Living With Food: The Science Supporting Eating Disorder Treatment

By Dr. Mark Warren

I had the pleasure of meeting Carrie Arnold, author and expert on eating disorders. She has recently published an article in Scientific American Mind which provides a terrific summary of what we know about the brain, its structure, biology, and functions and their subsequent role in eating disorders. Our thanks to Carrie for this fantastic and informative article.

Please click below to access a portion of this article. Copies of the full article are available at our front desk.

http://www.scientificamerican.com/article.cfm?id=inside-the-wrong-body

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

Contributions by Sarah Emerman

By Dr Mark Warren

One area that is a constant concern with those with eating disorders has to do with heart rate, in particular, low heart rate. This issue is generally observed at low body weight but can happen anytime there has been a significant amount of weight loss. In general, as one loses weight one loses muscle mass. With the loss of muscle mass there may be loss of heart mass as the heart is a muscle. The body, being generally wise, will try to preserve the heart as long as it can, but under the stress of continued weight loss or malnutrition wasting of the heart muscle can occur. Initially the heart may beat more quickly to compensate for being a smaller size, but this is quite exhausting for the heart and ultimately can lead to further damage. To conserve heart muscle and thus keep the entire body functioning as well as possible there will be a slowing of heart rate, called bradycardia. Bradycardia can be very dangerous and is one of the leading causes of illness, hospitalization, and death for those with eating disorders. Heart rates in the 40s or lower are particularly dangerous. As heart rate goes down the risk of arrhythmia, or abnormal rhythm of the heart, becomes more likely. A heart rate in the 40s will often fall into the 30s while asleep, thus increasing these risks. This is why clients with heart rate in their 40s will be hospitalized, both for safety in the moment and for overnight monitoring.

Sometimes there is confusion about the relationship of heart rate and exercise. Many patients erroneously believe, and are told, that a low heart rate is evidence of being an athlete. There are no studies showing that significant and rapid weight loss is normal for an athlete or healthy for the heart. The confusion usually results from the fact that, in general, athletes with low heart rates have low heart rates because they have gained significant muscle mass, including mass in their heart, and their heart does not have to beat as often to provide adequate oxygen and blood for the body. This is most definitely not the case in situations of weight loss, starvation and smaller than normal hearts. One should never assume that in the presence of an eating disorder that a low heart rate has anything to do whatsoever with athletic ability. A low heart rate is almost always due to the illness itself. The good news is that with cessation of physical activity, increase in food intake, and restoration of normal weight the heart can recover completely. The resolution of the illness can include lifelong heart health.

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

Contributions by Sarah Emerman

By, Drs Mark Warren and Lucene Wisniewski

As readers of this blog know, at CCED we have fully committed to Family Based Treatment (FBT). That being said, like many others in the field we have found that doing FBT can be extremely stressful for the family. Both child and parents are likely to experience the re-feeding process as being taxing on their relationship, their lives, and their ability to focus on other enjoyable actives.

Based on our experience and the feedback we have received from families, we have a sense that by providing increased support for parents and adolescents, FBT can be made more tolerable and thus more accessible to a greater number of families.

There are several ways in which we supplement standard Maudsley FBT. For the adolescents, our programs focus on eating meals prepared and provided by parents, and learning Cognitive Behavioral and Dialectical Behavioral Therapy skills to improve the ability to manage the re- feeding process. We also provide groups to help the adolescents develop relationships with other clients to diminish isolation and stigma during this stressful time. For parents, we provide up to 6 hrs per week of parental support either with staff or other parents whose children are also involved in FBT.

The ability for daily on-site face-to-face contact with other parents appears to be of much value and in many cases parents have stayed in contact after treatment and continued to provide support to one and other. It is our experience that by providing parental support, meal time assistance, teaching skills to adolescents, and creating a greater community of other families that the entire FBT process can be made easier for family members to tolerate the re-feeding process and feel supported.

If you are a parent who is currently doing FBT with your child and would like additional support we encourage you to reach out to other parents and clinicians who understand the process you’re experiencing. We suggest looking to Maudsley Parents and FEAST to make these connections.

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

Contributions by Sarah Emerman

Thanks to those of you who joined us on Monday at the Eating Disorder Network’s presentation, “The Recognition and Treatment of Eating Disorders.” We had a great turnout! There were many familiar — and several new — faces who came out to listen to Drs. Mark Warren and Laura Gillespie speak on this important topic.

