Recent Workshop Sets the Tone for Future BED Research

Last week, April 19^th and 20^th, I had the honor (along with my UNC colleagues Dr. Cynthia Bulik and Dr. Christine Peat) of attending the NIMH-funded workshop focusing on “Binge Eating Disorder: The Next Generation of Research.” The impetus for the workshop was the pending inclusion of binge eating disorder (BED) as an official diagnosis in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The workshop was hosted by the Uniformed Services University of the Health Sciences in Bethesda, MD, and attracted research and clinical leaders in the field, NIH representatives, and laypersons working with advocacy groups in the fields of eating disorders, obesity, and addictions. The goal of the workshop was to envision the next generation of BED research by capitalizing on the collective wisdom of members of this diverse group, who currently work largely independently.

Attendees were treated to a full day of presentations and discussion on key topics including BED risk factors across the lifespan (Drs. Bulik and Tanofsky-Kraff), assessment of BED and BED comorbidities and consequences (Drs. Tim Walsh and Stephen Wonderlich), the contribution of addictive processes to the development and maintenance of BED (Drs. Nora Volkow and Warren Bickel), obesity and other medical consequences of binge eating in adults and children (Drs. David Ludwig and Alison Field) and in animal models (Dr. Mary Boggiano), and interventions for persons with BED (Drs. Denise Wilfley, James Hudson, and James Mitchell). Special guest speakers from the Department of Defense (Dr. Anne Dobmeyer) and the Binge Eating Disorder Association (Chevese Turner) brought the day to a close by presenting information on the relevance of BED to the health and readiness of military personnel and on the personal and societal costs of BED. Following each presentation, audience members joined in discussions that were facilitated by representatives from the National Institute on Drug Abuse, the National Institute of Mental Health, the National Institute of Diabetes and Digestive and Kidney Diseases, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Several key take-home messages emerged from the workshop.

1)  There is a clear need for improved assessment methods that are brief and therefore can be readily used in primary care settings and easily incorporated into on-going epidemiologic studies.

2)  Assessment methods and research models need to incorporate a lifespan perspective to improve understanding of the developmental factors that influence the trajectory of BED and its medical and psychological consequences.

3)  Some but not all of the biological disturbances observed in substance use disorders can be observed in BED, and much more research is needed to map out common and unique pathways that may then be examined as targets for treatment in BED.

4)  Future BED research will be well-served by adopting the Research Domain Criteria (RDoC) matrix, which defines basic dimensions of functioning (such as ‘attention’ or ‘impulsivity’) across multiple units of analysis, from genes to brain circuits to behaviors, cutting across disorders as traditionally defined. For example, improved understanding of the role of “loss of control” in BED may be achieved more efficiently by studying different patient groups who exhibit a spectrum of impulse control problems (i.e., BED, attention deficit disorder, substance abuse, obsessive compulsive disorder) rather than focusing solely on persons with BED as defined in the DSM.

5)  Surgical interventions for obesity, some of which result in the removal or disengaging of key functional sections of the gastrointestinal tract, provide a unique opportunity to understand the role of nutrient sensing and gut-derived peptides in the development and maintenance of BED.

6)  Military personnel may be at greater risk for developing BED due to job-related weight and fitness requirements, deployment and relocation stress, and combat-related PTSD and brain injuries that impact impulse control. Basic research is needed to document the prevalence of BED, factors associated with new incident cases, and barriers to treatment seeking in military personnel. Obtaining funding for these research projects is challenging but feasible for non-military investigators.

7)  Expanding our toolbox of evidence-based treatments, improving access to such treatments, and confronting obesity-related stigma and other barriers to clinical care are essential to reducing BED and its consequences in our society.

We can all look forward to a summary publication based on the workshop proceedings. For spearheading this effort, all of us who are invested in research, treatment, and advocacy for BED tip our hats to Drs. Marian Tanofsky-Kraff and James Hudson, who did the lion’s share of organizing this groundbreaking workshop.

