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Brain Scientist: How Pixar’s ‘Inside Out’ Gets One Thing Deeply Wrong

By Lisa Feldman Barrett, PhD, with Daniel J. Barrett, PhD
Guest contributors

Pixar’s “Inside Out” is the latest in a long tradition of animated entertainment that teaches us about science.

Chemistry, as I learned from Saturday morning cartoons, is about mixing colorful, bubbling liquids in test tubes until they explode. “Roadrunner and Coyote” cartoons—those fine nature documentaries—taught me physics: If you run off a cliff, you’ll hang in mid-air until the unfortunate moment that you look down. Computer science is apparently about robots that kill you. And now, with “Inside Out,” we finally have cartoon neuroscience.

Your brain, it turns out, is populated with characters for each emotion, and they press buttons to control your expressions. This is all good fun and a sweet movie. What is surprising, however, is that some scientists have taken this model seriously for a century and actually search for these characters in the brain. Not as animated creatures, mind you, but as blobs of brain circuitry.

So happiness and fear are not brain blobs — they are whole-brain constructions.

This blob over here is your “fear circuit,” they say, or this other blob “computes anger.” And every time you experience an emotion, your corresponding blob of neurons supposedly leaps into action, triggering your face and body to respond in a consistent way. Your Fear blob makes you freeze with widened eyes. Your Anger blob makes you scowl and your heart speed up. And so on.

The thing is, this science of “blob-ology” is no more realistic than detonating test tubes and hovering coyotes. Today’s neuroscientists finally have the technology to peer into a living brain without harming its owner, and it’s clear that the brain doesn’t operate even remotely in this cartoonish fashion. We might perceive Joy, Fear and Anger as separate entities — even gloriously rendered in 32-bit color — but the evidence from neuroscience is overwhelmingly against it.

For example, my lab has analyzed nearly 100 published brain-imaging studies by other scientists, involving nearly 1,300 test subjects across 15 years, and found that no brain region is the home for any single emotion. (We do have brain circuits for behaviors like freezing and fighting, as do other animals, but not for complex mental states like fear and anger.)

In another analysis covering 22,000 test subjects across more than 200 studies over 20 years, we demonstrated that anger, happiness, sadness and other emotions don’t have consistent responses in the body either. And plenty of studies have shown that human facial expressions have tremendous variety, far more than would occur if they were automatically launched by “emotion blobs” in the brain. Continue reading

What If Your Doctor Really Listened Instead Of Just Telling You What To Do?

(Alex Proimos/Flickr)

(Alex Proimos/Flickr)

On many a Friday, Dr. Joji Suzuki goes trawling through the medical wards of Brigham and Women’s Hospital with trainees in tow, looking for smokers.

One recent Friday, he finds Thrasher West, a patient who’d had trouble breathing but now is about to go home, where a tempting half-a-pack of cigarettes awaits her.

Dragging in the smoke, blowing it out — smoking feels good to her, West tells Suzuki. But then, she thinks, “Damn. Why’d I do that? Because it’s not good for me –” (Here, her deep cough adds emphasis.) “It’s bad for my health…Aw, I’ll give it up when I finish the pack.”

Suzuki, the hospital’s director of addiction psychiatry, does not lecture her about the risks of smoking. He does not suggest nicotine patches or pills or any other aids for quitting. He just mostly listens, and thoughtfully echoes what she says, and draws her out — when, for example, she mentions that she once quit for five years.

Dr. Joji Suzuki (Courtesy)

Dr. Joji Suzuki (Courtesy)

“Something happened, and you made a decision to stop,” he probes.

Her sons begged her, West recalls. One said, “Mommy, please stop smoking, please stop smoking.”

“Pleading with you…” Suzuki reflects.

“He had tears in his eyes. And he’s my baby, that’s my baby boy.” She reassured her son that she would be around for a long time, she remembers, and he answered, “You keep smoking, no, you won’t!”

Suzuki interprets: “They love their mama so much, they don’t want to lose her.”

