Eating Disorders News by Marcia Herrin and Nancy Matsumoto

One way to find a Good Nutritionist

I am asked often by parents across the country for help in finding a local nutritionist who is an expert in eating disorders. A new organization of which I am a member, the International Federation of Eating Disorder Dietitians (IFEDD), provides just such a service. Parents and others can go to IFEDD website for a list of nutrition providers in the US and across the world.

I also suggest that parents ask their doctor and/or therapist for the names of good nutrtionists. Usually qualified and effective professionals are well known in their local communities.

Let me use this opportunity to tell you a little more about IFEDD. We lobby to increase insurance coverage for nutrition services which is a major problem in many states. IFEDD is also collecting published research on the effectiveness of eating disordered-specialized nutritionists. Nutritionists who belong to IFEDD can use these references when they make a case for insurance coverage for a dietitian in the treatment of a patient with an eating disorder.  

 

One major problem in the nutrition field is that there is very little published on nutrition techniques in the treatment of eating disorders. IFEDD is working to remedy this by providing grad students to help busy clinicians set up research projects.

 

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books, Marcia is also author of the recently published Nutrition Counseling in the Treatment of Eating Disorders (Routledge, 2013).

 

 Copyrighted by Marcia Herrin and Nancy Matsumoto.

 

Recovery is a Healthy State, not Weight

 

A question that comes up regularly in the eating disorder field is how to define recovery? Is it a maintaining a certain weight or BMI? It is abstaining from restriction, bingeing, purging, and over-exercise? Is it eating without fear and guilt? Is it accepting one’s body size and shape? It is self-esteem that is independent of size and shape? Of course it includes all of these factors. I like the idea of recovery defined as a Healthy State. I can’t take credit for this term. Rebecka Peebles, MD, my co-presenter on this topic at the Academy of Eating Disorders International Conference in Montreal in May, tells me that the concept of a "Healthy State, not Weight," was coined by Janet Treasure, MD and several British mothers whose daughters had anorexia. Professor Treasure, a psychiatrist at Guy’s Hospital, King's College London, is a leading figure in the field of eating disorders and the author of several books for parents that are very helpful. Rebecka also pointed me to Dr. Treasure’s unique educational project on youtube that includes a “lesson” on Healthy State, Not Weight and another lesson on how parents can help an eating disordered teen follow a food plan, Modeling Effective Parenting. You have to see these videos to believe them. Picture one-dimensional claymation? They really are educational and precious.  

 

Marcia

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books. Marcia is also author the soon to be published Nutrition Counseling in the Treatment of Eating Disorders (September, 2012). Read more from Marcia and Nancy by clicking here.

Copyrighted by Marcia Herrin and Nancy Matsumoto

 

Life without Ed's Jenni Schaefer inspires Dartmouth (and me).

Long time friend and ED activitist Jenni Schaefer, author of Life without Ed and Goodbye Ed, Hello Me, spoke at Dartmouth College last month. I joined many of my patients in the audience for an inspiring evening. I promised several who were not able to attend that I would write up my notes.

 

Jenni opened her presentation saying that she is proud to be a “living example of both the journey to freedom from an eating disorder and the rediscovery of self” and then she shared some of her personal recovery story from her book, Life Without Ed. Read more on Jenni’s website.

 

Jenni was born in Texas, and she recalls first feeling she wasn't thin enough at the age of 4, when she began to study dance. Jenni showed us her first little dance costume to make the point that her eating disorder gathered steam when she began to restrict food as a teenager to try to keep that "little girl's body." Jenni also told us about how difficult college was her. He life was organized around the belief that to be happy and successful, she had to be thin and be “unrelentingly perfect.” After being accepted into medical school, Jenni eating disorder worsened. Instead of going to med school, she took a leave and within the year began treatment with a therapist, nutritionist and a doctor beginning “a long slow recovery that changed my life.”


