Monday, August 31, 2009

NYT: Parenting and Food: Eat Your Peas. Or Don’t. Whatever.

The boy sneaks food. I’ve seen him. His appetite is formidable, and he knowingly eats more than he should or must, to the steady concern and occasional consternation of his parents.

Sometimes they keep count: “How many pretzels?” Sometimes they vainly suggest an apple instead. Often they look away, not wanting to aggravate an eating-related anxiety that they can already sense in him on the cusp of adolescence.

The girl treats food warily. Edging into adulthood, she worries about what too many French fries — what any French fries — could do to her, and monitors her waistline even though her own parents have never exhorted her to. Does she monitor it too closely and joylessly? Can parents prevent that? They wonder. So do I.

Neither of these children, with whom I interact occasionally, comes close to being a statistic or case study. He isn’t obese; she isn’t anorexic.

But they represent a larger group of young people between those widely publicized (and much more complicated) extremes. And they speak to a subtler parental challenge: how to coach children away from unhealthy eating without sowing panic; how to make them conscious of their intake without making them too self-conscious about its consequences.

Over recent years, worry about what and how much children eat has intensified, in part because of the regular references to childhood obesity as an epidemic. And right now, as children head back to school, where they graze beyond the gaze of parents, potentially dangerous eating habits are getting fresh attention.

School cafeterias and vending areas have become ground zero in the battle against overweight and poorly nourished children; from coast to coast this fall, students will encounter fewer sugary soft drinks, fewer fried foods, class birthday parties without cupcakes and class bake sales with calorie-reduced brownies.

That may help. But it’s just one piece of a puzzle that health experts and concerned parents are still sorting out. Conflicting information about the fiercest culprits in child weight gain abounds. Beyond genes, which obviously play a fundamental role, is soda pop a major factor? What about too little sleep?

There are hundreds of studies and thousands of opinions, and Tom Baranowski, a professor of pediatric nutrition at the Baylor College of Medicine in Houston, says they’re inconclusive. He has reviewed research suggesting that there are viral prompts for childhood obesity and research suggesting that children fond of fruits and vegetables aren’t any less heavy than those mad for Mountain Dew.

Dr. Baranowski’s verdict? “A lot more work needs to be done.”

Diet, it seems, is a dirty word. A Stanford University study found that a father’s projected attention to and remarks about a daughter’s weight may increase her risk of eating disorders. A University of Minnesota study found that children whose parents encouraged diets were significantly more likely to remain overweight than those whose parents didn’t.

Cynthia M. Bulik, the director of the University of North Carolina Eating Disorders Program, explained that “diet” implies deprivation, “and deprivation goes into that whole mindset that, ‘I deserve something when this is over, and this is short term.’ And it can’t be. It’s got to roll right into a lifestyle.”

Those words ring true for me. As a fat boy who ate expansively and compulsively, I went on the first of many strict diets at age 8 — and thereby commenced decades of untenable regimens and compensatory pig-outs, of binging and purging.

But my outsize hunger seemed flat-out chromosomal, and my insecurity about it predated those early weight-loss schemes. Should my parents have forbidden them? What’s the best course for today’s parent, in a society where fast-food come-ons drown out Alice Waters, and models no thicker than swizzle sticks still rule fashion magazines?

“We get nutrition advice, but that’s not the same as eating advice,” said Rebecca Saidenberg, a Manhattan mother of a 16-year-old girl, referring to child-rearing tips. She said that as her daughter went through puberty, she worked particularly hard to encourage healthy habits — balanced meals, restrained portions — in the hopes of minimizing the chances of a weight problem that might follow her daughter through life.

At the same time, Ms. Saidenberg wanted to push back against “a trend of treating food like medicine.”

“I don’t like that,” she said. “There are a lot of psychological pleasures that come from sitting at a table and enjoying a meal.” She doesn’t want her daughter deprived of those.

So she didn’t despair when the teenager recently returned from a summer trip to Italy during which, it was clear, the joys of gelato were fully explored. But she did get herself and her daughter a membership at a local gym, where they go together.

In my conversations with Ms. Saidenberg and other parents, I was struck by just how much thought they had given to coaxing their children toward sensible eating and away from extreme indulgence or self-denial. They clearly saw that as a parental responsibility akin to giving a child a first-rate education.

But their prescriptions and beliefs diverged, illustrating the elusiveness of a ready consensus about what’s most effective.

Joan Yamini, a mother of one in Austin, Tex., said it was important not to have unhealthy foods around the house, but Andrew Segal, a father of three in Glen Ridge, N.J., said that children who can’t find cookies, ice cream and similar snacks at home can always find them elsewhere — and probably will.

Every parent fretted over the right language to use with children.

