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Brain Differences Help Explain Eating Disorders

|By Shannon Firth A dog will do anything for a biscuit—over and over again. Most people will, too, because when sugar touches the taste buds it excites reward regions in the brain. A new study shows that people with eating disorders do not react to sweet flavors the way healthy people do, however, lending evidence to the hypothesis that brain differences predispose people toward bulimia and anorexia. A team of psychiatrists at U.C. San Diego studied 14 recovered anorexic women, 14 recovered bulimic women (who used to binge and purge) and 14 women who had never had an eating disorder, matched by age and weight. None of the women had had any pathological eating-related behaviors in the 12 months preceding the study. After fasting overnight, subjects received a modest breakfast to ensure similar levels of satiety. They were then fed small tastes of sugar every 20 seconds through a syringe pump while their brains were scanned. The women who had recovered from anorexia—those who formerly starved themselves—showed less activity than the healthy women in a reward center in the brain known as the primary gustatory cortex. The participants who were no longer bulimic showed more activity than the healthy women did. The results were published in October 2013 in the American Journal of Psychiatry. The researchers believe these abnormal responses to sugar predispose people to eating disorders, adding to a growing body of work suggesting that genetic and biological risk factors underlie most cases, according to study co-author Walter Kaye, director of U.C.S.D.'s Eating Disorders Research and Treatment Program. © 2014 Scientific American

Related chapters from BN: Chapter 13: Homeostasis: Active Regulation of the Internal Environment
Related chapters from MM:Chapter 9: Homeostasis: Active Regulation of the Internal Environment
Link ID: 19377 - Posted: 03.18.2014

'Love hormone' may treat anorexia

A hormone released during childbirth and sex could be used as a treatment for the eating disorder anorexia nervosa, scientists suggest. Small studies by UK and Korean scientists indicated patients were less likely to fixate on food and body image after a dose of oxytocin. About one in every 150 teenage girls in the UK are affected by the condition. The eating disorders charity Beat said the finding was a long way from becoming a useable treatment. Oxytocin is a hormone released naturally during bonding, including sex, childbirth and breastfeeding. It has already been suggested as a treatment for a range of psychiatric disorders, and has been shown to help lower social anxiety in people with autism. And one four-week study in Australia found people given doses of oxytocin had reduced weight and shape concerns. In the first of the most recent studies, published in Psychoneuroendocrinology, 31 patients with anorexia and 33 people who did not have the condition were given either a dose of oxytocin, delivered via nasal spray, or a placebo, or dummy, treatment. They then looked at a series of images to do with a range high and low calorie foods and people of different body shapes and weight. People with anorexia have previously been found to focus for longer on images of overweight people and what they perceive as undesirable body shapes. However after taking oxytocin, patients with anorexia were less likely to focus on such "negative" images of food and fat body parts. The second study, published in PLOS ONE, involved the same people and looked at their reactions to facial expressions, such as anger, disgust or happiness. It has been suggested that anorexia can be linked to a heightened perception of threat, and animal research has shown oxytocin treatment lessened the amount of attention paid to threatening facial expressions. BBC © 2014

Related chapters from BN: Chapter 13: Homeostasis: Active Regulation of the Internal Environment; Chapter 5: Hormones and the Brain
Related chapters from MM:Chapter 9: Homeostasis: Active Regulation of the Internal Environment; Chapter 8: Hormones and Sex
Link ID: 19357 - Posted: 03.13.2014

