Winter 2017 LACPA Eating Disorders SIG Events

Glenys Oyston, RDN [image description: photo of Glenys Oyston]1.  Date: Thursday, January 26 at 7:30 pm

Speaker: Glenys Oyston, RDN

Title: The Dangers of Dieting

Description: Dieting for weight loss is a cultural norm – everyone does it, has tried it, or has been told to do it at one time or another. But is dieting for weight loss truly beneficial, or is it causing more harm than good? Registered Dietitian Glenys Oyston, discusses how intentional weight loss efforts are actually harmful to the physical, social and psychological well-being of people who engage in them, and what to do about it.

Bio: Glenys Oyston is a registered dietitian, size acceptance activist, eating coach, and blogger who runs Dare To Not Diet, a coaching business for long-timer dieters and weight cyclers who want to break free of food restriction and body dissatisfaction. She coaches people online or by phone through one-on-one and group coaching programs. She is based on Los Angeles, CA. You can find her at www.daretonotdiet.com.

Glenys Oyston, RDN

Dare To Not Diet

Dietitians Unplugged Podcast

@glenysoRD on twitter

Facebook

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

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

 

abby22. February 10 at 11 am – LACPA Office (in conjunction with Sport and Performance Psychology SIG)

The LACPA Sport & Performance and Eating Disorders SIGs are pleased to announce our jointly held meeting for February, 2017:

Date: Friday, February 10, 2017

Time: 11:00 AM – 12:30 PM

Location: the LACPA Office, Encino

6345 Balboa Blvd. Building 2, Suite 126

Topic: When an Athlete Gets an Eating Disorder

Speaker: Abby McCrea, LMFT

More about our topic and speaker:

Clinical eating disorders cause significant problems for more than 40% of athletes. Subsequently, the subtleties between “good athlete” and “eating disorder” mindsets can become particularly tricky to discern after the onset of an eating disorder. Knowing the risks, possible causes, and how to support athletes with eating problems is essential for developing and sustaining athletic wellbeing. 

This talk is designed to help you:

  1. Explain how and why athletes get eating problems
  2. Recognize the subtle differences between a “good athlete” and an “eating  disorder” mindset
  3. Create ways to support athletes with eating problems

Abby McCrea is a Licensed Marriage and Family Therapist who has a private practice in Sierra Madre, CA. She graduated from Fuller Theological Seminary with a Master’s of Science degree and a clinical focus on the integration between psychology and spirituality. 

With over 13 years of experience in a variety of mental health settings including inner city gang rehab community programs, college counseling centers, and eating disorder residential centers, she brings a depth of understanding, experience, respect, and compassion to her work. In her private practice she specializes and works to empower teens, adults, and families that recovery from an eating disorder is possible.  Additionally, she is passionate about developing research and treatment for athletes with eating problems, and helps clients, families, and coaches in her practice to navigate and manage the delicate balance between life, sport, and recovery.

 Abby speaks nationally on the topics of eating disorders and athletes, eating disorder education, deconstructing social ideals of body image, spirituality and the rituals of eating problems, and identity development among teenagers in life transitions.

Please RSVP and/or direct any questions to Sari Shepphird at drshepp@msn.com

LACPA SIG Meetings are a LACPA member benefit and are open to all LACPA Members. For more information about LACPA Membership, SIG’s and other events, visit the LACPA events calendar: www.lapsych.org

Parking Information:

The LACPA office address is THE ENCINO OFFICE PARK, 6345 Balboa Blvd, Building 2, Suite 126, Encino, CA 91316 – second building from Balboa Blvd., conveniently located near ample free daytime/weekday street parking on Balboa Blvd, south of Victory Blvd.  Both sides of Balboa have all day free parking.  There is also plenty of free parking at the Sepulveda Basin Sports Complex on the west side of Balboa, south of Victory, 6201 Balboa Blvd. (2nd driveway past the Busway). 2-3 minute walk to the office door.  Wherever you park, please check the signs. 

Parking at The Encino Office Park lot between the hours of 9 a.m. – 6:30 p.m. is restricted to building tenants only.  Do not park in the lot at the building. 

 

Is Your Young Adult with an Eating Disorder Ready for College?

Is My Young Adult with an Eating Disorder Ready for College? [image description: young adults sitting on grass hanging out together]

You may be wondering: is my young adult with an eating disorder ready for college? Starting college is stressful for even the most well-adjusted young adult. Young adults with eating disorders often have trouble with transitions. Add an active eating disorder on top of the college transition, and you have a potential time bomb.

College brings a multitude of new situations to navigate: living away from parents; living with strangers; loss of personal space and privacy; unfamiliar environment; unfamiliar foods; loss of structure; drugs and alcohol; pressure to fit in; academic pressure; and sororities and fraternities. If a young adult has been struggling in recovery, these additional stressors typically make life even harder.

Young adults who are not completely recovered struggle in situations that healthy adults navigate with ease. Consuming enough food in a dining hall can pose a big challenge to students with eating disorders characterized by inflexible eating. In our experience, students who are not comfortable eating with peers and not comfortable eating a variety of foods (including starches, fats, and desserts) lose weight rapidly in this environment.

