How We Set Recovery Weights

Recovery Weight [Image description: doctor scale]
Photo by Samuel Ramos on Unsplash
If you have an eating disorder, or your child has one, there is a good chance that weight gain will be an essential part of the recovery process. This is true not just for people in objectively small bodies, but also for people in larger bodies who are diagnosed with Atypical Anorexia, a weight-biased diagnostic category included in the DSM-5. It is even true for people recovering from bulimia nervosa and binge eating disorder.

The eating disorders field lacks consensus on how to set recovery weights. I know a respected professional who argues adolescents should be routinely restored only up to the 25th percentile weight for age. They argue that this reduces their potential for experiencing weight stigma and reduces their anxiety. However, I see a problem with this, as do many of my colleagues and many families and recovered people.

This article discusses why weight recovery is a priority; what the research on weight suppression says; how we use growth curves in setting recovery weights; what evidence suggests that many providers set recovery weights too low; and how this applies to people in larger bodies.

Why Prioritize Weight Recovery

We know that while weight recovery in anorexia is not sufficient for recovery in and of itself, it appears to be a prerequisite for full psychological recovery. Eating disorder cognitions as well as most of the physical symptoms appear to recede only with full weight restoration. Food is medicine not just for the body, but for the brain as well. That is why we often say, “Food is medicine.”

The research on timelines for eating disorder recovery show that remission of eating disorder behaviors such as binge eating and purging takes an average of eight or nine months, and weight recovery takes on average 12 months. But it takes even longer to end eating disorder thoughts, including the preoccupation with shape and weight and urges to restrict, purge, or exercise. These thoughts can persist for nearly a year after a person has reached a normal weight, has stopped engaging in behaviors, or both.

Weight Suppression and Negative Energy Balance

We also know that weight suppression—defined in adults as the difference between a person’s current weight and their previous higher adult weight—predicts continuation of eating disorder symptoms including binge eating. In children and adolescents, weight suppression would be defined as a negative deviation from one’s expected weight curve. Therefore, at EDTLA we prioritize full weight restoration for all patients in all body sizes and with all eating disorders. Failing to fully restore a person to their recovery weight for body and brain could prevent them from a full recovery.

A negative energy balance—taking in less energy than one’s body needs—may be a primary contributor to the development of an eating disorder in someone who has the innate susceptibility. Cindy Bulik, Ph.D. describes how a negative energy balance lowers anxiety for a person with this vulnerability, creating a trap. Restriction becomes seductive under these conditions. Couple this with the evidence that the weight loss leading to the development of anorexia nervosa could be unintentional—such as a side effect of an illness or an overexpenditure of energy for sports combined with undereating.  Together these suggest the best defense against relapse is maintaining an adequate energy balance and a healthy weight where the brain is functioning well enough to not act on residual thoughts.

Using Growth Curves to Estimate Recovery Weights

In this section, I will discuss why using individual growth records is so important. We have received guidance from our colleagues specializing in adolescent medicine and eating disorders. Like many eating disorder dietitians, one of the things we do is look at childhood growth records when they are available. This method is more tailored than using population averages such as BMI to set recovery goals.

In the US, most pediatricians document children’s growth on the CDC growth chart, which plots height, weight, and body mass index (BMI) against age-based averages.  In healthy children and teens, height and weight each increase along a consistent growth curve. Some children and teens grow steadily along the 95th percentile, some along the 75th percentile, some along the 50th percentile, and still others along the 25thh percentile.

But not every body is the same, and it’s normal for individuals’ height and weight to follow different growth curves. For some children and teens, a weight along the 75th percentile and height on the 25th percentile is normal. This defines the growth curves for that individual. Just as not every woman of average height wears a size 8 shoe, not everyone of average height is meant to be at the 50th percentile for weight. There is always a normal distribution in a population. These growth percentages appear to be largely genetically determined.

A deviation on an individual’s growth curve for weight, height, or BMI—even in the absence of actual weight loss—may indicate there is a problem such as an eating disorder. A child should be growing and gaining weight during this time, so the failure of a child or teen to gain the appropriate weight can be equivalent to weight loss. This means that when there is actual weight loss, the amount of suppression—the difference between current weight and where one should be on a growth trajectory—is usually even greater than the actual pounds lost.

Thus, a parent may come to us and say, “My child has only lost 10 pounds.” However, when that weight is plotted and we notice that the child also failed to gain any weight in the months before they lost weight, we might now look at their curve and see that in fact, the child should gain 20 pounds (or more!) to catch up to where they should be on their own unique growth curve. Some kids may not have lost any weight at all—but have fallen short of their appropriate gain for so long that they now should gain at least 10 pounds.

This is why we also often say that weight is a moving target. To remain in recovery, a year from now an individual’s goal weight must be higher than the weight that would be healthy at their age today. And this is true even for children who are no longer getting taller, as it is normal for weight to continue to be gained through about age 20.