Janis Azarela, a mother of three in Sudbury, Mass., recalled the upset her husband caused a few weeks ago when he questioned their 16-year-old daughter’s decision to eat ice cream immediately following a three-mile run.

“He asked because she’d just worked so hard to run and be healthy — why not make a healthier choice?” Ms. Azarela recalled. “And she said, ‘Dad, are you calling me fat?’ ” The teenager abandoned the ice cream, stomped out of the kitchen and didn’t speak to him for a good long while.

Ms. Azarela said that her daughter is, in fact, slim, and gravitates naturally toward less fattening foods. Her 7-year-old son, on the other hand, has the fiercest sweet tooth in the brood. A budding problem? Time will tell, and meanwhile she has vowed to “keep reintroducing foods, because palates change so quickly.”

That’s consistent with advice from diet and nutrition experts, who agree, for the most part, on a few prudent strategies.

They say parents can and should encourage sensible eating and vigorous physical activity by engaging in both themselves; children are likely to imitate those behaviors.

Whether parents allow junk food or not, they should make sure healthier alternatives are even more available — and should promote them. They should also make time for family dinners, the nutritional content of which they can monitor more carefully than they can a quick meal in an economical restaurant.

And by actually involving children in the shopping for, and cooking of, meals, some parents have successfully given them a consciousness about food — and a way to think about it — that guards against an abuse or disregard of it. When it comes to overeaters who clearly thrill to that gluttony, it’s vital for parents to try to find some replacement activity — a hobby, say — that affords similar emotional gratification.

“Food lights some people up more than it lights other people up,” Dr. Bulik said. “We’re not born the same.”

I see that in the boy and girl. If they were merely emulating their parents, he’d be the measured eater and she the exultant one. That the opposite is true underscores the mysteries of appetite — and the tricky task parents face in trying to regulate it.

Frank Bruni is the author of a new memoir, “Born Round: The Secret History of a Full-Time Eater.”

Ask Ester: Dispelling myths about EDs

Q: I suspect my daughter has an eating disorder. What do I look for, and what can I do to help?

A: This is a very tough one for me. Many years ago I wrote about this in one of my columns. Many readers do not know that I was battling bulimia in my late teens and early twenties — a very dark time of my life.

I will get into my own experience in a little bit, but first let's look what an eating disorder can be.

An eating disorder is a disturbance in someone's eating behavior that compromises his or her physical and psychological health. Anorexia nervosa and bulimia are chronic problems in which there is a preoccupation with food, eating and weight loss.

Anorexia nervosa is still more prevalent in young women than in young men. The disorder typically begins in "tweens" or teenage girls who are either overweight or perceive themselves that way. The interest in weight reduction becomes an obsession with severely restricted calorie intake and often excessive exercising.

People with bulimia (including men) tend to lead secretive lives, hiding their abnormal eating habits. In a single binge, they can consume 10,000-15,000 or more calories. The binge usually occurs in several stages:

- anticipation and planning
- anxiety
- urgency to begin,
- rapid and uncontrollable consumption of food,
- relief and relaxation
- disappointment
- shame

My own experience as a bulimic:

I was always very muscular and actually was called a boy, even young man, many times. I was a lot stronger and faster than many boys growing up and always had to arm wrestle or fight (yes, I won every time!). At the age of about 13, I started Judo (a martial art where you throw people, break their arms and strangle them ... although of course they can "tap out").

I had to make my weight class, which was between 61.1 kg and 66 kg (137.4 and 148 pounds). I was always 2 to 3 pounds heavier. I used many techniques and tricks to lose weight very quickly, like running in a plastic bag, not eating anything or barely anything at all, and after the weigh-in eating like there was no tomorrow.

Myth: Bulimics always purge by vomiting

Fact: Not all bulimics try to rid themselves of the calories they have consumed by vomiting. Purging can also take form of laxatives, diuretics, exercising, or fasting.

As you can tell, I was already showing signs, but I was doing it to "make my weight class."After a severe back injury that ended my Judo career, I went to the gym to strengthen my back. When I walked in, everyone thought I have been lifting weights for years. As a matter of fact, I guess I had been: the weights were human bodies. Soon after I started lifting weights, I got excited to enter a body building competition.

When you need to make a weight class for Judo, they don't care how you look. With body building, looks are what matters: your muscles, your symmetry, your body fat. I did great with my "perfect" diet: no sweets, very low fat, everything steamed or grilled. I entered my first competition and won.

Afterwards, the reward is FOOD. Oh, and I binged. It wasn't just me; it was the other bodybuilders too. Before I knew it, the body fat I lost for the competition was "packed back on." And I felt FAT. Most bodybuilders have no problem with this and get back on a normal diet, possibly getting ready for another competition. Their binge was just a couple of days, or maybe one week. Mine turned into on and off binging and purging for years. As an instructor, it was very easy to say it was my job to teach four classes in a row almost every day of the week! I was purging by over-exercising and vomiting.