 

Jenni told us, “Never, never, never give up!” She then quoted Amelia Earhart who said “The best way to do it, is to do it.” In treatment, Jenni learned that her eating disorder was not about the food, but, but food was the best medicine for recovery. “A starved brain cannot get better.” She remembers thinking that following a food plan would be impossible. She couldn’t picture eating on regular basis or responding normally to hunger and fullness. But when she just starting eating as her nutritionist directed her, the real emotional recovery began.

 

Jenni then stopped talking and drew a graph on the chalkboard similar to this clipart.

 

 

“This graph of ups and downs describes my recovery. I learned from every fall. I learned to recognize the lies ED told. I learned to say no. I learned I could go to bed with the covers over my head and that the bad feelings would pass without me acting on my eating disordered thoughts.” One of my patients was so taken by this imagery that she asked Jenni to include this graph when she autographed a copy, Life without Ed.

 

Jenni ended the evening with several songs and some insights from her second book, Goodbye Ed, Hello Me, about finding real joy and peace in life. "It's not just about food and weight," she says. "I'm here to help people to fall in love with life."

 

At lunch earlier in the day, Jenni told me about her new book, Almost Anorexic, due out this summer. Jenni’s co-author is eating disorder expert and Assistant Professor of Psychology in the Department of Psychiatry at Harvard (and Dartmouth grad) Jennifer J. Thomas, PhD. Almost Anorexic is written for an overlooked but prevalent segment of people who suffer from many of the key symptoms of an eating disorder but do not quite meet the full diagnostic criteria of one of the eating disorders. I know many people who fall into this category. They often feel that their situations aren’t bad enough to deserve treatment. Jenni wrote this book for you. Thank you, Jenni!

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books, Marcia is also author of the recently published Nutrition Counseling in the Treatment of Eating Disorders (Routledge, December 2013).

 

 Copyrighted by Marcia Herrin and Nancy Matsumoto.

Marcia Goes Hollywood

I had the pleasure of working with Abbey Stone, celebrity editor for Hollywood.com, on an e-article challenging celebrities to talk differently about their eating disorder history. Instead of the typical celebrity story serving as a guidebook on how to develop an eating disorder, Abbey wants A-listers to focus on how they got help and to describe their path to recovery. Check it out at

CELEBRITY EATING DISORDER CONFESSIONS: INSPIRING OR DANGEROUS?

Marcia

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books. Marcia is also author Nutrition Counseling in the Treatment of Eating Disorders (2013). Read more from Marcia and Nancy by clicking here.

Copyrighted by Marcia Herrin and Nancy Matsumoto

 

Food Plan Commandments

Food plans are a standard tool nutritionists use to treat all eating disorders (anorexia nervosa, bulimia, binge-eating disorder, eating disorders-Not Otherwise Specified).

 

One of my hardest working patients, who prefers I call her Vivster here, authored 8 food plan commandments. Vivster and I hope others will find them inspiring and helpful. We’d like to come up with 10 commandments so we invite you to submit suggestions. Vivster wanted her commandments decorated with happy faces. I hope she likes what I chose.

         Food Plan Commandments

                                                                                                                                   

by Vivster

 

1) Thou Shall Not Skip Meals

 

2) Thou Shall Follow Thy Food Plan Accordingly

 

3) Thou Shall Not Have Distractions Such As Computer Games Or Other Excuses Before Food Plan

 

4) Thou Shall Eat Every Bite To Win Thy Fight

 

5) Thou Shall Trust Thy Support/Treatment Team

 

6) Thou Shalt Not Let ED Come Before Recovery

 

7) Thou Shall Find Meaningful And Healthful Ways To Cope With Feelings, Thoughts And Emotions

 

8) Thou Shall Celebrate Health And Success

 

9) ?

 

10) ?

 

 

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books, Marcia is also author of the recently published Nutrition Counseling in the Treatment of Eating Disorders (Routledge, December 2012).

 

 Copyrighted by Marcia Herrin and Nancy Matsumoto.

 

Recovery Record: A new free web-based tool.