The patterns of college life can make it harder to maintain a healthy weight. Students are likely much more active as they walk from place to place over a large campus. Different sleep patterns (all-nighters among them) can also increase energy expenditure. For these reasons, the caloric needs of college students are often substantial; 3000-3500 kcal per day baseline is not unusual. This would translate to needing over 100 fat grams per day. These factors should be considered when evaluating whether the young adult can eat enough calorically dense food on their own to sustain a healthy weight or refrain from bingeing and purging.

College culture brings additional pressure to a student in recovery. Roommates and peers may be dieting, there is fear of the “freshman 15,” and friendships may bond around visits to the gym and yoga classes. It can be harder to refrain from exercise when it is the place that socializing occurs.

Many parents want to send their young adults to school so as not to have them miss out on common milestones and universal experiences. However, the reality is that attending school while still plagued by intrusive eating disorder thoughts and behaviors will rob them of the very aspects of the experience you want them to have. Returning to a “normal” life too soon is a common cause of relapse, further delaying their ability to live a “normal” life.

From our experiences with the preparation of high school seniors to go off to college and the reception of incoming freshman from other eating disorder teams, we have developed the following list of questions for parents to ask when deciding whether a young adult is prepared for a healthy transition to college:

Six months of solid recovery is needed, meaning the young adult has consistently displayed the behaviors included in the checklist over that period of time.

Lauren and Katie’s college readiness checklist:

  • Has your young adult maintained a steady weight in the healthy range (according to childhood growth records) and menstruated consistently (if female-bodied) for six months?
  • Has your young adult been free of eating-disordered behaviors such as bingeing, purging, laxative use, and excessive exercise for six months?
  • Is your young adult able to independently and consistently prepare/choose meals (in a variety of settings) that contain enough energy-dense foods to maintain this weight?
  • Is your young adult able to serve themselves snacks and desserts?
  • Does your young adult consume beverages other than water (juice, milk, lattes)?
  • Is your young adult able to eat at a variety of restaurants, ordering and eating a balanced meal that is not simply the lowest calorie item on the menu?
  • Is your young adult able to go into a cafeteria and eat from the different food stations comfortably (sandwich bar, grill, etc.) and not just from the salad bar?
  • Is your young adult comfortable eating hot breakfasts (other than oatmeal)?
  • Does your young adult use condiments comfortably (dressing with fat, ketchup, mayonnaise, etc.)?
  • Is your young adult comfortable eating with friends?
  • Does your young adult eat at a normal pace?
  • Has your young adult reincorporated the majority of previously feared and avoided foods?
  • Is your young adult able to go without exercise at least every other day, or not at all if medically contraindicated?
  • If your young adult has returned to exercise, do they understand the need to add additional fuel following exercise?
  • Is your young adult able to eat in front of other people who aren’t eating? (There is no guarantee roommates will not be eating disordered – so taking care of one’s own needs and handling the self-consciousness inherent in doing so is an important recovery skill.)
  • Will your young adult be able to cope with potentially having a scale in the room and roommates who weigh themselves and discuss weight/dieting?
  • If your young adult misses a meal for any reason at all, are they able to make it up that day or the next day at the latest? Making it up may mean having larger portions at other meals, two extra snacks, or the equivalent of an extra meal across a 24- to 36-hour period.
  • Is your young adult able to increase their daily calories substantially to account for mileage logged when walking around campus?
  • Can your young adult be restful? Does he or she sit when everyone else is sitting?
  • Is your young adult able to be alone around processed and highly-palatable foods without having an urge to binge?
  • Has your young adult demonstrated an ability to tolerate anxiety without resorting to restriction, bingeing, or purging?
  • Does your young adult openly acknowledge their eating disorder and have insight about the need to construct a life and schedule that supports recovery?
  • Have you discussed with your young adult that any situation that puts them in a state of negative energy imbalance or weight loss could trigger a relapse?
  • Does your young adult understand that alcohol calories “do not count” towards energy needs?
  • Are temperamental traits (perfectionism, rigidity, comparing, etc.) acknowledged and appropriately managed?

How to prepare a young adult for college

If your young adult meets most of the above criteria and there is still time before they are expected to leave for college, there are things you can do to prepare them.

  1. Practice eating with them in different self-serve cafeteria-type settings including a variety of restaurants for breakfast, lunch, and dinner. Good options include Souplantation, Indian restaurants that have lunch buffets, and hospital cafeterias. Have them practice building a meal that will meet their dietary needs. Revisit the same places again with the expectation that they will choose different options.
  2. Have them practice walking five miles per day for a week (to simulate the amount of physical activity they’re likely to have on a college campus) and adding sufficient calories to keep weight steady.
  3. Do ‘surprise’ food exposures for a few months – at random times take your young adult to unexpected food locales/situations and make sure they can tolerate it. For example, make a spontaneous stop at Cold Stone Creamery and offer them a snack.
  4. Do a week of sauces and butter on everything.
  5. It is a good idea to have a college contract in place. This is an agreement between the parents and the student that specifies criteria required for staying in college (things like maintaining a healthy weight, not engaging in eating disorder behaviors, and having regular weigh-ins) and what the parents will do if these things are not met (for example, increase supervision, bring the child home, etc.).  A sample college contract can be found here.
  6. Make sure they have a meal plan that includes three meals per day in the dining hall.

