On the Efficacy of Self-Induced Vomiting (Purging)

A single in-lab assessment of caloric consumption, loss, and retention during binge-purge episodes in individuals with bulimia nervosa (BN) is frequently cited as evidence that purging via self-induced vomiting is an ineffective strategy for calorie disposal and weight control (Kaye, Weltzin, Hsu, McConaha, & Bolton, 1993). These findings have been widely interpreted to mean that, on average, purging  rids the body of only about half of the calories consumed, regardless of total quantity.

However, a closer examination of the study does NOT support the notion that purging is an ineffective compensatory behavior. Indeed, the findings of Kaye et al. (1993) would appear to have been both misunderstood and overgeneralized in the subsequent decades. This has important implications for therapeutic alliance in clinical practice as well as for understanding the nature of symptoms, metabolic processes, and physiological alterations in EDs.

THE STUDY

The study included 17 individuals, all of … Continue reading →

Thinking Critically to Move Forward: Reflections on the International Conference on Eating Disorders 2016

For those of you who follow me on Twitter, you may have noticed that I was at the International Conference on Eating Disorders (ICED), the major yearly conference put on by the Academy for Eating Disorders, over the past few days. As I write this post, I am sitting in the San Francisco Airport trying to synthesize my experiences into what may or may not turn into an epic blog post.

Despite my extreme extroversion on the Internet, I actually live in a funny place where I’m continually balancing my innate criticality and training as critical health psychology graduate student with the desire for folks to like me. I see this playing out at conferences like ICED, where people’s opinions of me and my fitness to do this work matter. I am unable to sit in a session and not voice my perspectives on Twitter, but I’m also continually filtering … Continue reading →

Reflections on the Weight Stigma Conference 2016

I’ve set myself a bit of an unrealistic conference schedule this year; with that in mind, I thought that if I’m going to write conference recaps at all, I had better do them immediately. Otherwise, I’m likely to forget where I heard a little gem or misattribute some brilliance – can you think of anything worse than misattributed brilliance? (I’m sure you can.)

This week I had the pleasure of attending the 4th annual Weight Stigma Conference in Vancouver, BC. As I write this, I’m still sitting staring at the beautiful mix of mountains and beaches that makes Vancouver a spectacular place to conference. I was also – in the interest of full disclosure around my largely positive views of the conference – on the organizing committee for the conference. I will say, though, that I don’t think my opinion would be different had I not had some say … Continue reading →

Whose Culture is it Anyway? Disentangling Culture and Eating Disorders – Part 6

I thought about writing a post about the factor structure of popular eating disorder scales to celebrate my completion of an advanced statistics course in structural equation modelling. When I sat down to read some articles about that, though, I found myself side-tracked– and thoroughly uninterested in deconstructing scale psychometrics. So with a promise to do that at some point, I return to a favourite topic of mine: culture and eating disorders.

When I was writing about culture and eating disorders for the blog last year, I received quite a few requests for articles about eating disorders in developing countries. I suspect that the desire for this kind of article stems from a need to highlight (for the doubters) that eating disorders are serious mental health issues that can impact anyone who is predisposed, regardless of whether they live in a media-saturated landscape or not. As I noted in the … Continue reading →

Many Types of Expertise: Recovered Therapists Reflecting on Recovery

Lately, I’ve been hearing a lot of noise in the social media sphere about whether or not those who have recovered from eating disorders should be treating eating disorders. Some have come out on the side of saying definitely not, listing reasons like the potential for bias, countertransference (the therapist making assumptions about clients’ emotions/experiences) or triggering. Others suggest that therapists who have “been there” can empathize with patients in a way that those who have not struggled with food cannot approximate.

