Booster Shots

Oddities, musings and news from the health world

Category: eating disorders

For obese binge eaters, good news and bad news

January 4, 2010 |  2:35 pm

Binge eaters who get a specialized form of talk therapy aimed at reducing their bingeing behavior are more likely than those who participate in a weight-loss program to shed their eating disorder two years after treatment, a new study finds. But among binge eaters who are obese, no treatments led to long-term weight loss.

Those findings are the newest evidence that binge eating--a pattern of frequent out-of-control consumption accompanied by guilt and shame and often contributing to obesity--may yield to therapies tailored to treating the disorder. But it also suggests that obesity--which affects most binge eaters--is tougher to treat, and will likely not go away even if the bingeing behavior is extinguished. The study, published in the Archives of General Psychiatry, comes as the American Psychiatric Assn. ponders whether binge eating should be recognized as an eating disorder distinct from bulimia and anorexia when the psychiatric community releases its updated diagnostic manual in 2013.

The study pitted three kinds of treatment--interpersonal therapy, a form of cognitive behavioral therapy described as "guided self-help," and a behavioral weight-loss program--against each other for 24 weeks. Immediately following the interventions and a year later, all three appeared to have roughly equal success in reducing the central--psychological--symptoms of binge eating disorder. The behavioral weight-loss program, however, resulted in greater weight loss at the earliest assessment period.

A year later, all three treatments still looked to have had similar rates of success in alleviating binge-eating symptoms. But by the two-year post-treatment mark, the two forms of talk therapy appeared far superior to the behavioral weight-loss program in maintaining a remission of binge-eating symptoms. Meanwhile, those in the behavioral weight-loss group steadily gained back the weight they had lost during the program; in the end, the number of subjects in all three intervention groups who had lost 5% of their body weight and kept it off showed statistically little difference: 21% of those in interpersonal therapy, 23% of those in cognitive behavioral therapy and 27% of those that had been in the behavioral weight-loss program were able to maintain a 5% weight loss. 

The study, led by Rutgers University psychologist G. Terence Wilson, underscores that, in treating binge eating disorder, treating the symptom--obesity--probably doesn't pay in the long run. And it's not effective either.

Think you may have a binge-eating problem? A good place to start is here, but also see our recent report on the subject, as well the fledgling support and advocacy organization for Binge Eating Disorder, here. Many people report they have had great success with Overeaters Anonymous, a 12-step program that views overeating as a form of addiction. To get the take of one of the nation's best-regarded binge-eating programs, check out the eating disorders program at Duke University.

-- Melissa Healy


Do these genes make me look fat?

December 7, 2009 |  4:41 pm

A very rare genetic anomaly may be responsible for certain cases of obesity, suggests a study published Sunday in the journal Nature.

The research found that people with deletions involving a specific gene had a “strong drive to eat" and packed on the pounds easily.

But don’t start blaming love handles on your DNA just yet – this study involved children who were dealing with severe obesity, about 220 pounds by age 10. Moreover, this particular genetic anomaly is so rare, it accounts for a tiny number of cases.

As the Centers for Disease Control and Prevention point out, most people gain or lose weight based on a combination of genetic predisposition, environmental factors and individual habits. Some of the best weapons against it include a healthy diet and regular exercise.

-- Amina Khan


Drawing back the curtain on binge eating

November 23, 2009 |  1:22 pm

Fries With psychiatrists mulling whether to classify binge eating as a bona fide eating disorder -- laid out in a package of stories in today's Health section -- the blog Jezebel launches a more personal discussion of the problem.

That post notes: "As someone who has been fortunate enough to receive proper treatment for an eating disorder, I find it somewhat troublesome that the concern over including binge eating disorder in the DSM comes back to worrying about doctors over prescribing medication or patients who rely on the diagnosis as some excuse to continue engaging in unhealthy behavior. ... I was able to get proper treatment because my eating disorder was clearly defined in the DSM."

People who have struggled with binge eating then weigh in. Others opine about the merits of the DSM classification.

Here's the L.A. Times' story, by staff writer Melissa Healy: Is binge eating a psychiatric disorder?

It begins: "Rina Silverman's refrigerator is almost always empty. She keeps it that way to avert episodes of frantic food consumption, often at night after a full meal, in which she tastes nothing and feels nothing but can polish off a party-sized bag of chips or a container of ice cream, maybe a whole box of cereal. The food she's eating at these moments hardly matters."
 
