Family-based Therapy May Effectively Treat Adolescent Anorexia Nervosa

MedicalResearch.com Interview with:
Stewart Agras, M.D.
Professor of Psychiatry Emeritus
Stanford University School of Medicine

MedicalResearch: What was the study about?

Dr. Agras: Family-based treatment (FBT) has been shown to be more effective than individual psychotherapy for the treatment of adolescent anorexia nervosa. This treatment focuses on helping the family to re-feed their child. The question posed in this study was whether Family-based treatment would have any advantages over Systemic family therapy (SyFT) focusing on family interactions that may affect the maintenance of the disorder. The participants were 164 adolescents with anorexia nervosa and their families – one of the largest studies of its type.

MedicalResearch: What is the background of study?

Dr. Agras: Anorexia nervosa has one of the highest death rates, from suicide or starvation, of any psychiatric disorder particularly in longstanding cases and is associated with major psychosocial disability. There are no evidence-based treatments for these cases hence it is important to treat anorexia early in its course in adolescence to reduce the number of persistent cases.

MedicalResearch: What were the main findings?

Dr. Agras: Both family therapies were equally effective in weight restoration and reducingeating disorder symptoms at the end of treatment and at follow-up.

However, Family-based treatment led to faster initial weight gain and significantly fewer days in hospital. This reduced the cost of treatment by half (about $9000 vs $18,000). It is likely that the early weight gain resulting from the focus on re-feeding with Family-based treatment reduced the risk of hospitalization. However, SyFT was found in a moderator analysis to be more effective than Family-based treatment for patients with obsessive-compulsive symptoms.

MedicalResearch: Were you surprised by any aspect of the results?

Dr. Agras: Yes. We expected Family-based treatment to be more effective than SyFT at end of treatment because of its specific focus on helping the family to re-feed their child.

MedicalResearch: What should clinicians and patients take away from this report?

Dr. Agras:

• First, this study confirmed the effectiveness of Family-based treatment in treating adolescents with anorexia nervosaand demonstrated major cost-savings from its use compared to SyFT.
• Second, for patients with more severe obsessive-compulsive symptoms SyFT may be the better choice. Parents should know that there is effective outpatient treatment for most adolescents with anorexia nervosa, that Family-based treatment is the preferred treatment, but that SyFT may be more useful for some adolescents.
• Finally, this study confirmed that patients with a shorter duration of anorexia nervosa improved more than those with a longer duration, underlining the need for early identification of this disorder in adolescence together with early treatment.

 

Citation:

Comparison of 2 Family Therapies for Adolescent Anorexia Nervosa: A Randomized Parallel Trial.

Agras W, Lock J, Brandt H, et al. Comparison of 2 Family Therapies for Adolescent Anorexia Nervosa: A Randomized Parallel Trial. JAMA Psychiatry. Published online September 24, 2014. doi:10.1001/jamapsychiatry.2014.10

If you or someone you love struggles with an eating disorder, please call us at (206) 909-8022 or visit us at www.RameyNutrition.com

Concerns rise for child anorexia crisis

A new study has revealed that some children as young as eight years old are going to extreme lengths to change their bodies because they are unhappy with their weight.

With up to two million Australians having developed serious eating disorders at a time in their lives, psychologists now want to act on what has become a body image crisis.

Tatiana Johns, now 23 years old, has suffered from anorexia for almost half her young life.

Struggling with undiagnosed depression, she found a website promoting ‘thinspiration’ giving tips from emaciated models.

“This was the start of my disorder. I was obsessed with losing weight and exercising and things like that,” Tatiana said.

“It just kind of went under the radar.”

From 14, Tatiana's weight plummeted to that of a girl almost half her age.

Kids as young at eight years old are going to extreme lengths to change their bodies, with images on social media being blamed for the crisis. Photo: 7News

Desperately hiding it from her parents, she tracked her mission to lose even more.

Eight-year-old Dana's anorexia, featured in a British documentary, highlights increasing numbers of primary school girls suffering from anorexia.