The conversation, lasting just a few minutes, may sound like a simple chat. But Suzuki is expertly following principles that have been hammered out over decades and studied in copious research. He listens — actively, empathetically — more than he talks. His comments and questions remind West of her reasons to quit, and bolster her confidence that she can do it. They tap into her values and goals — her love for her family, her desire to live.

By the end, West says she wants badly to stop smoking, and she urgently asks Suzuki to write her a prescription for nicotine patches.

She has just experienced the subtle power of a method that’s increasingly popular in medicine: It’s called motivational interviewing, often referred to just by its initials, MI.

“The big shift in the practice of MI for most practitioners is that you go from telling patients why they should change or how they could change to drawing out from the patient their own ideas about why change would be beneficial to them and about how they might be able to do it,” says Dr. Allan Zuckoff of The University of Pittsburgh, a national leader in the field and author of a new self-guided book, “Finding Your Way to Change: How the Power of Motivational Interviewing Can Reveal What You Want and Help You Get There.”

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Click to enlarge. (Courtesy Chang Jun Kim, of the Motivational Interviewing Network of Trainers)

Motivational interviewing goes back decades in the field of addiction counseling, Zuckoff says, but in medicine, it’s been really taking off in the last few years.

Hundreds of studies have been published on using it in health care, from diabetes control to reducing the risk of heart disease. It’s being tried for patients with incontinence, psoriasis, hepatitis C, Parkinson’s — virtually any disease in which the patient’s behavior — taking medication, choosing food — affects the outcome. And of course, it can be used for the lifestyle issues that are the biggest driver of American chronic illness: overeating, smoking and drinking and drugs, lack of exercise.

Continue reading

When My Mother Died: A Story Of ‘Incomplete Mourning’

By Sarah Baker

I was 8 years old and the sky was black the day my mother died.

That morning, after a five-year struggle with a brain tumor, she’d passed away at Bethesda Naval Hospital, where she had been admitted a couple of days earlier. I hadn’t seen her since.

Grieving wasn’t an option in our house. We were a “chin up, shoulders back” group led by Dad, a rising star in the Navy. At my mother’s graveside in Arlington National Cemetery, my 10-year-old brother and I stood like little replicas of John F. Kennedy Jr. 12 years earlier when he saluted his father’s coffin. There were no tears, no signs of weakness. Long periods of mourning or sadness were not in our family culture — our grief was put on hold. There were bags to pack, and new ports of call. I was Soldiering On.

The Hardest Thing

According to the advocacy group SLAP’D (Surviving Life After a Parent Dies), 1 in 9 Americans loses a parent before age 20. Of those, nearly half said it was difficult to talk about their grief and only 7 percent said a guidance counselor helped. Six out of 10 adults interviewed, who lost a parent when they were children, said it’s the hardest thing they’ve had to deal with.

Sarah Baker at age 6, two years before her mother died (Courtesy)

Sarah Baker at age 6, two years before her mother died (Courtesy)

For us, the coping mechanism of Soldiering On worked splendidly for years, even decades. I survived all of the moves due to Dad’s deployments, even thrived, people might say. I went to college, graduate school, found great jobs, married a wonderful man, and had two beautiful children. All seemed well, at least on the surface.

But years of anxiety and disassociation gripped me. Recently, though, I felt all that emotional baggage was not sustainable. My external world appeared blissful (and it was!) but my internal world reeled. I had periods of blankness, inability to focus, sleeplessness, feelings of isolation when I was surrounded by loving people; despair, longing for something else, numbness, repeating negative loops in my mind, and sensations of being half dead. These feelings came in waves — days of it followed by lightness and connection. The longest darkness lasted three months — the world drained of its colors and none of my usual “reset,” or coping, tools seemed to work.

Necessary Grief

Importantly, coping is not grieving. “There is a kind of sanity to grief,” says Kay Jamison, a professor of psychiatry at the Johns Hopkins School of Medicine and author of “An Unquiet Mind.” “It provides a path — albeit a broken one — by which those who grieve can find their way. Grief is not a disease; it is a necessity.”