And here are the related stories in the package:

Trying to define binge eating disorder

Binge eating: Is it a form of addiction?

Holidays can feed binge eaters' problems

And for more on binge eating, check out this collection of information, tips and resources from helpguide.org.

— Tami Dennis

Photo: For binge eaters, one serving isn't enough.

Credit: Tim Boyle / Getty Images


'Hungry: A Mother and Daughter Fight Anorexia': Q&A with authors Sheila and Lisa Himmel

August 22, 2009 |  7:00 am
HungrySheila Himmel is a food writer. She loves French fries, raspberry meringues and warm brioche, reveling in food’s texture, taste and tantalizing appeal. She was the restaurant critic for the San Jose Mercury News. She's a James Beard award-winning writer who is curating a cookbook exhibition at the San Francisco Public Library.

In her household, her daughter, Lisa, was starving herself — and keeping diaries of every calorie she consumed. During high school, Lisa became anorexic and, later, bulimic. Sheila learned of her daughter’s illness in the winter of her senior year of high school, during a doctor’s visit to find out why Lisa had stopped menstruating.

Sheila says of the incongruous situation: “I like irony better when it happens to other people. I would like to live irony-free from now on.”

Together, they’ve written "Hungry: A Mother and Daughter Fight Anorexia" (August 2009, Berkley Books, $15).

"Hungry" is a memoir of a family’s journey and a closer look at how food can be so loved and yet so loathed within the same household. The book addresses eating-disorder triggers, treatment facilities and revelations the pair had along the way. They tell their story side by side as a mother-daughter team, thus giving the reader both a parent’s perspective and that of a recovering anorexic at once.

Sheila and Lisa talked about their memoir and how their lives have changed:

Sheila, the irony of this situation was never lost on you. As a mother, what was your first reaction when you found out this was happening?

Sheila: My first reaction was horror. I was pretty side-swiped by this. It wasn’t anything I would have expected. Not only am I a food writer, but my husband was, and is, seriously into food. I felt like I was knocked over.

And Lisa, where are you now? Have you relapsed? Do you consider yourself healed?

Lisa: Right now and for some months, I’ve been doing pretty good — not having eating disorder behaviors. I wouldn’t say I’m healed though; that will take a lifetime. I know I’m in a place where I can rely on alternative methods for dealing with stress instead of relying on eating disorders.

What do you think triggered you to start starving yourself?

Lisa: First, it started as a choice to get in shape. I just wanted to exercise and lose some weight. But then it got addictive. You think: ‘Well, I got to this weight, how much further can I go?’ It’s like you just have to keep going. And I think that happens to a lot of people.

Did you use pro-anorexia (“pro-ana”) sites online?

Lisa: I did look at them — more so during my high school days, because they were more popular then. But I never really used them as advice. I personally don’t like photos of super-starving girls. I was looking at one site, and I just got so mad, and my dad brought home pizza and I ate two pieces because I was mad. It really is sort of a cult.

Tell me your reaction to treatment facilities. Do you think they work?

Lisa: Well, no. I’m really a stubborn person. I think eating disorders do that — make you very stubborn. The idea of being in a hospital-type setting, I didn’t like. I was looking for something less 12-step-based. I wanted something more based on feelings and to go through it slowly.

[Describing one treatment facility and their efforts to force feed:] Sometimes I was really full, and they’d say: ’You’re not really full, that’s just your eating disorder talking.’

You have to be really careful with treatment facilities because they are expensive. But the right one can be the key.

How were you affected romantically? You describe your relationship with your college boyfriend, Scott, in the book. Do you feel attractive now?

Lisa: It did affect the relationship. I think that is the reason he broke up with me — because I was so withdrawn.

There was a period where I did not feel attractive. But I actually have a boyfriend now that I’ve been with for over a year. I’m still at a point where I don’t see myself as others see me. I was out with friends recently and they said: "You’re glowing and you have this great smile." And I actually believed them for once.

Sheila, do any other women in your family have this issue?

Sheila: No, there wasn’t in my family at all. Ned’s family sort of has body image issues, but not eating disorders.

Was this whole situation for you some sort of hazard to your occupation? Do you view food differently now?

Sheila: When I was still with the [San Jose Mercury News] and I was still going out every night eating, it was hard to face food when your child is seriously ill.