A Big Reveal Touches a Nerve

By JENNIFER CONLIN It is the moment “The Biggest Loser” viewers anticipate all season. That episode when the finalists emerge, one by one, to bare all — or rather less — to a waiting audience of millions. But on Tuesday night, when Rachel Frederickson, 24, walked onto the studio stage 155 pounds lighter than at the start of Season 15, the reaction was not one of awe, but shock, apparent even on the trainers’ frozen faces. In the few months since Ms. Frederickson, 5 feet 4 inches tall, had left the ranch for her home, her body had radically changed from the athletic 150 pounds she had weighed upon her departure to a gaunt sliver of herself, obvious despite her shimmering silver dress, strappy sandals and big grin. Ms. Frederickson, as the scale would soon reveal, now weighed 105 pounds, and having lost 59.62 percent of her body weight would also be the competition’s winner, making her $250,000 richer. But as confetti dropped all around her, few were celebrating on Twitter. “I feel like Rachel lost too much,” one woman wrote. “I had to turn away.” Another posted, “There needs to be a red line that disqualifies finalists for too much weight loss.” Kai Hibbard, a finalist on Season 3, was at her home in Alaska when another former contestant, whom she declined to name, sent her a message. “Have you seen tonight’s winner?” it read. “NBC is about to have a public-relations nightmare.” When Ms. Hibbard pulled up Ms. Frederickson’s winning photo, she promptly burst into tears. “Rachel doesn’t know what damage she has done to her body and her mind, and sadly she won’t until the spotlight goes away,” said Ms. Hibbard, 35, who seven years ago lost 118 pounds during her competition but has since spoken out publicly against the show’s extreme dieting and exercise regimen. © 2014 The New York Times Company

It's Amazing How Much The 'Perfect Body' Has Changed In 100 Years

| by Nina Bahadur Addiction and eating disorder recovery site Rehabs.com worked with digital marketing agency Fractl on a project looking at the origins of Body Mass Index (BMI) measurements, and how the bodies of ideal women have compared to national averages over time. And their findings show that models and movie stars are getting smaller than the average American woman at unprecedented rates. Though BMI measurements don't distinguish between fat and muscle, and are thus fairly inaccurate in determining whether someone is obese or not, BMI data from the past makes for interesting comparisons. According to the Center for Disease Control, the BMI of the average American women has steadily increased over the past half a century, from 24.9 in 1960 to 26.5 in the present day. In a similar vein, Rehabs.com found that the difference between models' weights and the weight of the average American woman has grown from 8 percent in 1975 to over 23 percent today. The bottom line? There's more of a noticeable gap between the bodies of idealized women and everyday people. Picking up on this disparity, brands like Dove, Debenham's and H&M have made efforts to include diverse body types in their catalogs and ads. Organizations like The Representation Project are working to educate women and girls about media literacy and how to handle the sexualized images of women we see on television, billboards and the Internet. (Of course, we still have a very long way to go.) In addition to the work of brands and organizations, looking back on the "ideal" women throughout the past century tells us just how arbitrary any vision of "the perfect body" is. Sex symbols have varied in terms of body shape, height, weight and tone, from the hourglass figure of Mae West to the waif-like Kate Moss. Though the diversity of these icons is limited -- they are all white, and none could be accurately described as plus-size -- it's gratifying to see that different body types have been construed as sexy, and likely will be again. © 2014 TheHuffingtonPost.com, Inc

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 19222 - Posted: 02.08.2014

Are all psychological therapies equally effective? Don't ask the dodo

"Everybody has won and all must have prizes," declared the dodo in Alice in Wonderland when asked to judge the winner of a race around a lake. As judgements go, it is admirably even-handed and optimistic. But in the world of mental health the dodo's decision has come to symbolise a bitter dispute that strikes at the very heart of psychotherapy. The "Dodo Bird Verdict", first suggested in the 1930s by the American psychologist Saul Rosenzweig, proposes that the many and various forms of psychological therapy are all equally effective. It makes no difference whether, for example, a person is being treated with techniques drawn from psychoanalysis, neurolinguistic programming, or cognitive behaviour therapy (CBT). What really helps a patient to recover are straightforward factors such as the opportunity to discuss their worries with a skilled and sympathetic therapist or the degree to which they are prepared to engage with the treatment. Understandably, the Dodo Bird Verdict has ruffled many feathers within the profession, and provoked a slew of studies aiming to corroborate or disprove the idea. Are some types of psychotherapy really more effective than others for particular conditions? There is plentiful data to suggest that the answer to that question – contrary to Rosenzweig's theory – is "yes". But that data tends to come from research conducted by proponents of the ostensibly superior therapy, leaving sceptics to conclude that their conclusions are not impartial. This makes the results of a study of treatments for the eating disorder bulimia nervosa, published this month in the American Journal of Psychiatry, all the more convincing. Bulimia is characterised by binge eating, followed by attempts to compensate by making oneself vomit, taking laxatives or diuretics (water tablets), fasting, and/or exercising frantically. Underlying this behaviour is an intense concern – an obsession, even – with body shape and weight. © 2014 Guardian News

Why was this high school student losing weight and feeling so sick?