Funerals and other rituals bring people together and defend against loneliness. But if the grief lingers too long, is too severe, or unprocessed, it might begin to resemble depression. It’s a fine line indeed.

I now know I had never fully experienced the pain and sorrow of my grief. 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.

From The Eating Lab: Diets Don’t Work, But Why?

By Jean Fain
Guest Contributor

As soon as Traci Mann’s new book, “Secrets From The Eating Lab,” hit bookstores shelves, I ordered my copy. Not only because the University of Minnesota psychology professor is one of the leading researchers on the psychology of eating, dieting and self-control, but her 2007 Medicare study on effective obesity treatments was the irrefutable evidence I needed in writing about how diets don’t work — at least not as dieters expect — in my own book on eating with self-compassion.

Diets fail to facilitate significant or sustainable weight loss, Mann argues. What’s more, diets are unnecessary for optimal health.

Diets don’t work for a variety of reasons, from biology to psychology. After two decades of studying the scientific literature as well as her own diet subjects, Mann points the finger, first and foremost, at human biology. “Genes,” she argues, “play an indisputable role in regulating an individual’s weight: most of us have a genetically set weight range. When we try to live above or below that range, our body struggles mightily to adapt.”

Second to biology, Mann blames a combination of neuroscience and psychology. Our brains are hardwired to want food for survival, she explains, so restricting calories creates a psychological stress response, which facilitates weight gain, not loss. Also, she adds: “Studies show that willpower, the thing we all blame ourselves for not having enough of, is in many ways a mythical quality and certainly not something that can be relied upon for weight loss.”

Whether you’re interested in boosting your health or losing weight, Mann’s best advice is to ditch the diet and adopt her 12 “Smart Regulation Strategies,” her proven mental strategies for reaching your “leanest, livable weight.” Instead of counting calories, for example, she advocates penalizing yourself for succumbing to temptation as well as thinking about tempting foods in the abstract. So instead of thinking about the specific qualities of a glazed donut with chocolate icing, think of a donut as a generic dessert or just one of many breakfast foods.

Mann’s views come as no surprise to me, a therapist who specializes in eating disorders. The big surprise for me in her new book is that I only loved the first half — the half that pinpoints the problem with dieting. The other half, which focuses on her “no-diet” plan, well, I liked it only half as much. Turns out, a good bit of Mann’s plan calls for external changes, like using smaller plates and taking smaller portions, a la Brian Wansink’s Mindless Eating. Mann prescribes internal changes, too, but none are what I’d describe as truly mindful.

I was tempted to dismiss Mann’s plan as a collection of mental tricks, then I thought better of it. Instead, I set up a mini-interview via email with the professor turned author and I’m glad I did. Not only did Mann have some interesting things to say about dieting — her own experience and that of determined dieters –- but her answers reminded me that there’s no right way to address eating problems. In fact, there are many ways to go. To see if Mann’s way of reaching your leanest livable weight is a way you might want to go, read on.

JF: You’re pretty unusual in that you ditched dieting after just one diet. And yet, you’ve devoted your career to proving diets don’t work. Why is that?

TM: I ditched dieting because the diet I went on made me miserable, and I watched both of my parents cycle through diets and re-gain, diets and re-gain, ad nauseam. Continue reading

One Doc’s Oreos-And-Batman Perspective: TV Doesn’t (Necessarily) Make Kids Fat

(Donnie Ray Jones/Flickr)

(Donnie Ray Jones/Flickr)

By Steve Schlozman, MD

Here are three recent headlines that got me thinking about kids and fat:

“Watching one hour of TV per day increases risk for obesity by 50%”

“Watching TV for Just an Hour a Day Can Make Children Obese”

“Study makes surprising link between TV time and childhood obesity”

Oversimplifications? Um, yes. Each of these headlines greatly simplifies (dare I say, incorrectly simplifies) a critical social and health issue. Personally, I don’t think TV is the sole evil culprit here. It’s far more complicated.