I often say I learn everything I know from my patients. Here is a case in point. One of my most knowledgeable patients, I’ll call Tory A. Recently Tory told me that she liked journaling her food and behaviors, etc. on a new free “app” called Recovery Record because it didn’t count calories. A number of my patients use online and phone apps to log their food because of the privacy (no one knows that I am logging my food and I don’t have to carry around my journals). I have my concerns about these weight loss-focused, calorie-counting apps (most are free, too). Many of them go as far as to tell the user how many calories to eat. I tell my patients as well experienced and well educated as I am, I can’t off the top of my head on a first visit with a patient even make an educated guess on calorie needs. When I tested one of this apps, but signing in as a user, the next day it sent me a message telling me to stop eating at 3 in the afternoon or otherwise I wouldn’t lose weight. I tell my patients who use these apps (myfitnessplan and lose it are popular) to disable as many of the app’s settings as possible. I also suggest making up a weight and using that as current weight and goal weight and entering the calorie goal as 3000 for women and 3500 for men (examples of total calories that should meet most people needs) I have not found another food journaling app that doesn’t count calories until Tory mentioned Recovery Record. She said that it could be set up so I could have access to her food diaries and best of all it didn’t count calories!! As is my habit, I went in to research mode. I signed in as both a clinician and a patient. Wow! The app allows logging thoughts, feelings, and meals and snacks. As a clinician I have a code that my patient can enter to give me access to her records. Each patient’s records are securely and confidentially archived. My curiosity was piqued about how and why Recovery Record was developed. I learned on the app’s website that the idea was developed by a psychology PhD candidate who worried that the Cognitive Behavioral Therapy (CBT) self monitoring records that she was assigning her patients were tedious, frustrating, and boring. Jenna Tregarthen, the PhD student, then collaborated with researchers at Stanford’s Eating Disorder Research Program and Stanford’s Institute for Entrepreneurship to develop Recovery Record. It was launched in 2011. Last month after using Recovery Record’s clinician/user interface, Tory and I talked about how to improve it. After I used Recovery Record’s feedback link to share our thoughts, Jenna contacted me almost immediately to arrange a phone conference so we could talk at length and we did. I am not exactly a consultant to Recovery Record but Jenna was very responsive to my ideas and we continue to email. Jenna told me that she and her group are currently focused on how to make Recovery Record a better tool for clinicians. I encourage clinicians, parents, and other users to try out Recovery Record and pass along your suggestions for improvement.

 

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books, Marcia is also author of recently published Nutrition Counseling in the Treatment of Eating Disorders (Routledge, December 2012).

 

 Copyrighted by Marcia Herrin and Nancy Matsumoto.

I am Thankful that . . . .

 

I am thankful that the Academy of Eating Disorders (AED) has made its 10-page Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders free and downloadable. This wonderful resource is straightforward and easy-to-read and designed for local medical care professionals who are not specialists, but find themselves diagnosing and providing medical care for individuals with eating disorders and their families. Although, the booklet is not a comprehensive clinical guide, the diagnostic and medical management information is based on the best available research and best practices. AED hopes that these guidelines will improve recognition and prevention of medical morbidity and mortality associated with eating disorders. I encourage you to join with me in giving copies to local pediatricians, primary care providers, and therapists.

Marcia

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books. Marcia is also author the soon to be published Nutrition Counseling in the Treatment of Eating Disorders (Routledge Mental Health, November 28, 2012). Read more from Marcia and Nancy by clicking here.

Copyrighted by Marcia Herrin and Nancy Matsumoto

The New Alphabet Soup of Eating Disorder Treatment Approaches: A preview of a Renfrew Conference Workshop

 I am putting the final touches on the workshop I have been invited to give next weekend (Nov. 9-11, 2012) at the Renfrew Conference in Philadelphia. This conference is always rewarding to attend. In the spirit of this year’s title, “Exploring Controversy and Building Collaboration,” my workshop is focused on the unique circumstances nutritionists who specialize in eating disorders are in. And that is that there is NO (none, naughta, nothing, zip, ZERO) research on nutrition counseling in the treatment of eating disorders. Some researchers in the field have argued, therefore, that this means nutritionists are not necessary for effective treatment. I know from my over 25 years of clinical experience and from the premier professional organization dedicated to eating disorders, Academy of Eating Disorders stance on treatment, that “eating disorders typically require a treatment team consisting of a primary care physician, dietitian, and a mental health professional knowledgeable about eating disorders.”

