Living With Food: The Science Supporting Eating Disorder Treatment

We have long known that people with anorexia nervosa are often likely to also have comorbid depression. Much of the time the depression is not a separate illness but a result of the physical and biological changes that anorexia produces on the brain and body. Tiredness, exhaustion, malnutrition, chronic worry, and obsession with body size and shape can all make someone more depressed. In addition, on a biological level we believe that the brain’s ability to produce neurotransmitters that effect mood are also significantly depleted by malnutrition. Specifically, we know that serotonin production lessens as malnutrition develops, which makes traditional antidepressant medications less effective. We believe that it is likely that almost all neurotransmitters, which can affect a wide variety of brain function, are depleted with malnutrition. This may look like depression, or just a lack of ability to feel any emotions. 

This month an exciting new study has added to our knowledge of the biological changes of the brain from malnutrition. In a study led by Christina Roberto, at the Columbia University Center for Eating Disorders, Roberto found that individuals with anorexia suffered a loss of gray matter in the brain (which is the active part of the cortex). So, some of the changes we see may be due not only to neurotransmitters, but actual loss of brain mass. On a positive note, with restoration of weight, there is also restoration of gray matter, meaning that many of the brain changes from anorexia, whether neurotransmitter or gray matter itself, often correct as refeeeding occurs.

As we have discussed in this blog many times before, refeeeding is the most important single step for the treatment for anorexia. This new study adds to that data and makes clear once again that trying to talk someone out of their eating disorder is likely impossible as they may literally have lost the brain power to know whats going on. In terms of evidence based care, when looking for treatment for anorexia be cautious of treatments where refeeding takes a back seat to figuring out the why the eating disorder develops. As this study demonstrates, at the start of one's treatment, nutrition and refeeding should be the primary focus for most people.

For more on Roberto's study click here

Contributions by Sarah Emerman

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