Childhood Eating Disorders Blog

Dear Readers,

We heard some good news this week. Some of you may have read about the Mental Health Parity Bill that was passed in both the House and the Senate on September 23. This is big news for the eating disorders community because the bill requires health insurers to cover mental illnesses (which include anorexia, bulimia and binge-eating disorder) exactly as they do physical illnesses.

As many of you probably know from first-hand experience, under current law, it’s common for insurers to charge higher co-pays for mental health benefits. Often, in the case of eating disorders, insurers will simply deny coverage, claiming treatment is not medically necessary. (See our LA Times op-ed piece piece on the tragic consequences of this practice for one young anorexic woman in California).

I spoke to Mike Harney, policy advisor to Rep. Patrick Kennedy (D-RI), chief sponsor of the House bill, who explains that while the content of the House and Senate bills is identical, the House bill  

Is a stand-alone bill that provides for a $3.9 billion 10-year budget offset that would pay for the costs of the legislation, while the Senate version is part of a much larger tax bill. They will have to hammer out an agreement on which form of the bill they will send to White House for the president’s signature. “We’re confident we’ll get a bill this year,” says Harney.  

An earlier, more liberal version of the House bill would have required that all health insurance plans cover all illnesses included in the DSM-IV, or Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. Despite losing this stipulation in the bill, Harney says, “We would still expect that most plans will cover [eating disorders] and now they’ll have to cover them on the same basis as physical disorders.”

An earlier version of the Senate’s mental health parity bill, meanwhile, would have pre-empted any state legislation on mental health parity (meaning that even if a state had in place a more inclusive mental health parity bill, only the weaker federal bill would have been enforceable). The revised Senate bill passed on Tuesday allows states that have tougher mental health parity legislation in place to enforce that law. The new bill “establishes a floor, not a ceiling,” explains Harney.

As of 2007, 43 states had mental parity laws, and 17 of those, or 40%, defined mental illness broadly enough to include eating disorders. So you can see how this federal bill, which President Bush is said to support, will help so many more eating-disordered patients and their families get the treatment they need.

Take care,

Nancy

I’m always amazed to hear about people throughout history who had eating disorders before they even  had a name. Today, anorexia, bulimia and even binge-eating disorder are so widely recognized that there’s even an anthology of essays on various author’s struggles with food, weight and self-image. Titled Going Hungry: Writers on Desire, Self-Denial, and Overcoming Anorexia, this book, along with another book on a woman’s struggle with food and weight, Thin is the New Happy: A Memoir, by Valerie Frankel, were both reviewed in the article, Yearning for the Lean Years,  published  the New York Times a few days ago.

The first book is a serious look at the varieties of torture and self-doubt that men and women of varying ages and ethnicities have experienced in pursuit of the holy grail of thinness. Frankel’s book sounds like a tonic to anyone who has grown up with a mother who snatched Twinkies from their hand and groomed them (often unsuccessfuly) not be fat.

I’m glad to see these kinds of stories being told publicly, in both seriousness and humor. We need more public discussion, to hear more stories like these in order to fight the stigma of eating disorders. For every writer willing to dish up details about epic binges or fanatical starvation tactics, there are hundreds, thousands more, who are suffering in secret. I hope you realize you don’t have to do that any more. Good treatment for eating disorders is increasingly available, even in small towns; it’s mustering up the courage to ask for help that’s the hard part.  

Take care,

Nancy

Dr. Herrin has been invited to discuss Maudsley-inspired techniques for putting parents in charge of their eating disordered child’s food behavior at several upcoming conferences.

Sept. 18-20, 2008 in Austin, Texas @ National NEDA Conference. This conference is designed for individuals living with an eating disorder, a family members or friends looking to offer support to a loved one, or treatment professionals looking to help others.

Nov. 13-16, 2008, Renfrew Center Conference for Professionals. @ Philadelphia Airport Marriott. This conference also features Jane Fonda!

This is that time of year when parents call me for advice on sending their eating-disordered child off to college for the first time. I’m always reminded how important it is that parents make sure that a good tight system is in place for their recovering young college students. As much as we would like to turn treatment and monitoring over to the college, the truth is that colleges rarely get involved until students are in serious enough trouble to worry roommates, professors, and residential life staff.
I just got off the phone with Leigh. She is the mother of Simone, who is going off to her freshman year in college in a few weeks. Leigh called the school last week, leaving a message saying that she wanted to know what resources the college had on campus that would support Simone’s continued recovery from purging anorexia. Leigh had called me because she was frustrated she hadn’t heard back from the health center and worried the college would not be aggressive enough with treatment to keep Simone’s recovery on track.
I told Leigh that most colleges are not going to insist on treatment for incoming students, but they can do weight checks and many have counseling departments and even nutritionists. As Simone’s parent, Leigh will have to be the one to insist that Simone arrange for the weekly weight checks and check out the counseling and nutrition resources. In Simone’s case, Leigh is going to have the health center fax weekly weights to me. Simone and I have planned to continue treatment over videocam unless she finds a nutritionist to work with on campus.
It’s a good idea to talk over the transition to college with your child’s nutritionist or doctor and coordinate ongoing care with your child’s college health care center. Your goal is to not have anything fall between the cracks where treatment is concerned. Starting college is stressful under any circumstances, so try to make the transition in treatment as seamless and well-planned out as possible.
Marcia

