Sunday Smorgasbord

Time again for your weekly jaunt through the world of ED-related news that you may have missed. I hope you enjoy this week's selection of yummy morsels!

"Winning the War on Weight"

And so is titled a press release about a recent study out of Australia, which looked at what obese people thought about their ability to change their behaviors. From the press release:

"Severely obese individuals felt an urgent and desperate need to change their health behaviours, but felt completely powerless to do so. Most felt worried and scared about the potential health consequences of their weight. Most felt blamed and ashamed by public health and education campaigns about obesity, which did little to actually help them address their weight," Dr Thomas said.

Dr Thomas said in contrast, people whose weight fell within the mild to moderately obese range understood they were significantly overweight but did not believe they needed to lose weight to improve their health and wellbeing.

"Those individuals, with a BMI between 30 and 40, believed they could lose weight if they needed to, but did not feel this was an urgent health priority as most felt physically healthy," Dr Thomas said.

"Most of the study participants in this category deliberately sought to distance themselves from public health messages about obesity and the word obesity because of the social stigma attached to the condition. They also stigmatised those who were fatter than themselves."

The take-home point? Shaming people about their weight doesn't work! (Whoda thunk?)

Maybe we could start to win the war on weight when we sit down and just stop fighting it.

Health Tweeder

Described by @WiredScience as "a beautiful visualization of disease chatter on Twitter," Health Tweeder is definitely pretty to look at and fun to play with. It's a fantastic time-waster. I know- you can thank me later.

Historic Cookbooks, 1900-1910

If you're interested in what people were cooking and how they were eating, this link is for you. All of the cookbooks are scanned and full-text.

The Skinny on Fat in Fiction

A brief but insightful overview of the use of fat characters in recent literature. Writes Beth Carswell:

In reality, people walk around in various shapes and sizes, and that's just the way it is. If they're fat, it's only one aspect of the things that make them up - who they are, and what they are. Their size is incidental, circumstantial, not the main focal point of them as a person. But in writing fiction, the author, playing a God of sorts, has to make decisions. It seems in describing someone's physical attributes, there is a reason to make them that way, and fat tends to carry the most connotations.

Prefrontal brain function in children with anorexia nervosa

It appears that teens with anorexia are able to perform verbal tasks as well as their unaffected peers, but they use different neural patterns to arrive at their responses. The authors conclude that "might apply fewer brain circuits or fewer neurons per circuit during cognitive tasks and might use different brain circuits in relation to their preoccupation with eating behaviors." Whether this altered neural functioning is a result of the starvation arising from anorexia, or an underlying difference, remains to be seen.

Trends in ED hospitalization in Poland, 2003-2007

From the abstract (it's the only part of the article in English!):

Despite the increase in eating disorders prevalence rates in young people in the world, the systematic decrease of hospitalization of patients with eating disorders in Poland was observed. The decrease of patients' age was also noticed. Females were hospitalized much more often than males, what was observed in previous study.

It would be interesting to see whether this is due to a decrease in the actual number of eating disorders, a decrease in diagnosis, or an improvement of outpatient treatments. The abstract didn't indicate trends in EDs outside of hospitalization, which would probably shed some light on this trend.

Anorexia and brain imaging

Although the research isn't that new, there was a wonderful write-up on Walt Kaye's brain imaging research in the Psychiatric Times (creatively titled Anorexia and Brain Imaging).

A short excerpt:

...insights into the ventral (limbic) and dorsal (cognitive) neural circuit dysfunction, perhaps related to altered serotonin and dopamine (DA) metabolism, may help explain why individuals with anorexia often report that dieting reduces their anxiety while eating increases it and why they worry about long-term consequences but seem impervious to immediate gratification and unable to live in the moment.

Many women diet in this culture, but relatively few (0.5%) have anorexia, Kaye told Psychiatric Times. “Why is that? Well, you pretty much have to have a certain temperament and personality in childhood to be vulnerable for . . . an eating disorder,” said Kaye. “Not everyone who develops anorexia has all these traits in childhood, but most have one or more of them,” he said. “These traits include harm avoidance, anxiety, behavioral inhibition, difficulty with set shifting [easily moving from one mental set to another], a tendency to focus on details rather than the big picture, and perfectionism.” Even after recovery, these personality and temperament traits persist, pointing to underlying neurobiological factors.

