eating disorders

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Analysis: Can Mindful Eating Really Help You Lose Weight Or Stop Binging?

(t-mizo/Flickr)

(t-mizo/Flickr)

Updated 1/23

By Jean Fain
Guest Contributor

Mindfulness is all the rage. But does mindful eating — paying very close attention to your food and to your body’s signs of true hunger and satiety — really help you lose weight or stop binging?

On the one hand, paying closer attention to how you eat and why seems like a no-brainer for improved health. But in fact, mindful eating is steeped in controversy — pitting doctors against nutritionists, parents against children, therapists against clients, even colleagues against one another.

Proponents of mindful eating (also known as intuitive eating) like nutrition researcher Linda Bacon and other advocates of “Health at Every Size” — a self-described political movement promoting healthy habits and self-acceptance, rather than diets — recite a lengthy list of benefits related to mindful eating.

Critics of mindful eating offer a number of negatives: some say such navel-gazing about food makes it unappetizing, while others say mindful eating is superficial and ineffective, even irresponsible when it supplants traditional treatments for life-threatening eating issues.

Still others, like many who posted comments on my recent NPR interview with Jean Kristeller, author of the book, “The Joy of Half a Cookie,” dismiss mindful eating as a joke. One example: “Yes, let’s add more dietary neurosis to the babel of nutritional advice. How about this: eat the whole cookie. Have two, even. Just eat cookies less often, and eat nutritious food as the rule rather than the exception.”

According to Dr. James Greenblatt, an eating disorder expert, chief medical officer of Walden Behavioral Care and the author of “Answers to Binge Eating,” mindful eating is not only pointless in some cases, it’s potentially dangerous.

“Mindful eating clearly has a place in our treatment plans,” Greenblatt explained in a recent email exchange. “But, as a sole intervention for some of our patients, it is like asking opiate abusers to utilize mindful heroin detox. Many eating disorders reflect a severe neurochemical abnormality that needs to be addressed with biological interventions first, before adding other psychotherapeutic strategies and mindfulness.”
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Harvard Experts On Eating Disorders Call For Workplace Ban On Dangerously Thin Models

Models during Paris Fashion Week 2015, before French lawmakers passed a ban on too-thin models (Jerome Delay/AP)

Models during Paris Fashion Week 2015, before French lawmakers passed a ban on too-thin models (Jerome Delay/AP)

In April, the country that’s arguably most serious about fashion got serious about fighting starvation among its models.

Consider some headlines:

Quartz: “In France, you can now be jailed for employing extremely thin models”

• Reuters: “France bans super-skinny models in anorexia clampdown”

CBS: “In France you can be too thin”

French lawmakers passed a measure that’s expected to require models to have a body mass index of at least 18 — that translates to 120 pounds if you’re 5-foot-9 and 130 pounds if you’re 5-foot-11. It proposes punishments of up to six months in prison and hefty fines for agents who violate it. Israel had passed a ban on ultra-thin models as of 2013.

Now, two Harvard experts on eating disorders are calling for similar measures in the United States. In an editorial in the American Journal of Public Health, they argue that the Occupational Safety and Health Administration (OSHA), which regulates workplace safety, should set rules that bar hiring models below a healthy body mass index for runway work or photo shoots.

I spoke with Prof. S. Bryn Austin, the paper’s senior author and director of the Harvard Chan School of Public Health’s Strategic Training Initiative for the Prevention of Eating Disorders. Our conversation, lightly edited:

What exactly are you calling for? 

What we’re calling for is new attention and government intervention from OSHA, to take seriously the risks that are being forced on models in the professional fashion industry. Many of them are girls — they’re teenagers and some young women — and of course we know there are some boys and young men. The majority of models start working as children, some in their very early teens, and they’re very vulnerable to the pressures that adults working in the industry place on them.

One of the pressures we are very concerned about is the expectation that they be extremely thin — thin beyond what anyone would consider healthy and certainly beyond what any physician would consider healthy. They’re really putting pressure on these young women and girls and sometimes boys to risk starvation — self-starvation in a way — to achieve the standards to be able to work in the industry.

Do you want OSHA to consider the French model? Or what are the specifics you’re calling for?

We’re specifically asking OSHA to take a look at this problem, and we’re recommending that one way that OSHA could intervene would be to impose limits on how low somebody’s weight could be to be able to work in the industry. The point is not to punish the models themselves — we know they don’t need any more punishment, they’re already working under horrendous conditions. The purpose of these regulations would be to prevent agents, their employers, from forcing them to keep their weight so low, to lose weight in order to get jobs.