By Sandra G. Boodman, Dorsey Davidge felt her thrumming anxiety burst into barely controlled panic as she watched her 14-year-old daughter Cate Chapin struggle to get from her bedroom to the bathroom. During the last week of January, the eighth-grader contracted what appeared to be a bad case of the flu. After a week, a doctor decided she had pneumonia, a diagnosis that was later changed to a possible infectious disease. Davidge, a single mother who lives in McLean, had maintained her equanimity during the early days of Cate’s illness. But when she saw that her older daughter was unable to walk 10 feet without stopping midway to rest, she was shocked by how cadaverous-looking Cate had become in a matter of weeks. “I was really scared for the first time,” Davidge said. “She was incredibly weak, and I thought, “ ‘Oh, my God, my child is just wasting away.’ ” By then, the 5-foot-2 Cate, a skinny 95 pounds before she got sick, had shriveled to a little over 80 pounds. She had no appetite, was barely drinking anything and seemed unable to consume more than a quarter of a bagel at a sitting. “That day was the last straw,” Davidge recalled. She telephoned Cate’s pediatrician, who agreed that the girl needed to be admitted immediately to a Northern Virginia hospital. It would take another harrowing month — which included the insertion of a feeding tube to help restore Cate’s weight, consultations with a bevy of specialists and numerous tests — before doctors figured out what was actually wrong, a diagnosis made possible after Cate developed a seemingly unrelated condition that sent her to an ophthalmologist. © 1996-2013 The Washington Post

Male version of eating disorder replaces purging with muscle enhancers

Guest post by Bruce Bower Among 16- to 22-year-old U.S. males, 7.6 percent report taking various potentially dangerous substances at least monthly to counteract what they regard as an alarming lack of muscularity. Young men whose insecurities inspire them to use growth hormones, steroids and other body-altering chemicals represent the male counterpart of females whose idealization of thinness prompts them to induce vomiting and otherwise purge their bodies of food, proposes a team led by epidemiologist Alison Field of Boston Children’s Hospital. Purging and other eating disorders occur mainly in girls and women. Boys and men so obsessed with muscles that they take substances prohibited in competitive sports are more numerous than researchers and clinicians realized, and have been overlooked, Field and her colleagues conclude November 4 in JAMA Pediatrics. The researchers examined questionnaires that each of 5,527 males completed eight times between 1999 — at ages 12 to 18 — and 2010. Most participants were white and from middle-class families. No information on sports team participation was available. © Society for Science & the Public 2000 - 2013.

Related chapters from BN: Chapter 13: Homeostasis: Active Regulation of the Internal Environment; Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases
Related chapters from MM:Chapter 9: Homeostasis: Active Regulation of the Internal Environment; Chapter 8: Hormones and Sex
Link ID: 18871 - Posted: 11.05.2013

Fat and Thin Find Common Ground

By ABBY ELLIN When binge eating disorder gained legitimacy as a full-fledged mental condition in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders in May, many people in the eating disorders and obesity communities wondered: Will this inspire us to finally get along? It was a good question, since historically, the two groups have been at odds. Unlike people with anorexia or bulimia, who tend to be excessively thin, many binge eaters are overweight or obese. And much of the focus of anti-obesity efforts — listing calories at restaurants, banning cupcakes in schools, sending students home with body mass index “report cards” — are decried by eating disorder activists, who say such measures can encourage anorexia or bulimia. Anti-obesity activists, in turn, worry that the eating disorder community minimizes the medical risks of obesity, which the American Medical Association classified as a disease in June, and plays down the discrimination many obese people face. “They come out of different traditions,” said Kelly Brownell, dean of the Sanford School of Public Policy at Duke University. “Obesity was mainly dealt with in medical professions, and eating disorders were dealt with more in psychology professions.” But binge eating disorder, symptoms of which include consuming enormous amounts of food in a two-hour window without purging at least once a week for three months, could bridge the gap between the two worlds, while also reducing the stereotype that only thin people suffer from eating disorders. Copyright 2013 The New York Times Company