...Kaye said that evidence from imaging studies suggests that disturbances in the serotonergic system might contribute to vulnerability for restricted eating and behavioral inhibition as well as a bias toward anxiety, particularly excessive concern with consequences. Meanwhile, DA dysfunction, particularly in striatal circuits, may contribute to altered reward, decision making, stereotypic motor movements, and decreased food ingestion.

The article isn't simple--the magazine is aimed at psychiatrists, not otherwise clueless neuroscience geeks like yours truly--but it's written very clearly, and Google helped me figure out what terms I didn't know. If you ever want a good handout on up-to-date information on anorexia for medical professionals, this would be a good one to print and keep on hand.

Anxiety Avoidance

Although I'll probably never be in danger from giving myself bruises from all the pats on the back that I give myself, I do have to admit that I've come a long way in the past 9 months. But there's still a long way to go. I've pushed through the ED junk enough that I can function reasonably well in every day life. I can go out to restaurants and, though I don't look forward to it, I don't have panic attacks, either. I can manage my exercise urges. I eat what's on my meal plan with basically no anxiety.

And yet anxiety is what's holding me back from going further.

Let me explain. I don't really have any "fear foods" or any foods that cause more than a slight uptick in anxiety. There are, however, foods that I don't eat very often because they were associated with being "bad" foods. It's sort of like avoiding those foods has become a habit. Thou shalt not order cream sauces. Things like that. I know I can work cream sauce into my mealplan, and I don't fear I will turn into the Goodyear Blimp if I do eat cream sauce. I just don't consider eating cream sauce because that's just not what I do.

So taking the leap and eating cream sauces (I was picky about creamy things long before the ED, after I got ill after eating something with Alfredo sauce in early high school, and the association makes me gag a bit, but some are okay) would cause me anxiety, not because it's cream sauce but because it's different. And I am so sick of being anxious all the time that I avoid pushing myself and trying the cream sauce. I avoid breaking free from the rules and regulations of my meal plan. I don't fear instantly turning into the Fat-o-saurus Rex like I used to, I just fear the change.

An ex-therapist always told me "Anxiety won't kill you."
I raised an eyebrow. Wanna bet?

I break non-breakable combs. Don't tell me that anxiety is supposed to be non-lethal because with the combination of my luck and Murphy's Law, anxiety will kill me. Tell the comb-now-in-two-pieces that it's not breakable. Exactly.

I suppose this is the point at which many bloggers will quote FDR and say that we have nothing to fear but fear itself. Which I suppose is true, but it seems a little trite. I tell myself anxiety is just unpleasant and it will pass. But when? And will I go insane in the meantime?

I've adjusted to life without the constant nail-gnawing anxiety (though there are exceptions; see, for example, today) and the thought of having to face it again is overwhelming. I can function. There's nothing wrong with me--see? ::twirls around so everyone can have a good look::

The point is not so I can function in my fairly limited life right now. I'm a freelance writer. My stresses are minimal. I can (and frequently do) work in my pajamas. Not that my life is one easy freaking barrel of laughs, but stress-wise, its much less demanding than in the past. I don't have to deal with lunches with clients or a dinner party at work. And in this context, I am just fine, recovery-wise.

But when things aren't as nice and cut and dry as they are now...
When they aren't easy...
When I do have to deal with (and eat with) other people...
When I don't get to be the total control-freak that I am...

That's when the difference is going to be made clear. I know I'm not like other people in terms of food. I need to have certain items just because. I could eat different things if I had to, but I'd really prefer MY stuff in MY brands and MY flavors. I don't like random changes in plans, especially (especially!) when it involves eating. If I planned on leftovers and someone invites me to dinner, I'm going to decline and eat leftovers--not because eating out is scary or threatening, but because it's not what I had planned.

This gets in the way of living a normal, fulfilling life. I don't ever expect that I will turn into a spur-of-the-moment person, nor do I really want to. But I have to start approaching this anxiety about change a little closer than the distance currently dictated by my ten foot pole.

She would paint on anything.

On a hot June day this past summer, Kelsey Veldman lay down to take a nap and never woke up. She had been struggling with bulimia for nine years, and her heart finally gave out.

More than just a bulimic, though, Kelsey was an artist. Her mother said she would paint on anything. From her mom's blog:

As it turns out, her art will get its debut, and I will be helping to fund it. The proceeds will go to an fledgling organization to promote awareness about eating disorders. She would be okay with that part of the deal, she just would want to know why I didn't make a different decision when she was alive to benefit from it.