The Cleveland Clinic Foundation’s Dr. Gillespie spoke first about the warning signs of an eating disorder and what next steps to take for help and support. Though there are an abundance of warning signs and health concerns, below are a few she mentioned:

• A change in eating patterns, such as exclusion of an entire food group
• Smaller portion sizes
• Avoiding meals altogether, i.e. stating he/she already ate previously
• Weight loss during a typical child’s growth spurt
• Delayed puberty
• Extensive exercise
• Hair loss
• Poor healing, bruises easily

She discussed the importance of early recognition — within about three years — not only for health reasons, but also for higher treatment success rates.

Later, CCED’s co-founder and Medical Director Dr. Warren spoke on the history of eating disorder treatment. He mentioned recent advancements in treatment, such as these evidence-based therapies, Cognitive Behavioral Therapy, Dialectical Behavioral Therapy and Maudsley Family Based Therapy, have led to higher success rates in patients suffering from anorexia nervosa, bulimia nervosa and binge eating disorder.

He then went on to discuss the three steps of treatment:

1. Re-feeding and stopping negative behaviors
2. Surrounding oneself with a healthy community for support
3. Continuing therapy for a positive quality of life and developing acceptance-based strategies

Check out these images from Monday’s event featuring Drs. Mark Warren and Laura Gillespie, along with the Eating Disorder Network president, Sarah Dietrich (pictured top right).

By Dr. Mark Warren

Studies have shown that as many as 1/3 of all eating disorder treatment providers have a history of an eating disorder. The percentages may be higher but they are unlikely to be lower. Given the high incidence of professionals with a history of an eating disorder in the field many questions are raised. If a professional discloses that they have a history of an eating disorder there may be specific questions surrounding that person being truly in recovery. Clearly if a person is not in recovery then they should not be practicing in the field. Not only is it triggering for that individual, but they are unlikely to be able to sit with a patient in a fully present manner and truly work with them on their issues. Which of course brings us to the question: What is recovery? Does recovery lead to being recovered? Having already blogged on this, I will focus instead on other questions that result from working in a field where so many practitioners are recovered. One of these has to do with whether the practitioner will share their story of recovery with their patient, how they may share it, and how they know if it is helpful to their patient or not. How does one judge the impact of a practitioner telling their story to a patient? Those who have recovered often ask themselves whether it is right or wrong for them to share their story. For some they may feel that they are intruding on the patient's experience if they share too much, for others they may feel that they are keeping a secret from their patient. For patients, the question may emerge around having the right to know if their practitioner has had an eating disorder and how it informs their knowledge about treatment. In some areas of mental health, substance abuse being most prominent, the substance abuse history of the therapist is almost always considered part of the therapy. In other areas of mental health, mental illnesses and recovery may rarely be shared. Eating disorders are somewhat unique in how they fit into the psychological and treatment world.

On a related note, we also must ask how to we provide support to those with eating disorders who are recovered and working in the field. Because these individuals are coming into contact with triggering issues on a daily basis we need to consider what we can do as a field to help prevent relapse. Central to both of these issues is the stigma around eating disorders and whether one has to make a decision to keep it a secret or share the secret may be filled with questions around managing stigma that may be there for patients. We are just beginning to understand how these differences affect professionals in recovery and our patients. Additional  information and blog posts will follow this one on how we understand this process.

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

Contributions by Sarah Emerman

Join us on Monday, May 7, as CCED’s Dr. Mark Warren presents “The Recognition and Treatment of Eating Disorders” with the Cleveland Clinic Foundation’s Dr. Laura Gillespie. The one-hour presentation, held at John Carroll University’s Dolan Center, will educate patients and families, as well as medical professionals, on recent advancements in eating disorder treatment.

In addition, the talk will arm audiences with the knowledge of how to spot the illness in yourself, a loved one or a patient in your practice and what next steps to take for help and support. Drs. Warren and Gillespie will set aside time to answer specific questions from the audience regarding the recognition and treatment of eating disorders.

The event is free and open to the public. It is designed to offer patients hope due to significant advancements in eating disorder treatment in recent years. We encourage you to join us and register for this important event.

• What: “The Recognition and Treatment of Eating Disorders”
• When: May 7, 2012
• Who: Eating Disorder Network, and supporting sponsors: Cleveland Center for Eating Disorders and John Carroll University
• Where: Dolan Center at John Carroll University
• Register: Call 216-765-0500 or sign up online here. Walk-ins are welcome!