Myth: You can never recover from an eating disorder

Fact: Recovery takes a long time, but with hard work and the proper treatment (or in my case, lots of prayers with God), you can fully recover from an eating disorder.

My sister at one point found out. It was very hard to be confronted with the fact that you can't hide it anymore, but also a relief. Unfortunately, neither she nor I knew what to do. You can't just stop an eating disorder — even when you want to.

Myth: People with eating disorders do this to hurt their family and friends

Fact: People with eating disorders are doing this to themselves. They are usually upset when they know the people around them are worried or hurt by their eating disorder.

I was in denial for so long, but I was also very miserable and alone during that time of my life. An eating disorder is an addiction to food. But guess what? You have to eat to live.

Telling a food addict to eat better is like telling an alcoholic to just have one drink a day or a heroin addict you can use it only once a day.

Myth: You cannot die from bulimia.

Fact: Bulimics are at high risk for dying, especially if they are purging, by vomiting, using laxatives, and over exercising. Many bulimics have died from cardiac arrest which is usually caused by low potassium or an electrolyte imbalance. Others have died from a ruptured esophagus.

Famous gymnast Kathy Johnson, Nadia Comaneci and Cathy Rigby have come forward and admitted to fighting eating disorders. In sports where athletes are judged by technical and artistic merit, the pressure to be thin is enormous. In 1988, at a meet in Budapest, an American judge told Christy Henrich — at that time one of the world's top gymnasts — that she was too fat and needed to lose weight if she wanted to be on the Olympic team. She resorted to anorexia nervosa and bulimia to control her weight. Her disorder eventually took her life.

Christy Henrich died of multiple organ failures.

We have come a long way since then.

Myth: You can always tell when someone is Anorexic.

Fact: Not all anorexics look like the extreme cases we see on talk shows and magazines, some maybe anywhere from 5-15 pounds underweight. They look thin, but don't have what society considers to be the anorexic look. That does not mean that their health is not in danger. Signs to look for from the experience of a recovering bulimic:

- Obsesses about weight, weighing numerous times a day, especially before and after eating;

- Eats very little, or eats lots of food, then immediately disappears to the bathroom and is gone a while.

- Exercises more than 3 hours or more a day most days of the week.

- Very unhappy with their appearance even when you think they look great.

- Brush their teeth many times a day.

- Knuckles have calluses, redness or teeth marks.

- Leaves the toilet a mess, or super-clean

When you suspect a problem, please talk to your doctor or her pediatrician. They will guide you and give you the appropriate steps to take. As many people know, when a loved one is having an eating disorder, the whole family suffers.

Please stand by them even when they kick and scream.

You can check out the following websites:,

Contact Ester Marsh with health and fitness questions at 704-636-0111 or

Ask the Expert - Week 5

Dr. Kathryn Zerbe, professor of psychiatry at Oregon Health and Science University and a longtime expert on eating disorders, recently took readers’ questions on anorexia, bulimia, binge eating and other problems. Here, she responds to one reader’s question about growing up in a household where eating disorders were common.

Question: In recent years, an increasing number of men have been diagnosed with eating disorders, and not just compulsive overeating, but also disorders like anorexia and bulimia that have traditionally been associated with women. (Full disclosure: I am one such man.)

Does this represent men wanting to take on feminine roles, or feeling that they cannot relate at all to traditional, ultra-macho conceptions of masculinity, and want to take on a more “feminine” persona? Does it differ for homosexual and heterosexual men? To what do you attribute the recent rise in these disorders among men?


Dr.. Zerbe responds:

Two large studies have reported that some 10 to 11 percent of patients with an eating disorder are men, though more recent studies report that as many as 30 percent of patients with anorexia or bulimia are male, and as many as 40 percent of binge eaters are men.

Fortunately our society is moving away, albeit slowly, from stereotyping men and women. Hence, like you, more men are admitting to having anorexia, bulimia, binge eating problems and even just a preoccupation with being a particular weight.

Clinicians are learning more about the millions of men who suffer from body image conflicts, compulsive exercise, weight obsession and other accompanying psychiatric problems like obsessive-compulsive disorder and depression that can accompany a bona fide eating disorder. Men also tend to use steroids more than women to develop a desired masculine build, a condition sometimes called “reverse anorexia.”

Participating in sports like wrestling, gymnastics or running can also place certain men at risk of developing an eating disorder. Those in certain occupations, such as flight attendants, members of the armed forces or actors, may also be at increased risk compared to men in the general population.

Although a large study from 2007 found that gay men do appear to have more eating disorders than straight men, these men do not necessarily want to be feminine. Nor do they seem to have trouble with their masculine role, as they define it. They do, however, desire to be attractive to potential partners and believe that being a particular weight and shape is appealing.