Marcia & Nancy

Dear Readers,

 We know that eating disorders can destroy lives, both of the sufferer and her/his family or loved ones. We know about the devastating health consequences of anorexia, bulimia, and binge eating disorders. We know that eating disorders can strip victims of their confidence and increasingly isolate them from the world, we know that anorexia has the highest successful rate of suicide among mental disorders, and on and on.

But how does the parent, the loved one or the health professional motivate the eating-disordered patient to make the superhuman effort that is required to overcome his/her disorder? Highly intelligent kids and adults die all too often from eating disorders, despite (in some cases) having read a shelf full of books on the condition that is killing them. Simply knowing what your disease can do to you doesn’t mean you’re going to be able to muster the will to overcome it.

Marcia has noticed that for young women, certain facts about eating disorders can trigger a shift, and help turn the patient from victim to conqueror. Sometimes it is the fear of losing the ability to bear children due to the  effects of long-term starvation that finally motivates them to get better. Others are galvanized when they are told they have the brittle bones of an 80-year-old, or are courting the loss, over time, of brain function.

It takes someone, either Marcia, a pediatrician, psychologist or parent to explain these facts. For parents, it can be useful to have a store of such information at your fingertips.

On a recent visit to Canada, I came across this headline in The National Post daily newspaper: Anorexia can take 25 years off life: report. The article described a study, led by University of British Columbia psychiatry professor Dr. Laird Birmingham, which found that girls who develop anorexia at age 15 will live on average to age 56 — 25 years less than the average Canadian female. The study looked at the deaths of 954 women from anorexia in British Columbia.

Birmingham said he hopes the study will make people take anorexia more seriously and help fight the “stigma” of anorexia. I assume he means the not uncommon but mistaken view of the disease as pasttime of spoiled rich girls who have no regard for all those in the world who are starving. But I look at the study findings as another good factoid to casually introduce into conversation when you are trying to broach the sensitive subject of your child’s anorexia. As Marcia knows from experience, arming your child with facts about the disease you are both fighting can help build a sense of what’s at stake. It might not work right away, but those factoids will be filed away somewhere in your child’s brain for later use. Or the one you choose could  be the one tidbit that turns the tide.

 Granted, this is only one small study, and only gives an average life expectancy of the particular group studied. But the gist of it: that anorexia can shorten lives, tells a cautionary tale, and one that may hit home with your child or loved one suffering from anorexia.

Take care,

Nancy 

Dear Readers,

There is an interesting court case about to start in Los Angeles involving the parents of a 26-year-old anorexic, Janell Smith, who committed suicide after her insurance company cut off coverage for her hospitalization. It’s amazing how this is still happening, and how insurance companies are still getting away with it. 

Marcia and I, along with the esteemed David Herzog, M.D., who besides teaching psychiatry at Harvard Medical School, heads the Harris Center for Advocacy in Eating Disorders at Massachusetts General Hospital, wrote this op-ed piece on the court case, published in today’s Los Angeles Times.

We’d love to hear any of your eating disorder-related health insurance stories.

 Take care,

Nancy

Dear Readers,

The issue of rising obesity among young children has been a difficult one for those in the eating disorder field. Yes, the increase has been frightening, and something should be done about it. But the fear is that approaching the problem too zealously, or without giving a child the right information and tools to manage weight, well-meaning parents and health care professionals could be putting the child at risk for an eating disorder as she or he grows up.

I saw this issue addressed again recently in a June 10 article in The Wall Street Journal, “The War on Obesity Targets Toddlers.” The article discussed parents of mere 3-year-olds who were informed their toddler was overweight and told something needed to be done. Hospitals and clinics, in turn, have duly responded to this “crisis.”

The Cincinnati Children’s Hospital Medical Center, for instance, reports the Journal, now has a weight-management group for 2- to 5-year-olds, and there are a number of pre-school programs across the nation aimed at increasing physical activity for both overweight and normal-weight kids.

