Living With Food: The Science Supporting Eating Disorder Treatment

As CCED continues to grow, so does our need for experienced and dedicated staff. We have several positions that we are looking to fill and are seeking out clinicians that are well versed in Family Based Treatment and/or Dialectical Behavioral Therapy.

Please check out our Employment Opportunities page under the About Us section on our website, or contact Katie Dent at KDent@eatingdisorderscleveland.org.

By , Dr. Mark Warren

A few weeks ago we were privileged to attend the Academy for Eating Disorders International Conference in Miami, FL. Not only was this a terrific opportunity to meet with colleagues and friends from around the world, but the conference also showcased a number of sessions about how research translates into clinical practice. There were several presentations on Family Based Therapy (FBT) that we found very impactful and we were fortunate to have conversations outside these formal presentations with several FBT therapists. Some of the practitioners we spoke to expressed frustration at conducting FBT while not having a formal team. We heard from several people who are working to do FBT that they do not have psychiatrists, individual therapists, pediatricians, or dietitians who support the work they are doing. In some ways this information is an extension of what many parents have said in terms of their frustrations in getting evidence based care for their children. It reinforces how difficult it may be to get the best care, even if you have wiling and educated providers. 

At CCED we have been fortunate to have a system where all staff are educated in FBT. The principles of FBT are therefore reinforced at any point of contact. Our sense coming home from this conference is not that it is impossible to do FBT on your own in your community, but the degree of difficulty is certainly higher. From our own experience our relationships with pediatricians, psychiatrists, therapists, and dietitians, who are supportive of FBT is key to our work. Without the reinforcement that the FBT model is most likely to be helpful for their children, the fear, frustration and historical confusion about evidence based care may seep into an otherwise highly qualified therapist’s treatment program. For those of us in Cleveland or other communities where FBT is a well accepted practice, we have a sense of confidence that we can do FBT in the way that has great fidelity to the treatment as originally described. For those in places that do not have that level of support, it left us feeling that the creation of a good relationship with primary care physicians, family doctors, pediatricians, and internists is probably the next important step for therapists and the families they work with to ensure that FBT happens successfully.

For more information on Family Based Treatment please take a look at the following links:

Maudsley Parents 

F.E.A.S.T

Eating with your Anorexic 

Should you have any questions or comments regarding this post, please email blog@eatingdisorderscleveland.org. 

Contributions by Dr. Lucene Wisniewski and Sarah Emerman

Check out Defining Recovery off of the F.E.A.S.T. website. It's a wonderful depiction of what recovery will look like, and reminder of why it's so important to seek out effective treatment and continue fighting for a life free of eating disorder thoughts and behaviors. 

Should you have any questions or comments regarding this post, please email blog@eatingdisorderscleveland.org.

By, Drs Lucene Wisniewski and Mark Warren

One of the most common questions in eating disorder treatment is “What is my goal weight?”. Although the answer is generally “I don’t know”, for many patients goal weight is generally determined by ideal body weight, which comes from the Metropolitan Life Ideal Height and Weight Tables.  In 1943, the Metropolitan Life Insurance Company introduced their standard height-weight tables for men and women. At that time, the weights were billed as "desirable" weights, indicating that persons at those desired weights had the lowest mortality rates. That being said, over time the phrase "ideal weight" became commonly associated with these tables. 

The notion of target weight suggested by these tables, therefore, is simply a starting place. Many other factors influence the recommendation of a goal weight, such as the point at which menstruation resumes, the weight at which thoughts about food and eating decrease, among other things. Nonetheless, at the start of treatment, since it is almost impossible to know exactly where things will end up, this number is what we generally mean when we say goal weight. A confusion that arises for many people recovering from anorexia is the difference between resolving medical complications and reaching goal weight. The two of these are both treated through weight gain but are not by any means the same thing. Issues such as bradycardia, prolonged QTc, loss of menses, oteopenia, and orthostasis, will hopefully be resolved prior to goal weight being reached. In some cases they may persist long after this has happened. In no case, however, does the resolution of these complications necessarily mean that target weight has occurred. Although important, the purpose of reaching goal weight is not simply to reverse medical complications, but also to reach a healthy physical state to prevent relapse and provide basis for high quality life worth living as you move on from treatment into day to day life. The resolution of medical complications is of course highly desired, necessary, and will cause great relief to someone with this illness, but it is not a measure of the end of treatment, the end of weight gain, or the resolution of the eating disorder itself.

For more info on the medical complications of eating disorders please take a look at the following links:

Osteoporosis and Osteopenia 

Cardiac Complications 

Refeeding Syndrome 

Should you have any questions or comments regarding this post, please email blog@eatingdisorderscleveland.org.

Contributions by Sarah Emerman