We gave 18 as an example of what a BMI limit might be. We already know 18 is a very low BMI, and where doctors start to get concerned about somebody’s health. The World Health Organization considers a BMI of 16, which is just a little lower than that, to be medically dangerous, on its face. And then when you’re working with children, the metric changes a little bit but the idea is the same.

So you’re calling for workplace regulation — is that because attempts to do this in a more voluntary way have failed? Continue reading

Workout Supplements: Does Overuse Signal An Eating Disorder Among Men?

(USMC/Flickr)

(USMC/Flickr)

By Marina Renton
CommonHealth Intern

You’ve seen them at the gym: extremely body conscious men, driven to achieve a level of physical perfection through grueling workouts.

Well, new research suggests that overusing popular supplements like whey protein and creatine to improve workout performance may signal an emerging eating disorder.

Researchers presented their findings at the American Psychological Association’s annual convention in Toronto earlier this month.

Almost 200 18- to 65-year-old men who consumed legal appearance- and performance-enhancing drugs (APEDs) and worked out at least twice a week participated in the study, led by co-authors Richard Achiro and Peter Theodore, both from the California School of Professional Psychology at Alliant International University, Los Angeles. In addition to asking about their supplement use and eating habits, researchers surveyed the participants about their psychological well-being, asking about their body image, self-esteem and gender role conflicts.

Almost 30 percent of the people surveyed said they were worried about their supplement use. Over 40 percent had increased their supplement intake over time. Twenty-two percent said they consumed the supplements instead of a meal, even when that wasn’t their intended use. Eight percent had been advised by their doctor to curb their use of supplements, and 3 percent had been hospitalized for kidney or liver problems stemming from their supplement intake.

Continue reading

The Checkup: How To Feed Your Muffin Top, And Other Weight Loss Wisdom

If you’ve ever hated your weight or wished to trade in a specific body part, or yearned to step off the debilitating dieting roller-coaster, you are so not alone. Indeed, you are us.

So here, we vent about our personal challenges — how to finally lose that last 10 pounds, escaping from our self-imposed food prisons — and explore some new strategies for relief. It’s all in the latest installment of our podcast, The Checkup, a joint venture between WBUR and Slate. We call this episode “Muffin Top,” Download it here before your next meal.

•First, we explore Motivational Interviewing, an increasingly popular technique that can spur you toward making changes in your eating and other behaviors. Included: A new book with the subtitle: “How the Power of Motivational Interviewing Can Reveal What You Want and Help You Get There.”

•We ask an eating disorders expert about why diets don’t work and whether we’ve entered a post-Weight Watchers era.

•And we also also get intimate about the psychic costs of actually achieving your goal weight and trying, desperately, to maintain it.

In case you missed other recent episodes: “Teenage Zombies,” explored the curious minds of adolescents, with segments on sleep, porn and impulsive choices; “Power to the Patient” looked at ways we can all feel in more control of our health care; “High Anxiety” included reports on hormones, parenting and fear of flying; and “Sexual Reality Checks” examined penis size, female desire and aging.

Better yet, don’t miss a single episode and just subscribe now.

Each week, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues.

If you listen and like it, won’t you please let our podcasting partner, Slate, know? You can email them at podcasts@slate.com.

A Weight Watching Life, And (Maybe) A Post-Diet Era

The diets in my life have come and gone: the grapefruit diet, no-fat diet, juice cleanses and Atkins. But through it all, there’s always been Weight Watchers. With its point system and lo-cal dinners, weigh-ins and group therapy vibe, Weight Watchers offered an all-encompassing road map to controlled eating. I tried it, Betty Draper of “Mad Men” tried it, you probably know someone who’s been there. It was a diet, yes, but also more: a structure to control the chaos of disordered eating.

Sadly, as many of us know, no single “diet” really works. Without a wholesale lifestyle shift, and replacing old, destructive patterns with healthier habits — a much slower and sometimes painstaking process — one failed diet begets another and another.

