Author Archive for Sarah Blake

Won’t YOU Come Chat With Us?

 

The Center for Eating Disorders (CED) has now hosted five on-line support group chats – two for family members and friends of individuals struggling with eating disorders and three for the individuals themselves. Embarking on this new use of technology has been a bumpy ride for us and our users, some of whom have had difficulty getting into the chat-room and/or obtaining a login to do so. Oh, the joys of technology – it is wonderful – but only when it works! While we are still working out some of the kinks, if you would like to participate in a future chat, check out the system requirements in advance and turn off your pop-up blocker before trying to enter the chat room!

For those who have been able to get on-line with us, the technology has been well used. Chats have gone in a myriad of directions — one chat focused on the pressures of conformity and how much harder it is to not conform to what others are doing, but how much better it feels to go with your own values and convictions. Another chat led to a discussion about how to obtain treatment for an adolescent who did not think she was sick and how to best support a fiancée with an eating disorder.

Most recently, we had our most active chat to date! The participants discussed, among other things, recovery and “getting to the other side” of the illness. Individuals chatted about the frustrations associated with recovery, but the chat also led to a direction of hope in the journey. Helpful resources were discussed as well, including Jessica Weiner’s book, “Life Doesn’t Begin 5 Pounds From Now” and “Goodbye Ed, Hello Me”, the new book by Jenni Shaefer, who will be speaking at CED’s annual fall outreach event on October 25th at the Conference Center at Sheppard Pratt.

As the most recent chat progressed, the conversation led participants to discuss the dilemma of figuring out who they really are without their eating disorders and what their passion is in life.  Suggestions and ideas about helpful coping skills were also shared during this fast paced discussion.

SO, what might you bring to our next chat? Questions? Concerns? Insights? There is room for all of this and so much more! The next live chat support group is scheduled to take place on Thursday, September 3rd from 8:30 – 9:30 p.m. To participate in a live chat, you must first register with a username and password on CED’s online forum. This will allow you to access the discussion board where you will find the link to the chat 10-20 minutes before the chat is scheduled to begin.

We would love the chance to chat with you!!

If you have questions about how to join our live chat, or if you experience technical difficulties, please call or email Kate Clemmer at 410-427-3886, kclemmer@sheppardpratt.org or Sarah Blake at 410-427-3856, sblake@sheppardpratt.org.

photos courtesy of:

i.dailymail.co.uk, newsimg.bbc.co.uk & pc1news.com

Published by Sarah Blake
August 27th, 2009 in CED Events, Celebrity Topical News, Editor's Picks
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Over Focus on Overweight

The internet was buzzing with news after President Barack Obama nominated Regina Benjamin, a physician from Alabama, to be our next surgeon general. Some articles reported the facts of the nomination and the speeches that followed. Many listed Dr. Benjamin’s credentials: she studied at Morehouse and the Alabama School of Medicine; started a family practice in a fishing village in Alabama; got her MBA at Tulane; and converted her practice to a medical clinic for the poor. In her clinic, if patients could not pay, she treated them for free. Hurricanes George and Katrina twice destroyed the clinic, and she went into debt to rebuild it. As she went through this journey, she was awarded the title of one of Time Magazine’s “50 Future Leaders, Age 40 and Under” and won a MacArthur “genius” grant. (Just to name two of her many accolades). These articles certainly shed light on what appears to be a dedicated professional who goes above and beyond the call of duty.

However, not all reports were positive. While some were applauding her nomination, others were not as pleased. The debate on a candidate usually focuses on the person’s qualifications which a few people did express concerns about, citing her lack of experience for a post of this stature. A couple individuals also commented that they suspect her nomination was due to race and not her qualifications. However, the majority of online articles discussing why Dr. Benjamin should not be confirmed for this position settled solely on her “shape”. One such article entitled, “Is Regina Benjamin Too Fat to be Surgeon General?” discusses the fact that critics within the community believe that the individual who will be in charge of the “War on Obesity” should not appear to have an issue with weight herself. The debate rages on about Dr. Benjamin’s need to lose weight, and about individuals’ refusal to let fat be socially acceptable.

We at the Center for Eating Disorders are saddened that despite tremendous education in the community, there is still so much more work to be done. People clearly remain convinced that there is only one body type that all Americans should aspire to be. Have we forgotten that people come in all shapes and sizes? Genetically, each person is built to be different; some individuals are created to be shorter, taller, smaller, or larger. The misperception that size equates with health and is a measure of one’s competence is a longstanding prejudice.