This is why we will ask to see your child’s (or your) growth records. We will estimate what their weight should be for their current age based on their growth history. Returning to their own growth curve is usually a minimum estimate because we cannot know for certain where some one’s body will end up. We will consult with your child’s pediatrician. You may also want to consult with a specialist in eating disorders and adolescent medicine.

Please be aware that some non-ED specialist pediatricians may not be well-informed about this individualized process of setting goal weights. I once had a pediatrician who told a teen’s parents she would be happy if my patient got to a certain weight because that was the weight that the pediatrician—who was herself quite petite—had weighed at the patient’s age.

What? A pediatrician setting a goal weight for a patient based on her own unique growth history!?? When you take your clothes in for alterations, does the tailor cut the clothes to fit the tailor?  Do you see the problem here?

Speaking of growth curves, the use of growth curves to spot early eating disorders is an underutilized practice. In a recent study on pediatric patients hospitalized with an eating disorder, 48% of patients experienced a deviation in the growth curve a median of almost 10 months prior to the first eating disorder symptoms being reported by parents.

We will also show you how your teen’s weight should be tracking on the weight curve. Teens generally gain 30 to 40 pounds in the course of puberty. While many children gain weight and grow naturally during this period, we find that children who have had an eating disorder may need continuing guidance to help their weight keep pace with their age and height. We encourage parents to keep an eye on their teen’s weight to make sure weight continues to track along the expected curve. We respect parents and educate them on this.

The Field Tends to Set Recovery Weights Too Low

Looking at historical growth curves is especially important because parents have shared that in their experience, health professionals often set their teens’ recovery weights too low. This is not surprising; even providers are susceptible to weight stigma. It is challenging for providers to take on a whole cultural system that reinforces the false virtue of thinness.

At EDTLA, we do our best to challenge our own weight biases and that of our patients and their families. We believe that facing the anxiety of a patient or a child restoring to a slightly higher weight has benefits that outweigh the costs. We help the family challenge the belief that being fat is worse than remaining ill. I never want to be the provider who set a goal weight so low that it contributed to prolonging a mental illness from which it may take a patient 9 to 22 years to recover.

Challenging weight bias and setting higher weights goals does not always make us popular. Teens with eating disorders are by definition, terrified of gaining weight. In her blog, eating disorder specialist pediatrician Julie O’Toole discusses the setting of goal weights and how parents fear that too much weight gain will make their teen more depressed and anxious. Dr. O’Toole emphasizes the importance of basing treatment goals on data rather than placating the eating disorder.

Remember that an irrational fear of weight gain is often a symptom of the disorder. The anxiety over one’s body size often improves significantly with recovery, which requires more regular eating patterns and—ironically—weight gain. Please note this is rarely immediate. It may take up to a year of being at one’s healthy weight and learning to tolerate a changed body before the eating disorder thoughts fully subside. On the other hand, appeasing the fear of gaining more weight can maintain the fear and potentially the disorder.

How Does This Apply to People in Bigger Bodies?

We are often asked why a person who has historically been at a higher-than-average body weight must be returned to a weight that is higher than average. We recognize that bodies naturally come in a variety of shapes and sizes.  Some people are meant to be larger. We often encounter patients and families who say “but they looked better when they were a few pounds less” and want to use the eating disorder as an opportunity to keep a person’s weight suppressed. We believe that using an eating disorder as an opportunity to avoid returning to a previous higher weight could hinder the individual from reaching full recovery. And the research on weight suppression supports this. In the words of Julie O’Toole, “Rarely can a child who is genetically programmed to be larger than average be safely held at a ‘thin’ body weight. Size acceptance may be a part of the family’s treatment challenge.”

Of Course, Recovery is About More Than Weight

Remember, though, that an estimated recovery weight is just that—the best estimate of where recovery will occur. I think it is important for parents to have a roadmap and to know generally whether they might be needing to add (at least) 10 pounds or 20 pounds or 40 pounds because it gives you a realistic expectation of how long the weight recovery phase may take. Again, this may change over time and our estimates are usually a minimum weight and bodies may go higher.

Ultimately, recovery is about state, not weight. And recovery means more than just weight recovery. We are looking for recovery of physical health—normalization of heart rate, blood pressure, and body temperature and resumption of menses when appropriate—as well as psychological recovery which includes improved mood, decreased eating disorder thoughts, return of normal hunger cues, and more regular eating, a less fraught relationship with food, improved social functioning, and a return of interest in other age-appropriate activities.

In one informal survey of 29 parents whose teens were given a recovery goal of 19 BMI, most reported recovery actually occurred at a BMI of 23 or greater and none achieved recovery at a BMI lower than 21. Parents will report that often, with an additional ten extra pounds, their teens were more likely to attain state recovery. If someone is not doing well at what we initially estimated to be a recovery weight, we will review that and may suggest after a few months that we raise the goal weight a little.