If your young adult does not meet the criteria listed above, then please consider having them defer college or start at a local college while living at home. It is better to delay their starting than to have them start and get overwhelmed by their symptoms and need to drop out. Life is not a race. College can wait. Your young adult will get more out of the experience when she or he is fully recovered. By contrast, sending them to college when they are not ready may reduce their chance for a full recovery.

Thanks to Rebecka Peebles, MD, Therese Waterhous, PhD/RDN, CEDRD, and JD Ouellette for their helpful feedback and contributions to this piece.

Download copy of article here: Is your young adult ready for college?

Presentation at NEDA 2015 conference

image description: Lauren and Katie presenting NEDA 2015

Katie and I had the honor of presenting in the Individual, Family, and Friends track at the National Eating Disorder Association Conference in San Diego yesterday.  The title of our talk was:  Family Based Nutrition Therapy:  Creating A Supportive Environment.  It was a chance to share the way we work to support families who are helping children with eating disorders.

Here are some of the key points of our talk:

Interested in Weight Loss? We CAN’T Help You. Here’s Why

Learn more about the non-diet approach at Eating Disorder Therapy LA - Health at Every Size (HAES) [image description: woman looking at fruit in grocery store]
Yale Rudd Center for Food Policy & Obesity

Learn More About Our Non-Diet Approach

At Eating Disorder Therapy LA, we treat eating disorders (including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Other Specified Feeding and Eating Disorder or OSFED) across the weight spectrum. We often get inquiries from clients interested in help for binge eating or emotional eating, with their primary goal being to lose weight.

We always tell them that while we believe we can help them with their disordered eating, if weight loss is their real goal, we cannot help them. By contrast, we are willing to help with, and in fact are rather insistent upon, weight gain for our patients who are below their body’s healthy weight.

Many prospective clients seeking help with weight loss have completed a diet regimen (or often, in their minds, “failed” one) and are suffering from binge eating. They want to eliminate the binge eating and concurrently lose weight. While we are expert at helping clients to stop binge eating and learn to regulate eating, we will not consent to “help someone” lose weight.

Here’s why:

  1. We don’t think anyone really has the answer to help someone lose weight. The research shows that diets don’t work. We are not so grandiose as to believe that We are any different.

    • Traci Mann’s 2007 review of 31 weight loss studies showed that on average, 41% of dieters regained even more weight than they lost on the diet. In an interview about the study, Dr. Mann said, “You can initially lose 5 to 10 percent of your weight on any number of diets, but then the weight comes back. We found that the majority of people regained all the weight, plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority. Diets do not lead to sustained weight loss or health benefits for the majority of people.”
    • Harriet Brown, the author of Body Of Truth – a detailed analysis of the war on obesity and the diet industry – wrote in an article about the book, “In reality, 97 percent of dieters regain everything they lost and then some within three years. Obesity research fails to reflect this truth because it rarely follows people for more than 18 months. This makes most weight-loss studies disingenuous at best and downright deceptive at worst.”
  2. Dieting and weight suppression may be the major drivers of binge eating and ironically, can cause weight gain.

    • Research on “weight suppression,” which is the difference between someone’s current weight and their highest adult weight, shows it is linked to both anorexia and bulimia. Drexel University psychologist Dr. Michael Lowe, Ph.D. is one of the leading researchers on weight suppression. His research shows that the greater the weight suppression, the more severe and difficult to treat was the eating disorder. His research also shows that the more weight-suppressed a person is, the more likely they are to regain weight in the future. To me, this suggests that some bodies are naturally larger and will resist all attempts to reduce in size. Attempting to fight the body’s predestined weight may contribute to binge eating behaviors and even higher future weights.
    • Evelyn Tribole, coauthor of Intuitive Eating in a review of dieting wrote: “Dieting increases your chances of gaining even more weight in the future, not to mention increase your risk of eating disorders, and body dissatisfaction. “
  3. Weight cycling – the repeated cycle of losses from dieting followed by the usual weight gains after going off the diet – creates its own health issues, in particular, additional stress on the cardiovascular system.

  4. Weight loss can trigger both anorexia and bulimia. Research from the Mayo clinic shows that 35% of the young people who visited the clinic with anorexia started out in the “obese” or “overweight” weight range.

  5. Dieting is incompatible with Cognitive Behavioral Therapy (CBT), the treatment we provide for adult eating disorders.

    While CBT is very effective for eliminating binge eating, it relies on a non-restrictive approach to eating. The goal of CBT is to disrupt the diet-binge cycle through a pattern of regular eating and relaxation of dietary rules. Patients are encouraged to end restrictive dieting and behaviorally challenge dietary rules through behavioral experiments and exposure to forbidden foods as part of treatment.

  6. Counterintuitively, when overweight binge eaters successfully complete CBT treatment for binge eating, they do not lose appreciable amounts of weight.

    Even adding a behavioral weight loss program following completion of CBT for binge eating does not lead to additional significant weight loss. However, it is possible that long-term abstinence from binge eating may prevent future weight gain especially as compared to untreated binge eaters.

Our first responsibility as practitioners is to do no harm. Even if weight loss is a client’s stated goal for treatment, and even if their doctor is advising it, we fear that “helping” someone to diet may increase their binge eating and disordered eating. This may in turn cause greater weight gain or weight cycling – a far worse alternative than remaining at the current weight. We will also work with you on accepting emotional eating as a normal process.