Expanded Clinical Definition of Anorexia May Help More Teens

By Tara Haelle A change in the way anorexia is diagnosed may make it easier to help more teens, not just thin ones, with the illness. Previously, overweight or obese teens were more likely to fall through the cracks when they developed anorexic behaviors. Now, the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has broadened the disorder criteria by taking away the weight requirement. The change shifts the focus of the diagnosis from “being thin” to the behaviors of those with the illness. The previous criteria perpetuated the idea that anorexia is a weight disorder—rather than a psychological one. “A lot of people need help even if they don’t narrowly fit the definition of an illness,” says David Hahn, medical director of The Renfrew Center of Philadelphia. “This criteria makes clear that the behaviors, even without a very low weight, are pathologic and need to be addressed. The criteria may very much help pediatricians catch an eating disorder sooner and may teach the public and families to intervene more quickly if it’s understood that anorexia doesn’t only mean underweight.” Anorexia nervosa most often begins in adolescence and affects approximately 0.3 percent of teens. An additional 0.8 percent were found in one large study to have “subthreshold anorexia nervosa”—they showed the symptoms but did not meet all the criteria. Overall, about 6 percent of teens suffer from some kind of eating disorder, such as bulimia, binge-eating and other eating issues previously classified in the DSM-IV as “Eating Disorder—Not Otherwise Specified” (ED-NOS). © 2013 Scientific American

When Food Goes Bad: Binge Eating and Reward

By Scicurious For my food week post, I’m going at it a little differently. We spend a lot of time talking about food, thinking about whether it’s good for us, bad for us, which aspects of it are good or bad for us. We talk about why we crave some foods vs others, and we talk about why some foods taste disgusting. We talk about whether you’d want to replace your entire diet with a chalky fluid substance. Foodies spend a lot of time taking pictures of it, diet mags spend a lot of time talking about how to eat less of it. Food is surrounded by a culture that permeates almost everything we put in our mouths. But food is more than what we like or don’t like. Food is more than a relationship between our stomach and our tongues and noses. There is a very strong relationship between food and your brain, and when it goes wrong, the results can be devastating. There is anorexia, where there is distorted body perception, huge fear of weight gain, and food restriction so severe it can kill. On the opposite end, there is binge eating, uncontrollable eating that people are unable to stop, despite health consequences and social stigma. Critical to both of these problems are issues with “reward”. Food needs to be rewarding, it needs to make you crave it, want more of it, seek it out, work to obtain it. We need to crave food because if we didn’t, we’d all starve to death due to lack of motivation. In binge eating, though, that craving becomes an obsession. And it’s a dangerous one. People who binge eat severely are at risk for obesity, heart problems, diabetes, and other health problems. There is also a lot of anxiety, depression, guilt, and other mental distress that goes along with binge eating. This is more than just a need for portion control or more exercise. It’s a serious compulsion and mental illness, and it shouldn’t be taken lightly. © 2013 Scientific American

Is there an anorexia-autism connection?

By Bahar Gholipour Girls with anorexia may tend to have traits that are usually found in people with autism, a new study suggests. Researchers compared 66 teen girls who had anorexia with about 1,600 girls who did not have the eating disorder, using questionnaires they had previously developed to assess thinking and personality types in children with autism. Girls with the eating disorder anorexia may tend to have traits usually found in people with autism. The girls with anorexia were found to have more interest in systems and order, and lower scores in empathy — a profile more similar to people with autism than to typical adolescents, the researchers said. The finding suggests the two conditions may share certain features, such as rigid attitudes and behaviors, a tendency to be very self-focused and a fascination with detail, the researchers said. “Traditionally, anorexia has been viewed purely as an eating disorder. This is quite reasonable, since the girls’ dangerously low weight and their risk of malnutrition or even death has to be the highest priority” for treatment, said Simon Baron-Cohen, a professor of developmental psychopathology at the University of Cambridge in England. But his study suggests that “underlying the surface behavior, the mind of a person with anorexia may share a lot with the mind of a person with autism,” Baron-Cohen said. People with both conditions have a strong interest in organizational systems; girls with anorexia are intensely interested in the system that governs body weight, shape and food intake, he said. © 1996-2013 The Washington Post