“At that moment I wanted to die. I gave up eating altogether,” Dana said.

The Australian Institute of Family Studies’ new survey of 4000 kids found the majority has tried to control their weight by age 10.

Now, a new preventative program in Sydney schools aims to alert parents.

“I think parents would be really surprised at the impact that social media can have on their child's body image,” Clinical Psychologist Ariana Elias said.

Tatiana, 23, reads diary entries from when her eating disorder began from 14 years old. Photo: 7News

“It's really helpful if parents can understand what they can do to help mediate and then protect their kids.”

A large share of the blame is being directed at social networking sites, leaving children exposed to body image propaganda.

If you or someone you love struggles with an eating disorder, please call us at (206) 909-8022 or visit us at www.RameyNutrition.com

Eating disorders becoming a reality for women in midlife

Eating disorders have long been considered a disease that affects young women and adolescents, but experts say women in midlife are increasingly vulnerable to the tangled and potentially fatal scourge.

"Women with midlife eating disorders have been invisible sufferers, but it's a problem we're seeing more than ever," says Adrienne Ressler, a specialist at The Renfrew Center, a residential facility with 16 national locations designed to treat anorexia nervosa, bulimia nervosa, binge eating disorder and related mental health problems. "Eating disorders were categorized early on as a problem affecting affluent, Caucasian adolescents, and it's been difficult to break through that myth. But the numbers are definitely changing."

"In 2001, 10 percent of our residential population was made up of women age 35 and above," Ressler said. "By 2003, 26 percent were midlife and older."

Combine that with common midlife stressors — teenagers, college costs, career transitions, marital dissatisfaction, aging parents — and you've got an environment ripe for a disease that is largely triggered by anxiety, Ressler says.

"Midlife eating disorders can be part of a chronic illness they've had their entire lives," she says. "Maybe they've been dealing with chronic anxiety or depression and an eating disorder gets revived or triggered by specific midlife events."

Close to 50 percent of people with eating disorders meet the criteria for depression, according to the National Association of Anorexia Nervosa and Associated Disorders.

Ressler emphasizes the importance of seeking help for a midlife eating disorder, given the mental and physical health complications triggered by depleting your body of nutrients.

"The biggest thing we can do is to normalize this population and let them know there are lot of women just like (them)," she says. "Women have often spent their lives putting themselves last, but they need to know they are important enough to get help and take care of themselves."

One of her favorite quotes, Ressler says, comes from the author Mary Ann Evans, who wrote under the pen name George Eliot in the mid-1800s.

"It's never too late to be what you might have been," Ressler says. "I think a lot of midlife women think it's too late to take care of themselves or start to feel good. But it's never too late."

If you or someone you love is ready to take control of an eating disorder to find a full recovery, please call us at (206) 909-8022 or visit us at www.RameyNutrition.com

The silent epidemic (dis)eased (re)presentation

If there’s one thing Duke has taught me, it's that beauty is only skin-deep. And if you really want to turn heads, you shouldn't let it get too deep.

Around Duke, we seem to have a lot of elephants in the room. And, as Duke students, we do a decent job addressing them. When it comes to body image, however, we ignore the elephant. We brush off these conversations and deny the influence it has on all of us. But there’s no denying the physical, mental and social toll body image has on members of our community.

According to a recent study by exercise physiologist Glenn Gaesser, over half of females between the ages of 18-25 would prefer to be run over by a truck than be seen as fat and two-thirds surveyed would rather be perceived as mean or stupid.

But body image concerns are not exclusive to the collegiate environment—they’ve seeped into our elementary schools, too. Slowly, the world of dieting is taking over childhood narratives.Time Magazine reports that 80 percent of all children have been on a diet by the time they have reached the fourth grade. Take that in. Rather than giving their bodies space for puberty and physical and mental development, 80 percent of 9-year olds are dieting to limit their body size. At 9 years young, dieting isn’t about portion control. It’s starvation.