The medical community has long known that the amount of TV that a child watches correlates with obesity. We can even make some leaps from these data towards implicating causality. Unless your little ones happen to be doing aerobic exercises while they tune in to their cartoons, it’s easy to see how passive watching can equal active weight gain.

However, be wary of oversimplification and especially of the “one-size-fits-all” policy statements that these headlines often generate. The study authors here do, in fact, suggest further limiting TV exposure based on the existing American Academy of Pediatrics guidelines for young children as a means of controlling the rate of obesity in this country. (Currently, the AAP recommends limiting screen time to one to two hours or less for children over the age of 2, and discouraging screen time altogether for those who are younger.)

So, here’s the big question: Is the recommendation that TV time be further limited an entirely appropriate conclusion?

Beyond The Headlines

The answer, like many answers to social policy questions, is both yes and no.

What we know for certain is that we can’t really discern from the headlines what we ought to do, though there is ample reason to believe that most American rarely go beyond the headlines. Thus, we run the risk of jumping to more draconian conclusions than might be appropriate simply because we don’t have or take sufficient time to examine the flood of information.

How do we guard against this leap to oversimplification?

Here are a few key questions:

•Was there a large and diverse population studied?

There have been solid links between lower socioeconomic groups and some ethnic minorities and increased television time, as well as between lower socioeconomic groups and obesity.

The causes for both of these issues are of course multi-factorial. Fatty foods and higher calorie foods are cheaper. TV can function as a babysitter in households where parents are busy working and living paycheck to paycheck. However, the study in the headlines above, conducted by the Department of Education in conjunction with physicians at the University of Virginia, was indeed both large and diverse.

Over 12,000 children starting kindergarten were enrolled in the investigation, and a year later follow-up data was available for more than 10,000 of these children. These data included height and weight, as well as statistical analyses to account for differences in race, gender and socioeconomic effects. In other words, the numbers here are sufficiently large and diverse for us to feel comfortable drawing at least preliminary conclusions.

Causality, Really?

But beware, always beware, of flashy headlines. A Google search yielded all of the headlines above with equal weight, and yet one of the headlines clearly implicates causality. “Watching TV for just an hour a day can make a child obese.” (My italics.)

However, this study does not in any way suggest causality. There are a number of potentially unrelated factors that also happen everyday that might be associated with obesity, but not function as a cause of obesity. These could include behaviors like longer baths to cool down. We don’t know until we do the study whether longer baths would be associated with obesity. In other words, always be wary of blanket statements of causality with regard to the complexity of human behavior.

•What about the ample availability of screen-based material on demand? Perhaps the fact that children can often watch both what they want and when they want it affects their activity patterns in negative ways. We could ponder the fact that TV content, even for kids, has arguably (though not in all spheres) gotten better and of higher quality. There is even evidence that TV watching can improve behavior among kids, and this evidence also comes from the American Academy of Pediatrics. Does that mean we ought to make a policy statement advocating that TV should be less compelling?

Confessing My Bias

Things get even messier when we take the necessary step of examining our own personal biases. In my case, that examination includes a shameless confession regarding the ways my own penchants might complicate my interpretation of these data. Continue reading

What To Expect When You’re Birthing At Home: A Hospital C-Section (Possibly)

Screen shot 2015-03-20 at 9.07.11 AM

By Ananda Lowe
Guest Contributor

The term “homebirth cesarean” didn’t exist before 2011, when Oregon mother and student midwife Courtney Jarecki coined it. But now, a Google search returns almost 2,000 entries on the topic.

The term refers to a small but emerging community of mothers who have experienced the extremes of birth: They’d planned to have their babies at home, but ended up in a hospital, most often in the operating room having a cesarean section, major abdominal surgery. Needless to say, the effect of such a dramatic course change takes a toll, and can often be overwhelming.