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 7: Life-Span Development of the Brain and Behavior
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 4: Development of the Brain
Link ID: 18497 - Posted: 08.13.2013

The Anorexic Brain

By Meghan Rosen In a spacious hotel room not far from the beach in La Jolla, Calif., Kelsey Heenan gripped her fiancé’s hand. Heenan, a 20-year-old anorexic woman, couldn’t believe what she was hearing. Walter Kaye, director of the eating disorders program at the University of California, San Diego, was telling a handful of rapt patients and their family members what the latest brain imaging research suggested about their disorder. It’s not your fault, he told them. Heenan had always assumed that she was to blame for her illness. Kaye’s data told a different story. He handed out a pile of black-and-white brain scans — some showed the brains of healthy people, others were from people with anorexia nervosa. The scans didn’t look the same. “People were shocked,” Heenan says. But above all, she remembers, the group seemed to sigh in relief, breathing out years of buried guilt about the disorder. “It’s something in the way I was wired — it’s something I didn’t choose to do,” Heenan says. “It was pretty freeing to know that there could be something else going on.” Years of psychological and behavioral research have helped scientists better understand some signs and triggers of anorexia. But that knowledge hasn’t straightened out the disorder’s tangled roots, or pointed scientists to a therapy that works for everyone. “Anorexia has a high death rate, it’s expensive to treat and people are chronically ill,” says Kaye. © Society for Science & the Public 2000 - 2013

Brain 'pacemakers' promising for anorexia treatment

Surgically implanting pacemaker-like devices into the brains of people with severe anorexia might help improve their symptoms, a small Canadian study suggests. Anorexia affects an estimated 15,000 to 20,000 people in Canada, mainly young women who face a high risk of premature death. The mortality rate is between six to 11 per cent. About 60 to 70 per cent of people with anorexia recover fully with traditional treatments, said Dr. Blake Woodside, medical director of the eating disorders program at Toronto General Hospital. But in Wednesday's online issue of the medical journal The Lancet, Woodside and his co-authors describe using deep brain stimulation to treat six women with severe anorexia that did not respond to treatment. The treatment involves surgery to implant the electrical stimulators. It's considered minimally invasive and the stimulation can be turned off. In the pilot study, the average age of the women at diagnosis was 20 and they ranged in age from 24 to 57 when the surgery was performed. Five had a history of repeated hospital admissions for eating disorders. While the study was meant to test the safety of the procedure, not its effectiveness, Woodside's team found three of the six patients achieved and maintained a body mass index greater than their historical level. © CBC 2013

Struggling With Anorexia on the Web

By LAURA GEGGEL For years, young people — often girls and young women — have frequented Web sites promoting anorexia and bulimia as a source of inspiration and tips on staying thin, even as online companies have worked to ban such content. Now, groups and Web sites focused on recovery from eating disorders are fighting back. “We need to be looking at these communities and see what we can learn from them, and what we can provide as a positive alternative,” said Claire Mysko, manager of Proud2Bme.org, a Web site and online community focused on healthy recovery that is financed by the nonprofit National Eating Disorders Association. “That’s what we’re trying to do here.” This Saturday, the group is taking its message to the University of South Florida in Tampa for its free annual Proud2Bme Summit. Attendees will be encouraged to engage in activities like taking a stand on Twitter against “body snarking,” a bullying tactic that draws attention to a person’s body or weight gain, and hear from speakers including Julia Bluhm, a 14-year-old who collected more than 86,000 signatures to petition Seventeen magazine to print one unaltered photo spread a month. “Our goal here is to make it a space where people can connect,” Ms. Mysko said. The site began in 2011 after the success of its Dutch counterpart, Proud2Bme.nl, whose co-founder Scarlet Hemkes struggled with anorexia and bulimia as a teenager and young adult and was horrified to find countless sites where girls competed to lose weight or shared tips on how to lie to parents about weight loss. Inspired by France’s move in 2008 to ban such sites — commonly called pro-ana (for pro-anorexia) sites — Ms. Hemkes collected 10,000 signatures with the hopes of inspiring similar Dutch legislation. When that didn’t work, she created a community on Hyves, a Facebook-like social network for girls with eating disorders, before founding Proud2Bme with a psychologist, Eric van Furth, in 2009. Copyright 2012 The New York Times Company