This post has described our thinking, which is informed by research, parent feedback, and expert opinions by leaders in the intersection of adolescent eating disorders, FBT, and Health at Every Size ®. We hope it helps you understand our recommendations.

But you don’t have to take our word for it. We invite you to do your own research. Below we’ve compiled some resources from leaders and colleagues in the field. And we strongly suggest you watch this video by Eva Musby.

Sources and Further Reading

Bulik, Cynthia, UNC Exchanges Blog: Negative Energy Balance: A Biological Trap for People Prone to Anorexia Nervosa

Butryn, M. L., Juarascio, A., & Lowe, M. R. (2011). The relation of weight suppression and BMI to bulimic symptoms. The International journal of eating disorders44(7), 612–617.

Eddy KT, Tabri N, Thomas JJ, et al. Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up. J Clin Psychiatry. 2017;78(2):184-189. doi:10.4088/JCP.15m10393

EDTLA Blog: Are We Setting Recovery Weights Too Low

EDTLA Blog: Unintentional Onset of Anorexia Nervosa

FEAST of Knowledge 2020 – 08 Health At Every Size (HAES) by Rebecka Peebles, MD

Full Bloom Podcast: Why do my child’s caregivers need to present a united front around body positivity? with Lauren Muhlheim, Psy.D., FAED, CEDS

Kartini Clinic Blog, April 12, 2013 Determining Ideal Body Weight 

Kartini Clinic Blog Sept 1, 2016 Setting Goal Weights

Lebow, Jocelyn, Leslie A. Sim & Erin C. Accurso (2017): Is there clinical consensus in defining weight restoration for adolescents with anorexia nervosa?, Eating Disorders 2018 May-Jun;26(3):270-277. 

Marion, M., Lacroix, S., Caquard, M. et al. Earlier diagnosis in anorexia nervosa: better watch growth charts!. J Eat Disord 8, 42 (2020).

Musby, Eva Weight-Restoration: Why and How Much Weight Gain?

Musby, Eva: Growth Charts and Weight Gain Made Simple

New Plates Podcast Episode 21: State Not Weight with Dr. Rebecka Peebles

College, COVID, and Eating Disorders: What You Need to Know

College, COVID, and Eating Disorders [Image description: woman with mask in front of computer]
Photo by engin akyurt on Unsplash

As I’ve talked about in depth here, the transition to college away from home is challenging for most young adults. It is especially fraught for young adults with eating disorders. In that article I provided a College Readiness Checklist for students who are either considering their first move away from home after a history of an eating disorder or returning to college after being diagnosed with an eating disorder. I have learned the hard way. I’ve witnessed the heartbreaking reality of what can happen to students who go away before they’re ready. I may seem stringent, but we’re talking about one of the most deadly mental illnesses and this is your child’s life and future.

I was recently asked whether the same standards should apply in the current climate. I replied that I thought the standards should actually be more stringent given the pandemic. This has been on my mind all summer; now, I am prepared to sound the alarm.

Students with eating disorders of all types—anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder (ARFID)—often have a narrow range of foods they are comfortable eating. They often struggle with flexibility.

The pandemic has thrown a wrench—really, a whole toolbox—into the college experience. Among the changes this fall is that most dining halls have pivoted to prepackaged meals. This will be an added challenge for students with eating disorders. Students have already reported that the results are long lines as they wait for food, far fewer food choices, no option to portion their meals themselves, and no option to mix and match. These prepackaged meals may be insufficient in nutrients or energy, especially for students in recovery who have high energy needs.

Add to this the experience of students who are quarantining either due to outbreak or exposure, or as required by the college upon return to campus as a preventative measure.  Most are in dorm rooms without access to a kitchen. Social media has exploded with unfortunate food stories:

These stories are garnering attention, people find it laughable, and the colleges are receiving criticism, but I can only think about how the students with eating disorders are impacted.

Eating disorder recovery requires eating at regular intervals and meals sufficient to maintain recovery. Even a small negative energy balance can increase the risk for relapse in individuals with anorexia nervosa or increase the risk of binge eating for those with bulimia nervosa or binge eating disorder.

Students who are not very stable in their recovery may not be able to handle the current climate. They may not be able to seek additional food if portions are too small. People early in recovery often experience shame about hunger. It could be very triggering to receive portions that are not satisfying. Patients with eating disorders may not be able to advocate for their nutritional needs or do the problem-solving required to make sure the meals are sufficient. Finally, receiving an entire day’s worth of meals at the end of the day would be a natural trigger for those who have struggled with binge eating—or for most people!

Add to this the stress of academics and social issues and the uncertainty about the rest of the semester, and you have a perfect storm for relapse.

If you have any doubts about whether your student may be ready for college under these challenging circumstances, I strongly encourage you to consider keeping them home this semester. If there ever was a time to err on the side of caution, it is now.

