January 29, 2007

What's on the menu for new research?

Are you, like me, impatient to know what research is going on right now? A good place to peer into the future (and your tax dollars) in the US is the NIMH Clinical Trials. In the UK, you can read about current ED studies HERE out of THE Maudsley. (I'd love to add more countries: send them on!)

NIMH Clinical Trials: Eating Disorders

January 25, 2007

Why you can't be "a little" Maudsley

If Maudsley works:

Why do we stop thinking "the disease is controlling the sufferer" after they turn 21?

If Maudsley works:

Why is full nutrition optional after 21?

If Maudsley works:

Why are parents at fault for sufferers over 21?

If Maudsley works:

Why are sufferers given the choice whether or not to cooperate after 21?

If Maudsley works:

Why does insight have to come before behavior change in adults?

January 22, 2007

Gisele Bundchen's Mother's School of ED Prevention

Now that internationally known model Gisele Bundchen set us straight on the true cause of eating disorders:

"Parents are responsible, not the fashion industry"

We rushed to her mother for an exclusive interview:

Mama Bunchen's Tips for Preventing Eating Disorders:
* Encourage your daughter to make a living based on her appearance.
* Assure your daughter that her looks are so important that people will listen to anything she says.
* Make sure your daughter confuses the fact that people listen to her with there being anything to listen to.
* Reassure her that no matter how uninformed and damaging her comments, as long as she says nice things about you, she's a good daughter.

Post script: There has been more coverage of one model's comment about parents causing eating disorders than all the mentions there have ever been on the Maudsley approach, the one treatment approach which says the opposite. I despair.

(post post script: I feel better: "Families do not cause anorexia nervosa")

January 20, 2007

Round-up of recent research

What's interesting in research lately?

Presence of depressive symptoms may explain elevated homocysteine levels previously reported in patients with eating disorders or vice versa. Longitudinal studies are needed to unravel this hen or egg problem" out of Germany.

From Psychiatric News, an excellent piece on insurance and "biologically based" illness.

"Preliminary evidence supports the use of olanzapine for treatment of anorexia nervosa by demonstrating that olanzapine 2.5-15 mg daily promotes weight gain and has positive effects on associated psychological symptoms."

"Parenting as Therapy for Child's Mental Disorders" from the New York Times.

"Family functioning of patients with an eating disorder compared with that of patients with obsessive compulsive disorder." paper out of Turkey says, in part: "It is difficult to conclude that patients with AN or BN have a specific type of family functioning which is totally different from the family functioning of patients with OCD."

Belgians looking into "Pain experience related to self-injury in eating disorder patients" wherein "some experience as painful, while others report analgesia during episodes of SIB."

January 16, 2007

Maudsley Parents Virtual Family Dinner

I want to invite you to dinner. Yes, you.

On February 25, the first day of NEDA's Eating Disorders Awareness Week, the Maudsley Parents are holding a Virtual Family Dinner.

To celebrate the role of family support in recovery, the Maudsley Parents group will sponsor a worldwide Family Dinner. All participants will share a meal with available family members that day, and the Maudsley Parents site will dedicate a place on the board to share the experience.

If you care to "join" us, just post your dinner plans at the Maudsley Parents forum and then, if you like, send your mailing address to the moderator so we can send you a gold fork lapel pin. No charge, no sales pitch, no nothing. Just a bit of connection with other parents who understand the poignancy, and life-sustaining nature, of a simple family meal.

Now, how many place settings are we going to need?

January 15, 2007

Good luck, Olympia!

Sometimes it is just time.

Last fall it was time for my daughter to take some time off to stop a relapse of ED behaviors.

This morning it is time for Olympia to return to college. She's packed her clothes, a pile of pens, and a strong set of tools to stay well.

She also leaves with our loving support, our admiration, and, um, our credit card...

Best wishes to my fierce, funny, brave, smart, amazing daughter. Another chapter in your very cool adventure.

January 11, 2007

Force Feeding

Let's talk about force-feeding. Unless you feel pressured - I mean, I can't MAKE you read this, you have free will, you can stop reading this right now. Don't read this! Stop reading!

Sorry.

I asked a therapist yesterday whether she had heard of the Maudsley approach. Two beats.

"Isn't that force feeding?"

Grr.

We have got to change the linguistics of eating disorders.

1) "eating disorders" will now be called "not-eating disorders."
2) "anorexia" will now be referred to as "malnutrition"
3) "bulimia" has a new name: "nutrition loss"
4) "refusal to maintain healthy weight" will be correctly labelled as "inability to self-nourish"
5) No one will be allowed to say "environment" without specifying that this includes dieting, prenatal nutrition, and inappropriate athletics.
6) Asthma medicine will now be "force-breathing" and insulin relabelled: Forced Metabolism."
7) Inpatient treatment will now be called "force feeding."
8) And feeding your children, especially when the child is inclined not to, has a new name: "good parenting."

January 8, 2007

My ulna's BMI

The move to ban "unhealthy models" saddens me. Not because I believe it will put poor, starving models out of work. Not because I believe my daughter was inspired to life-threatening malnutrition by the sight of Kate Moss. It makes me sad because the protest against the ban calls the models at and above the 18 BMI "larger."