Here is how EDTLA can still help in the absence of weight loss:

  • We provide CBT-E for bulimia, binge eating disorder and subclinical disordered eating. I trained with one of the original developers of cognitive behavioral therapy for eating disorders. Clinical trials show 65.5% of CBT-E participants meet criteria for remission from their eating disorder. Relief from cycles of binge eating usually leads to benefits such as freedom from obsessing about food, greater productivity, decreased anxiety about food decisions, and improved self-esteem. Commonly, patients experience decreased guilt and shame around eating and food. Relationships improve as clients become more able to fully participate in meals with loved ones and friends. It also commonly leads to the expansion of other enjoyable areas of one’s life outside of dieting and body image.
  • We work with clients on challenging weight stigma (both their own internalized and in the larger community). We also work on improving body image.
  • My associates and I follow a Health at Every Size® approach. At Eating Disorder Therapy LA, we recognize and celebrate that bodies come in all shapes and sizes. We focus on creating and maintaining healthy behaviors including flexible eating and enjoyable exercise.

Many clients arrive in therapy feeling that they cannot feel better unless they lose weight. However, the majority of those who go through a full course of treatment make significant improvements in their eating behaviors and are surprised at how much better they are able to feel even without weight loss.

Suggested Reading and Viewing:

Bacon, Linda, Health at Every Size

Brown, Harriet, Body of Truth

Mann, Traci, Secrets from the Eating Lab

Saguay, Abigail, What’s Wrong with Fat

The Problem with Poodle Science (video by the Association of Size Diversity and Health)

Why Dieting Doesn’t Usually Work (TED talk by Sandra Aamodt)

Warning Dieting Causes Weight GAIN (video by Evelyn Tribole MS RD)

Why do dieters regain weight?

Additional References:

Berner, L.A., Shaw, J.A., Witt, A.A. & Lowe, M.R. (2013). Weight suppression and body mass index in the prediction of symptomatology and treatment response in anorexia nervosa. Journal of Abnormal Psychology, 122, 694–708.

Mann, T., Tomiyama, A., Westling, E., Lew, A., Samuels, B., Chatman, J. (2007). Medicare’s search for effective obesity treatments: diets are not the answer. American Psychologist, 62(3):220-33.

Lebow, J., Sim., L., and Kransdorf, L. (2015). Prevalence of a History of Overweight and Obesity in Adolescents With Restrictive Eating Disorders. Journal of Adolescent Health 56, 19-24.

Additional HAES articles

Various articles that are found on the ASDAH website:

“Attitudes Toward Disordered Eating and Weight: Important Considerations for Therapists and Health Professionals”, Matz, J & Frankel, E

“Obesity and Anorexia: How Can They Coexist?”, Bulik, C. and Perrin, E.

“Obesity, Disordered Eating, and Eating Disorders in a Longitudinal Study of Adolescents: How Do Dieters Fare 5 Years Later?”, Neumark-Sztainer, Dianne, et. al

“Shared Risk and Protective Factors for Overweight and Disordered Eating in Adolescents”, Neumark-Sztainer, D., et al

“Multiple Disadvantaged Statuses and Health: The Role of Multiple Forms of Discrimination”, Grollman, E.A.

“The Problem with the Phrase Women and Minorities: Intersectionality–an Important Theoretical Framework for Public Health”, Bowleg, L.

Children/Teens

“Dieting and Unhealthy Weight Control Behaviors During Adolescence: Associations With 10-Year Changes in Body Mass Index”, Neumark-Sztainer, D., Wall, M., Story, M., Standish, A.

“Helping Without Harming – Kids, Eating, Weight and Health”, Robison, Jon; Cool, Carmen; Jackson, Elizabeth and Satter, Ellyn

“Overweight and Obese Children Eat Less Than Their Healthy Weight Peers”, Hoyle, Brian

“Weight Status as a Predictor of Being Bullied in Third Through Sixth Grades”, Lumeng, J.C., Forrest, P., Appugliese, D.P., Kaciroti, N., Corwyn, R.F., and Bradley, R.H.

The Hidden Benefits of Full Fat Dairy by Katie Grubiak, RD

Galbani Whole Milk Mozzarella Cheese
full fat dairy
Galbani Whole Milk Ricotta Cheese
Greek Gods’ Greek Yogurt

History of the Low-Fat Movement

Since the 1980s, physicians, the federal government, the food industry, and popular media have championed the low-fat approach to dieting and weight control. The idea stemmed from a few studies published in the 1940s, which showed a correlation between high-fat diets and high-cholesterol levels. Because high-cholesterol levels were known to be a major risk factor for heart disease, low-fat diets were highly recommended as a preventive measure for at-risk individuals, and eventually for the entire nation. This advice became so widespread by the 1980s that reduced-fat and low-fat options dominated the diet-related product market.

The Argument for Low-Fat Dairy

Although this national preoccupation with low-fat products has waned since the 1990s, low-fat dairy products have sustained their popularity. Low-fat dairy products are lower in calories and saturated fat than their full-fat counterparts, while still boasting substantial amounts of protein and calcium. To experts worried about slowing the impending “obesity epidemic”, low-fat dairy at first seems an obvious choice – especially if choosing low-fat products can help prevent heart disease.