With most classes online and social options at college significantly limited, this provides a unique opportunity to keep them home so they have more recovery time under their belt before they have to face such eating challenges. They will not be missing much, and you can work on strengthening recovery so that when the pandemic is over they can return as a healthier student capable of embracing the full college experience. You can use my article—which outlines steps to prepare a student for the challenges of navigating recovery in college— to make sure they are fully prepared when the time is right.

February 2018 LACPA Eating Disorder SIG

Jeffrey Hunger, Ph.D. [image description: photo of Jeffrey Hunger]Date: Wednesday, February 20th at 7:30 pm

Presenter: Jeffrey Hunger, PhD 

Title: Weight Stigma and Disordered Eating: A Multi-Method Approach

Description: We present multi-method evidence underscoring the role of weight stigma in disordered eating cognitions and unhealthy weight control behaviors. In Study 1, experienced weight stigma was associated with indices of disordered eating (e.g., dietary restraint, shape concerns), and this was mediated by greater anticipated stigma. In Study 2, participants were randomly assigned to imagine an experience with weight-based mistreatment or a control experience. Individuals who imagined a weight-stigmatizing experience, compared to those in the control condition, reported greater anticipated weight stigma, which predicted greater willingness to engage in unhealthy weight control behaviors (e.g., purging) and higher state disordered eating symptoms (e.g., drive for thinness). Study 3 employed a longitudinal design, finding that weight labeling predicts increases in disordered eating symptoms and unhealthy weight control behaviors over a four-year period. These results are discussed within a broader framework that conceptualizes weight stigma as an important contributor to disordered eating behaviors.

Bio: Jeffrey Hunger, PhD, is a postdoctoral scholar in Health Psychology at UCLA. He received his bachelor’s degree in psychology from the University of Minnesota, master’s degree in psychological research from CSU Fullerton, and PhD in Psychological and Brain Sciences from UC Santa Barbara. As a social and health psychologist, Dr. Hunger is interested in using insights from psychology to understand and ultimately improve the health of stigmatized groups (e.g., higher bodyweight individuals, racial and sexual minorities). Dr. Hunger’s research is published in top outlets across psychology, public health, and medicine, and has been featured in the New York Times, Huffington Post, NPR, and more. To learn more about his work, please visit JeffreyHunger.com

Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland) or street parking

RSVP to: drmuhlheim@gmail.com

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

May 2018 LACPA Eating Disorder SIG

Gretchen Kubacky, Psy.D. on Polycistic Ovary Syndrome  [image description: photo of Gretchen Kubacky]Date: Tuesday, May 15, 2018 at 7 pm

Presenter: Gretchen Kubacky, Psy.D.

Title: Polycystic Ovary Syndrome and Eating Disorders: What’s the Connection?

Description: Polycystic Ovary Syndrome (PCOS) is currently estimated to affect up to 22% of women. It is the primary cause of female infertility and other endocrine disruptions. Women with PCOS have much higher rates of depression, anxiety, and eating disorders, particularly Binge Eating Disorder. Dr. Gretchen will present an overview of the physical and psychological symptoms of PCOS, how those symptoms present clinically, and discuss the challenges of appropriately diagnosing and treating eating disorders in women with PCOS. 

Bio: Gretchen Kubacky, Psy.D. is a health psychologist with a private practice located in West Los Angeles. Dr. Gretchen works primarily with hormonal issues and chronic and invisible illnesses, with a specialty in Polycystic Ovary Syndrome (PCOS). She is the creator of PCOS Wellness, a Certified PCOS Educator, and a member of the PCOS Challenge Health Advisory Board.  She is also a Certified Bereavement Facilitator for children and adults, co-editor of the Los Angeles Psychologist magazine, and a frequent speaker and author on health psychology topics. For more information about her private practice and PCOS education services, see www.DrGretchenKubacky.com and www.PCOSwellness.com.

Location: The meeting will be held in the office of Dr. Gretchen Kubacky, located at The Gardens building, 2001 South Barrington Avenue, Suite 121, Los Angeles, CA  90025 at 7:00 p.m. on Tuesday, May 15, 2018. Suite 121 is on the ground floor, at the north end of the building. After 6:00 p.m., you may park for free on the ground floor of the building. The parking entrance is located on the south end of the building, adjacent to Yoga Raj studio. There is also free and metered parking on the streets surrounding the building. The building and office are wheelchair accessible. 

RSVP: drmuhlheim@gmail.com

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

Fall 2017 LACPA Eating Disorder SIG Events

Hope Levin, M.D. [image description: photo of Hope Levin]Date:  Wednesday, September 13 at 7:30 PM

Presenter:  Hope Levin, M.D.

Title: Psychopharmacological Treatment of Eating Disorders

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Hope W. Levin, M.D. is a board-certified child, adolescent and adult psychiatrist.  Since 2006, she has worked as a staff psychiatrist at UCLA Counseling and Psychological Services where she serves as the psychiatrist on the eating disorders treatment team.  She co-founded the UCLA Campus-wide Eating Disorders Partnership to collaborate with campus professionals who provide treatment to students with eating disorders.   In addition to her work at UCLA, Dr. Levin is a staff psychiatrist at The Renfrew Center of Los Angeles and maintains a private practice in Santa Monica.

