Walking a Mile in Your Shoes: Treating Eating Disorders with a Personal History of Eating Problems

Andrea 9 Comments

A big topic at ICED, and one that seems to continually resurface, is treatment professionals in recovery. One the one hand, many see healthcare professionals with a history of eating disorders as possessing a kind of empathy that may be inaccessible to those who have not “been there.” On the other, some argue that this history complicates the patient-professional relationship in potentially detrimental ways.

You’ll find proponents of both sides of this debate from both professional and patient communities, and there are compelling arguments to be made on both sides of the coin. As an eating disorder researcher with a history of eating disorders, I don’t think you will be surprised that I lean toward the “it’s totally fine” side of the debate.

One thing that stood out to me about the larger discussion on this topic at the conference, however, was how we need to be careful about not … Continue reading →

Gendering the Pro-Anorexia Paradox: Men in Pro-Ana Spaces

Andrea 12 Comments

When someone says “pro-ana,” what comes to mind? Likely, given the strong reactions pro-anorexia websites provoke, you may be able to conjure up an image of what would take place in such a forum. Thoughts of “thinspiration,” emaciated and waif-like images, and starving tips likely spring to mind, alongside considerations of the dangers of a community that would encourage behaviors that can be very harmful to health.

I’d venture to say that it is unlikely that you have pictured a man participating in these sites. Given that we know that men get eating disorders too, and that they may feel alienated in their struggles, is it surprising that some might seek out online communities, including pro-ana?

As Tetyana noted in previous posts on pro-ana (here and here), these sites can serve a harm reduction purpose and/or provide a space for sufferers to openly and honestly share their struggles … Continue reading →

Hypermetabolism in Anorexia Nervosa

Tetyana 21 Comments

Weight restoration is a crucial component of anorexia nervosa treatment. It is a challenging process for a multitude of reasons. Adding to the complexity and the challenge is the fact that during weight restoration, individuals with anorexia nervosa tend to require increasingly more calories to maintain the same rate of weight gain.

That is, individuals need to continually increase their caloric intake, in steps, sometimes upwards of 100 calories (technically, kilocalories) per kilogram per day, to continue gaining weight. For instance, an individual weighing 45 kg may need to eat 4,500+ calories to continue gaining 1-1.5kg (2.2-3.3lbs) a week. Indeed, studies have found that standard resting energy expenditure (REE) equations tend to overestimate caloric needs at the beginning of refeeding but underestimate them in the later stages (Forman-Hoffmann et al. 2006; Krahn et al., 1993).

After achieving a healthy weight, individuals recovering from anorexia nervosa still typically need to … Continue reading →

Political Bodies: What is the Impact of National or Regional-Level Eating Disorder Prevention?

Andrea 1 Comment

When it comes to prevention, I’ve noticed a strong interest in working toward large-scale prevention initiatives. I’ve written about prevention before, noting the potential for unintended effects, as well as schoolgirls’ reactions to and acceptance of prevention interventions (here). But what about the larger scale efforts to prevent body image concerns and eating disorders?

Countries from the US to Australia to Israel have taken strides to implement initiatives aimed at improving national body image (a lofty goal? Perhaps.); you might have heard about bans on thin runway models and airbrushing, among other efforts. We know that eating disorders are not solely caused by thin-ideal internalization or bad body image; in fact, body image might not even be that useful of a concept for everyone, as I wrote about here.

However, improving body satisfaction could be a useful end goal in and of itself. Why not … Continue reading →

Polar Opposites? The Social Construction of Bulimia and Anorexia Nervosa

Andrea 10 Comments

Some might argue that bulimia nervosa is more “hidden” than anorexia nervosa — it is not always obvious that someone is suffering from bulimia (though, I would argue, it is not always obvious that someone is suffering from any eating disorder). Even when it is “discovered,” BN is often placed in opposition with AN — as if the two were polar opposites.

Indeed, attempts to define a phenotype (a set of observable traits or characteristics) for AN and BN tend to oppose the two and to suggest that the people who develop AN are inherently different from those who develop BN. While I believe there is some scientific evidence for personality differences between the two, the degree of diagnostic crossover and symptom variability in eating disorders makes me feel like this split is at the very least overly simplistic.