The Issue with the Low-Fat Dairy Argument

There’s just one problem with this logic – according to a review article recently published in the European Journal of Nutrition, there is no conclusive evidence to suggest that full-fat dairy consumption is associated with increased risk of obesity, heart disease, or diabetes. In fact, in 11 of the 16 studies reviewed, high-fat dairy intake was inversely associated with obesity risk. In a 12-year longitudinal study conducted in Sweden, researchers Dr. Sara Holmberg and Dr. Andres Thelin found that men who reported a low intake of dairy fat (skim milk, no butter, etc.) had a higher risk of developing obesity in the 12-year period than were men who reported a high intake of dairy fat.

Why Whole Dairy?

Much of this research may come as a surprise to those familiar with the calories-in, calories-out model of weight maintenance. How could eating dairy products that are significantly higher in calories help people avoid weight gain?

Researchers aren’t certain why full-fat dairy may aid in healthy weight maintenance, but there are a few ideas gaining traction in the field: 

  • Fullness 
    • To produce low-fat dairy products, “excess milk fat” is separated out of whole dairy. Much of this “excess milk fat” is made up of fatty acids found in milk, which are thought to make people feel full sooner and stay full longer. Thus, low-fat dairy products simply don’t keep you as full as whole dairy products do.
    • The fatty acids in whole milk also make whole dairy products richer, thicker, and more satisfying, which can add to the experience of fullness, and keep you full for longer.
  • Role in Gene Expression & Hormone Regulation.
    • The fatty acids found in whole milk may be involved with gene expression and hormone regulation in the body. Though these relationships are unclear, it is possible that fatty acids speed up metabolism or limit the body’s storage of fat.
  • Real Food, Not Just Nutrients.
    • Though macronutrient content can tell us a lot about the health benefits of food, whole fat dairy is more than just the sum of its (major) parts. Real food is a complex mix of macro (fat, carbohydrates, protein) and micro (vitamins and minerals) nutrients. Absorption of all of these macro and micronutrients is dependent upon several factors, so altering the macronutrient breakdown of dairy products (by removing fat) changes the way these products are metabolized by the body.For instance, Vitamins A, D, E, and K are fat soluble nutrients, which means that absorption of these nutrients is compromised when no fat is present.

When I have helped my clients with eating disorders to add full fat diary products back into their diet after a period of having avoided them, positive changes take place.  They often notice a decrease in food obsession and a reduction in volume of intake. Although most clients fear overeating whole full fat (and higher calorie) products, this does NOT happen. Instead, portion control often occurs more naturally since satiety comes from the taste, texture, & actual full fat macronutrient presence.  Clients recognize that they CAN feel in control but still go to their favorite real full fat foods which they previously feared and avoided. In reality, the low fat foods were the ones that they could not limit.   I have only seen satiety benefits as well as metabolic benefits of a diet higher in fat, 30-35% of total calories. To try it for yourself, I suggest:

Some recipes incorporating whole fats

  • *Maple Hill Creamery 100% Grass-Fed Organic Milk Creamline Yogurt-Lemon flavored with granola & banana for breakfast
  • *The Greek Gods Greek Yogurt-Honey Strawberry flavored with cut up pear for a snack
  • *Toasted Caprese Open Faced Sandwich-
    • French Sandwich Roll-cut in half
    • Expeller Pressed Extra Virgin Olive Oil
    • Fresh Basil Leaves
    • Heirloom Tomatoes Sliced
    • Galbani Fresh Whole Milk Mozzarella or Galbani Whole Milk Low-Moisture Mozzarella Cheese

    • Pink Himalayan Salt

  1. Drizzle the olive oil over each half of the sliced French roll
  2. Place sliced Whole Milk Mozzarella Cheese over the French roll with olive oil
  3. Lay Basil Leaves on top of the Mozzarella
  4. Lay sliced Heirloom Tomatoes over the Basil
  5. Grind & sprinkle Pink Himalayan Salt over the Tomatoes
  6. Opened faced-Toast in toaster oven for 3-5 minutes or heat in oven 350 degrees F for 5-8 minutes

Sources:

  • The full article from European Journal of Nutrition can be found here.
  • The full article from the Scandinavian Journal of Primary Health Care can be found here.
  • For a through and clear explanation of this topic, refer to this TIME Magazine article.
  • An additional study in the American Journal of Clinical Nutrition can be found here and is summarized here.
  • Another article is here.

Research Assistant, Erin Standen contributed to the writing and research of this post.

July LACPA Eating Disorder SIG Meeting

I am so excited to confirm the next speaker for the Eating Disorder SIG who will be joining us from Washington, DC.

