12/28/17

A Parent Primer for First-Time Eating Disorder Diagnosis

This time of year is a common one for high school and college students to first be diagnosed with an eating disorder. The stress of the end of the first semester of a new school year can exacerbate already existing tendencies to turn to food for comfort and lead to a true disorder. For college students being on their own for the first time is also a reason for the descent into more severe eating behaviors.

Families now confronted with getting help for their child can be overwhelmed by the maze of treatment and the confounding task of getting adequate help for a sick child.

The first step for any family is to find a trusted clinician knowledgeable about several components of these illnesses. The person must be versed in the diagnosis of an eating disorder, capable of assessing the severity of the symptoms, connected enough to assemble a team and aware of the positives and negatives of all treatment modalities.

Beware of practitioners who solely urge one form of treatment, especially if that option is a hospital or residential treatment program. That choice can frequently be best for someone newly diagnosed, but the proliferation and directed marketing of new programs can influence clinical decisions and cloud clinical judgment.

Programs can lead to quick return of adequate nutrition but also can trigger a quick relapse for two reasons. The first is that programs tacitly promise an immediate cure. Without a treatment team back home, it is easy to turn to the residential program for guidance even after discharge and not find ways to reconnect with the world. Second, patients can wish to relapse to return to the safety provided by living in a caring and nurturing bubble protected from the stress of life. Instead of getting better, it perpetuates the desire to hide away from the difficult obstacles of recovery ahead.

The important step as a family is to assemble a treatment team of experienced clinicians whom the family can trust. Even if that team quickly decides upon residential treatment, the family can focus efforts on recovery in the real world. Any inpatient setting is only a stopover to improve nutritional status and health, not a place for full recovery. The family can also turn to the team for support and ensure the primary support is accessible in daily life and not just the duration of a residential stay.


Last it is important to know full recovery is the goal and very attainable. The myth that no one gets better from an eating disorder is pervasive in our society. Getting the right help for the patient, learning about how to provide family support and coming together as a family all are crucial to help the child get well.

12/14/17

The Ill-Fated Merger of Finance and Eating Disorder Treatment

As more financial investment pours into the eating disorder residential treatment industry, it is a relief to know there are more options for patients who need intensive help. However, clinicians are left with several questions and concerns about the intention and skill of these centers. 

The first pressing question is the effect on the quality of treatment when financial personnel run a sensitive and challenging clinical endeavor. The quick proliferation of treatment centers means hiring and training of less experienced people hastily in order to staff new programs quickly. Clearly, this can affect the quality of treatment.

Second, it’s very possible that the bottom line will lead to sacrifices of the more nuanced and crucial aspects of treatment that distinguish an excellent program from one that checks all the boxes of an adequate one. Focusing on running a business successfully is often at odds with clinical care. 

Third, the expansion of marketing of these programs may very well attempt to convince clinicians to utilize residential programs when other clinical options are preferable. The treatment community has to be reflective enough not to be swayed by shiny new promotional materials. What’s best for the patient must remain paramount. 

It’s concerning that the influx of money and power may very well corrupt a clinical endeavor driven by passion and determination to serve a community of sick people not treated well by the medical establishment. The likelihood is that savvy investors will capitalize on access to funds from a wealthy constituency willing to pay for treatment at the places deemed the best. 


The most insidious result of the newfound changes in the eating disorder residential treatment industry is the increased admission of adolescents to programs. Although some teenagers get very sick, many kids first diagnosed can recover quickly when families initially become aware of the problem. However, these kids are so susceptible to experiences and their egos are still so malleable that immediate long term care as a first line defense may very well set them up for a longer course of illness. I’ll expand on this idea in the next post.

12/8/17

The Truth about Nutrition Labels



Understanding why nutrition labels became ubiquitous has to start with a brief history lesson. One of the reasons urban areas could grow so quickly in the mid-twentieth century was the increased availability of mass produced food. At the time, packaged foods and the concomitant ease of food shopping seemed like a wonder of the modern world.

However, the change in the types of food available to the masses also included diets largely consisting of processed foods, a completely new food group for people to eat. Medical data over time started to show the detrimental effects of manmade foods such as margarine and how the increased salt or sugar intake of processed foods has long term health effects. Regular foods don’t have the same ingredients, ease of digestibility or addictive quality of processed foods, and our bodies react very differently to these foods. 

Once medicine brought to light the risks of processed food, government regulation moved in to try to slow down the exploding food industry. One result was the suggestion of dietary recommendations, the food pyramid (recently replaced by the food plate) and mandatory nutrition labels on packaged foods. Granted, the food industry lobbies have altered the government recommendations, yet there is still a component of the federal guidelines meant to inform and protect the population.

What the government regulators have struggled to incorporate is the drive for thinness and pressure of the diet and, more recently, exercise industries which use nutrition labels to their own advantage. The labels were meant to be guidelines that would help consumers recognize foods made with chemicals or with hidden calories from factory processing. Instead, labels and serving sizes enable people at the mercy of the drive for thinness to justify restricting their food intake and feel compelled to constantly diet.

The other confounding factor has the been the overemphasis of weight in the government regulation of food. The data about weight and health is very limited, yet diet and exercise industry representatives continue to help urge the public to be scared of weight gain even though chronic dieting is an equal if not more insidious aspect of modern life. Chronic dieting is the cornerstone of eating disorders, disordered eating and our collective obsession with weight and food as I explained in detail in a previous post.

The sole purpose of nutrition labels is to recognize foods as more or less processed and help people identify foods that are more real. In today’s world, it’s impossible to avoid some processed food and there is no evidence that eliminating all processed foods is necessary. The goal of a balanced diet is moderation and variety of all things.


However, there is no use in obsessively reading labels to determine how many macronutrients one eats in a day, a normal serving size or for calorie counting. The regulations around nutrition labels allow so much room for error that these data are useless for any individual dietary choices and only serve to confuse the true reason label became a federal regulation in the first place.