There is some research that suggests that gay men with an eating disorder may be more likely to have been the victim of sexual or physical abuse as a child. You and other men should be aware that the same physical consequences that occur in women with eating disorder take their toll on men, too, including osteoporosis and osteopenia (thinning bones).

Take a look at one of these books about eating disorders in men to learn more: “Making Weight: Healing Men’s Conflicts With Food, Weight, Shape and Appearance,” by Arnold Andersen, Leigh Cohn and Tom Holbrook; or “The Invisible Man: A Self-Help Guide for Men With Eating Disorders, Compulsive Exercise and Bigorexia,” by John F. Morga

Monday, August 24, 2009

The Renfrew Center brings hope and recovery to Bethesda, MD!


Below is a message from the Renfrew Center about their expanded resources.

At Renfrew, we understand that recovery is a process. As you move forward in your journey, you may find that you are still struggling with issues related to your eating disorder. During these difficult times, additional treatment may be necessary in order to get back on track.

Having access to the right resources is crucial as you walk the road of recovery. On August 24, 2009, we expanded our treatment network to bring our services to a greater number of individuals in need. We are pleased to share with you that we opened a new facility in Bethesda, MD.

The Renfrew Center of Maryland will offer a comprehensive range of services including:

Day Treatment Program
Intensive Outpatient Program
Group Therapy
Individual, Family, and Couples Therapy
Nutrition Therapy
Psychiatric Consultation

The Renfrew Center believes that all individuals can develop the resources they need to lead a healthier life. We have almost 25 years of experience treating eating disorders and more than 50,000 adolescents and adults have trusted us as their partners in healing. You can too.

For more information about The Renfrew Center of Maryland, please call
1-800-RENFREW or visit

The Renfrew Center of Maryland
4719 Hampden Lane
Suite 100
Bethesda, MD 20814

Friday, August 21, 2009

Ask the Expert - Week 4

Dr. Kathryn Zerbe, professor of psychiatry at Oregon Health and Science University and a longtime expert on eating disorders, recently took readers’ questions on anorexia, bulimia, binge eating and other problems. Here, she responds to one reader’s question about growing up in a household where eating disorders were common.

My mother-in-law is in her 60s and has struggled with bulimia since her early 20s. Both my husband and his sister struggle with food but in different ways. She is very thin, is addicted to exercise and is obsessed with her body image. My husband overeats and is overweight. This is impacting his health. I know that there are many books and resources for adult children of alcoholics. Are there any resources for adults raised by a mother with an eating disorder?


Dr. Zerbe responds:

There is only one book that I know of that addresses your question specifically, but I bet there will be more in the future. Take a look at Daniel Becker’s “This Mean Disease: Growing Up in the Shadow of My Mother’s Anorexia.” Mr. Becker describes his mother’s 30 year battle with anorexia in a way that is not only touching and thought provoking but shows how each family member must make changes in his or her life to really deal with the effects of such a severe problem on the life of the family.

Your problem is coming to the attention of more and more therapists because we are seeing eating disorders in older women and men. There are a number of good books and resources out there for loved ones who have a family member with an eating disorder, but nothing takes the place of having those with food issues talk with someone knowledgeable and understanding.

For example, I am thinking of one of my patients, I’ll call him Jeff, whose mother and father both had significant issues with their depression, body image and low weight. Jeff is now in recovery, but we discovered in his therapy that an obsession with thinness went back at least to both of his grandmothers, who could never be too thin and always seemed to be angry and demanding.

As Jeff’s psychiatrist, I could not give a formal diagnosis, such as depression, dysthymia (low mood) or an eating disorder, to any of his family members, since I wasn’t treating them. In fact, they refused all interventions that Jeff asked them to get. But I offered him therapy and medications, and a book I suggested he read, Judith Viorst’s classic 1986 work on adult life transitions called “Necessary Losses: The Loves, Illusions, Dependencies, and Impossible Expectations That All of Us Have to Give Up in Order to Grow,” helped him come to accept what he could and could not do for his mother and father, as much as he wanted to help them.

Jeff gradually embraced more of his own life and faced down his eating problem. He is now married and raising a couple of children, and has become aware through his reading how common eating concerns are becoming in younger and younger children. And though he struggles from time to time with his body image, he is a lot better than when he started his therapy work over six years ago.

As Jeff put it, “I don’t want my parents’ problem to become the problem of my own kids. We will have a ‘no teasing’ policy at the dinner table when it comes to body image, and my wife and I plan to start media awareness of the slender body ideal even when they are in grade school.”

Another resource I recommend for those who grew up or live in a household with eating disorders is the Web site from Gurze books, which publishes a catalog of excellent books on the subject. (They can also be reached at (800) 756-7533.) You will likely find something that helps you and perhaps raises the awareness of your loved ones.