Wednesday, July 22 at 7:15 pm  headshot from Lobby Day Kathleen [image description: photo of Kathleen MacDonald]

Presenter:  Kathleen MacDonald

Title:   Advocacy and the Eating Disorder World:  Why Clinicians Matter

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

Description:  Capitol Hill, Advocacy and Eating Disorders –what possible connection do all three of these things have and why should you care about how they intersect?  Together we’ll discuss the answer to this question and discover how clinicians have a major role to play in eating disorder advocacy.  You will learn concrete ways to advocate for eating disorder legislation –ways that will not take up too much of your precious time, but ways that WILL make a difference.  You will also learn how to empower your clients, when they’re ready, to advocate for eating disorder legislation –a process that can be cathartic, empowering and life-changing.  And perhaps most of all, you will learn how one voice can make a difference on Capitol Hill –how the impact of one voice has the capacity to send ripples out beyond the halls of Congress, and into the lives of millions who suffer the insidious diseases we call eating disorders.  

Bio:  Kathleen MacDonald is Director of Social Media & Advocate Relations for the Eating Disorders Coalition for Research, Policy & Action (“EDC”) and a Health Insurance Advocate at Kantor & Kantor, LLP.   She believes that eating disorders education, along with early intervention and identification of symptoms and behaviors that can lead to the development of eating disorders is central helping to prevent people from suffering these deadliest of all mental illnesses.  Some of Kathleen’s professional experience includes: Patient Advocate for those impacted by eating disorders; FREED Foundation College Speaking Tour; assisting in the EDC’s creation and drafting of the Anna Westin Act of 2015 and the FREED Act (the Federal Response to Eliminate Eating Disorders Act), the first comprehensive bill in the history of Congress to address eating disorders research, education, prevention, and treatment; and writing appeals against the denial of insurance benefits for eating disorder treatment.  Kathleen has been involved in eating disorder advocacy since 2002.  She currently lives in the Washington, DC., area with a few English Setters, a few cats and a loved one of the two-legged variety.

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

This is a really unique opportunity to hear from someone who has worked on eating disorder policy.  New members can join LACPA in July and get 14 months of membership so encourage your nonmember friends to join now and take advantage of this amazing speaker!

Look before you leap: Binge Eating Disorder, Vyvanse, and evidence-based psychotherapies

Binge Eating Disorder, Vyvanse, and evidence-based psychotherapies [image description: capsule of Vyvanse]Guest post by Elisha M. Carcieri, Ph.D. 

Binge eating disorder (BED) has been making headlines with the recent announcement that the FDA has approved lisdexamfetamine dimesylate (Vyvanse) for the treatment of BED.

So, what is BED, how is it treated, and what does this new treatment option mean for sufferers?

What is Binge Eating Disorder

BED is a condition in which a person engages in recurrent episodes of binge eating at least once a week for three months1. Binge eating episodes typically involve eating rapidly until uncomfortably full, and eating when one is not necessarily hungry. Some individuals with BED report feeling unable to stop the episode, and describe themselves as being out of control during a binge. Binge eaters often binge alone and make efforts to hide their behavior from friends, partners, or family members. Episodes of binge eating often end in feelings of guilt, shame, and depressed mood. Unlike other eating disorders, such as bulimia nervosa, people with BED do not vomit or use other methods of compensation (such as excessive exercise or fasting) to shed calories or lose weight after a binge. It should be clear that this is a very different experience than, say, overeating on Thanksgiving, having a second piece of birthday cake, or eating foods that are outside of your normal pattern while on vacation.

Until 2013, BED was not a diagnosable eating disorder. It was instead grouped in with other unspecified eating disorders that didn’t quite meet criteria to be formally diagnosed. After much research, the most recent iteration of the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), has included BED as a specific eating disorder distinct from other diagnoses.

Despite only recently being formally acknowledged, BED is the most commonly occurring eating disorder. Prevalence estimates vary, ranging from 1.6-3.5% of women, 0.8-2% of men, and 1.6% of adolescents.1, 2, 3 BED occurs as commonly among women from racial or ethnic minority groups as for white women, 1 and is often seen in people with severe obesity.1, 4 Up to 30% of people seeking bariatric surgery or other interventions for weight loss are suffering from BED5. While it is more common for women to meet all of the criteria for BED, men tend to engage in binge eating as frequently as women2. Like all eating disorders, the causes of BED are complex. There is evidence for genetic, biological, and environmental risk factors. BED is associated with significant chronic health problems. It is also common for individuals with BED to struggle with other mental health disorders at the same time, including depression, anxiety, and substance use disorders.

The good news is that there are established treatments that work for BED. Unfortunately, effective psychological interventions for eating disorders don’t get as much press as pharmaceuticals. Nevertheless, those suffering from BED should be aware of what is available.

Treatment for Binge Eating Disorder

Evidence-based psychological treatments are first-line considerations for the treatment of BED. A psychologist or other mental health professional qualified to treat eating disorders usually conducts psychological treatment for BED on an outpatient basis. Cognitive behavioral therapy (CBT) is the most well studied and established treatment for BED with demonstrated effectiveness.6 The treatment involves reducing episodes of binge eating using tools such as establishing regular eating patterns and self-monitoring of food intake and patterns of eating. CBT also addresses concerns about shape and weight, and examines and challenges patterns of thinking that may be keeping a person stuck in a pattern of binge eating. CBT for BED involves discussion and planning of how to maintain progress, and how to recognize and respond to relapse. Studies have demonstrated improvements lasting up to 12 months post-treatment with CBT.7 Interpersonal therapy (IPT) has also been proven effective for BED with strong research support.8 IPT involves more of a focus on interpersonal (relationship) difficulties with an understanding of how these problems may have precipitated BED, or how they might be keeping the BED going. Finally, there is evidence that dialectical behavior therapy (DBT), which focuses on mindfulness, emotion regulation, and distress tolerance, is effective at treating BED.9