As a matter a fact, a recent study published in the Journal of Obesity (June 2009) looked at the body mass index of Canadians (11,326 individuals aged 25 or older) in the 1994-95 National Population Health Survey. They followed up with these individuals 12 years later to find that the risk of death was significantly higher for people who were underweight or very obese, but that overweight people actually had a significantly lower risk of death. In fact, it is thought that being overweight may serve as a protective factor against mortality.  Previous studies have produced similar results, but this was the largest study of its kind to date.

Clearly, this information highlights that it is time to rethink our automatic associations between size and health.  We at The Center for Eating Disorders urge that the nomination of Regina Benjamin be evaluated solely on her credentials and accomplishments and not on her size or body type.

Do you have thoughts on this issue? Join in on the discussion on our discussion board!

Published by Sarah Blake
July 31st, 2009 in Celebrity Topical News
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The Science of Eating Disorders

 photo courtesy of http://www.makeuseof.com/

 For many years it has been observed that eating disorders (EDs) sometimes run in families, but it has not been known why. Do EDs develop because family members model disordered eating behaviors/attitudes that are emulated by those who observe them? On the other hand, is there a genetic cause that has nothing to do with modeled behavior? Or, is it a combination of both factors? These questions address the classic nature vs. nurture debate. Fortunately, as technology has become more sophisticated over the last 10 years, there has been much research into the role of genetics in EDs, and the results have already begun to help guide prevention and treatment efforts.

Family studies have produced the following conclusions:

  • If an individual’s mother or sister has had Anorexia Nervosa (AN), they are twelve times more likely than someone without a family history of AN to develop AN.
  • If an individual has a family member with Bulimia Nervosa (BN), they are four times more likely to develop BN than people without a family history of BN.
  • If an individual has a family member with Binge Eating Disorder (BED) they are two times more likely to develop BED than people without a family history of BED.

Twin studies that compare identical twins and fraternal twins have been helpful in detecting the genetic contribution to the development of EDs. This is because twins “share” the same family environment. However, while identical twins share 100% of their genes, fraternal twins only share 50% of their genes.

Twin studies have found that:

  • AN and BN are more likely to occur in both twins when they are identical (100% of the same genes) than in fraternal twins (50% of the same genes), suggesting that genetics play a very important role.

In genetic linkage studies, researchers collect genetic samples from multiple generations of family members in which at least two members have EDs. They look for common variations and “linkages” in the actual genes that may be passed from parent to child. Linkages are areas on a chromosome that contain several hundred genes. In genetic association studies, specific genes of interest are compared between people who do and do not have EDs.

Genetic studies have produced the following findings:

  • Significant linkages have been found on chromosome 10 for BN and chromosome 1 for AN. At this point it is unknown which genes in the identified linkages are involved in EDs and what these genes control.
  • Genes that control the neurotransmitter serotonin have received a lot of study and results suggest these genes may play an important role in EDs, particularly AN. Serotonin is involved in the regulation of appetite and eating behavior.
  • Certain personality traits common in people with EDs are also considered moderately heritable. Traits seen in childhood before people develop AN or BN include obsessionality and perfectionism. These traits are neither good nor bad; for instance, perfectionism that is directed towards achieving a “perfect body” might exacerbate an ED while perfectionism that is directed towards achieving “perfect grades” can make people successful in school.

What Are the Implications?

EDs are complex illnesses caused by multiple factors. While it appears that people may inherit a genetic vulnerability for EDs, this does not guarantee development of an ED. Rather, researchers think inherited genes may be “turned on” when an individual is exposed to particular environmental factors such as a culture that emphasizes thinness, dieting behavior, a traumatic event, participation in high-risk sports, or a combination of triggers. Ultimately, the hope is that a better understanding of the genetics of EDs will continue to inform prevention and treatment efforts and reduce stigma associated with the illness.

For more information, see http://www.anbn.org/.

Submitted by: Sarah Hubbard, PhD

Published by Sarah Blake
June 14th, 2009 in In the News
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“Exercise Bulimia”

Shoes

Is there such a thing as too much exercise? You can’t go anywhere or watch anything today without being inundated with hundreds of advertisements for diets, work-out videos and equipment, gym memberships, or reminders about how you’re supposed to look in a bathing suit. This affects all of us: men, women, college students, athletes, adolescents, moms, dads, you name it. A number of articles written in college papers, on “exercise” bulimia recently came to our attention. “Exercise Bulimia Overlooked,” written by Iliana Paul, In the Mount Holyoke News, was one such article and discussed how this disorder is becoming more prevalent in females across college campuses in the United States. As this is an important topic, we would like to highlight and clarify several important aspects of Anorexia Nervosa and Bulimia Nervosa, for our readers.