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For both young girls and young women, recurrent dieting practices can lead to severe eating disorders, such as anorexia and bulimia nervosa. Despite this, the American College Health Association estimates that at least 44 percent of college women are dieting and 61 percent are exercising to lose weight. An estimated additional 10 percent of women are using laxatives, pills, or vomiting to attain their desired weight. A young woman with anorexia is 12 times more likely to die than other women her age without anorexia. So it comes as no surprise that anorexia is the third most prevalent chronic illness among adolescents, and the mortality rate for anorexia is higher than for any other psychiatric disorder.

Body image concerns are not unique to only females or young children. 27 percent of college men are dieting and 45 percent are exercising to lose weight. But losing weight is only one side one aspect to the problem. Studies show many college men suffer from muscle dysmorphia, a body image disorder that pressures males to ‘bulk up’ by gaining more muscles. Often both athletes and non-athletes who desire more muscles can be seen in the gym for several hours a week, taking in excessive lean meats and supplementing meals with protein.

These numbers should jolt us awake to the toxic environment that numerous industries are building for us. This desire to look a certain way is fed to us by many actors. The diet-related industry is a 50 billion dollar a year enterprise. Fashion models taunt us with their beautifully chiseled bodies, though they are thinner than 98 percent of American women. We look and admire, forgetting that their salary, their livelihood, depends on this unhealthy look, forgetting that this thinness is slowly destroying their organs, and forgetting the number of friends they have alienated in the quest to live this ‘thin life.’ Social media sites promote standards of beauty that are reinforced by ‘likes,’ ‘shares’ and ‘comments,’ though the backstory of the editing process never enters our timeline (but props to the several actresses who have blasted the magazine and entertainment industry for photoshopping their bodies!)

‘Healthy living’ isn’t about balancing your kale chips and carrot lunch with your afternoon workout. It’s about listening to your body—your entire body—and responding. What you eat—or don’t eat—has a direct effect on how you feel. In order for you to function at full capacity, that is, in order for you to think, read, concentrate, solve organic chemistry problems, memorize Shakespeare sonnets, research alternative energy solutions to our energy crisis and contemplate diplomatic and political strategies to human crises such as those in Ukraine and occupied Palestinian territories, you need to feed your brain the right nutrients. The brain’s energy source is glucose, which is converted from carbohydrates. Your brain also needs proteins and fats to build neurotransmitters, which are messenger chemicals that allow neurons to communicate (and as students, we need these neurons to constantly communicate). Not giving our bodies the nutrition it deserves is playing to our lowest form of living—as a mere human vessel—without allowing ourselves the confidence, energy and fuel it needs to attain our optimal potential in life.

As I reflect, I find that I often don’t ‘eat my own words.’ The Center for Disease Control may frown on the days where nothing will satisfy my hunger other than the midnight Ben and Jerry’s cone or the side of steak fries from the Loop, and that’s fine. We’re human. We can satisfy our indulgences every now and then. After all, being healthy is about being happy, too, right?

We’re also all different. We all can’t all look the same because inherently we are not. We should celebrate our differences as affirming, empowering reminders of our individuality (my extra long second toe is a daily reminder that I am, indeed, my father’s daughter).

Our bodies are created to bear blemishes, but our bodies also bear many blessings. Every day, our bodies work hard on the inside to produce the person we are on the outside. Rather than working to change our body, perhaps we should work on honoring, respecting and fueling it. Only then can we differentiate between the messages our bodies are sending us and the messages society is sending. You don’t have to take up less (or more) space to be worth more. Once we stop “fixing” our image, we are able to create bodies that inspire, empower, and excite us.

My advice: Embrace you. Own you. Love you. Rock what your mama gave you. Our culture—our younger generations—depend on all of us to change the health narrative.

The internet encouraged anorexia but it can also be used to fight it Manoush Zomorodi

It takes more than blocking sites.Reuters/Stefano Rellandini

Joanna Kay says she first started skipping meals when she was 14. Her parents were going through a divorce and they weren’t really easy to talk to. But the internet was. When the family finally got AOL, Kay would go online, alone in her bedroom, for hours. She quickly discovered communities that taught her how to be anorexic, to hide food from her parents, to purge. It was the early 2000s and people with eating disorders were gathering to share weight-loss tips on Myspace, Livejournal, and Xanga.