Dr. Levin completed her undergraduate education at Cornell University and medical school at MCP Hahnemann School of Medicine.  She completed general psychiatry residency at University of Pennsylvania where she was Chief Resident, and child and adolescent psychiatry fellowship at the Massachusetts General Hospital/McLean Hospital program, Harvard University where she was also Chief Resident.

Dr. Levin gave this talk previously to our group in March 2012. She will present updated information.

RSVP to:  drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

Tuesday, October 3 at 7:30 PM

Presenter:  Bobbie Eisenstock, Ph.D.

Title: Media and Body Image: How Media Literacy Can Help Counteract Unrealistic Body Ideals

Description: In our media saturated world, it’s hard to escape the onslaught of messages that tell us how we should look, sell us products to achieve the ideal body, and pressure us to reshape our bodies with promises of happiness and success. How can we protect our self-image from media’s narrow and unrealistic ideals that can make us feel less confident and accepting of our bodies? Research demonstrates that media literacy can help counteract media’s role in normalizing cultural body standards that are naturally unattainable for most and can adversely affect body positivity. This mini-workshop highlights essential media literacy strategies and resources for self-care in the digital age.

Location:  LACPA Office, Encino

Bio:  Bobbie Eisenstock, Ph.D. specializes in the social and psychological effects of media and new interactive technologies on children, teens, and families. She facilitates media literacy workshops for parents, educators, and health practitioners to promote healthy child and adolescent development. A recipient of NEDA’s Westin Family Award for Excellence in Activism and Advocacy, Dr. Eisenstock is on the faculty at Syracuse University in Los Angeles and California State University, Northridge where she directs the Proud2Bme civic engagement project about media literacy and body image. Her students developed NEDA’s Get REAL! Digital and Media Literacy Toolkit and How to Spread Body Positivity in Your Community.

Here is a link to media literacy tips Dr. Eisenstock wrote for NEDA that were posted on its website earlier this month:

https://www.nationaleatingdisorders.org/blog/media-body-image-what-you-need-to-know

LACPA ADDRESS and PARKING INSTRUCTIONS: 6345 Balboa Blvd, Bldg 2, Suite 126, Encino 91316. The buildings are on the south-west corner of Victory and Balboa, and Bldg 2 is the second building from Balboa.  If you come from the Westside, take the 405 to the 101 and exit going north on Balboa to just before Victory (park on the street or in the Sepulveda Basin Sports Complex (6201 Balboa Blvd.) on the west side of Balboa, just south of Victory).  Or take the 405 to Victory (past the 101 if you are coming from the Westside) and exit West onto Victory.  Take it to Balboa and turn left, now heading south.  On your right, you will see the buildings.  The LACPA office is right by the entrance off the parking lot, on the left if you walk in from the parking area.

Parking at The Encino Office Park lot between the hours of 9am – 6:30 pm is restricted to building tenants only.  We can park there in the evening and on weekends, but not 9 – 6:30 weekdays.

RSVP to:  drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

 

November 2016 LACPA Eating Disorder SIG events

The Los Angeles County Psychological Association Eating Disorders SIG will be hosting 2 events in November 2016

Tuesday, November 1 – 7 – 8:30 pm in LACPA Office (Encino) – DBT for Eating Disorders 

Speaker: Charlotte Thomas, LCSW, Program Manager of Portland DBT’s Pathways to Mindful Eating Program

Talk Description: charlotte [image description: photo of Charlotte Thomas]

Dialectical Behavior Therapy (DBT) is an evidence based treatment developed by Marsha M. Linehan, PhD for complex multi-diagnostic individuals with pervasive emotion dysregulation and high risk suicidal behavior. Over the past two and a half decades, research has consistently demonstrated DBT as being effective for patients with a variety of complex problems such eating disorders and substance abuse disorders, where emotion dyscontrol is at the core of the patient’s issues and often interfere with treatment and long-term maintenance of therapeutic progress. This presentation will use a session- to-session birds eye view of the implementation of DBT with complex eating disorders in order to demonstrate use of DBT principles and skills in a concrete, “real world” manner. My hope is to communicate my excitement for DBT, share outcomes commonly generated by DBT, and to generate curiosity among individuals participating in the training.

Goals:

Upon completion of this presentation, participants will:

  • Learn about the first 7 sessions of treatment using a composite client with a complex Eating Disorder
  • Understand the biosocial model of DBT as applied to a composite client
  • Learn about the timing and use of strategies such as dialectics, behavioral chain analysis, and diary cards

Speaker bio:

Charlotte Thomas, LCSW

Charlotte received her master’s degree in Social Science Administration (MSSA) at Case Western Reserve University in Cleveland, OH and trained with Lucene Wisniewski PhD, FAED and Mark Warren MD, FAED for the following 4 years in the evidence based treatment of eating disorders. She is now a licensed clinical social worker in the state of Oregon. Charlotte’s professional interest is in treating eating disorders and associated needs including borderline personality disorder, depression and anxiety. She has experience in private practice mental health settings, providing individual, family, and group services for teens and adults. At Portland DBT Institute, Charlotte is the Program Manager for the Pathways to Mindful Eating program and provides direct service to clients, supervision to staff, and serves on the management board for the clinic helping to inform general clinic policy.