Sex. Females are not the only ones who are known to suffer from eating disorders (ED). This is a very common stereotype. Even though there is an increased likelihood for females to be seen with an ED, the known male population in eating disorder clinics around the U.S. is increasing yearly. About 10% of patients with an ED, known to mental health professionals, are male (Wolf, 1991; Fairburn & Beglin, 1990). Males may have an even greater risk of having an ED oriented around over-exercising, possibly from athletic or social gender role pressures.

Age. Individuals of all ages are affected by eating disorders. While eating disorders are highly prevalent in individuals 15-25, eating disorders effect individuals ages 10 and younger, and spans in the other direction up to 70 and beyond. 

DSM – IV – TR. “Exercise” bulimia is not an official diagnosis of an eating disorder in the DSM – IV. According to the manual’s diagnostic criteria, there are two types of Bulimia Nervosa: purging type or non-purging type. Thus a person suffering from Bulimia Nervosa, non-purging type would be seen having recurring binge eating episodes followed by behavior that would indicate that they were trying to lose weight (e.g. excessive exercise). Patients with Anorexia Nervosa may also exercise excessively while not taking in the appropriate amount of calories required for the amount of activity they’re participating in.

Physical exercise can be a great way to stay healthy. However, the old adage, “Do not start an exercise program without consulting with your physician,” remains. If caloric intake isn’t a part of your weekly work-out, you could cause more harm to your body then any good the exercising may be doing. Lack of nutrition plus compulsive exercise could result in significant medical and psychological issues for athletes and non-athletes alike. This can include osteoporosis, amenorrhea (loss of menstrual periods), muscle injury, depression, dehydration, stress fractures, and even cardiac arrest. So, yes, there is such a thing as too much exercise. Moderation is key, after the doctor has given his or her stamp of approval!

Submitted by: Kate Dykeman, Outreach Intern

Published by Sarah Blake
May 24th, 2009 in In the News
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Dangerous Diet Pills: Hydroxycut Recalled

Recently, the FDA recalled Hydroxycut products, the popular line of weight-loss supplements that have been on the market since 2002. Consumers were warned to immediately stop using the product after it was associated with 23 reports of serious health problems, including the death of a 19-year-old male due to liver failure.

This is not the first instance of a weight-loss supplement being removed from the market as a result of its serious health consequences. (Remember the recalls on Fen-Phen and Ephedra?) However, many consumers were still surprised to hear the news; the popularity and wide availability of Hydroxycut products for the past seven years have provided a false representation of the products’ safety.

It’s important to realize that unlike pharmaceutical drugs, manufacturers of dietary supplements do not need FDA approval before putting their products on the market. Instead, the FDA will step in to identify harmful products after they are already on sale. The problem with this system is that it can be difficult to identify isolated incidents, especially since the FDA depends on voluntary reports which can often come late or not at all. Case in point: the death of the 19-year-old male from his use of Hydroxycut occurred in 2007, but was not reported until March of 2009.

We here at The Center for Eating Disorders at Sheppard Pratt, would like to take this opportunity to remind you about the dangers of using any type of dietary supplements, which have the potential to become addictive and affect your health. Seizures, cardiovascular disorders, and rhabdomyolysis were just a few of the reported health problems associated with Hydroxycut. Additionally, there were reports of liver damage from those who took the doses recommended on the bottle, which goes to show that you do not have to abuse these popular supplements to be a victim of their harmful side effects.

In the often constant focus by society and individuals on the pursuit of thinness, the thought to the cost associated with this pursuit is often lost. This recall sheds light on just some of the tremendous dangers associated with this desire to change ones body through this type of “quick fix” via a pill. The list of consequences and of unhealthy schemes are too numerous to list here, but before embarking on another weight loss plan, give some thought – are the risks REALLY worth it?

Published by Sarah Blake
May 12th, 2009 in Celebrity Topical News
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Anorexia Nervosa and Autism Spectrum Disorder Link?

We saw this recent article in New Scientist about some links between Anorexia Nervosa and Autism Spectrum Disorder, particularly in some of the thinking styles.

Janet Treasure, PhD FRCP FRCPsych, a researcher and clinician in London, who spoke at the Center for Eating Disorders Symposium in 2008, has been researching this concept and has found that more than 1 in 5 individuals with Anorexia meet criteria for Autism Spectrum Disorder.  The Autism Society of America  states that Autism is reported to be found in 1 to 1.5 million Americans. As you can see, this represents a significantly higher rate in those with Anorexia then in the general public. With this information, additional research has been done to look at these thinking patterns, and potential therapies that may assist in working with these patterns.

The Center for Eating Disorders thinks that while more research is necessary, this study holds promise and we plan to keep our eyes and ears open for additional findings. Stay tuned to our blog for more information as it becomes available!