By: Dr. Kim Brownley

Read Full Post »

Second Annual NEDA Walk

On Sunday, April 15^th, 2012, members of the UNC Eating Disorders Program supported the second annual National Eating Disorder Association (NEDA) Walk in downtown Raleigh. Our program’s team members raised over $700 to donate towards NEDA’s fundraising goal!

Teams from Raleigh, Durham, and Chapel Hill gathered in support of the cause, and local clinics and nutrition programs advertised their services to walk participants. Before the start of the walk, one brave young woman stood in front of the crowd and described her struggle with an eating disorder. Her determination to improve and her excitement for the event set the tone for an afternoon of support, friendship, and fun.

If you are interested in joining our team next April, please check back for more details as the event approaches. If you are interested in donating to NEDA, please visit the following site: NEDA Donations.

Read Full Post »

The “War” on Obesity: At What Cost?

The “war on obesity”, or “war on fat” as some have labeled recent obesity prevention initiatives, may have unintended consequences. A recent article “The Obesity-Eating Disorder Paradox” published in Harvard Political Review proposes that obesity and eating disorders represent extremes in the manifestation of “a serious cultural disorder”—a cultural obsession with dieting, weight and physical appearance. The article is a call for those working to fight these two problems to join forces in promoting an integrated approach to prevention.

While no study to date has clearly documented the impact of obesity prevention programs that emphasize diet and weight control strategies, it is not surprising that their impact is more complicated than anticipated. I recall a recent conversation with a coworker who described her six-year-old son returning from school looking worried and discouraged. He stated emphatically that he would not be eating dinner so as to avoid becoming fat. He had been subjected to school programming aimed at “educating” young children about the potential risks associated with obesity, the complexities of which were lost on his six year old brain, which only registered fear and horror.

The messages children receive about body weight and eating are not limited to the school environment. The role of “Big Diet, Big Fashion and Big Media” only promote what our own Dr. Cindy Bulik calls a “culture of discontent”, where advertising keeps people perpetually dissatisfied with their bodies, with the focus being on closing the gap between reality and a unattainable ideal that can border on obsession. Further, despite the fear and shame tactics applied in some obesity prevention measures, rates of obesity have only continued to rise (in fact, they have nearly tripled among children in the past three decades).

Obesity is a complex problem entangled with issues of social-equity and access to healthcare, healthy lifestyles, and food choices. Programs designed without considering these complexities may only serve to immobilize people with shame, guilt and hopelessness—emotions that psychosocial researchers have long linked to inaction. For example, the implementation in some states of BMI “report cards” to parents, touting the risks of overweight and obesity, or TV ads featuring dejected overweight children may further stigmatize children and adolescents in the presence of their peers, negatively impact body and self-esteem, and lead families to feel disempowered and helpless.

In a recent article published in the Public Health and Nutrition, Sánchez-Carracedo and colleagues provide a rationale for an integrated model of prevention simultaneously targeting both obesity and eating disorders. From studies suggesting that body dissatisfaction may actually predict excessive weight gain among adolescent girls, to the known fact that diets are generally unsuccessful, various “war on obesity” strategies may reinforce body image concerns, and either lead to additional weight gain or disordered eating. War is not the answer. Targeting both obesity and eating disorders requires carefully designed interventions at multiple levels (family, school, peers, and public policy).  Fortunately, this type of initiative seems to be gaining momentum as organizations like the American Psychological Association put forth guidelines as a part of its public interest policy. They recommend and integrated prevention approach targeting “improving nutrition and physical activity; increasing body satisfaction; decreasing weight stigmatization and weight-related teasing; promoting responsible marketing to children; supporting healthy home environments; and addressing cultural and socioeconomic factors related to obesity and disordered eating”. Other programs like Michelle Obama’s “Let’s Move” campaign may be a step in the right direction with a focus on being active and achieving a healthy and balanced lifestyle, rather than diet and weight control. Ultimately, future conjoint efforts from individuals with expertise in different sectors (mental health, prevention and treatment of eating disorders, and public health) are not only necessary, but have potential to re-shape our culture’s attitudes about and approaches to weight and body image.