 Friday, November 4 – 12 to 1:30 pm in LACPA Office (Encino) in conjunction with the Couples SIG – Panel Discussion: The Impact of Particular Addictive/Compulsive Behaviors on a Couple’s Relationship, and How to Help – Hoarding, Gambling, and Eating Disorders

3 speakers include:

  1. Regina F. Lark, PhD: Family Stuff
  2. Cristin Runfola, PhD:  Uniting Couples in the Treatment of Eating Disorders.
  3. Margaret Altschul, MBA, MA, LMFT: Win, Lose or Draw:  What happens to couples when one partner is a problem gambler?

Speaker bios and talk descriptions below:

Regina F. Lark, PhD: Family Stuff: The impact of compulsive hoarding on relationships with family and friends, creates as much dysfunction as the “stuff” piled around the room. Dealing with it effectively “takes a village” and a strategic plan to calm the relationships between loved ones and the physical environment. Dr. Lark’s presentation will explore the effects of the hoarding disorder and chronic disorganization on the family dynamic, and present strategies for finding clarity amidst the chaos.

Dr. Lark is the owner of A Clear Path: Professional Organizing and Productivity. As a Certified Professional Organizer she specializes in working with people with chronic disorganization, ADHD, and hoarding. She is also a relocation specialist, helping families move or downsize from one home to the next. She is a featured speaker and educator, and is the author Psychic Debris, Crowded Closets: The Relationship between the Stuff in your Head and What’s Under your Bed, Second Edition, (Purple Books, 2014). She serves on the Board of the National Association of Professional Organizers, and is a member of the National Speakers’ Association. She earned a  Ph.D. in History at the University of Southern California.

Cristin Runfola, PhD: Uniting Couples in the Treatment of Eating Disorders. Dr. Runfola will describe recently developed couple-based interventions for eating disorders, including how core cognitive-behavioral couple therapy interventions can be applied and integrated with individual CBT principles for these disorders. Further, she will present data from recent pilot studies conducted with couples affected by anorexia nervosa (UCAN) or binge-eating disorder (UNITE), which yield promising results.

Cristin Runfola, PhD, is a clinical instructor at Stanford University who specializes in the treatment and research of eating disorders. Dr. Runfola’s primary research interest is in developing and testing the efficacy of clinical interventions designed to improve outcome for eating disorders. She underwent extensive training in cognitive-behavioral couples therapy and worked with colleagues at UNC-CH to develop and test manualized protocols for treating anorexia nervosa and binge-eating disorder in a couple context. She is the recipient of various awards, such as the AED Clinician Scholarship Award and NIMH/AED Early Career Investigator Travel Fellowship Award, for her work.

Margaret Altschul, MBA, MA, LMFT: Win, Lose or Draw: What happens to couples when one partner is a problem gambler?

Imagine discovering that your joint bank accounts are gone, your credit cards are charged to the max, and your car is about to be repossessed. This is often the scenario confronting couples when one person is a problem gambler. Problem gambling by one partner brings to a relationship all of the chaos, fear and betrayal of addictions and affairs combined. This presentation will help you gain awareness and understanding about Problem Gambling and learn how you can help couples dealing with the unique challenges this addiction creates.

Margaret Altschul, MBA, MA, is a Licensed Marriage and Family Therapist with a background in education and business. In addition to working with couples, Ms. Altschul applies her training and experience in using EFT and Gottman methods to help adults improve difficult relationships with parents, siblings and people at work. Margaret is authorized by the CA Office of Problem Gambling to provide counseling (at no cost to the client) to people with gambling addiction as well as family members affected by gambling.  She is Director of the Wagner Program at American Jewish University where she trains human services volunteers in basic counseling skills

* LOCATION for both events: LACPA ADDRESS and PARKING INSTRUCTIONS: 6345 Balboa Blvd, Bldg 2, Suite 126, Encino 91316. The buildings are on the south-west corner of Victory and Balboa, and Bldg 2 is the second building from Balboa. If you come from the Westside, take the 405 to the 101 and exit going north on Balboa to just before Victory (park on the street or in the Sepulveda Basin Sports Complex (6201 Balboa Blvd.) on the west side of Balboa, just south of Victory).  Or take the 405 to Victory (past the 101 if you are coming from the Westside) and exit West onto Victory.  Take it to Balboa and turn left, now heading south. On your right, you will see the buildings. Go a bit past the parking lot for the building (we are not allowed to park there during the day), past the Army’s center to the next driveway, which is for the Sepulveda Basin Sports Complex (2nd driveway past the Busway), and park in there. Or park on the street just south of the entrance for the sports complex parking lot. Both sides of Balboa have all day free parking. Allow a 3 – 5 minute walk to the buildings. Walk into the building’s parking area and go to the second building. The LACPA office is right by the entrance off the parking lot, on the left if you walk in from the parking area. Wherever you park, please check the signs

Parking at The Encino Office Park lot between the hours of 9am – 6:30 pm is restricted to building tenants only. We can park there in the evening and on weekends, but not 9 – 6:30 weekdays.