Reading the obituary of Jean Nidetch, a founder of Weight Watchers who died this week at 91, made me realize, yet again, the obsessive and punishing ways we compel ourselves to diet, and how, deep down, food and weight are as much about emotion as physiology. The New York Times described Nidetch as “pumpkin-shaped all her young life” and “raised in a family that ate as a consolation for disappointment.” Here’s more:

She was born Jean Evelyn Slutsky in Brooklyn on Oct. 12, 1923, the daughter of David and Mae Rodin Slutsky. Her father was a cabdriver and her mother a manicurist. Her compulsive eating habits began as a child, she recalled in a memoir…

“I don’t really remember, but I’m positive that whenever I cried, my mother gave me something to eat,” she wrote. “I’m sure that whenever I had a fight with the little girl next door, or it was raining and I couldn’t go out, or I wasn’t invited to a birthday party, my mother gave me a piece of candy to make me feel better.”

And that launched a life of binge eating and yo-yo dieting. Eventually, though, it pushed Nidetch to seek an escape: through tough-love control and, well, vigilant weight watching.

But we’re not in Brooklyn with the Slutskys anymore. Diets have evolved. Lifestyle Medicine is all the rage, and a far more holistic, Pollan-esque approach to food is taking hold. (“Eat food. Not too much. Mostly plants.”) Also, it turns out, not all calories are alike.

Are we then, at long last, in a post-diet era? Can we all just agree that diets do not work in the long term? I asked Jean Fain, a Harvard Medical School-affiliated psychotherapist and the author of “The Self-Compassion Diet” for her thoughts on the passing of a diet icon and where Weight Watchers stands today. Here’s what she wrote:

As the embodiment of Weight Watchers, Jean Nidetch did a lot of good. Her success (she lost 72 pounds and kept it off) inspired waist watchers to stop looking to medical professionals to solve their eating issues and to start finding inspiration, strength and direction from those who understand the problem far better – other successful dieters.

With a little support from fellow Weight Watchers, members not only learn that yes, they can lose weight, they find out they can have a lot more fun as group, rather than try to go it alone.

Inadvertently, Nidetch also did real harm with her eating system and the conditional support that goes with it. (Members get applause and other positive reinforcements for losing weight, for instance, but little or nothing for gaining weight.)

While Weight Watchers insiders claim their program is more successful than other diets, studies that compare various diets to each other do not support that. Whether or not the international slimming organization actually has a 16% success rate, (a number quoted in the book “Secrets from the Eating Lab” by Traci Mann) truth be told, the overwhelming majority regain what they lose and sometimes more. Diets like the one the organization promotes can exacerbate the very eating problems they were hoping to resolve. When that happens, those who most need support are least likely to get it because they’re too ashamed to go to meetings, let alone get weighed in.

More than a Weight Watchers ice cream bar, a lo-cal recipe or the conditional support of a group that fails to acknowledge the shame that members carry, what waist watchers need more than anything is a heaping helping of self-compassion.

Compassion for yourself is the missing ingredient, the antidote to this and most other weight-loss programs because most plans revolve around self-discipline, deprivation and neglect. You’re supposed to stick to the plan no matter what. If you’re starving, keep eating tiny portions. If you’re exhausted, keep moving – no pain, no gain. Going on vacation? Keep counting points, calories or carbs. It’s not a very compassionate (or realistic) approach; it’s not very effective. And it’s no fun. Continue reading

Anorexia: Potentially Deadly, Treatable And Still Not Always Covered By Insurance

(Mary Lock/Flickr)

(Mary Lock/Flickr)

By Drs. Gene Beresin and Steve Schlozman

People die from Anorexia Nervosa.

This is true of other psychiatric syndromes, but with anorexia, the cause of death couldn’t be more straightforward. People with anorexia literally expire from the complications of malnutrition.

They starve and they die.

Your heart cannot beat if you don’t feed it. Your immune system can’t protect you without food. Your bones crumble, your kidneys fail, your liver sputters and your brain wanders, all as a result of inadequate food.

Suicide is common. Without proper nutrition, depression is prominent and thinking is blurred. Coping mechanisms falter. Life can seem unlivable.

So, here’s the really strange thing about anorexia: Despite its awfulness and potentially fatal outcomes, despite a death rate more than 12 times higher than any other psychiatric syndrome, insurers still balk at providing adequate coverage.

In 2008, the Federal Mental Health Parity and Addiction Equity Act put special restrictions on the coverage of the treatment of eating disorders. While the explanations for this exception vary — some have suggested that this is because eating disorders are thought to lack a biological basis — it is clear that getting standard of care treatment for anorexia remains problematic even to this day.