But it has caused me to appreciate food more — for community, for family. It ties us together. It has made me appreciate good food that much more.

Lisa’s illness has made me more aware. You can’t avoid food in our culture; it’s in our face all the time. If that’s what your issue is, you can’t escape.

Lisa didn’t choose to have eating disorders, no one would. They are horrible. I think it was a combination of genetics, image issues and American culture — worship thinness, but fetishize food — that got her.

Do you think what you did for a living shaped or affected Lisa’s eating disorder in any way?

Sheila: I know that Lisa feels my job was problematic, so it was. I can see how listening to constant talk about restaurants and food would be grating, at best, for someone with serious food issues.

Did you feel what your mom did for a living affected your disorder?

Lisa: For the first five or so years of her job, I joined along willingly and with much enthusiasm. I had always had a fairly advanced appreciation for ethnic cuisine and fancier fare for my age. But when I got into the anorexia, I found her job to be more of a hassle and a barrier than fun. As my mind became so consumed with thoughts of food -- what would be okay to eat, what would not -- I found it difficult to distract myself from those thoughts, even in what should be the comfort of my own home, as my mom and dad constantly talked about food. The restaurant she just went to, which dish they liked the best, what would taste good with bacon grease.

Her job did not directly begin my disorder, but it was definitely a factor.

What’s your advice to other parents who are going through this?

Sheila: I think parents worry too much about doing the wrong thing. Jump on it. Do something and don’t worry about using the exact right words. Your concern comes through. You’re the parent. Just get in there and try something. Keep going until you find something that works.

What’s your advice to other girls who might be considering doing this to themselves?

Lisa: It’s hard to have one set solution because it gets ingrained in someone’s head once they start. It isn’t fun and doesn’t make anyone any happier. The bottom line is: It’s not worth it. I think the best everyone can do is live a healthy and balanced life. Surround yourself with positive people too.

Do you have any long-term health effects from the eating disorders?

Lisa: I have a lot of digestive issues still. Growing up, I had no allergies, but now I am sensitive to dairy, spices and soy. It’s frustrating. Because of bulimia, the body naturally wants to get rid of food. I have a lot of trouble with vegetables. My hair is a lot thinner than it used to be. So far, my cell count and blood work is good, but now I’m more sensitive to potassium deficiencies. I get dizzy really easily.

Was it difficult to write this book?

Sheila:  It’s difficult to even read it again. Even now when I read certain chapters I just cry.

-- Lori Kozlowski

Photo: Berkley Books


A theory on why anorexics spurn food

July 22, 2009 |  7:00 am

Anorexics spurn food

What causes someone to starve himself? That's the central question among researchers hoping to solve the puzzle of anorexia. A new theory, proposed by one of the leading researchers on the disorder, suggests that faulty wiring in the brains of people with anorexia causes them to fail to recognize when they are hungry and feel anxious and depressed when they do eat.

"Individuals with anorexia tend to report that dieting reduces anxiety, while eating increases it," said Dr. Walter H. Kaye, the lead author of the report, in a news release. "This is very different from most individuals, who experience hunger as unpleasant." Kaye is director of the Eating Disorders Program at UCSan Diego.The theory, published online this week in Nature Reviews Neuroscience, helps explain the motivation propelling people with anorexia to starve themselves. In effect, starvation makes them feel better -- psychologically.

Kaye's research suggests that anorexia occurs in people who tend be perfectionists or have anxiety or obsessive-compulsive tendencies. Changes in hormones triggered by puberty may promote these tendencies. Once a patient begins an altered pattern of eating, neuro-chemical changes take place in the brain. Brain scans performed by the co-author of the study, Julie L. Fudge, of the University of Rochester Medical Center, show that people with anorexia have an imbalance between circuits in the brain that regulate reward and emotion and circuits associated with consequences and the ability to plan ahead.

"Brain-imaging studies also show that individuals with anorexia have alterations in those parts of the brain involved with bodily sensations, such as sensing the rewarding aspects of pleasurable foods," said another co-author of the study, Martin Paulus. "Anorexics may literally not recognize when they are hungry."

The science suggests that successful treatment of the disorder may lie in correcting these neural imbalances.

-- Shari Roan

Photo credit: Mark Boster  /  Los Angeles Times


This isn't to say everyone should develop 'orthorexia'

July 10, 2009 | 10:15 am

Carrots Americans are getting fatter all the time. The excess pounds are costing us a bundle. But eating less will make us live longer. If this week's headlines don't nudge you toward a condition called "orthorexia," you're a hard-core couch potato. Or possibly just well-balanced.

