Last week I had the opportunity to attend and present at the Eating Disorders Association of Canada (EDAC-ATAC) Biennial Conference in Vancouver, BC. I was presenting part of my Masters thesis, which felt great. I always love talking to clinicians in the field, and I found that this was a very practical and applied-focused conference.
I sometimes feel like somewhat of an outsider at eating disorders conferences as I am “research only”- I do not have the credentials to counsel or treat individuals with eating disorders. However, I felt quite welcome at this conference. People were quite willing to engage with a relative newbie, in typical Canadian fashion.
If you follow me on Twitter, you’ll have noticed that I was tweeting up a storm. You might also have noticed that I was one of the only people doing so. I learned that this association is relatively new, in its present incarnation. EDAC-ATAC held its first large gathering in 2008, which is not all that long ago, which I actually found quite alarming. It might also explain the lack of social media presence! All this to say, if you like reading tweets about conferences, the hashtag is #edac14.
It seemed that most conference attendees were from BC, Ontario, and Quebec, with some representation from Nova Scotia and Alberta. Of course, not all those doing work with individuals with eating disorders across the country were in attendance, but I was still struck by the lack of representation from the territories in particular, as well as some of the Atlantic provinces like PEI and New Brunswick. One of the challenges we face in Canada is our enormous geography, which has implications for establishing consistent treatment approaches, protocols, and even just the logistics of meeting up as a large group.
To put things into context, the flight from Toronto to Vancouver was a) only about an hour shorter and b) more expensive than an upcoming flight to Dublin this November. Thinking about the fact that I could attend due to my privilege of being a funded PhD student, the time and expense of the journey puts me in mind of how difficult it can be to access appropriate support in such a large country where services tend to be centralized in Ontario and in the West.
Slight digression aside, I thought it might be a good idea to contextualize my tweets against a more coherent reflective piece about the conference. I’d like to share some highlights and invite discussion about a few ideas raised at the conference. If you’d like to see my presentation slides, you can access those here, and I’d be happy to talk about my presentation, too!
PRAGMATISM AND CRITICALITY
Overall, I was struck by the pragmatism throughout the conference, and found critical perspectives to be better represented than they were at ICED. There was quite a strong focus on prevention, as well. The first keynote, by Dr. Dianne Neumark-Sztainer, addressed the history, present, and future of prevention; there were also a few workshop sessions about prevention by Jackie Grandy from NEDIC and Dr. Shelly Russell-Mayhew from the University of Calgary.
Dr. Neumark-Sztainer’s presentation intrigued me. At one point near the beginning of the talk, she mentioned that one way forward in prevention was to work on dissemination while avoiding corporatization. I think this, though mentioned somewhat in passing, is a key point. When working to roll out prevention programs, how can we avoid eating disorder prevention and positive body image promotion becoming yet another way to sell products? There are several companies which seem to (sometimes quite paradoxically) use messages of “love your body” to become more sympathetic to consumers and, resultantly, become more popular as brands. While I’m not saying that these aren’t good messages to have in the public sphere amidst all of the body negativity we encounter on a daily basis, they can at times seem like a hollow promise, particularly when what is being sold is a thinly-veiled diet (I’m looking at you, Special K).
Getting back to the focus on prevention, I found it interesting that so many sessions focused on prevention, given that we still debate whether prevention is possible. Presenters advocated for:
- System-wide approaches, looking beyond changes in individuals to address family, school, and broader sociocultural contexts
- Avoiding weight stigma when planning and implementing prevention programs, for example by targeting weight-based bullying in school contexts
- Designing messages that are aimed not to “shock and terrify” but to inform and provide resources for support
- Starting prevention earlier rather than later
- Being cautious in how messages are presented to avoid blame and/or negative unintended consequences (for example, the perpetuation of the very behaviours that interventionists are trying to prevent)
Of course, I think these are worthwhile ways to approach prevention. While I am not incredibly optimistic about the possibility of prevention (particularly given the evidence we have about some immutable risk factors such as heritability), I do think that prevention messages done well have the potential to at the very least promote positive body image. As my friend Glen likes to say, “negative body image is never benign,” regardless of whether it actually leads to the development of an eating disorder.
So, am I convinced that prevention efforts can stop an eating disorder from developing? No. However, I’m becoming more convinced that prevention efforts might help to improve relationships with food, weight, and bodies. I will qualify this still more with a note that I think it is absolutely essential that we look more closely at how messages about food, bodies, and health are being transmitted in society in general and in schools in particular. Shelly Russell-Mayhew remarked upon the lack of curricula for teachers that explicitly address how to deliver health curricula in a non weight-stigmatizing way.