Tetyana blogged about the lifetime prevalence of eating disorder professionals in recovery in 2013; she wrote about a 2002 study that revealed that around 33% of women and 2% of men treating eating disorders had a history of an eating disorder themselves. I have also written on the subject before (here); I focused on a 2013 study looking at experiences that recovered clinicians held in common.… Continue reading →

Whose Weight Are You Watching? Schools, Surveillance, and Eating Disorder Prevention

Health class in school is an experience few of us would like to repeat, I’m sure. Though it’s been a good many years since I was subjected to the joys of health education, I continue to think about the types of lessons I had, particularly about eating disorders, and how lacking these were. I can only imagine that things have gotten progressively worse with the focus on the “obesity epidemic” that is so pervasive today.

In one of my favourite articles ever, Pinhas et al. (2013) outline some issues with healthy curricula related to “healthy eating” in schools in the wake of obesity rhetoric. These include:

  • The simplistic “energy in, energy out” message can be highly problematic for some children, who may take this to mean they need to engage in restrictive behaviours
  • Without addressing weight stigmatization in schools, messages about health hold little purchase, and tend to
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What Are You Re-covering? Critical Conversations About Eating Disorder Recovery

As usually happens, when I spill my brain out onto Twitter I end up having some minor (or, let’s face it, major) discussions and disagreements with other Twitterites. It’s both a wonderful and a stressful experience, in part because one of the hazards of the medium is its rapid-fire and protracted style. Inevitably, discussions lose their nuance and some of what I am advocating for gets lost in the ether.

The latest discussion centered around recovery and how it is portrayed in the literature. I’ve been working on a meta-analysis of recovery studies, and commented that I was tired of the way that researchers tend to write about recovery as “becoming whole” or finding oneself. Because I am a critical researcher and a generally squeaky wheel, and based on some research I’ve done, I question whether this framing is helpful for all of those who have recovered/are in recovery/want to … Continue reading →

Bariatric Surgery and Eating Disorders: A Double-Edged Sword

The high prevalence of eating pathology prior to bariatric surgery reduces the likelihood of what researchers have termed “optimal” weight loss post surgery. However, such weight loss is in part due to post-surgical complications like “dumping” (rapid gastric emptying because digestive systems cannot process the food) or vomiting that can develop into conscious efforts to lose weight. Conceicao et al. (2013a) describe, for example, one patient who deliberately binged and purged on foods that would make her vomit spontaneously.

These kinds of results raise a number of questions:

  • How prevalent are eating disorders (EDs) post-bariatric surgery?
  • What are the risk factors for developing an ED?
  • To what extent is the surgery itself a potential trigger?

PREVALENCE OF DISORDERED EATING AMONG INDIVIDUALS SEEKING BARIATRIC SURVERY

Researchers interested in bariatric surgery have explored how often those seeking bariatric surgery engage in disordered eating or have EDs. Prevalence rates vary between studies depending … Continue reading →

Let’s Talk about Systems Level Change for Eating Disorders

This past Wednesday, January 27th, was Bell Let’s Talk day in Canada. In case you’re unfamiliar with the campaign, Bell Canada (a telecom company) donates 5 cents to mental health awareness initiatives for every social media post or text with the hashtag #BellLetsTalk. In general, the campaign has been lauded for its contribution to decreasing shame and stigma around mental illness, which is awesome. There are a number of critics, though, who point out that:

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Finding What You’re Looking For? Exploring the Eating Disorder Examination Questionnaire

If you’ve ever been assessed for an eating disorder in a clinical setting, there is a good chance you’ve completed the Eating Disorder Examination Questionnaire (EDE-Q). The EDE–Q is a self-report questionnaire widely used in ED assessment and research. Clinicians and researchers calculate several different scores from patient or participant responses to the questionnaire:

  • A score on the global scale, which provides a measure of the severity of ED psychopathology
  • 4 sub-scales: eating restraint, eating concern, weight concern and shape concern

There are a number of cut-off scores that can be used to distinguish between clinically significant and non-significant cases. In this post, I will look at a few papers critiquing the use of the EDE-Q in clinical and research settings.

BACKGROUND

The EDE-Q was originally developed as an assessment tool for bulimia nervosa and binge eating and contains few, if any, questions that specifically assess anorexia nervosa symptomology. … Continue reading →