Eating woes patients bare their souls, help others

Friday, August 21, 2009

Becky Allen, Kristina Saffran and Liana Rosenman have lived through hell.

Each of the New York-area teens almost died from serious eating disorders and underwent extensive treatment to recover.

Now on the other side, they want to help others suffering from similar illnesses. The trio formed Project HEAL: Help to Eat, Accept and Live. The not-for-profit organization seeks to raise money for patients who can't afford treatment and to help "diminish society's obsession with body image by encouraging [people] to accept their bodies."

In less than a year, the group has awarded two treatment scholarships.

The girls recently shared their stories with about 40 patients and families of the Penn State Hershey Medical Center's Eating Disorders Program. They spoke at the invitation of their former doctor, Dr. Rollyn Ornstein, who joined the local recovery program last year.

On the group's Web site, Becky Allen remembers just wanting to "disappear."

"I never thought someone with an eating disorder could turn into a strong leader; I was not even sure someone with an eating disorder could recover," she wrote. "Now, I want to maintain this lifestyle so that I can be living proof to others and show that recovery and the regaining of a life is possible."

Kristina Saffran tells about being admitted to the hospital "at under 65 percent ideal body weight. There was fluid around my heart. Within a few days, I was told that I might have to be transferred to the ICU to drain it. This was a huge wake-up call for me. I could have died. I decided that I was going to give this a fighting shot."

Dr. Richard Levine, director of the Penn State program, said he hoped hearing the teens' real-life stories would help "inspire and empower patients and their families."

"When young people are in the midst of the illness, it's hard to see beyond to the horizon of recovery," Levine said.

"They're such vibrant young women with such wonderful goals and aspirations. Our patients can see how rich life can be in recovery in contrast to a world dominated by food: eating, restricting, vomiting, or overexercising. They can see there's a whole other world out there -- with places to go and people to meet -- besides just worrying about what's on their plate for lunch."

The Penn State Eating Disorders Program sees about 30 to 35 new patients each month, Levine said. The program had about 12,000 patient visits during fiscal year 2008.

Patients from throughout central Pennsylvania are treated for anorexia nervosa, bulimia nervosa and related illnesses, Levine said. They range in age from 8 to 40-plus and include boys, girls, men and women, he said.

"Everything is a team approach," Levine said. "We have medical specialists, psychiatrists, psychologists, dietitians, social workers, nurses and nurse practitioners. It involves the whole team."

For more information call the Penn State Eating Disorders Program at 531-7235 or visit Project HEAL.

Thursday, August 20, 2009

Did Bullying Cause A Girl's Anorexia? From Jezebel

Original Article

In what may be the first lawsuit of its kind, a mom is suing the Pittsburgh Public Schools for failing to stop the bullying she says caused her daughter's anorexia.

The mother says three boys began calling her daughter (identified in the suit by the initials B.G.) "fat" in sixth grade, and that two more boys joined in the daily bullying the next year. Her lawyer Edward A. Olds elaborates: "The offensive comments explicitly and implicitly conveyed the message that B.G. was unattractive and overweight. The comments were sexual in nature or conveyed sexual stereotyping."

B.G.'s mom says a guidance counselor did nothing when told about the bullying, and that school officials began harassing her when she tried to homeschool her daughter. She also says that the boys' actions triggered the anorexia that landed her daughter in an inpatient program in February 2008, at a "dangerously low" weight.

However, Lynn Grefe, CEO of the National Eating Disorders Association, says it's too simplistic to say bullying causes an eating disorder. Rather, she says, "With eating disorders, we say you're born with a gun and life pulls the trigger." Carrie Arnold of ED Bites adds:

"[T]he bullying didn't cause this poor girl's anorexia. It might have triggered it, yes, in the sense that the bullying caused her to throw her lunch away, which led to the energy imbalance, which led to anorexia. But it didn't cause her anorexia. Science shows us that genetics form the biggest risk factor for eating disorders, although many environmental factors can play a role in triggering the disorder. This type of bullying is sadly common, and if every case resulted in anorexia, we would have many more cases of eating disorders than we presently do."

"The causes of eating disorders are extremely complex, and not fully understood — the question of whether skinny models actually "incite thinness," for instance, is still being debated. But the cause-trigger paradigm that Grefe and Arnold cite seems to be the most common one, and if we accept it, we need to ask how severe a trigger has to be in order to merit a lawsuit. Could an anorexia sufferer sue a magazine? Her parents? Since weight loss itself can be a trigger for anorexia, could someone sue the restaurant where she got food poisoning?