In 2010, the U.S. Court of Appeals for the 9th Circuit found itself facing what was essentially a logic problem. The case of Harwick versus Blue Shield of California noted that while the insurer agreed that the residential treatment requested for a patient with anorexia was medically necessary — thus making it in compliance with existing parity statutes — coverage for residential treatment was not authorized because residential treatment was not part of the health plan. The court ruled in favor of the patient in this case, but the fact that this even ended up in court is shameful. Can you imagine an insurer refusing to pay equally for the medically necessary care of any other disease with such clear risks?

So, while patients, their families and physicians continue to fight for coverage, we know that treatment for this disorder can be life-saving.

In this context, here’s the story of a young woman who recovered.

Nicole (who asked that her last name not be used) is a remarkable 16-year-old. She is academically and socially accomplished and she speaks with wisdom that belies her age. She also faced Anorexia Nervosa head on and here discusses her struggles with humility and insight.

What we can learn from her story?

To begin with, we can acknowledge that her bout with anorexia has not been easy. She suffered significant depression and even suicidal ideation as she muscled through the course of the illness. This aspect of her history is perhaps the most important take-home message. The work towards recovery from an eating disorder is never straightforward. Each patient finds a unique way to work with his or her treatment team and family to progress towards health. We can also note that Anorexia is a typically insidious and largely unconscious development. As you can hear from Nicole, the syndrome essentially snuck up on her and her family. Continue reading

Should Schools Screen Kids For Eating Disorders? Study Finds It Would Cost Little

(Wikimedia Commons)

Veronica Thomas
CommonHealth Intern

Do you believe yourself to be fat when others say you are too thin?

Would you say that food dominates your life?

Have you recently lost more than 14 pounds in a three-month period?

I wonder, if I had answered these questions during my sophomore year of high school, would my anorexia have been caught earlier on? As a female ballerina with a Type A personality, I was an obvious candidate, but it took several months of starving myself before my eating disorder was diagnosed and treated.

According to a new Boston Children’s Hospital study, school screenings with questions like these could be a cost-effective way to detect eating disorders. At 35 cents apiece, a brief questionnaire could help identify and treat some of the most serious and potentially dangerous psychiatric disorders in kids.

Yet while the price is low, recent experiences with school obesity screening suggest that the issues can go beyond money.

Eating disorders, which include anorexia, bulimia and binge-eating disorder, affect at least 3.8 percent of teen girls and 1.5 percent of teen boys in the U.S. While effective therapies exist, only about 3 to 28 percent of teens actually receive treatment.

If left untreated, eating disorders can lead to serious medical complications, hospitalizations and even death. I think my own anorexia went undiagnosed for so long mainly because of the many lies I told about my diet—”I already ate,” “I had a huge lunch”—and the countless hours I spent in school and dance classes, out of my parent’s sight and scrutiny.

But I was lucky: I narrowly avoided hospital time. I only had to make frequent visits to my own health care trifecta—pediatrician, dietician and therapist. Had my anorexia been more severe or diagnosed even later—as is often the case—my treatment might have involved residential therapies and been much more expensive.

So could school screenings help catch the diseases earlier? The new study, published in the American Journal of Public Health, assessed whether they could help minimize both the health burdens and the cost burdens of eating disorders.

Using a computer simulation, the researchers compared the annual screening of 10- to 17-year-olds with a no-screening scenario. Continue reading

Tele-Coach: How An Eating Therapist Learned To Love Skype

By Jean Fain
Guest contributor

“How’d you do with your eating since last we met?” I recently asked members of my group on food issues.

“I’m really struggling,” said Heidi, a 27-year-old entrepreneur from Boston. “When I get overly full, that self-critical voice takes over. All I can think is ‘Screw it! I’ll start fresh tomorrow.’ I don’t know how not to let my eating spiral into overeating.”

Author Jean Fain while Skyping (courtesy).

Author Jean Fain while Skyping (courtesy).

Lydia, a 45 year-old minister from Akron, jumped in: “Instead of believing that self-critical voice, I’ve been telling myself: ‘That’s not what I believe.'”

“Did you hear that?” I asked Heidi. “Next time you start thinking ‘Screw it,’ you might try ‘That’s not what I believe’ or another of Lydia’s inspired responses.”

Heidi and Lydia (not their real names) are talking face to face, but not in person. Thanks to recent telecommunications advances, the 650 miles between the two are no barrier to participating in my eight-week group on using self-compassion for eating issues. Nor is a six-hour time difference. Last week, one participant Skyped in from her Lisbon hotel room.