The word was termed some years ago by Colorado physician and alternative medicine expert Dr. Steven Bratman to define an obession with healthy eating. Here's a quick overview from Psychology Today and another from Suite101.com. The condition isn't an officially recognized disorder, and the term doesn't appear to have gained much traction in pop culture, much less the medical field. 

Here's an excerpt from Bratman's original essay on the topic, published in Yoga Journal in 1997:

Orthorexia begins, innocently enough, as a desire to overcome chronic illness or to improve general health. But because it requires considerable willpower to adopt a diet that differs radically from the food habits of childhood and the surrounding culture, few accomplish the change gracefully. Most must resort to an iron self-discipline bolstered by a hefty dose of superiority over those who eat junk food. Over time, what to eat, how much, and the consequences of dietary indiscretion come to occupy a greater and greater proportion of the orthorexic's day.

He and co-author Steven Knight wrote a book about the condition in 2001: "Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating."

A WebMD story, "Orthorexia: Good Diets Gone Bad," which features Bratman prominently, offers a bit more context. And a nice tip sheet from the Palo Alto Medical Foundation explains how to recognize the symptoms in teens.

For those who want their explainers video-style, here's one person's YouTube video introduction to the topic.

And the original essay, whether you agree that the condition is real or simply another form of obsessiveness, anorexia or something else entirely, is intriguing. Here's more:

The act of eating pure food begins to carry pseudospiritual connotations. As orthorexia progresses, a day filled with sprouts, umeboshi plums, and amaranth biscuits comes to feel as holy as one spent serving the poor and homeless. When an orthorexic slips up (which may involve anything from devouring a single raisin to consuming a gallon of Haagen Dazs ice cream and a large pizza), he experiences a fall from grace and must perform numerous acts of penitence. These usually involve ever-stricter diets and fasts.

And about those headlines from the week: The obesity epidemic: Pounds and dollars rise together; Obesity hitting California's economy in a big way, study finds; Permanent diet may equal longer life.

There's a medium here somewhere.

-- Tami Dennis

Photo: Ken Hively / Los Angeles Times


Young vegetarians may have eating disorders

April 1, 2009 | 10:52 am

Veg

We want our children to eat more fruits and vegetables, and hooray for the kids who do. But a new study suggests that a sizable number of adolescents and young adults who say they are vegetarians actually have a eating disorder.

Previous research has also found a link between young people who say they are vegetarians and eating disorders. Some researchers have found that adolescents with eating disorders may adopt a vegetarian diet as a weight-loss tool that is considered socially acceptable. The new study analyzed data from surveys, questionnaires and observations taken at 31 Minnesota schools in 1998. The 2,516 adolescents and young adults in the study ranged in age from 15 to 23. The students were categorized as current vegetarians, former vegetarians or never vegetarian. A vegetarian diet can mean eating only plant sources or consuming some dairy and eggs or even some chicken and fish.

The study found that 19.6% of the current vegetarians and 20.9% of former vegetarians used some form of extreme, unhealthy weight-control behaviors (such as using a diet pill or laxatives or inducing vomiting), and 21.2% and 16%, respectively, said they had binged on food with a loss of control. In comparison, 9.4% of the never-vegetarian group had used extreme, unhealthy weight-control behaviors and only 4.4% said they had lost control while eating and binged.

"These findings suggest that ... current adolescent and young adult vegetarians are at greatest risk for binge eating with loss of control. Reasons for this might be due, in part, to heightened awareness of food intake in general among practicing vegetarians and, thus, a greater likelihood to report eating and feeling a loss of control. Possible triggers for binge-eating episodes may also be related to self-imposed restrictions of certain foods or a decreased level of satiety related to decreased intake of protein and fat," the authors wrote. The study, published today in the Journal of the American Dietetic Assn., was conducted by researchers from the College of Saint Benedict and Saint John's University, the University of Minnesota and the University of Texas, Austin.

To detect eating disorders, doctors should ask their patients about their vegetarian status, the researchers said. And parents, they said, should probe their children about their motives in choosing a vegetarian diet.

-- Shari Roan

Photo: South Koreans promote vegetarian diets. Credit: AP / Ahn Young-joon



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