Larger than what? My ulna? The fashion industry is balking at a minimum standard of 18, which is 1/2 a BMI point BELOW the definition of "underweight."

A 1/2 point less than what, if imposed on a population of refugees, would be considered by the WHO as a human rights abuse. In fact, perhaps we need to put Kofi Annan on this fact: today's models have on average a BMI of 16.3.

This is our standard of beautiful? This is attractive to us? We buy things from people who sell this standard?

We've redefined the ENTIRE normal BMI range as "large" "plus" "round."

This is evil. And worse still, it makes people with eating disorders seem rational. It makes us as parents and caregivers look like hypocrites when we assure our children that we want them to be "normal" and "healthy," not "fat."

By the standards of our media, 95% of us ARE too fat, too large, unacceptable, and pretty much invisible. We have normalized a vision of acceptable appearance which is arrestedly prepubescent (and 6 feet tall) for models, store mannekins, cereal commercial pitchmen, and entire staffs of fictional hospitals.

January 5, 2007

You are what your bacteria eat!

I'm a sucker for research. Some people like shopping, I enjoy strolling through PubMed. Today I'm interested in bacteria.

"Fully 10 percent of our own dry body weight consists of bacteria" That's "dry" weight, after you remove all the water! Who knew?

And some of the little bacterial buggers are actually now being implicated in the development of obesity. Which, naturally, leads me to wonder what we'll learn about anorexia and bulimia.

Turns out diet, exercise, and metabolism have a seething, symbiotic dance partner we know little about.

These wee fellows have the ability to wring every calorie possible out of the food you eat, ironically, getting better and more efficient as your weight rises. Turn this upside-down and what will we find about people who are underweight?

"Just eat" "just stop eating" "calories in - calories out" "just.... not that simple.

Complicated thing, a human body. Come on, B. theta and M. smithii, let's dance!

January 3, 2007

Bulimia is a metabolic disorder?

I know, I know, I'm a reflexively mechanistic thinker who is always looking for the Eureka explanation and a magic pill. But you have to admit this is interesting: "Bulimia may result from hormonal imbalance."

"'We have shown that one third of female bulimics have metabolic disorders that may explain the occurrence of the eating disorder. These disorders may in certain cases express the hormonal constitution of the patient, rather than any mental illness', says Dr Sabine Naessen about the research results that are presented in her doctoral thesis."

Now, mind you, we'd already know this was true if people with eating disorders were routinely given thorough medical testing. But just as it took us until the 1980s to figure out that ulcers were caused by a bacteria and not "stress," so are we in 2006 still blaming the victims.

January 2, 2007

Is Maudsley cheaper?

Cindy, a friend in the DC area whose son has anorexia, alerted me to today's Wall Street Journal, "Eating Disorders: Families Fight Back: Insurers Have Long Covered Only a Fraction of Huge Costs; Now, Pressure to Pay More" by Elizabeth Bernstein.

I am grateful to all the work out there to get eating disorders covered by insurance. Parents are forced to desperate measures to get treatment - financial ruin on top of the heartbreak and disabling illness.

But as a passionate advocate for family-based treatment, I worry.

The medical and psychiatric community needs to treat eating disorders as the neurobiological illness they are. Eating disorders are real diseases, not choices.

But the $1-2K daily cost of inpatient treatment isn't necessarily the thing I want them to pay for.

1) I'd like to see the day when no one diets or overexercises in the first place, triggering the physical imbalances which create eating disorders. Spend money educating the public about the danger (and futility) of dieting. Spend money on early detection. Save medical care dollars by educating coaches and pediatricians on detection and intervention.
2) I want insurance companies to STOP PAYING for treatments without scientific basis. Equine therapy, psychoanalysis, and individual psychotherapy for children come to mind. Might also want to take a close look at the failure rates of the treatment centers out there -starting with the ones who use unscientific methods to advertise their 'success rates.'
3) Maudsley therapy isn't free, but home-based treatment is less expensive, shorter in duration, and with a better success rate means less expense over time. Pay for early intervention with evidence-based care which trains the CAREGIVERS, not the sufferer, to provide guaranteed nutrition and an emotionally safe environment.

Inpatient treatment has its place. Families with limited resources need emergency respite and adjunct care. Safety has to come first, and no home should be safe harbor for eating disordered behaviors.

Finally, I challenge inpatient treatment programs to start treating the family as part of the treatment from the beginning - not for a condescending 'family week,' but integrated into the treatment team from the beginning through discharge and after care. The UC San Diego program model, and the Boswell Center in Jacksonville both operate in this way.

Am I terrified that insurance companies will discover Maudsley and use it as a way to pay even less, and put the burden back on under-equipped families? Yes. But I can't let that fear cloud the issue: sufferers deserve early intervention with effective methods. Families deserve coverage for what works, and what will prevent years of disability and poor outcomes.

A false choice is peddled to vulnerable parents: ineffective outpatient treatment versus parentectomy. The real choice needs to be: effective outpatient support or effective inpatient support.