Here’s Marcia’s reaction to this trend of labeling younger and younger kids as obese and trying to teach them better eating and exercise habits: “These kinds of programs do make me nervous, but I am aware that research has been done showing that good weight loss programs for children and teens don’t cause eating disorders.”

An University of Minnesota study published this year that found that when parents correctly realized that their child was overweight they tended NOT to react in constructive ways such as offering more fruits and vegetables, fewer high-sugar drinks, snacks and fast foods; cutting down on tv viewing; increasing family meals and exercise, and teaching kids how to make healthful food choices. Instead, the parents in this study simply put their kids on a restrictive diet. We know that such diets do not work, especially for girls, who are more likely to develop body image problems and/or an eating disorder. Of course this Minnesota study targeted adolescents, not 3- and 4-year-olds, but still this finding is likely true for parents of toddlers who are overweight as well.

The key seems to be to make sure that whether you are working with a younger or an older child, you have the proper nutritional supervision as you embark on a weight-loss program. It’s important to remember that your child is still growing, and needs a variety of foods: protein, fats, carbohydrates, fruits and vegetables. The Journal article points out that kids up to about age 5 need a higher percentage of fat in their diet than adults do, as well.

Marcia herself has worked with many overweight children with good success. “What I’ve found is that these kids end up protected from eating disorders because they have learned healthy ways to manage their weight,” she says. “I also talk to my young patients about body image and genetics AND the dangers of eating disorders.”

Marcia’s advice to parents: “Make sure any weight loss program you enroll your children in addresses these important issues.” A child who knows that weight and size are largely genetically determined, that body acceptance is important to maintaining a stable weight, and that starving oneself can lead to an eating disorder is a child who has a better chance at healthy weight management.

Take care,

Nancy

Having spent a good part of the day writing reports and requests in my never-ending battle to get insurance companies to cover nutrition treatment for eating disorders, I was heartened to read the news that a lawsuit  by parents against Aetna has led this insurance company to improve its coverage for eating disorders. Unfortunately, coverage for nutrition treatment was not included. I am hoping that this development is the first step towards getting decent coverage for eating disorders. I encourage parents and professionals who are fighting insurance company to reference the Aetna lawsuit. Peace, Marcia

Dear Readers,

My freelance writing has taken me lately into research on orthorexia, a topic that Marcia addressed a little while back in one of her posts. Described as a “fixation on righteous eating,” orthorexia is a condition where obsession with eating healthily becomes so extreme that it leaves no room for other interests or activities and can imperil the sufferer’s health.

Sounds familiar, right? Marcia described it as a modern-day variant on anorexia. Another researcher I spoke to sees orthorexia as an amalgam of an eating disorder and its frequent partner condition, obsessive-compulsive disorder (OCD). The term “orthorexia” is not in the Bible of mental illnesses, the DSM (Diagnostic and Statistical Manual of Mental Disorders), so is not recognized by the psychiatric community as an eating disorder or any other type of mental illness. So we are relying on the definition of the man who first coined the term back in 1997,  Steven Bratman, M.D.,  who described what he saw: people not motivated by a desire to lose weight, but by the desire to become as healthy and “pure” as possible.

But once you starting talking to eating disorders professionals who have seen these so-called “orthorexics” first hand, it appears that as Marcia surmised, things aren’t so clear cut. Marcia told me, “We’re seeing a lof of kids falling into this type of dangerous eating  and parents are missing it because it looks like their child is interested in becoming more healthy. Almost always these kids are vegetarian. There are a number of studies about the higher risk of eating disorders among vegetarians, and declaring one is vegetarian often precedes the diagnosis of an eating disorder.”

 Marcia also noted that often she sees patients like these striving to elevate their vegetarianism into veganism, an even higher level of self-denial.

So can someone who fits the orthorexic profile so clearly also want to lose weight, counter to Dr. Bratman’s definition of the condition? 

“I have not seen a young teenager where there isn’t an eating disorder lurking in all this,” declares Marcia. Among adults, she adds, it can be harder to tease out the eating-disordered component in the orthorexia because the “healthy behaviors” are so ingrained in the person’s life that it has become the norm for them.

Marcia often hears the refrain “I didn’t mean to lose all this weight!” from her patients. When she hears this, she always asks herself, “Is the healthy eating/vegetarianism/veganism/raw foodism/ a cover for an eating disorder?” She explains, “It’s hard to find a woman who doesn’t feel reinforced by the culture because she is thin.”  I suspect the same goes for many men who suddenly find they are thinner as a result of a new and obsessive interest in “healthy eating.”Let us know your thoughts on this topic!

Take care,

Nancy