(“Homebirth cesarean” can also refer to births that were planned to occur at a freestanding birth center outside of a hospital, but eventually were transferred to the hospital for a cesarean.)

How often does this happen?

Home births, though a small fraction of the approximately 3.9 million births a year in the U.S., are on the rise. Based on the most recent birth data from the National Center for Health Statistics, “the 36,080 home births in 2013 accounted for 0.92% of all U.S. births that year, an increase of 55% from the 2004 total.”

Eugene Declercq, a professor of community health sciences at Boston University School of Public Health, studies national birth trends. He said in an email that while there are no nationwide numbers on homebirth transfers to the hospital, “the studies that have been done usually report about a 12% intrapartum transfer rate.”

But beyond the numbers, what happens emotionally when your warm and fuzzy image of natural childbirth in the comfort of home suddenly morphs into the hard reality of a surgical birth under fluorescent lights?

A woman who'd planned a homebirth but ended up having a cesarean in the hospital. (Photo courtesy: Courtney Jarecki)

A woman who’d planned a homebirth but ended up having a cesarean in the hospital. (Photo courtesy: Courtney Jarecki)

Jarecki founded the homebirth cesarean movement to figure that out. She connected women who, like herself, shared the experience of giving birth through full surgical intervention, despite their original plans of having their babies at home or outside of the established medical system.

In Jarecki’s case, she labored at home for 50 hours until her midwives detected a rare complication known as a constriction ring, or a thickened band of tissue in her uterus that was impeding progress. Shortly after this, meconium appeared, and Jarecki knew it was time to go to the hospital. Her emotional response to the intensity of the situation, however irrational, was one of anger, shame and failure at her ability to give birth normally. A cesarean followed.

Over the next several years, Jarecki began helping other homebirth cesarean mothers emerge from the silence and shame they felt confronting their unexpected surgeries. Some of these women also report that their postpartum recovery was tougher because their unique needs were not adequately addressed by their home birth midwives or their hospitals.

Jarecki started by launching a (now busy) Facebook page as a support group for these mothers and their health care providers.

Childbirth Expectations vs. Reality

Rule number one in childbirth is that it rarely unfolds as you expect. Continue reading

In Memory: A Fat Kid’s Love For Mr. Spock

By Steven Schlozman, M.D.

I remember the exact moment I realized that I could be Mr. Spock.

I was 9 years old, trapped in the “Husky” jeans section of the local Macy’s department store. Looking around at the selection of very big pants, I understood viscerally what I had known intellectually for years.

“Husky” meant “fat.” It meant that I was fat.

Not super fat, but fat enough to be in the Husky section.

I was awkward, developing in that tortured way that evolution see’s fit to make us endure. Staring at the mirror while my Mom gathered trousers for me try on, I was pissed off that because of this shopping trip, I was missing the rerun of “Star Trek” that aired on weekday afternoons.

(Daniel Arrhakis/Flickr)

(Daniel Arrhakis/Flickr)

“What would Spock think about the ‘Husky’ designation?” That’s what I was pondering. I was wondering how the master of logic would justify and make sense of the clearly derogatory way I was feeling about myself.

“Fascinating,” I imagined him saying, and he would raise that patented eyebrow.

Then I looked in the mirror, furrowed my brow, took note of the barely present peach fuzz growing under my nose, and with all the power of a Vulcan mind meld, I imagined that my right eyebrow was being pulled by a thread towards the stars. That one eyebrow was to boldly go where no eyebrow of mine had ever gone before.

And I did it. I raised that eyebrow.

“Fascinating,” I muttered. And then I did it again, and again. It was like a teeny Bar Mitzvah moment. “Today, I am a Vulcan.”

Spock meant that much to me. Spock could be friends with a tough guy like Kirk. Spock was unfazed by McCoy’s insults. Spock tolerated with admirable self-control the romantic advances of Nurse Chapel. Spock would, I was certain, be emotionally impervious to the Husky section of Macy’s.