“When I went on these sites I saw things like girls posting their highest and lowest weights, how many calories they’re eating a day, how many times they ran around the block to burn the apple the ate. It would spur me to say, ‘If these girls can do it, then I can do it just as well if not better. I can lose even more weight. I am going to eat even less,'” says Kay.

We all know that the internet can be a dark place. People can be cruel to each other; they can band together in subcultures where dangerous behavior is accepted, encouraged, and normalized.

The eating disorder community is one of those places. Since the beginning of the internet, people suffering from anorexia, bulimia and all kinds of eating disorders, have come together to support each other and give each other inspiration—or #thinspiration as the latest movement is called—to keep going and stay focused on the goal of controlling their bodies.

An estimated 11 million Americans suffer from eating disorders, and anorexia has the highest mortality rate of any psychiatric illness. Back before social media, when someone on a pro-anorexia or pro-bulimia website became ill or died (I heard stories ranging osteoporosis to suicide), some members would be shocked enough to seek recovery—to quit the internet and their eating disorder. Then, you could still avoid digital media—and pro-eating disorder websites—if you tried hard enough.

Kay made friends and found a real-life community when she went to college. She even decided to stop restricting her food and going online. She gained a few pounds and felt better. But one day, she got tempted and did an internet search. To her dismay, she found pro-eating disorder communities had morphed with Instagram, Pinterest, Tumblr and the likes, and grown. “I realized this whole community had exploded on all these different sites and now there are pictures and links and all different rabbit holes to go down. I knew that this was not good for me but it just drew me in,” Kay says.

One Pinterest photo of an arm the width of a garden hose would have Kay thinking about her weight all day. She slid back into anorexia.

In 2014, if you are trying to recover from an eating disorder, temptation is just a tweet or Instagram away. And when a single picture of boney arm or a post about a celebrity who weigh less than 100 pounds can mess with your head, it’s not just the internet that’s a dangerous place. It’s your whole world.

Lawmakers in Italy recently proposed a bill that would fine and even jail people who create pro-eating disorder websites. In the US, if you search for “thinspiration” on sites like Tumblr, Pinterest, or Instagram, a warning box pops up, directing you to The National Eating Disorders Association. Several social media sites have guidelines that prohibit content that promotes or “glorifies self harm.” Users are banned from tagging photos with certain eating-disorder codewords, but they get around restrictions easy. Instead of tagging a photo with #thinspo, they’ll use #th1nspo and it catches on quickly.

danah boyd, a researcher at Microsoft and fellow at Harvard’s Berkman Center for internet and society, says blocking code words or visible signs of psychological trouble is useless. “What we see online is that young people cry out for help. They make it very visible when they are struggling. We usually try to block the thing that is visible rather than use it as an opportunity to get at the underlying dynamics that are at play,” she explains.

boyd is calling for what she defines “digital street outreach:” “We have all of these notions of street outreach in physical cities. How do we do the same thing online? How do we create a community of people who are looking out for young people who are clearly in trouble, helping them individually, rather than assuming we can do it algorithmically,” she says.

For a lucky few, the internet can open a window to recovery that the real world often can’t. Surfing on the web one day Kay stumbled onto webinar being given by an activist who runs a well-known eating disorder treatment center. “She said you don’t have to be ready to recover, you just don’t have to want to spend one more day or one more hour or one more minute living like you are. And I just became a waterfall of tears,” says Kay.

She began looking at recovery websites and nutritionist blogs but in the end, she checked herself into a 40 day in-patient program.

Today, at 26, back at work and front of a computer, Kay finds the only way to stay on track is to keep a tab open with Twitter and communicate with her support network there all day long.  “I’ll say ‘Don, I’m having a hard day and I could use a little positive word’ and he’ll come back and say something nice,” she says.

The help she found online inspired Kay to even start her own blog,middlegroundmusings, where she writes about that place between being anorexic and having recovered.