 What’s a good nutritionist to do in this situation I asked myself. Dig deep into the research, go to all the conferences that I can afford, talk to other top clinicians, pay attention to what works and then beg, borrow, and steal (with attribution of course) from evidence-based approaches. My workshop distills my efforts to provide top-notch effective nutrition treatment for eating disorders. Here is the blurb from the Conference Brochure:

The New Alphabet Soup: ACT, CBT-E, DBT, FBT and MI-Based Nutrition Techniques presented by Marcia Herrin, EdD, MPH, RD, LD

Following a comprehensive review of ACT, CBT-E, DBT, FBT and MI techniques designed to address nutritional issues in the treatment of eating disorders, this presentation describes how to match therapeutic approaches to particular clinical situations and how to monitor effectiveness of approaches. Clinical examples are used throughout, including live demonstrations and a coached meal experience. 

Long-time readers of this blog might remember way back in 2009, Nancy (my blogging and writing companion extraordinaire) posted Deciphering the alphabet soup of E.D. treatment options. In this post Nancy does an excellent job of describing how therapists use different psychological approaches CBT, DBT, or ACT. Notice that in less than four years we are now talking about ACT, CBT-E, DBT, FBT and MI. For those readers who can’t come to Philly to participate in my workshop (and for those that can attend please come say hello), below are the professional treatment guides and self-help workbooks that I have begged, borrowed, and stolen from:

 Acceptance and Commitment Therapy (ACT)

 The guiding principle of ACT is “Change with you do, not what you think or feel.” ACT focuses on indentifying core values and committing to action that leads one in a valued direction. ACT also focuses on stepping back or detaching from thoughts and feelings, accepting that it is normal to have painful or unpleasant experiences. ACT points out that being focused on feeling good, being right, managing anxiety, handling depression can distract us from the bigger picture and our values.  

 

Heffner, M., Eifert, G. H., & Hayes, S. C. (2004). The anorexia workbook: How to accept yourself, heal your suffering, and reclaim your life. Oakland, CA: New Harbinger.

Sandoz, E. K., Wilson, K. G., & DuFrene, T. (2010). Acceptance and commitment therapy for eating disorders: A process-focused guide to treating anorexia and bulimia. Oakland, Calif: New Harbinger Publications. [for professionals]

Sandoz, E. K., Wilson, K. G., & DuFrene, T. (2011). The mindfulness and acceptance workbook for bulimia: A guide to breaking free from bulimia using acceptance and commitment therapy. Oakland, CA: New Harbinger Publications.

Cognitive Behavior Therapy (CBT, CBT-E)

CBT-Expanded to treat anorexia nervosa as well as bulimia and binge eating disorder (BED). CBT is most evidenced-based approach for bulimia and BED and is based on the idea that you can change negative behaviors by changing your way of thinking. CBT-E is also pared down from standard CBT to primarily focus on food related interventions. The guiding principle is to “do a few things well rather than many things badly.”

 Agras, W. S., & Apple, R. F. (2008). Overcoming eating disorders: A cognitive-behavioral therapy approach for bulimia nervosa and binge-eating disorder: therapist guide. Oxford: Oxford University Press.

Apple, R. F., & Agras, W. S. (2008). Overcoming your eating disorder: A cognitive-behavioral therapy approach for bulimia nervosa and binge-eating disorder. Oxford: Oxford University Press.