Of course, non-anorexic people sue restaurants for giving them food poisoning, and this brings up an important point: many triggers for eating disorders are bad things anyway. Bullying is a good example. Even if it didn't "cause" B.G.'s anorexia, the school should have put a stop to it. Law professor Bruce Ledewitz says the real issue is that bullying "deprives the victim of an educational opportunity." And Arnold writes, "Schools should refuse to tolerate bullying because it's harmful and wrong, not just because someone developed an eating disorder." So while the lawsuit brought by B.G.'s mom may encourage a simplistic understanding of eating disorders, it might also encourage schools to prevent their students from making each other miserable.

Wednesday, August 19, 2009

Working Together for Recovery: Families and Professionals as Partners in Eating Disorder Treatment

Bethesda Marriott Hotel
5151 Pooks Hill Road
Bethesda, Maryland 20814
October 5, 2009, 1:30-5:00

The afternoon program brings together two leading researchers in the field of eating disorders to talk about how families and treatment providers can work together toward recovery. Learn about research into the neurobiology of eating disorders, and how parents and professionals can partner to best advantage. Maudsley Parents co-chair Harriet Brown tells her family's story of struggling with anorexia nervosa and offers strategies for families going through it. The program includes time for Q & As and offers an opportunity to meet and mingle over coffee. We hope to see you there!

Who should attend? Family members, friends, treatment providers, activists and others involved in outreach and advocacy

Walter Kaye, MD
New Insights into the Neurobiology of Eating Disorders: What Families Should Know
Genetically-influenced personality traits and powerful neurobiological drives play an important part in eating disorders. Understanding these processes helps families develop insights into the symptoms that occur in ED, so they are better able to understand, interact, and shape more adaptive coping strategies. In addition, such insights are important for providing the foundation necessary to develop more effective treatments. Read more about Dr. Kaye here.

Daniel le Grange, PhD
Family-Based Treatment for Anorexia Nervosa and Bulimia Nervosa: The Maudsley Approach
Families can play an active and positive role in treatment for anorexia nervosa and bulimia nervosa. Understand the scientific support for family-based treatment and learn specific strategies families can use. Read more about Professor le Grange here.

Harriet Brown, Maudsley Parents Co-chair
Family-based Treatment in Action: One Family's Experiences
A parent perspective on putting family-based treatment into action and ten things everyone should know about anorexia nervosa. Read more about Harriet Brown here.

Register online at

Early bird registration through September 14 $25/person
Regular registration from September 15 $40/person

Tuesday, August 18, 2009

GMA Explains Some Chronic Overeaters "Aren't Trying To Be Bad" - Gawker

Kate Kane's hunger is so insatiable that her family has been forced to padlock the refrigerator. But, today Good Morning America explained Kate isn't just shamefully disregarding her diet: Her hunger stems from a genetic disorder. Clip here

Story, copy and video from Gawker

New Jersey takes a better path for treating the mentally ill

New Jersey takes a better path for treating the mentally ill
Posted by By James Pavle and Kristina Ragosta/Special to The Star-Ledger August 18, 2009 7:25AM

New Jersey created a great opportunity to provide better outpatient treatment for individuals with severe mental illnesses when Gov. Jon Corzine signed Senate Bill No. 735 last Tuesday.

The governor's signature marks years of efforts by supporters to update New Jersey's outdated mental health treatment law. Before the bill was signed, the only option to treat individuals overcome by severe mental illness in New Jersey was one of the state's scarce remaining hospital beds.

Society has a responsibility to help those who cannot help themselves before their illness escalates to tragedy. Medical research now shows that nearly half of those with schizophrenia or bipolar disorder lack insight into their illness. They simply do not realize they are sick and in need of treatment because their brain disease has affected their ability for self-assessment. They cannot recognize that the symptoms of their illness -- hallucinations, delusions, paranoia and withdrawal -- are, in fact, symptoms, not reality.

Since they do not believe they are sick, they see no reason to apply for services and medication that would allow them to recover to a productive, normal life.

New Jersey now joins 42 other states that have improved their mental health treatment laws to allow assisted outpatient treatment as a less restrictive, less costly alternative to hospitalization for individuals suffering from severe mental illness. Such laws authorize a judge, typically only after a showing of medical necessity or danger, to order a person to follow a treatment plan, which can include medication, while living in the community.

Non-compliance with treatment, specifically non-adherence to medication, is strongly associated with hospitalization, arrest and violence among people with severe mental illnesses. Studies and data from states using assisted outpatient treatment laws prove they are effective in reducing these outcomes as well as homelessness, incarceration and victimization.

Assisted outpatient treatment also promotes long-term voluntary compliance. The research shows it can improve the individual's quality of life as well as physical and mental health -- not to mention the benefits for the individuals' families and the surrounding community.