Binge Eating Among Men Steps Out of the Shadows

By ABBY ELLIN After downing 70 chicken wings in about an hour, Andrew Walen realized he had a problem. Oh, he had known something was wrong over the years. Normal people don’t consume 4,500 calories worth of food in one sitting, or order takeout for four when dining alone. But it took a maniacal feeding frenzy for him to finally accept the reality: He was a binge eater, and he had absolutely no control around food. “Ultimately, it was about numbing out and self-loathing,” said Mr. Walen, now 39 and a therapist in Columbia, Md. “There was this voice in my head that said, ‘You’re no good, worthless,’ and I turned to food.” Mr. Walen is one of an estimated eight million men and women in the United States who struggle with binge eating, defined as consuming large amounts of food within a two-hour period at least twice a week without purging, accompanied by a sense of being out of control. While about 10 percent of patients with anorexia and bulimia are men, binge eating is a problem shared almost equally by both sexes. A study published online in October and then in the March issue of The International Journal of Eating Disorders found that among 46,351 men and women ages 18 to 65, about 11 percent of women and 7.5 percent of men acknowledged some degree of binge eating. “Binge eating among men is associated with significant levels of emotional distress, obesity, depression and work productivity impairment,” said Richard Bedrosian, a study author and director of behavioral health and solution development at Wellness and Prevention Inc., which works with employers and health plans. Copyright 2012 The New York Times Company

Eating disorders affect women over 50

By Jennifer Huget One of the best-kept secrets among women over 50 is not so secret any more, thanks to a study published last week that shows eating disorders and body-image problems aren’t uncommon among that demographic. There’s been lots of concern over the years about young women’s eating disorders. But a disturbing picture of older women’s bingeing, purging and using extreme measures such as diet drugs, diuretics, laxatives and excessive exercise to promote weight loss is starting to emerge. The new study, conducted through the Eating Disorders Program at the University of North Carolina School of Medicine and published June 21 in the International Journal of Eating Disorders, was based on an online survey of 1,849 women age 50 or older. Their average age was 59, and about 92 percent of respondents were white. Only 42 percent of the women were of normal weight, according guidelines set by the U.S. Centers for Disease Control and Prevention. Among the others, 29 percent were overweight and 27 percent obese. (Two percent were underweight.) Fully two-thirds of the women reported being unhappy with their appearance. More than one-third — 36 percent — said they’d spent at least half of their past five years dieting. Forty percent said they weighed themselves more than once a week, and — ugh, this sounds familiar — 41 percent reported checking their body daily through such measures as pinching their belly fat or noting whether their thighs rubbed together. And almost 80 percent said their weight and shape was either moderately important to or the most important factor influencing their self-perception. © 2011 The Washington Post Company

Boys dying to be thin: the new face of anorexia

By Yardena Schwartz Brick, N.J.: Lindsey Avon and her 28-year-old husband Victor have been together for 10 years. But when Victor decided to lose some weight in college, Lindsey had no idea what he was really going through. It wasn’t until Victor checked himself into an inpatient eating disorder treatment center that Lindsey, 29, realized her then-boyfriend was fatally anorexic. Santa Cruz, Calif.: Nearly all of Avi Sinai’s school friends were girls, who constantly talked about how “fat” they were and how they longed to be thinner. Avi’s mom and his girlfriends’ mothers were shocked that Avi, just 10 at the time, was the one who succumbed to the obsession with being skinny. Okemos, Mich.: Susan Barry, 60, spends every day wishing she had known more about male anorexia when her son, TJ Warschefsky, was still alive. He died in 2007 at the age of 22 after an eight-year battle with the disease. His heart gave out in the middle of his nightly routine of 1,000 sit-ups. He weighed 78 pounds. “He didn’t want to be skinny,” Barry said of TJ, who was a star athlete and straight-A student. “He wanted a six pack, he wanted rock hard abs. That’s how it all started.” Their stories may sound rare, but experts say cases like Avi Sinai, Victor Avon and TJ Warschefsky are growing more and more common. Far from the world of beauty magazines, pin-thin celebrities and runway models, anorexia is striking what many consider to be an unlikely group: boys and young men. © 2012 msnbc.com