RSVP to: drmuhlheim@gmail.com

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org 

December 2016 LACPA Eating Disorder SIG

image description: photo of Shannon KoppDate: Wednesday, December 7 at 7:30 pm (Note: new date)

Presenter: Shannon Kopp – Author of Pound for Pound: A Story of One Woman’s Recovery and the Shelter Dogs Who Loved Her Back to Life (HarperCollins Publishers) and Founder of SoulPaws Recovery Project.

Title: The Healing Power of the Paw: How Animals Can Play a Vital Role in Eating Disorder Recovery

With the highest mortality rate of any mental illness and afflicting up to 30 million people in America, eating disorders can have heartbreaking consequences. For eight years, Shannon Kopp battled the silent, horrific, and all-too-common disease of bulimia. Despite a near decade of weekly therapy, medication, loving support from family, and a hospitalization and rehab stay at Rosewood Center for Eating Disorders, she continued to grow progressively sicker.

Then, at twenty-four, she began working with shelter dogs at the San Diego Humane Society, where she felt a deep sense of calm and comfort around the animals. Gradually over time, when Shannon wrestled with anxiety, she began turning to the loving presence of a dog (rather than to the eating disorder). A dog’s ability to live in the present moment helped to pull her out of her head and back down to earth. The dogs grounded her, and they created a vital sense of emotional security.

Shannon adopted a dog and began bringing her dog with her to therapy, and soon, Shannon was sharing on a deeper and more honest level than ever before. This marked the beginning of her eating disorder recovery—she will celebrate seven years free from bulimia on August 28th.

Research on the human-animal bond (known as Anthrozoology) has increased steadily over the years. Studies have shown that blood-pressure-meds.com may decrease stress levels by lowering blood pressure and creating a sense of general well-being—for the both human and animal!

Today, Shannon offers free animal therapy—SoulPaws Workshops— to those suffering from eating disorders in her community. (Learn More About SoulPaws Workshops Here: http://shannonkopp.com/workshops/)

Location: The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio – Shannon Kopp is an eating disorder survivor, animal welfare advocate, and the best-selling author of Pound for Pound: A Story of One Woman’s Recovery and the Shelter Dogs Who Loved Her Back to Life (HarperCollins Publishers). She is also the founder of SoulPaws Recovery Project, offering free animal therapy to those suffering from eating disorders. Shannon’s story has been featured on CNN, Fox News, Huffington Post, Salon, NPR and more. www.shannonkopp.com

http://www.harpercollinsspeakersbureau.com/speaker/shannon-kopp/

RSVP to: drmuhlheim@gmail.com

SIG meetings are open to all LACPA members. Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

April and May 2016 LACPA Eating Disorder SIG events

image description: Lyn GoldringPlease join us:  

Wednesday, April 20 at 7:30 PM

During April all LACPA Special Interest Groups (SIGs) and Clubs are available to non-members as a way of introducing them to some of the many FREE benefits of LACPA membership.

Presenter:  Lyn Goldring, RN, Director of Nursing, Monte Nido and Affiliates

Title:  Medical Complications in Eating Disorder Treatment

Description:  Eating disorders affect every system of the body. The physical consequences of severe food behaviors often go unseen because the body is highly adaptive. Developing an adequate “medical tool kit”allows clinicians and health care providers know what questions to ask and what physical test should be done to evaluate the severity of the Eating Disorder. With wisdom and humor, Lyn gives practical advice on understanding and addressing medical issues in a non-medical setting.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Lyn practiced her nursing skills all over the world before finding her way to Monte Nido. Withconsistent compassion she helped to create our current nursing program, managing the well being of our clients’ and a team of nurses at both houses. Lyn’s wisdom and British wit are an essential element of our program, while clients find a safe haven in her kindness.