What is interesting is how BN has come to occupy a … Continue reading →

Energy Expenditure in Anorexia Nervosa Patients

Tetyana 7 Comments

How many calories do patients with anorexia nervosa need to eat to gain a kilo (2.2 lbs)? It seems like a simple question and one that we should have figured out a long time ago, given the importance (err, necessity) of refeeding and weight restoration in recovery from anorexia nervosa.

Unfortunately, research in this area has often led to contradictory results (see Salisbury et al., 1995 and de Zwaan et al., 2002 for reviews). Fortunately, a paper by Stephan Zipfel and colleagues (2013, freely available here) sheds light on one potential cause of the discrepancies.

But first, some definitions:

TDEE stands for total daily energy expenditure. TDEE has three components: resting energy expenditure (REE), dietary-induced thermogenesis (DIT), and activity-induced thermogenesis (AIT). The gold standard for measuring TDEE is through something called the doubly labelled water technique. REE is usually measured through indirect calorimetry. (These techniques were used in this … Continue reading →

Disordered Eating and Athletic Performance: Where’s the Line?

Emma 4 Comments

If a person severely restricts his diet and exercises for hours each day, he has an eating disorder. If another does exactly the same but it is because she wants to make the lightweight rowing team (which has an upper weight limit), she’s a committed athlete. When the two overlap, and an athlete presents with eating disorder symptoms, how do we distinguish between the demands of the sport and the illness?

I’ve been interested in the distinctions we make between disordered and non-disordered eating and exercise behaviours for a while now. Recently, when I was browsing through articles, I came across a literature review by Werner et al. (2013) (open access) of studies examining weight-control and disordered eating behaviours in young athletes.

The authors start by noting the sheer lack of research that has actually been done in this area. This is worrying: typical onset of eating disorders is during … Continue reading →

Reflecting on the 2014 International Conference on Eating Disorders

Andrea 1 Comment

Tetyana’s Note: Instead of writing two separate posts, I’ve decided to interject and add my own thoughts/opinions to Andrea’s post. For one, I think this will reduce repetition and I think it will be better to have any differing opinions in one place (I think this will facilitate discussion, I hope).  I will clearly mark my own comments so that they are not for conflated with Andrea’s. If I don’t comment it is because I wasn’t there, have nothing to add, or completely agree and thus have nothing/little to add. Admittedly, I’m going to focus more on things I didn’t like because I think it is important to talk about how the field can improve. – Tetyana

I am finally writing down some thoughts and reflections from ICED after taking a week to marinate on the proceedings and to grade a lot of papers. I love going to conferences — … Continue reading →

For the Health of It: Disentangling “Healthy Eating” and “Orthorexia”

Andrea 14 Comments

When is “healthy eating” not so healthy? The line between “normal” and “pathological” eating behaviours is blurry, to say the least. For some time, researchers have been attempting to define a “new” category of eating disorders: orthorexia. This category would capture “obsessions” with “healthy eating” that are (presumably) not already captured in current diagnostic criteria for eating disorders.

If you’ve been reading my posts for a while, you might already know how I feel about the liberal sprinkling of the suffix “orexia” onto behaviours related to food, exercise and body image (see, for example, my post on “drunkorexia”). The problematics of language use and eating disorders are numerous; we tend to use diagnoses as currency in discussing eating disorders, often glossing over the intricacies of behaviours with food and exercise by lumping them into (continually shifting) diagnostic criteria.

Of course, labeling is necessary to a certain extent. Diagnoses can help … Continue reading →

Good Clinicians, Helpful Comments, & Unpopular Opinions: SEDs Readers' Responses – Part II

Tetyana 5 Comments

A few weeks ago, I asked SEDs readers a bunch of questions about their experiences with an eating disorder. Then, pretending to be a qualitative researcher, I went through the answers to see if I could find trends. I blogged about people’s responses to the first half of the question here; this post will be about the second half of the questions. (Here’s a ED survey results – Parts I and II to the pdf with all of the raw data).

Please note that this analysis was not rigorous, so in grouping and identifying themes (or how many times a theme/word was mentioned), I will use words like “approximately.”

[The breakdown for the last half of the respondents is:

6. What are characteristics of good eating disorder clinicians?

By far the two most comment themes, mentioned ~13 times each were “understanding” and variations of “willing to challenge,” “confront,” and … Continue reading →