Protocol to Treat Anorexia Is Faulted

By RONI CARYN RABIN When a malnourished teenager with anorexia nervosa is admitted to the hospital, weight gain is a top priority — and food is medicine. But doctors mete out meals with caution, providing fewer calories than needed at first because the patients may be so frail that major swings in diet can be life-threatening. The strategy, called “start low, advance slow,” often results in further weight or fluid loss during the first day or two of hospitalization. Now some researchers and health providers, both in the United States and abroad, are challenging the start-low approach, suggesting that many patients could be fed more aggressively as long as they are closely monitored for medical complications. Scientific evidence in support of the start-low method has been scarce. In a study published online in The Journal of Adolescent Health in August, researchers at the University of California, San Francisco, sought to evaluate it more closely, examining weight gain in hospitalized teenagers on a recommended refeeding protocol, in what they believe is the first study of its kind. The study, which involved 35 young people, found that 83 percent on the start-low regimen, who were fed 1,200 calories a day with increases of 200 calories every other day, lost weight. Over all, patients did not regain the newly lost weight until the sixth day in the hospital, on average. © 2012 The New York Times Company

UCSF study challenges thinking on anorexia

Victoria Colliver, Chronicle Staff Writer The standard approach to feeding patients hospitalized with anorexia nervosa - starting with a low number of calories and increasing them very gradually - is being challenged by new research from UCSF. This approach to bringing malnourished patients back to health was based on the long-held notion that pushing food on them too quickly can result in potentially fatal metabolic imbalance, but researchers now say it fails to produce significant and necessary weight gain in the first week of hospitalization and results in longer hospital stays. The UCSF study, published in next month's issue of the Journal of Adolescent Health, suggests that most patients can start at higher calorie levels, tolerate more food and be able to be released from the hospital more quickly. The research is considered the first to test the traditional recommendations against a higher-calorie diet. "The truth is, this is another one of those cases where you have clinical guidelines that are consensus based, but they really aren't based on the evidence," said study lead author Andrea Garber, associate professor of pediatrics in UCSF's adolescent medicine division. The American Psychiatric Association, the American Dietetic Association and other groups recommend the current guidelines, which have been in place since 2000 and stem from studies of prisoners of war in the 1950s. The approach starts with a foundation of about 1,200 calories a day and adds 200 calories every other day. © 2011 Hearst Communications Inc.

Eating disorders stalk women into adulthood

By Linda Carroll What finally washed away Kari Adams’s denial was the flood of tears streaming down her dad’s face. Frightened by Kari’s plunging weight, her family had been begging the 41-year-old mother of two to seek help for months. But nobody could convince Kari that anything was wrong – until she saw her dad’s tears. “That’s when it hit me,” she said. “He never cried before in my whole life.” Kari’s story echoes that of many other middle-aged women in America. Major transitions and traumatic mid-life events — crumbling marriages, job losses or kids going off to college — can rekindle eating disorders that had begun years before. “It’s rare that an eating disorder shows up completely out of the blue in mid-life,” said Douglas Bunnell, vice president and director of out-patient clinical services at The Renfrew Center, where Kari eventually sought help. The more common scenario, Bunnell said, is the resurgence of a life-long problem. Eating disorder experts are seeing more and more patients like Kari these days. The Renfrew Center has seen a 42 percent increase in the number of women over the age of 35 seeking help. That’s prompted the center to come up with a special program geared to their older patients. Therapists focus on stressors that trigger eating disorders in adults and on the underlying issues inflaming the problem, such as anxiety. “For these people, there’s something soothing about not eating,” Bunnell said. “The eating disorder has become embedded in the way they manage anxiety.” © 2011 MSNBC Interactive

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