Fairburn, C.G. (2008). Cognitive Behavior Therapy and Eating Disorders. [for professionals]

www.getselfhelp.co.uk/freedownloads2.htm

www.possibility.com/wiki/index.php?title=EffectsOfSemiStarvation

www.psychiatry.ox.ac.uk/research/researchunits/credo/cbt-and-eating-disorders-fairburn-2008-pdf-files/Ch06t1.pdfunderweight

Dialectical Behavior Therapy (DBT)

DBT teaches patients how to replace disordered behaviors with more skillful behaviors and how to tolerate negative emotions. DBT works to give people a very clear and step-by-step understanding of their difficulties by identifying what particular behaviors, situations, thoughts, feelings cause problems and what new behaviors and skills can prevent problems. DBT also focuses healthier ways to handle painful emotions by recognizing and accepting feelings without judging them as “good” or “bad.” 

Astrachan-Fletcher, E., & Maslar, M. (2009). The dialectical behavior therapy skills workbook for bulimia: Using DBT to break the cycle and regain control of your life. Oakland, CA: New Harbinger Publications.

Safer DL, Telch CF, Chen EY (2009). Dialectical behavior therapy for binge eating and bulimia. [for professionals]

www.dorset-pct.nhs.uk/.../mental.../Eatingness%20Skills.pdf -

 

Family-Based Treatment (FBT)

We have talked a lot about FBT in this blog and have written one of the parent resources mentioned below. FBT clinicians teaches parents to play an active role in restoring weight and normal eating patterns in their eating disordered child. Once this is accomplished parents are coached in how hand the control over eating back to the adolescent, and encourage normal adolescent development.

Alexander, J., & Le, G. D. (2010). My kid is back: Empowering parents to beat anorexia nervosa. London: Routledge.

Brown, H. (2010). Brave girl eating: A family's struggle with anorexia. New York: William Morrow.

Herrin, M., & Matsumoto, N. (2007). The parent's guide to eating disorders: Supporting self-esteem, healthy eating, & positive body image at home. Carlsbad, CA: Gürze Books.

Lock, J., & Le, G. D. (2012). Treatment manual for anorexia nervosa: A family-based approach. New York: Guilford. [for professionals]

Lock, J., & Le, G. D. (2005). Help your teenager beat an eating disorder. New York, NY: Guilford Press.

Treasure, J., Smith, G., & Crane, A. (2007). Skills-based learning for caring for a loved one with an eating disorder: The new Maudsley method. London: Routledge.

www.feast-ed.org

www.maudsleyparents.org

Motivational Interviewing (MI)  

MI techniques help patients recognize problems and then make informed decisions about whether or not they want to work on change (e.g., I won’t be able to run track if my weight is as low as I want it to be). The goal of MI is to help the patient identify reasons to work toward change. Clinicians are encouraged to adopt a curious and empathic stance, to highlight options and to emphasize that patients are ultimately responsible for change.

Arkowitz H, Westra HA, Miller WR, and Rollnick S. (2007). Motivational Interviewing in the Treatment of Psychological Problems. [for professionals]

Myers, E. S. (2006). Winning the war within: Nutrition therapy for clients with eating disorders. Lake Dallas, Texas: Helm Publishing.

Rollnick, S & Miller, WR (2007). Motivational Interviewing in Health Care: Helping patients Change Behavior. [for professionals]

www.garyrosetraining.com

www.miinstitute.com

www.motivationalinterview.org

Marcia

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books. Marcia is also author the soon to be published Nutrition Counseling in the Treatment of Eating Disorders (September, 2012). Read more from Marcia and Nancy by clicking here.

Copyrighted by Marcia Herrin and Nancy Matsumoto

 

BMI Calculator for Families (and Professionals)

I have found a wonderful resource for families: a free BMI calculator (https://mygrowthcharts.com). A family account saves data, tracks growth online, uses standard World Health Organization (WHO) and Centers for Disease Control (CDC) growth charts. This account also includes specialty charts including infant growth charts, Down Syndrome, Turner Syndrome, Quadriplegic Cerebral Palsy, Diastrophic Dysplasia. And charts can be shared with treatment team professionals.  

