of Western Europe as in the United States, it is a good sign when they are openly discussed by people involved in politics.

Peace, Marcia