To read more about APA’s specific recommendations and Michelle Obama’s “Let’s Move!” campaign go to the following websites:

http://www.apa.org/about/gr/pi/advocacy/2008/eating-disorders.aspx

http://www.letsmove.gov/

By: Sarah Forsberg

Read Full Post »

Body Shaming and Veganism: It just keeps getting worse…

I recently wrote about the widespread use of body shaming in media campaigns and highlighted unflattering billboard images in Albany, New York sponsored by the Physician’s Committee for Responsible Medicine (PCRM). Based on the backlash from this campaign, I would have hoped we had seen the end of these stigmatizing messages. Unfortunately, that has not proven to be the case.

PCRM has since taken their message on the road to Chicago and Miami, where new billboards have gone up to coincide with the start of baseball season that read “Hot Dogs Cause Butt Cancer” and feature a cartoon of an obese man in a revealing hospital gown enjoying a hotdog. They have also expanded into a new media platform with a commercial airing in Dallas and on the CNN Airport Network that proposes a “Sit Next to a Vegan” option for fliers. Instead of paying for extra legroom or an aisle seat, PCRM suggests charging customers to sit next to a vegan, implying this will land you beside a slender, attractive blonde and give you “all the room that you want.”

PCRM’s president Dr. Neil Barnard explains that they’re “taking a tongue-in-cheek approach to getting the word out, but the epidemic of obesity is no joke.” What’s also “no joke” is the shaming and stigmatization inherent in these ads. PCRM is an organization of health professionals that supports research and advocacy around the health benefits of vegan diets and the ethical treatment of animals—the fact that their compassion for animal welfare does not extend to fellow human beings is appalling.

As stated so eloquently by Ginny Messina, RD, “when we advocate for animals, we’re supposed to stand against the bullies, not adopt their culture of unkindness, disrespect, and mean-spiritedness…let’s all of us who stand for kindness, compassion, and an ethic of justice lead the way.”

I couldn’t have said it better myself.

By: Susan Kleiman

Read Full Post »

A Step In the Right Direction

A new law recently passed in Israel will ban “malnourished” models from appearing in the nation’s media. According to this new policy, models who are under a body mass index (BMI) of 18.5 or who are unable to produce a medical report from within the last 3 months verifying their good health will be ineligible to participate in photo shoots or runway shows. In addition to these requirements for the models themselves, media outlets are now also required to indicate whether they digitally altered any photographs to make models appear thinner. Promoters of the law hope that such a move will help promote more a realistic body image and decrease public acceptance of an unrealistically thin beauty ideal. For many within the eating disorders field, this bold move has been applauded as a necessary step in helping address the media’s contribution to negative body image and disordered eating practices. While not the only factor relevant in their development, the cultural acceptance and perpetuation of an unattainable beauty ideal has certainly demonstrated importance in the etiology of body dissatisfaction and eating disorders. Our own Dr. Cynthia Bulik expressed support for the provision in the Israeli law that requires disclosure of images that have been altered to “enhance” a model’s appearance. She adeptly points out that the manipulated images to which women and young girls are subjected are “powerful and … dangerous” and are unrepresentative of real women’s bodies.

While other countries have enacted similar practices for their major runway shows (e.g., Madrid and Milan fashion weeks), Israel is the first to take such a courageous step in tackling some of the inherent challenges within an industry that is so heavily invested in selling a specific image and marketing it as a standard of beauty. The law is in stark contrast to the ideals of many within the industry including fashion icon Donatella Versace who was recently lambasted for her unwillingness to use “real women” in the launch of her collection at H&M retailers. While the attitude of Versace (and several other notable designers) is certainly disheartening, the Israeli policy engenders hope that as the spirit behind the law becomes more accepted, other countries will follow suit and embrace more healthy, realistic, and diverse images to promote in their media.

By: Christine M. Peat, Ph.D.

Read Full Post »