“Fascinating,” I said, and again I raised my right eye brow.

I share the world’s sadness for Leonard Nimoy’s passing. I am grateful that he stuck around so long after he began his “five year mission.” I feel like a kid every time I hear his voice in the Imax theater at Boston’s Museum of Science. Every time I hear his voice, I am wearing Husky jeans but feeling OK about it.

These days I’m still raising one eyebrow on an almost daily basis. I even had a patient’s parent give me Vulcan ears for Christmas a few years ago.

“They’re not because you’re emotionally cold,” she explained.

No, I thought, Spock wasn’t cold.

“They’re because you’re not freaked out by our child. They’re because you’re interested.” Continue reading

10 Bits Of Blizzard Therapy From Laura Ingalls Wilder’s ‘The Long Winter’

A train stuck in snow in 1881, the ferocious winter Laura Ingalls Wilder wrote about. Note the man standing on top for scale. (Minnesota Historical Society on Wikimedia Commons)

A train stuck in snow in 1881, the ferocious winter Laura Ingalls Wilder described. Note the man standing on top for scale. (Minnesota Historical Society on Wikimedia Commons)

I pulled Laura Ingalls Wilder’s “The Long Winter” from my son’s bookshelf with the very explicit intention of helping myself feel better about this epic weather.

It worked.

Of course, any reading of the vivid “Little House on the Prairie” accounts of laborious pioneer life will always work to induce a great surge of gratitude for our modern comforts. Friends of mine call it “The Brutal Series.” (Wilder is back on the bestseller list, I see, with a never-before-published autobiography written in 1930.)

But “The Long Winter” offers, I would argue, the best of all antidotes to feelings that this is a horrible, awful, nasty winter. The trick is to compare our current winter woes not to our usual milder weather but to a dire prairie winter: the kind of winter when young Laura would wake, shivering, to a frigid house buffeted by blizzard, spend the dreary day twisting hay for heat and grinding wheat for the coarse brown bread that was her family’s last remaining food, crawl back into a cold bed and shiver until the shivering itself made her warm enough to fall asleep.

“There were no more lessons. There was nothing in the world but cold and dark and work and coarse brown bread and winds blowing.”

Suddenly, the Boston winter of 2015 feels more like a season of relative ease and mild inconvenience.

There’s nothing like reading the whole book, but here are 10 boons of modernity that “Long Winter” passages cast into gratitude-inducing relief:

1. Weather forecasts

“Heap big snow come.” That’s the closest thing Laura’s family gets to a forecast, from “a very old Indian.” The more detailed forecast: “Heap big snow, big wind.”

Much as we may sometimes curse the messengers who bring us dire forecasts, life without them meant that Laura’s Pa took his life into his hands every time he ventured the couple of miles back to their claim land to load the hay he carted to their house in the tiny town of De Smet. A blizzard could hit at any time, and he’d be unable to make his way home.

Author Laura Ingalls Wilder (Wikimedia Commons)

Author Laura Ingalls Wilder (Wikimedia Commons)

2. Powerful plows

A major element of “The Long Winter’s” plot is the snow blockade (see photo above) that stops all train traffic to the town for months, cutting it off from supplies. The “cut” around the tracks repeatedly fills with 20 feet of snow and ice, beyond the snowplow engine’s power to remove.

Even driving a horse and cart over such deep snow becomes a dangerous ordeal when the horse steps on a snow surface with air pockets beneath and falls, panicked, into a deep snow pit. It then falls to the driver to dig the horse out.

3. Stronger houses

Early in the winter, Laura wakes to find that “ice crackled on the quilt where leaking rain had fallen.”

…Her teeth chattered while she pulled on her clothes. Ma was dressing too, behind the curtain, but they were both too cold to say anything. They met at the stove where the fire was blazing furiously without warming the air at all. The window was a white blur of madly swirling snow. Snow had blown under the door and across the floor and every nail in the walls was white with frost.