She noted that this is especially concerning given that teachers may come into the classroom with weight biases of their own (Yager & O’Dea have also written about this, here). She also highlighted how addressing eating disorders in grade 8 or 9 might already be too late, given the social milieu we live in where weight becomes a distraction away from what we’re really talking about when we’re talking about health. I was also pleased to see that she noted, in all the consideration of how to combine eating disorder and obesity prevention (something about which I’ve historically been quite skeptical), that weight is not a behaviour and so should not be treated as such in prevention programs. I wanted to leap out of my seat and cheer.
One of my favourite presentations of the conference was from Elise and Sally of “We Bite Back,” an online peer support forum. These women do not identify as academics or clinicians, but are individuals with lived experience who moderate a community designed to be supportive in recovery without judgment. I found the presentation refreshing perhaps for the very reason that it was different: the speakers cited research, but their presentation was not about research per se.
Instead, they highlighted the strategies they and their members and moderators use to provide an online space where those at various stages of recovery can go to access supportive others. They were pragmatic about the potential downfalls of peer support approaches, which was also welcome, particularly when we think about the audience at the conference- likely 90% clinicians.
I don’t want to turn this post into a “sell” for the need to research and fund these kinds of programs, but I was honestly very impressed with the presentation and think that this kind of support needs further investigation. I particularly appreciated the balanced perspective the presenters offered on what purpose pro-ana sites serve and why it might be a bad idea to ban these outright. This put me in mind of the posts Tetyana has written about pro-ana (here and here) and the one I wrote about males in pro-ana sites.
In a sense, We Bite Back offers an alternative to pro-ana that allows people to be where they are in their eating disorder or recovery in a way that allows people to decide where they are in recovery and what is and is not triggering to them. One thing that I found particularly intriguing about their approach and how much they allow members to self-monitor is “whiting out” triggers (and adding trigger warnings) that prevents numbers from being immediately visible but allows them to be seen if the user wants to see them.
The respect for autonomy there is really interesting; I also think that this approach helps to avoid the complete sheltering against triggers which can be unrealistic “out in the world” where potential (and sometimes unexpected) triggers can bombard us.
CLINICAL PRACTICE GUIDELINES
Another focus of the conference was whether we could conceivably develop clinical practice guidelines for eating disorders across Canada. While the American Psychiatric Association (APA) offers guidelines for level of care, speakers like Dr. Josie Gellar complicated the picture of where motivation and medical acuity meet to determine what level of care might be best for an individual with an eating disorder. Again, I was struck by how the individual with an eating disorder was at the centre of her discussion.
This was the first time I had heard clinicians talk about using a quality of life or harm-reduction oriented approach in certain cases. I’ve seen this a little bit in the literature, for example in approaches for severe and enduring anorexia and in the case of a recovery model which complicates what it means to be well beyond symptom remission. It was great to see Dr. Gellar and others critically explore whether “motivation” is really a good marker of the level of care someone might need or want.
In the same panel, Dr. Blake Woodside remarked on the potential difficulties associated with establishing a panel for clinical practice guidelines. I was pleased again to see pragmatism, here: he talked about the need to balance interests and be aware of the biases (financial and otherwise) that people bring to the table that might drive their decisions. He also noted that panels of this sort rarely include patient and family voices- I would love to see this change, and if a panel were to be established to determine clinical practice guidelines I think it would be amazing to see at least some representation from people with lived experience.
Finally, Dr. Leora Pinhas reflected on how we need to be more clear about what we’re talking about when we toss around words like “family-based treatment” or “patient-centered care.” She also noted that currently, many individuals with eating disorders (between 67-83%, she said) are not having their needs met. She noted that meeting medical needs is much easier than meeting other needs, and that we should think critically about whether people are getting the best treatment for them or just what is on offer.
THE INDIVIDUAL AT THE CENTRE
Through all of these presentations (and others that I enjoyed but would mean this post would be even longer than it already is…) I noticed such a strong thread of the individual at the centre. I really felt as though most of these clinicians were taking seriously a commitment to providing the best possible care to as many patients as possible, and in innovative ways where possible.
On a more discouraging note, these kinds of conferences always remind me of how far we have to go. The fact that we are still sending people across the country to seek care is alarming; also, though the conference was sizeable, the total number of treatment centres and options in the country seem quite low when you think about the size of the country and the complex needs of diverse individuals. I am also always continually struck by the lacking presence of certain parts of our country, as I mentioned earlier.
Overall, I felt like I learned a lot at this conference and met some amazing and committed clinicians. I hope that this summary has been in some way helpful; if you would like any more information about any of the points I would be happy to discuss in the comments!