Published by Sarah Blake
April 25th, 2009 in Editor's Picks, In the News
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Q & A with Michael Levine, Ph. D.

Dr. Levine is a gifted speaker and the co-author The Prevention of Eating Problems and Eating Disorders: Theory, Research, and Practice.  He is the Samuel B. Cummings Jr. Professor of Psychology at Kenyon College and former chair of the Psychology Department. In addition, Dr. Levine received the Lori Irving Award for Eating Disorders Prevention and Awareness and the Meehan-Hartley Award for Leadership in Public Awareness and Advocacy. He is currently a Fellow of the Academy for Eating Disorders.

Last year, Dr. Levine provided us with an excellent presentation entitled “What are we waiting for?” The Necessity of Universal and Selective Approached to Preventing Disordered Eating. The feedback was so good, we brought him back this year to discuss, “Mass Media, Eating Disorders and the Bolder Model of Treatment, Prevention, and Advocacy. Dr. Levine joins us today to answer a few questions about eating disorder prevention, explain a little about what the Bolder Model of Treatment is and to explain the risks involved in a poorly constructed eating disorder prevention program.

Can eating disorders really be prevented?  At what age is it best to begin implementing prevention efforts? The honest answer is that no one really knows yet whether eating disorders can be prevented, because long-term longitudinal studies have not yet been conducted. There is substantial evidence that some risk factors can be reduced — and some protective factors (such as media literacy) increased — over a one-to-two-year period. It is probably best to begin full-blown prevention efforts around the ages of 6 or 7. At this age, we can begin to promote eating a variety of foods (including fruits and vegetables), to facilitate an active life style, to promote multiple competences, and to reduce weight-and-shape-based discrimination and teasing.

What is the Bolder Model of treatment, prevention and advocacy?  Where did it originate?

The “Boulder [Colorado] Model” of clinician-practitioner training, better known as the standard “scientist-practitioner model” informs current Ph.D. programs in Clinical and in Counseling Psychology. It was developed in the late 1940’s as the first Ph.D. programs in clinical psychology were being developed. The “Bolder” model of treatment, prevention, and advocacy was developed in the late 1990’s by the late Dr. Lori Irving and Michael Levine. It takes the feminist dictum that “the personal is the political” (and vice versa) and adds the professional element. An introduction to this approach may be found in:

Irving, L. (1999). A bolder model of prevention: Science, practice, and activism. In N. Piran, M.  P. Levine, & C. Steiner-Adair (Eds.), Preventing eating disorders: A handbook of interventions and special challenges (pp. 63-83). Philadelphia: Taylor & Routledge.

What are the signs of an ineffective or detrimental prevention program?

Ineffective programs, some of which are potentially detrimental, tend to treat students as ignorant and easily led astray by culture. These unhelpful programs tend to lecture at students so as to provide them with frightening information that is designed to deter them from, for example, extreme dieting. These programs run the risk of being a waste of time, and, worse of being either voyeuristic (e.g., “look at the horrible, thin anorexic people”) or of inadvertently promoting unhealthy means of weight management. One prominent sign of an ineffective program is students who are disinterested because they do not see the issues as having anything to do with them.

Contrary to that, what major elements make up a successful approach to eating disorder prevention?

My review (Levine & Smolak, 2006) of every published and unpublished study that I could locate failed to reveal consistent elements in the successful programs. That said, I believe that the most successful programs have more (rather than less) of the 5 C’s:  Consciousness-raising in regard to personal, social, and cultural influences on body image and eating; Connection-building, that is, fostering of relationships between students and between students and positive adult mentors; Competence-building, that is, the development of life skills such as stress management and assertive communication; and Change via Choice, such that participants in the program are encouraged to put their knowledge, connections, and competencies to work changing unhealthy personal, social, and cultural practices. The work toward these changes must reflect choices and other input that the participants provide.

Levine, M. P., & Smolak, L. (2006). The prevention of eating problems and eating disorders: Theory, research, and practice. Mahwah, NJ: Lawrence Erlbaum Associates.

Many thanks to Michael Levine for giving us a glimpse into what is needed for a  prevention program to be successful and at what point prevention can begin. This is such an important topic, as developing solid, valid prevention programs is the aim of so many professionals working in the eating disorder field. We look forward to hearing Michael share more about this topic on Saturday – April 18th at our annual symposium. If you have not yet registered, but would still like to come, you can register for this event, by visiting our Events Page. 