Pharmacological Treatments for Binge Eating Disorder

In addition to psychological treatments, some antidepressants and anticonvulsants have proven helpful at reducing the frequency of binge eating in patients with BED.6 The newest and only medication specifically approved by the FDA for BED is Vyvanse, a central nervous system stimulant that has been approved to treat ADHD in children and adults since 2007. The approval for BED came after clinical trials demonstrated that the average number of binge eating days per week among sufferers were decreased in those who took Vyvanse, compared to those who took a placebo.10 Sounds promising…but there are other considerations to keep in mind…side effects, long-term use, and the question of whether a medication can address the complex nature of a serious eating disorder such as BED.

The potential side effects of Vyvanse include decreased appetite, dry mouth, increased heart rate or blood pressure, difficulty sleeping, anxiety, gastrointestinal problems, feeling jittery, and even sudden death among people with heart problems. The drug is also particularly risky for individuals with a history of seizures or mania. Vyvanse may cause psychotic or manic symptoms in people with no history of mental illness, and has a high potential for abuse, dependence, tolerance, and overdose.

Vyvanse appears to decrease symptoms over a short period of time (about three months) while taking the medication. However, it is unlikely that the medication will result in long-term changes in complex binge eating behavior once the drug is stopped, meaning that one might expect to take Vyvanse for the rest of their lives in order to keep BED at bay. This is problematic considering the chronic nature of BED, 2 and the fact that the negative emotion, distress, shame, and weight or shape concerns that are often related to BED would almost certainly remain unaddressed.

While there are no identified side effects to engaging in psychological treatment of BED, these treatments do take time (often around 20 weeks), and not every person will respond to an intervention the same way. It may take some trial and error to find the right therapist or treatment. However, psychological treatments are more equipped than medication alone to address the binge eating behavior itself, and the different ways binge eating relates to other areas of a person’s life and functioning. Rather than simply masking and reducing symptoms in the short term with a medication, completing a course of evidence-based therapy can provide the insight and tools needed for managing the patterns of disordered eating that are characteristic of BED for life. Many people with BED may benefit from trying a psychological approach before initiating treatment with a serious medication like Vyvanse.

Implications for Patients

All of these factors should be carefully considered when making a decision about treatment for BED. With all eating disorders including BED, it is important to get help sooner rather than later. For many people, turning to their primary care doctor is the first step. Patients should keep in mind that these conversations can be sensitive and difficult, and many providers may not be familiar with BED. Other providers may be familiar with the recent approval of a new drug, and will be eager to explore prescription medication options for treatment.

If you aren’t getting anywhere with your doctor, it is always appropriate to ask for a referral to a medical provider who is more familiar with eating disorders. Your doctor may also be able to provide you with a referral to a mental health provider, such as a psychologist, who can provide one of the therapies discussed above, and to a nutritionist or dietician who specializes in eating disorders for even more comprehensive support. Remember that it is important to seek help from professionals qualified to treat eating disorders, and treatment decisions should be tailored to the unique needs of each person.

If you do see a psychiatrist regarding any medication, we have some recommendations.

References

1. American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders: DSM 5. bookpointUS.

2. Hudson, J. I., Hiripi, E., Pope Jr, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological psychiatry, 61(3), 348-358.

3. Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., & Merikangas, K. R. (2011). Prevalence and correlates of eating disorders in adolescents: Results from the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 68(7), 714-723.

4. Marcus, M. D., & Levine, M. D. (2005). Obese patients with binge-eating disorder. In The management of eating disorders and obesity (pp. 143-160). Humana Press.

5. Kalarchian, M. A., Marcus, M. D., Levine, M. D., Courcoulas, A. P., Pilkonis, P. A., Ringham, R. M., … & Rofey, D. L. (2007). Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. The American journal of psychiatry, 164(2), 328-334.

6. Brownley, K. A., Berkman, N. D., Sedway, J. A., Lohr, K. N., & Bulik, C. M. (2007). Binge eating disorder treatment: a systematic review of randomized controlled trials. International Journal of Eating Disorders, 40(4), 337-348.

7. Wilson, G. T., Grilo, C. M., & Vitousek, K. M. (2007). Psychological treatment of eating disorders. American Psychologist, 62(3), 199.

8. Wilfley, D. E., Welch, R. R., Stein, R. I., Spurrell, E. B., Cohen, L. R., Saelens, B. E., … & Matt, G. E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of general psychiatry, 59(8), 713-721.

9. Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of consulting and clinical psychology, 69(6), 1061.

10. McElroy S. L., Hudson, J. I., Mitchell, J. E., et al. (2014) Efficacy and Safety of Lisdexamfetamine for Treatment of Adults With Moderate to Severe Binge-Eating Disorder: A Randomized Clinical Trial. JAMA Psychiatry.