Yes, I’ve jumped on the telemedicine bandwagon. I’m just discovering what hospitals, home health agencies and other major health organizations have been touting as the most cost-effective alternative to traditional face-to-face medicine since castor oil.

Clients with food and body image issues generally feel a lot less self-conscious attending a group remotely than up close and personal.

I knew about the telemedicine or “telehealth” trend, using technology to remotely deliver health-care services and information. But I’d never seriously considered joining the high-tech trendsetters. For decades, I’ve been happily providing individual and group therapy the old-fashioned way, and there are major legal questions about virtual psychotherapy, particularly across state lines.

According to Marlene M. Maheu, Ph.D., Executive Director of the Telemental Health Institute, “It’s the wild west. Clinicians are making up their own rules and disregarding those they agreed to follow when they got their licenses, and the consumers are at risk. They really don’t know who’s the right person to go to.”

Then, three things converged:

• Sixty-five members of The Center for Mindful Eating from around the world enthusiastically participated in my teleconference on The Self-Compassion Diet.
• My clients started complaining about sitting in traffic during the interminable reconstruction of Route 2 in Concord, Mass.
• One client couldn’t say enough about her Skype sessions with Los Angeles nutritionist and mindful eating author, Evelyn Tribole.

So I asked myself: “Why not Skype with clients?” Well, because telemedicine has real downsides. Besides the fuzzy legal regulations, I had at least three other concerns: Continue reading

Study: Facebook Use Linked To Eating Disorder Risk

topgold/flickr

topgold/flickr

Maybe we should start a series called, “How social media inflame appearance-related disorders.”

First there was Sylvia Pagan Westphal’s concerned exploration of some teen girls’ obsession with the “thigh gap.” She wrote that social media pressure is “like peer pressure on steroids — a vehicle for immediate feedback about you, the way you look, or what you think of others. And those opinions are so widely broadcast. Depending on a teen’s social media prowess, that can mean hundreds, even thousands of extra eyes.”

In a sadly similar vein, a recent study — Do You ‘Like’ My Photo? Facebook Use Maintains Eating Disorder Risk — out from Florida State University finds that “spending just 20 minutes on Facebook actually contributes to the risk of eating disorders by reinforcing women’s concerns about weight and shape and increasing anxiety.” More from today’s press release:

“Psychology Professor Pamela K. Keel studied 960 college women and found that more time on Facebook was associated with higher levels of disordered eating. Women who placed greater importance on receiving comments and “likes” on their status updates and were more likely to untag photos of themselves and compare their own photos to friends’ posted photos reported the highest levels of disordered eating.”

The finding is significant because more than 95 percent of the women who participated in the study use Facebook, and those with Facebook accounts described checking the site multiple times a day, typically spending 20 minutes during each visit. That amounts to more than an hour on the site each day, according to Keel. Continue reading

Young Girls Afraid To Gain Weight And Get Fat, Study Finds

mikebaird/flickr

mikebaird/flickr

A smart, health-conscious mom I know just drew the line: she’s going to stop reading “Grain Brain” — the compelling, controversial, potentially crazy-making new book that details the evils of carbs in general and grains in particular. She, and so many others, initially loved the book, which argues that carbs, even the whole grain variety, can “destroy” your brain and “cause demential, ADHA, anxiety” and more.

The problem, says this mom (beyond the what-can-I-possibly-pack-the-kids-for-lunch-with-no-grains dilemma), is that all the chatter about “bad foods” around her daughters might possibly increase their chances of developing an eating disorder.

This rang true to me as I came across this recent U.K. study on eating disorders in early adolescence.

Researchers from University College London Institute of Child Health and the London School of Hygiene and Tropical Medicine found that “six in 10 13-year-old girls, compared to four in 10 boys the same age, are afraid of gaining weight or getting fat.” And it got worse when the young teenage girls got a bit older, notes the report, published online in the Journal of Adolescent Health.

The bottom line results, according to the study of more than 7,000 13-year-olds: “Extreme levels of fear of weight gain, avoidance of fattening foods, and distress about weight and shape were common among girls.”

Here’s more from the study, according to the news release:

•One in three girls (34%) and one in five boys (21%) were upset or distressed about weight and shape

•One in two girls (53%) and four in 10 boys (41%) avoided fatty foods

•A quarter of girls (26%) and one in seven boys (14.5%) had restricted their food intake (by fasting, skipping meals or throwing away food) in the previous three months Continue reading