I should have, because she was an incredible artist. I'm not sure I even realized how much so until we were choosing pieces to display at her funeral. Most of the pieces were not things I had ever seen. Marissa knew where they were. As she pulled out more and more, I realized there was a lot about both girls I was totally isolated from, even as they lived under my roof. However, the art itself was amazing. Of course, I was not looking at them objectively, but I think most people would agree she had real talent and potential. Without the benefit of expensive supplies, she'd paint on anything. There are a few pieces on cardboard, including the self portrait we used for her memorial card. It was indicative of how a vision can't be squashed. Well, I guess it can be actually. Death squashed it.

But, did it? Will she live on a little by my agreeing to share her art to help raise awareness about the disease that ripped us apart for all those years? I guess we shall see. We hope those of you who can will see along with us. Any artists out there are encouraged to donate a piece and come to the event to promote your art. Don't do what we did; pursue your dream.

In two weeks, Kelsey's art will be auctioned off to benefit the Austin Foundation for Eating Disorders.

Date: Saturday, Feb. 20, 2010, 7-9pm
Location: Space 12 - www.space12.org
3121 E 12th Ave, Austin TX 78702

For more on Kelsey's story, click here.

(h/t The Fat Nutritionist)

Body fat- it's not a bad thing

A new study confirms previous research that a higher percent body fat is associated with better outcomes for anorexia, and that lower body fat percentages are associated with relapse (Bodell and Mayer, 2010). The research isn't exactly groundbreaking, nor is the science--it's a pretty straightforward statistical analysis--but the results bear repeating.

For most of my treatment, I've had clinicians low-ball my weight. They'd use some sort of plug-n-chug formula and tell me what I needed to weigh. Only twice was I asked what I weighed before the eating disorder during these "What should healthy Carrie weigh?" conversations. The second time, I lied because that is what people with eating disorders do when they are terrified of gaining weight and want to avoid it at all costs. Nothing egregiously inaccurate, but still.

One dietitian told me a weight that was about 20 pounds below my pre-AN weight. Another treatment center let me pick what weight I wanted to end up at (I pulled a random number out of the air because I knew I was being discharged in 24 hours and didn't want to jeopardize that). A different treatment center told me my target weight down to the half pound. Even as deeply entrenched in my illness as I was at that point, I found it ludicrous. If drinking a bottle of water can cause the difference between "too thin" and "too fat" or even healthy and not, then your standards are seriously whacked. Not one of them looked at body fat percentage. Not one of them looked at growth charts. Not one of these treatment experiences resulted in a lasting recovery.

I was all too happy to be told these very low target weights because that meant I could keep a bit of the eating disorder. But I also remember this tremendous sense of betrayal, that the people I had hired and was paying my hard-earned money (dude, I was a college student! I'm not paying $100 per 50-minute hour because I have a bunch of spare change laying around that I don't know what to do with!) didn't really have my best interests in mind. I don't think these people were deliberately malicious--they thought they were doing right by me--but they were wrongheaded and rather harmful. Because what I heard when I was told these low weights was that "See, I really was fat. There really was something wrong with my weight. I was right to stop eating and start exercising." If my weight was fine before anorexia, then why wasn't that my goal weight? I was very healthy and athletic and, the depression and anxiety notwithstanding, relatively happy. And if all of these professionals were telling me I would be just fine at X pounds, then why should I struggle through and get back to Y pounds?

I'm not saying that we should be checking percentage body fat every time someone walks in the door. Frankly, I don't want to know my body fat percentage as it's just one more number to obsess over. But it makes no sense to be afraid of it, either. To buy into the ED deception that having a normal, healthy amount of fat on your body is something to be afraid of. It's a tool to help people towards recovery. We know that shooting too low on weights can leave a person very vulnerable to relapse, so I can't quite figure out why we keep doing it.

Pot, Kettle, Black

I'm sorry, but my irony-meter (ironometer?) just dinged so loud I was practically deafened:

Weight Watchers Sues Jenny Craig Over Deceptive Advertising

To me, any weight loss program advertisement is pretty deceptive--if you are mandated to have "*results not typical" in small print, you can pretty much guess that what you are hawking is worthless. I mean, Weight Watchers portrays your hunger as a little fuzzy square-shaped monster, which isn't exactly accurate. ABC's Good Morning America* has more on the story here:

"Jenny's delicious cuisine and the support of your personal consultant make all the difference," Bertinelli, who lost 49 pounds on Jenny Craig, says in the commercial. "Jenny Craig clients lost, on average, over twice as much weight as those on the largest weight loss program."