Elisha Carcieri, Ph.D., is a licensed clinical psychologist (PSY #26716) practicing in the Los Angeles area. Dr. Carcieri earned her bachelors degree in psychology from The University of New Mexico and completed her doctoral degree in clinical psychology at Saint Louis University. During her graduate training, she conducted research focused on eating disorders and obesity, and was trained in using cognitive behavioral therapy (CBT) for eating disorders and other mental health disorders such as anxiety and depression. Dr. Carcieri completed her postdoctoral fellowship at the Long Beach VA Medical Center, where she worked with Veterans coping with mental illness, disability, significant acute or chronic health concerns, and chronic pain. In addition to cognitive behavioral strategies, she also incorporates alternative evidence-based approaches such as mindfulness, and acceptance and commitment-based strategies, depending on the needs of each client. Dr. Carcieri has experience working with culturally diverse clients representing various aspects of diversity including race/ethnicity, gender, age, disability, and size, and welcomes new clients from all backgrounds. She is a member of the American Psychological Association (APA), the Academy for Eating Disorders (AED), and the Los Angeles County Psychological Association (LACPA). 

LACPA Eating Disorder SIG upcoming events (Fall 2014)

I am excited to announce the next 3 upcoming meetings of the Los Angeles County Psychological Association Eating Disorder Special Interest Group (LACPA ED SIG).  We have amazing speakers lined up.  The LACPA membership year begins in September, so now is the time to join or renew to maximize your benefits.  SIG events are open only to LACPA members, but are FREE.  For information on membership, see the LACPA website. www.lapsych.org.  One does not need to be a psychologist to join LACPA; other professionals may join as well.

Dr. Stacey Rosenfeld
Dr. Stacey Rosenfeld

Date: Thursday, August 28th

Time: 7-8:30

Title: Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight

Presenter: Stacey Rosenfeld, Ph.D.

Location: The office of Stacey Rosenfeld, PhD (2001 S. Barrington Avenue, Suite 114, Los Angeles)

BIO: Stacey Rosenfeld, PhD, is a clinical psychologist, licensed to practice in New York and California, who treats patients with eating disorders, anxiety/depression, substance use issues, and relationship difficulties. A certified group psychotherapist, she has worked at Columbia University Medical Center in NYC and at UCLA in Los Angeles and is a member of three eating disorder associations. The author of the highly-praised Does Every Woman Have an Eating Disorder? Challenging Our Nation’s Fixation with Food and Weight, inspired by her award-winning blog of the same name, she is often interviewed by media outlets as an expert in the field.

Dr. Rosenfeld is also the founder of the LACPA ED SIG but will be leaving the group in the fall due to relocation.  This will be a unique opportunity to hear her speak and also to acknowledge the contributions she has made to the Los Angeles community during her fruitful three years here.

Maggie Baumann, MFT, CEDS
Maggie Baumann, MFT, CEDS

Date: Tuesday, September 16th

Time: 7-8:30pm

Title: Pregnancy & Eating Disorders: Journey Through the Facts and Recovery

Presenter: Maggie Baumann, MFT, CEDS

Location: The office of Stacey Rosenfeld, PhD (2001 S. Barrington Avenue, Suite 114, Los Angeles)

Bio:  Maggie Baumann is a psychotherapist in Newport Beach who specializes in treating people struggling with eating disorders, including pregnant women and moms with eating disorders. She is a former board member for the Orange County Chapter of the International Association of Eating Disorder Professionals (IAEDP) and serves as a committee member on the national IAEDP certification board.

Maggie has been a featured guest on nationwide talk shows and TV segment profiling pregorexia and moms with eating disorders. She was a mental health blogger for Momlogic.com, where she shared her own story of suffering from pregorexia over twenty-five years ago. Additionally, Maggie serves as a guest eating disorder expert for KidsinTheHouse.com, a video parenting resource. She is also authoring a chapter on eating disorders and pregnancy for an upcoming book on Eating Disorders in Special Populations (publication date: 2015). Now, Maggie has partnered with Chicago-based residential treatment center, Timberline Knolls, in hosting their Lift the Shame eating disorder support group the first web-based support group for pregnant women and moms with eating disorders. Lift the Shame, is a free group and has members from across the US and abroad.

T-FFED [image description: "T-FFED" with trans flags underneath"]
T-Ffed: Trans Folx Fighting Eating Disorders
Date:  Thursday, October 23

Time:  7- 8:30 pm

Title: TRANSforming Eating Disorder Recovery: Deconstructing the Overrepresentation of Eating Disorders in Trans and Gender Diverse Individuals, and How Healthcare Professionals Can Better Serve Our Communities

Presenter:  Dagan VanDemark

Location:  The office of Dr. Lauren Muhlheim (4929 Wilshire Boulevard, Suite 245, Los Angeles)

Bio:  Dagan VanDemark is the Founder and Executive Director of the pending non-profit T-FFED: Trans Folx Fighting Eating Disorders, based in LA but quickly gaining national reach. Dagan, a genderqueer trans boi, battled bulimia/EDNOS for fifteen years. They have a B.A. in Gender Studies from CSULB, a certificate in Grant Writing and Administration from CSUDH, and they are enrolled in both the Non-Profit Management certificate program at UCLA and a transgender leadership initiative through Gender Justice LA. They speak on university panels about gender variance and sexual diversity, and write/blog extensively about transgender communities’ experiences with eating disorders.

Please RSVP for any or all of the 3 events to drmuhlheim@gmail.com