New York is an example of a state that effectively implemented its assisted outpatient treatment law, known as Kendra's Law, which was adopted in 1999. A comprehensive independent evaluation of that law recently conducted for the state confirms that the court orders, in addition to community treatment, work to help those who need it most. This independent evaluation proves that, when implemented effectively, these types of laws can save lives.

The timing of the New Jersey law is critical as the state recently settled a case to release hundreds of psychiatric patients into the community over the next five years. It is well known that New Jersey's state psychiatric hospitals already are severely overcrowded, and readmission rates are estimated to be as high as 36 percent at one of the state hospitals.

County budgets are being adversely impacted by high hospital readmission rates as well, because counties are responsible for 50 percent of the cost of care that their residents receive in state psychiatric hospitals. Assisted outpatient treatment will help to lower hospital readmissions and is needed to reduce overcrowding and budget shortfalls.

The new law provides a great opportunity. Now the state needs to keep the momentum going and ensure that counties use it. The law is scheduled to be phased in over three years. Each year, one-third of the state's counties will implement assisted outpatient treatment. New Jersey counties must put this powerful tool to good use, to improve the lives of individuals suffering from severe mental illness and to prevent further tragedies caused by untreated severe mental illnesses.

James Pavle is executive director and Kristina Ragosta is legislative and policy counsel for the Treatment Advocacy Center, a national nonprofit organization based in Arlington, Va.

Friday, August 14, 2009

Ask The Expert: Week 4

Each Friday, I will post a question answered by Dr. Kathryn J. Zerbe. The questions are part of an on-going coversation with Dr. Zerbe from the New York Times.

NY Times Bio
Dr. Zerbe is the author of “The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment” (Gurze Books, 1993) and “Integrated Treatment of Eating Disorders: Beyond the Body Betrayed” (Norton, 2008). She has had 25 years of experience working with individuals with eating disorders and directed the Eating Disorder Unit at the Menninger Clinic for five years. She also served on the American Psychiatric Association’s Work Group on Eating Disorders in 2000 and 2006.

Week Four
(Edited to correct typos/spelling in original question)

There is so little focus in our society given to binge-eating. General sentiment seems to be, “go on a diet.” Yet there are some people who’s eating disorders actually manifest themselves via binging and not purging.

Do you think this is changing/will change? Also, are there treatment programs for this? I’ve looked at a couple of web sites, but binge eating seems to be regarded as sort of an “also ran” alongside anorexia and bulimia.

Thanks for your input.

Dr. Zerbe responds:
You are certainly correct that binge eating disorder gets less attention than anorexia or bulimia, but we are learning much more about it because research is starting to focus on it a lot. Doctors are using some medications for it, such as fluoxetine (Prozac), but cognitive-behavioral therapy also can help people who suffer learn coping skills that help them avoid binging.

I certainly agree with you that “going on a diet” is not the answer. One needs to learn what might be causing the person to binge in certain circumstances and to find ways to deal with food that is “all around us” in the modern world. Many people turn to food in times of stress because in our modern society it is so readily available (think of the fast food restaurant down the street or the multitude of snacks and candies in your local grocery store) and how relatively inexpensive food is compared to 50 years ago.

We also tend to eat alone a lot more than in the past (snacking by the computer; having lunch at our desks), so we learn to eat faster and without thinking or talking to anybody. Family mealtimes slow our eating down, and we get psychological nurturance when talking with our loved ones, but so many times nowadays this just doesn’t seem to happen as often as it might.

One concrete suggestion I have for the binge eater is to never get too hungry. Try to eat protein at every meal and always have some low calorie snacks available, especially in the car or at times when you might be tempted to binge. Then, begin to look at the triggers that might cause you to binge. Journal about them, and if at all possible, seek out a professional with experience in eating disorders to discuss them with. You might also consider looking for a helpful book about binge eating that fits your needs by going to the Gurze Books Web site on Eating Disorders at

Tuesday, August 11, 2009

NPR Piece: Minneapolis writer chronicles her eating disorder

Listen Here

St. Paul, Minn. — Nicole Johns doesn't look like she has an eating disorder, and for a long time that was a problem. She was diagnosed as having EDNOS, or an Eating Disorder Not Otherwise Specified.

She has now written a book about her experience in the hope she can help others.

"Even when I was at my worst, you probably wouldn't have been able to pick me out as someone with an eating disorder if I was just walking down the street," Johns said.

"It's one of the misconceptions I am trying to correct in my book -- that if someone isn't underweight or they aren't visibly sick, they don't have an eating disorder and they don't need help," said Johns. "You can have an eating disorder at any weight, you can be overweight, underweight, average weight. It doesn't matter. It's not all about the weight."

Now in recovery, Johns describes her experiences in her new book, "Purge: Rehab Diaries."