Kay only recently told her now-husband about her anorexia. They stuffed invitations to their wedding while she was in treatment.  She still hasn’t broken the news to her parents but says that blogging is helping her prepare for that conversation: “I lost my voice for 12 years and this is the first time I have been able to talk back.”

Obesity fear can cause eating disorders

Regarding the Sept. 1 story, "Misses actively take on obesity," about the emphasis of some Miss America contestants on fighting obesity through healthy eating and activity:

Of course, reducing obesity in the United States is a worthy goal; however, the in-your-face emphasis on it during the last decade often affects people who are not obese at all. I am mostly concerned about children and teens who sometimes take the "healthy eating" campaign to the extreme. According to a CNN report, "Fat is the new ugly word on the playground."

There is so much emphasis on obesity that we are going to produce a lot of anxieties in kids about weight. One study I found online showed that eating disorders in children under 12 increased 119 percent between 1999 and 2006. I would expect that the percentage is even greater now with the recent emphasis on restricting fast foods and sugary drinks and sending letters home from school if a child's body mass index, or BMI, is too high. Another study found that 81 percent of 10 year-olds are afraid of being fat.

In addition to anorexia and bulimia, a recently named disorder called orthorexia sneaks up on parents. It starts with a child's desire to eat more heathfully but can be taken so far that it can lead to malnutrition as foods are eliminated from the diet because they are not "pure" enough.

Here's another interesting fact I found while I was researching the negative aspects of the "healthy eating" emphasis: The average BMI of Miss America winners in the 1920s was 22. The average in the 2000s was 16.9. According to the World Health Organization, a normal BMI falls between 18.5 and 24.9. Would a Miss America with a BMI of 22 be considered overweight today?

Dieting to death: Miss World Singapore finalist was 'walking skeleton'

By 

• Lifestyle Correspondent

Published Monday, September 08, 2014

Miss World Singapore finalist Angeline Yap Siling.

Svelte and beaming with confidence Angeline Yap Siling is all geared up to win the crown for Miss World Singapore coming Saturday.

But this finalist was once a 'walking skeleton' in her mother's words.

She was weak, fragile and set on a dangerous and perhaps irreversible downward spiral in life.

For seven long years, Angeline battled with anorexia nervosa (an eating disorder).

At her lowest, the beauty queen weighed just 33kg.

(Facebook)

Not only did she lose a lot of weight, she lost nearly all her friends and almost her life.

She harmed herself, degrading her appearance and also tried to kill herself.

It all began when her relatives joked about her eating habits and asked if she was eating her sister's food.

Miss Yap, who has an identical twin sister, was always the bigger and taller of the pair growing up.

In Secondary 3, she started comparing her body with those of her sister and her schoolmates in her all-girls school.

She started feeling fat, not pretty enough and not good enough like the rest.

So the 15-year-old started starving herself- dieting to death.

Only after the death of her close friend, who also had anorexia, did Miss Yap finally decide to turn her life around.

Now weighing a healthy 47kg for her 1.64m frame, the 27-year-old is hoping to win the Miss World Singapore 2014 crown against 19 other finalists.

She told The New Paper: "I wanted to join the pageant because I know I have the potential to win and I want to use this as a platform to reach out to young girls with eating disorders."

What is Anorexia:

Anorexia is a serious eating disorder that affects women and men of all ages. It can damage your health and even threaten your life.

For some people, restricting their food and weight can be a way of controlling areas of life that feel out of their control and their body image can come to define their entire sense of self worth. It can also be a way of expressing emotions that may feel too complex or frightening such as pain, stress or anxiety.

Restrictive dieting and excessive exercise can be contributing factors to the onset of Anorexia. Women and girls with Anorexia may use dieting behaviour in a bid to achieve a culturally constructed thin ideal whereas men may over exercise and control their diet to achieve a muscular body.

It is commonly accepted that Anorexia is more frequently diagnosed in females across the ages. However, a recent population study has suggested that in adolescents, there are an equal number of males and females suffering from this illness.

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