4. Heat Continue reading

A Miracle Drug For Binge Eating? Not So Fast, Says Therapist

(Bloody Marty/Flickr)

(Bloody Marty/Flickr)

By Jean Fain
Guest Contributor

For more than 20 years, my binge-eating patients have wished for a magic wand. And for all that time I told them there is no wand — there are only strategies that require awareness and effort to get a handle on their eating.

Last week, when the FDA announced it had approved Vyvanse for the treatment of binge eating disorder (BED), I found myself at an uncharacteristic loss for words. With headlines touting a magical cure for this most common adult eating disorder, I feared there was nothing I could say to stop the stampede for this next, new drug.

The news, in and of itself, is hopeful. Vyvanse (lisdexamfetamine dimesylate) has been the subject of rigorous research, first for ADHD, and now for BED. In two good-sized studies with more than 700 adult participants diagnosed with moderate to severe binge eating, this central nervous system stimulant proved more effective at reducing binge days per week than placebo for three months.

What’s more, the FDA’s approval has proven a good opportunity for a drugmaker, U.S-based Shire, and leading eating disorder associations — the National Eating Disorder Association and Binge Eating Disorder Association — to coordinate a nationwide educational campaign. If even a fraction of the estimated 2.8 million Americans diagnosed with the disorder get help as a result of the campaign’s public service announcements and new website, there’s reason to be hopeful.

There’s also reason to be cautious. Consider some of the issues before you take tennis great and Shire spokesperson Monica Seles’ advice to “talk with your doctor.” To help you do that, here are the pros and cons in my clinical experience and that of my colleagues.

But first, if you’re unclear on what constitutes binge eating disorder, here’s how the Binge Eating Disorder Association defines it:

“Routinely eating far more food than most adults would in a similar time period under similar circumstances.” Binge eaters typically feel out of control during a binge, and afterward, they’re consumed with guilt, self-disgust and embarrassment. Other hallmarks of the disorder: eating extremely fast, in secret, to the point of uncomfortable fullness, even when not hungry. Unlike other eating disorders, people with BED don’t try to “undo” excessive eating by throwing up, taking laxatives and other excessive actions.

OK, so here are a few points to consider…

Pros:

•More Treatment Options

With the FDA’s first and only approved medication for BED, patients now have another way into treatment: their family doctor. Rather than seeking out a psychotherapist or a nutritionist, which many are reluctant to do, they might feel more comfortable asking their physician about a prescription and other treatment options for this lesser-known eating disorder, which was only recognized two years ago as a distinct disorder by the American Psychiatric Association.

•Fewer Binge Days

Vyvanse has been shown to markedly reduce, if not eliminate, binge episodes in two studies, both funded by Shire. According to last month’s JAMA Psychiatry study, participants who got a daily dose of 50-70 mg, reduced the frequency of binge days per week from about five to less than one over the course of 12 weeks. By comparison, those taking placebo continued to binge more than two days per week. What’s more, half the participants taking the 70 mg dose stopped binging after four weeks, compared to one fifth of those taking placebo.

•Possible Weight Loss

Because Vyvanse has yet to be studied as a weight loss aid, it’s approved only in the treatment of binge eaters, not the overweight or the obese. That said, study subjects who took Vyvanse lost about 10 pounds. The potential weight loss may come as welcome news to bingers taking an off-label prescription for an antidepressant or anti-seizure medication. A common side effect of most antidepressants is weight gain. While binge eaters are often thrilled with the weight loss that the anti-seizure drug Topomax can facilitate, they’re none too pleased by the mental impairment.

Cons:

•Greater Risk of Abuse/Dependency

There’s a reason Vyvanse is a controlled substance with a black box warning. The potential for abuse and dependence is a real risk. Take it from psychiatrist Daniel Carlat, editor in chief of The Carlat Psychiatry Report, who expressed his reservations in a recent email exchange:

“I’m concerned that the FDA’s approval of Vyvanse for binge eating disorder is going to worsen our problems with stimulant abuse,” Carlat says. Continue reading