Johns binged and purged for more than a decade. She obsessed about calories, and would weigh herself 10 or 15 times a day. Sometimes she drank bottles of maple syrup and soy sauce, only to bring it all up again.

Yet she remained at an appropriate weight for her size. It was only after she collapsed and went into treatment she was diagnosed as having EDNOS, an Eating Disorder Not Otherwise Specified.

Johns told MPR's Euan Kerr she hopes the book will help people understand the realities of the condition.

Broadcast Dates
All Things Considered, 08/06/2009, 5:54 p.m.

Mailing #2!

My second mailing of 23 information packets headed off to their destinations this morning. I can't believe I've sent almost 50 info packets already! I also put together some pamphlets with my card for my mom to hand out.

I've finished with the first NJ Catholic schools list, but I'm still filling in some of the gaps. I keep finding more schools! My next effort will be focused on NJ college sororities.

Monday, August 10, 2009

New Jersey ANAD Support Groups

Livingston (Northern NJ)
Barbara Reese, MSW, LCSW
Phone: 973-783-2292, Mailbox #3

Friday, August 7, 2009

Ask the Expert - Week 3

Each Friday, I will post a question answered by Dr. Kathryn J. Zerbe. The questions are part of an on-going coversation with Dr. Zerbe from the New York Times.

NY Times Bio
Dr. Zerbe is the author of “The Body Betrayed: A Deeper Understanding of Women, Eating Disorders, and Treatment” (Gurze Books, 1993) and “Integrated Treatment of Eating Disorders: Beyond the Body Betrayed” (Norton, 2008). She has had 25 years of experience working with individuals with eating disorders and directed the Eating Disorder Unit at the Menninger Clinic for five years. She also served on the American Psychiatric Association’s Work Group on Eating Disorders in 2000 and 2006.

Week Three

I am fairly certain that my sister in law (mid-30s) suffers from bulimia–she is extremely thin and looks unhealthy, but eats a lot whenever I see her, typically at family meals/restaurant visits. She always leaves to visit the bathroom fairly obviously not long after we’ve finished eating and I’ve occasionally smelled vomit when I follow her into the bathroom. I understand she had an experience with an eating disorder about 10 years ago but I don’t know that she ever stopped having a problem. The family doesn’t speak openly about it so I don’t feel comfortable approaching her myself, and I’m also not 100% sure of course. Do you have any suggestions on how to handle this situation?

From Dr. Zerbe:
These situations in a family are always difficult to handle. It does sound to me as if your sister-in-law could have relapsed into bulimia based on your observation of her leaving to go to the bathroom after eating large amounts of food and sometimes smelling vomit.

I suggest you talk to her and express your concerns. You might also try to enlist at least one other family member who shares your observations to sit down with you. Because denial of the problem is so common in those with an eating disorder, she may not listen or tell you the truth immediately, but at least you know that you have done what you could. You might also suggest a book or looking at the Academy for Eating Disorders Web site, which has valuable information about these life threatening illnesses.

Thursday, August 6, 2009


My first set of information packets was mailed yesterday! It took a while, but I did it!

Take Action! From NEDA/Eating Disorders Coalition

Call your Senators today!

Lautenberg, Frank R. - (D - NJ)
(202) 224-3224

Menendez, Robert - (D - NJ)
(202) 224-4744


After years of hard work by mental health organizations such as the Eating Disorders Coalition (EDC), as well as other advocates and consumers, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 last year. The bill requires the Departments of Labor (DOL), Health and Human Services (HHS) and Treasury to issue regulations before the effective date for the Act which is January 1, 2010. It is essential the regulations are issued to avoid misinterpretation of the law and to ensure access to critical mental health and addiction services.

Senators Al Franken, Ted Kennedy, Sheldon Whitehouse and Jack Reed are circulating a Dear Colleague Letter in the Senate which will be sent to the Secretaries of the three departments responsible for issuing the regulations insisting they act quickly and consider the comments that were filed in response to the request for information (RFI).

The EDC provided comments to the agencies earlier this year urging the agencies to interpret the law in a manner that would include eating disorders coverage. In order to make sure that years of hard work and advocacy pay off let's call our Senators and ask them to sign onto this letter with Senator Al Franken and colleagues!

The Message:

"Hi my name is XX. I am a constituent calling about the implementation of mental health parity regulations. I would like to urge the Senator to make sure mental health parity regulations are issued by October 3, 2009 by signing onto Sen. Franken's, Kennedy’s, Whitehouse's and Reed’s Dear Colleague Letter by 5:00 pm on August 6th. It is essential that eating disorders treatment is specifically addressed in this legislation. Thank you for passing that information on to him/her."

Thanks! Every voice matters - we've had many examples of how one person writing a letter or making a phone call to their legislators makes a difference.

Once you make your call email and tell us who you called! Thanks so much!