I had to search high and wide to find a workable BMI calculator that would let me track my patients’ progress. I finally found MEDDA, a Wisconsin-based company, which develops software for healthcare professionals, In 2011, MEDDA developed "My Growth Charts," a free tool for patients and families and $175/year for healthcare professionals. It program is easy to use (professionals get to trial it for 30 days), it saves data for individual patients, tracks growth online, print charts, calculates percentiles and BMIs for age. MyGrowthCharts is password protected so you can keep an ongoing record of your child’s weight progress. BMI growth charts are used in Family-Based Treatment (FBT)/Maudsley Approach to track progress in restoring an anorexic child’s historic growth curve (per CDC growth chart percentiles). In this kind of treatment parents (usually with the help a professional) are in charge of feeding their anorexic child at home. I included below a MyGrowthChart for one of my patients. You can see how dramatically an eating disorder affected this child’s natural development.

 

 

Marcia

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books. Marcia is also author the soon to be published Nutrition Counseling in the Treatment of Eating Disorders (September, 2012). Read more from Marcia and Nancy by clicking here.

Copyrighted by Marcia Herrin and Nancy Matsumoto

There's No Place Like Home: Eating Disorders and the Family

I am proud to announce a wonderful educational and supportive conference designed especially for families of children with eating disorders. All of the speakers are respected colleagues of mine and top of their fields.

 

There's No Place Like Home: Eating Disorders and the Family

November 30-December 1, 2012

Alexandria, Virginia

Sponsored by F.E.A.S.T. (Families Empowered And Supporting Treatment of Eating Disorders) 

F.E.A.S.T., a parent advocacy organization for Eating Disorders, announces its 2nd Annual Conference: "There's No Place Like Home: Eating Disorders and the Family". Nov. 30 & Dec 1, 2012. Alexandria VA. This conference is aimed at parents and caregivers at all levels, of people diagnosed with eating disorders. Attendees will learn about media and eating disorders, support for all family members, navigating insurance coverage, and updates in effective treatment options from inpatient and residential to outpatient and individualized therapy.

The Keynote Speaker on Nov 30th will be “Mental Health and the Media” by Jeff Bell, author of “Rewind, Replay and Repeat” and nationally recognized speaker and advocate for OCD awareness . Featured presentations will be given by: Dr. Craig Johnson PhD, FAED: Chief Clinical Officer Eating Recovery Center, Denver CO on “The Evolution of the Field of Eating Disorders: Parents, Patients, and Professionals”; "History of Media Coverage of Eating Disorders: How Parents Can Understand & Respond" by Carolyn Costin, MA, MED, MFT, author and pioneer ED advocate and clinician; and Lisa Kantor, JD, on "Paying for Treatment: How Does Insurance Work?".

In the past 10 years, there have been revolutionary changes in how eating disorders are understood and treated. Media messages regarding eating disorders are often full of misleading information, or don’t seem to apply to your situation. Navigating the new information and all the treatment options can be overwhelming, particularly in today’s changing healthcare climate.

Parents are often frustrated by a lack of readily available, good information about eating disorders and confusion as to what treatment options are available. This is an opportunity to network with providers and other parents and find out more about eating disorder resources near you. If you'd like to learn more about current treatments and what you can do for your child or loved one with an eating disorder AND your family, this conference is for you.

There is also an opportunity to participate in a Congressional Briefing in Washington, DC on Thurs, Nov 29^th 2012. Conference fees include breakfast, lunch, snacks, all conference sessions and access to the Learning Room. This conference accepts no industry funding, and has no corporate sponsor. For registration and more information go to:

F.E.A.S.T. 2012 Symposium 

F.E.A.S.T. - Families Empowered And Supporting Treatment of Eating Disorders

P.O. Box 331 Warrenton, VA 2018

Phone: 540-227-8518

info@feast-ed.org

 

Marcia

Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books, Marcia is also author of the soon to be published Nutrition Counseling in the Treatment of Eating Disorders (December 2012). Copyrighted by Marcia Herrin and Nancy Matsumoto