RSVP to:  drmuhlheim@gmail.com

In an effort to reach out to our community, LACPA is opening up SIGs to nonmembers for a limited time only. Take advantage of this opportunity and encourage your colleagues to attend a SIG during APRIL to experience one of the many benefits of being a LACPA member. In accordance with current policy, non-members will NOT be allowed to attend SIGs during any other months of the year.

image description: A. Janet Tomiyama

Tuesday, May 10 at 7:30 PM

Presenter:  A. Janet Tomiyama, Ph.D., Assistant Professor,Department of Psychology, UCLA, Director, UCLA Dieting, Stress, and Health Laboratory www.dishlab.org

Title:  Dieting, stress, and weight stigma

Description:  Does dieting work to promote long-term weight loss and health? This talk will discuss evidence suggesting the answer is no, and will cover the potential negative consequences of dieting, including stress. Further research on stress and its effects on comfort eating will be presented, as well as novel research on weight stigma and its negative effects on eating, stress, and long-term weight gain.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  A. Janet Tomiyama, Ph.D., is an Assistant Professor in the Department of Psychology at the University of California, Los Angeles. She received her B.A. in Psychology in 2001 from Cornell University, and her M.A. and Ph.D. in Social Psychology with concentrations in Health and Quantitative Psychology in 2009 from the University of California, Los Angeles. In 2011, she completed a Robert Wood Johnson Health and Society Scholar Fellowship jointly at the University of California, Berkeley and the University of California, San Francisco. Her research centers around eating, dieting, stress, and weight stigma.  She is one of the leading researchers demonstrating the flaws of BMI as an indicator of health. http://www.nature.com/ijo/journal/vaop/ncurrent/abs/ijo201617a.html

RSVP to:   drmuhlheim@gmail.com

May event is only open to LACPA members.

Los Angeles Eating Disorder Events for Professionals January 2016

We are so lucky to have two amazing dynamic internationally recognized speakers regarding eating disorders in January via the Los Angeles County Psychological Association (LACPA).  One is a FREE SIG event (members only) and the other is a CE event with a charge (open to all professionals).

1)  Eating Disorder SIG meeting featuring international speaker and fat acceptance activist, Ragen Chastainimage description: photo of Ragen Chastain

Wednesday, January 20 at 7:15 pm 

Title:   Elimination is Oppression – The Ill-Advised Fight Against Obesity

Presenter:  Ragen Chastain

Description:  You can’t have a “War on Obesity” without creating a war on fat people. There is no non-stigmatizing way to say “The world will be better when no one who looks like you exists.” The shame, stigma, bullying, and oppression that have arisen from massively failed attempts to “eradicate” obesity have far-reaching negative health effects on people of all sizes, including those struggling with Eating Disorders.  The solution is not to double down and do more of the same. The research is clear that body size and health are not the same, and that a focus on body size in healthcare does a disservice to people all sizes.  We can, and we should, create complete, thriving public health programs without the use of eliminationist language, without creating a culture of appearance-based stigma and oppression, and without waging war on anyone.

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles) – free parking in the lot (enter on Highland)

Bio:  Ragen Chastain is an internationally recognized thought leader in the fields of self-esteem, body image, Health at Every Size, and corporate wellness.  She is a sought after speaker on the college, corporate, and conference circuits who has set the stage on fire everywhere from Google Headquarters to Cal Tech to the Models of Pride Conference.  She is the author of the blog DanceswithFat,  the book Fat: The Owner’s Manual, a columnist for Ms. Fit Magazine, and frequently appears as a topic expert on television and in print media. Ragen is a featured interviewee in the documentaries America the Beautiful 2 – The Thin Commandments, Ragen’s More Cabaret, and A Stage for Size.  She lives in Los Angeles with her partner and their adorable dogs and in her free time she is training for her second marathon and her first IRONMAN triathlon.

RSVP to Dr. Lauren Muhlheim at drmuhlheim@gmail.com

SIG meetings are open to all LACPA members.  Nonmembers wishing to attend may join LACPA by visiting our website www.lapsych.org

2)  A CE event (tell your colleagues who are nonmembers; we provide CEUs for psychologists, nurses, drug counsellors, MFTs, LCSWs, and LPCC)

“Unraveling the Enigma of Male Eating Disorders” with Stuart Murray, Ph.D. on Saturday, January 30, 2016 image description: photo of Stuart Murray

10:00 a.m. – 1:00 p.m. CE Credits 3.0 

Held at the NEW LACPA Office

6345 Balboa Blvd. Building 2, Suite 126

Encino, CA 91316

Click here to register online:

http://www.lapsych.org/events/event_details.asp?id=726923

This three hour workshop will provide a historical, theoretical, and clinical overview of eating disorder in males. Dr Murray will provide a historical overview of the development of our diagnostic framework, highlighting how this may be inaccurate in indexing male eating disorder concerns. Dr Murray will also provide an overview of the most recent empirical evidence pertaining to the transdiagnostic array of EDs in males. Finally, this workshop will include an in-depth discussion of the clinical quandaries faced in working with EDs in males.

Stuart Murray, Ph.D., is an Assistant Professor at UCSF, where he leads an international research group dedicated to advancing our understanding of male eating disorders. He also serves as the Director of the National Association for Males with Eating Disorders, and as the Co-Chair for the Academy of Eating Disorders Special Interest Group on Males & EDs. To date, Dr. Murray has published more than 70 scientific journal articles and book chapters, and has conducted workshops and seminars internationally on the topic of male eating disorders.