Those claims have Weight Watchers fighting mad. The company says Jenny Craig's so-called science is a big fat lie.

"The claims that they are using in that advertising was just patently deceptive," said David Kirchhoff, the president of Weight Watchers International.

And now Weight Watchers is taking the fight to court.

"They compared a study they did this year, for one purpose, to a study we did 10 years ago," Kirchhoff said.

The Jenny Craig ads never mention Weight Watchers by name, but Kirchhoff says "everybody knew. You say the world's leading weight loss company; everybody knows who you are talking about."

Jenny Craig stands behind its message, and their science.

The real irony is, of course, that science supports neither of these companies' weight loss programs. An independent study from UCLA shows that diets don't work. Despite the assurances from corporate big wigs that these programs aren't a diet ("They're a lifestyle change!"), um, they're a diet. You're restricting your food to try and lose weight--if that's not a diet, then I don't know what is.

Still, the legal issues brought up in this lawsuit--"whether the ad claim is false, or misleading to the point of being the functional equivalent of false, and whether or not an ordinary person would be impacted by the ad's claims"--are both relevant and important. I'm curious to see where it ends up; the chuckles I get from my off-the-charts ironometer are merely a bonus.

*Holy leaping Freudian slip, Batman! I initially typed "Food Morning America."

The Devil in the Details

New research on people with body dysmorphic disorder shows that their brains focus on the details of their faces, rather than taking in the face as a whole. The study, titled "Abnormalities of Visual Processing and Frontostriatal Systems in Body Dysmorphic Disorder," was published in the most recent issue of Archives of General Psychiatry.* CNN covered the story, an excerpt of which is below:

It turns out that people with this condition have abnormal brain function when it comes to looking at pictures of their own faces, according to a new study led by Feusner and published in the Archives of General Psychiatry.

When viewing themselves in photographs, patients with BDD underutilize parts of the brain used in seeing the face's overall shape and size, he said.

"If you just see the pieces of your face, and not seeing how they fit into the whole, then it's going to look distorted," he said. "That's how we interpret the findings."

What is especially interesting are the similarities between BDD and anorexia. Similar to what this study found in people with BDD, previous research has found that people with anorexia tend to focus on the details, which leads to a trait known as Weak Central Coherence (Southgate, Tchanturia, and Treasure, 2008). People with AN also show abnormalities in neural functioning when looking at images of themselves, but not other people (Sachdev et al, 2008).

More from the CNN story:

"...the part of the brain that helps guide behavior and maintain emotional flexibility, the frontostriatal systems, had unusual activation patterns.

"What we think may be happening is that they may be seeing details, perhaps even seeing details normally, but that they're not able to contextualize it," [Fuesner] said...The study is "groundbreaking" in its demonstration that patients with BDD are too focused on the details aren't able to see the whole picture when they see themselves, said Sabine Wilhelm, director of the BDD Clinic and Research Unit at Massachusetts General Hospital, who was not involved in the study. This can be observed anecdotally in treatment, but this study confirms it at the level of brain processing, she said.

Feusner's previous research found that when BDD patients viewed the faces of other people -- not their own faces -- the brain's left hemisphere, associated with categorization and details, was more more active. Healthy individuals used the right hemisphere, the part of brain that processes more holistically.

It is too early to directly apply the findings to treatment, but one possibility is that patients with BDD could be retrained to see their own faces, he said.

Considering that people with BDD show many of the same difficulties in executive functioning (i.e., "a loosely defined collection of brain processes which are responsible for planning, cognitive flexibility, abstract thinking, rule acquisition, initiating appropriate actions and inhibiting inappropriate actions, and selecting relevant sensory information.") as people with AN, perhaps the underlying neurological similarities shouldn't be surprising.

The Semel Institute at UCLA is currently recruiting subjects for a study to compare neural processing in people with BDD, people with AN, and healthy controls. Click here for more information- I will phone the study site tomorrow as I am interested in participating and I will post more information as I get it.

*I haven't yet been able to get ahold of the full-text of this study- my alumni association dues need to be updated before I can get a copy, so I apologize.