Published by Sarah Blake
April 14th, 2009 in Celebrity Topical News
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Q & A with Judith Banker, MA, LLP, FAED

In addition to being the founder and Executive Director of an eating disorder treatment center, Judith Banker currently serves as President of the The Academy for Eating Disorders (AED), a global professional association dedicated to promoting excellence in eating disorder education, training, treatment, research and prevention.   She has lectured internationally on eating disorder treatment, and we are honored to welcome her to Baltimore for the Center for Eating Disorders’ annual professional symposium, Eating Disorders: State of the Art Treatment.   During this year’s symposium on April 18, 2009, Ms. Banker will deliver her presentation, Dynamic Tension to Dynamic Strength:  Integrating Research and Practice in the Treatment of Eating Disorders. For a sneak peak at her presentation, check out today’s blog in which Ms. Banker offers insight into the ” research-practice gap”  and why it is such an important issue for eating disorder professionals to learn about.

Ms. Banker, how would you define the term “research-practice gap”?  Is it unique to the field of eating disorder treatment?

The term research-practice gap (RPG) refers to a complex gap in attitudes, systems, knowledge and dialogue between those who primarily conduct research and those in direct practice who provide treatment to individuals and families. The RPG is not at all unique to the field of eating disorders- it occurs in most fields with a strong science and research-driven component.

What are some of the underlying causes of this gap between research and practice?

The RPG is driven by a combination of forces and conditions.  These can include, 1) a lack of opportunities for researchers and clinicians to interact and engage in dialogue about treatment issues, 2) a lack of training programs that promote a scientist-practitioner model,  3)  the use of different jargon by those in research and those who practice clinically, and 4) practical conditions such as a lack of time, funding and support for professionals to participate in both research and practice.

Why do you feel this is this an important area of study for eating disorder professionals?

There are many gaps in the knowledge base in our field. The lack of dialogue and contact between researchers and practitioners can be detrimental to both parties and to our patients.  When therapists and providers don’t have a chance to communicate to researchers, it results in the loss of important clinical observations that could help to inform the research.  Similarly,  when the research findings do not reach clinical settings, it means treatment providers are not always implementing the most effective treatments in their practice.  In the end, it is the quality of patient care that suffers. We need research-practice integration to build our knowledge base and to develop the very best, most effective treatments for people with eating disorders and their families.

In addition to attending your workshop on April 18th, where can clinicians and treatment providers go to learn more about your research and the work you have done around this issue? 

AED Past President, Kelly Klump, and I wrote a chapter on the RPG that is available in a book edited by Ida Dancyger, PhD & Victor Fornari, MD, entitled, Evidence Based Treatments for Eating Disorders: Children, Adolescents and Adults (Nova Science Publishers, 2009). 

Additionally, the AED has created a listserv that is open to all members for discussion regarding causes and solutions for the RPG.  The AED also sponsors annualGlobal Think Tank sessions at the AED International Conference on Eating Disorders where attendees can address how to promote research-practice integration in our field.  Eating disorder professionals can learn more about these opportunities at www.aedweb.org.

Many thanks to Judith Banker for taking the time to offer her knowledge in regards to the Research-Practice Gap.  It is clearly a relevant topic that, for the purpose of improving and advancing treatment for individuals with eating disorders, deserves more attention from professionals in the field.  We hope many of you will be able to find out more during Ms. Bankers presentation at The Center for Eating Disorders’ annual symposium on April 18, 2009.  To register for this event, please visit our Events Page. 

Published by Sarah Blake
April 9th, 2009 in Celebrity Topical News
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“Do More and Talk Less” – Dianne Neumark-sztainer, University of Minnesota

Parents always want to do the right thing for their kids. In this culture of obesity, that generally means helping them make the right food choices and teaching them about healthy diet and exercise – right? Well, that all depends on your definition of “diet.” According to a study by researchers at the University of Minnesota, parents who encouraged their overweight adolescents to diet (the most common strategy used when dealing with an overweight teen) reported five years later that their children were still overweight, further supporting that the dieting strategy is prone to backfiring.

With parents’ increased concern about their children’s weight, researchers of this study decided to focus on weight-related parenting behaviors, focusing on parents who accurately saw their children’s weight, as well as those who did not. The results of the study indicated that even if parents accurately understood that their child was obese, they were not more likely to engage in behaviors which might help their child to develop healthier habits in relation to food and exercise.

While some experts believe that school evaluations assessing a child’s weight are key components in fighting the rising rates of obesity, the Minnesota research study shows otherwise. The tried-and-true are still the best methods to help kids build healthy habits:

  • Provide and eat healthy foods in the house
  • Have regular family meals
  • Be physically active with your kids

For more information on this study, check out the Pediatrics Journal.

Published by Sarah Blake
July 2nd, 2008 in Body Image
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