Is The Doctor In? Eating Disorders Training Amongst Medical Professionals — Part 3

The thing about critiquing systemic issues like lacking training environments for medical professionals (and others) is that we have to be cautious to not place undue blame on those who are stuck immobilized between the desire to a) train or b) get training in eating disorders. If the solution to the egregious lack of training was simple, I feel sure that someone would have done it already! What I am gesturing at, here, is that the reasons behind lacking training opportunities are deeply rooted in socio-political, historical, and economic trends and policies. Those providing training and those seeking training do not exist in some glorious black hole devoid of austerity (frugalness, restrainedness) and neoliberalism.

In this post I’ll focus on a few studies that help to illuminate why these gaps in training might exist, including dominant sentiments (in the general public, in government, in training environments themselves) toward eating disorders. … Continue reading →

Energy Expenditure in Anorexia Nervosa Patients

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 … Continue reading →

The Sobering Reality (and the Silver Lining) of Treating Anorexia Nervosa in Adults: A Randomised Controlled Trial

The challenges of treating anorexia nervosa are plenty; some of these challenges — like low prevalence rate and high treatment dropout rate —  make conducting randomised controlled trials aimed at identifying effective treatment methods really hard as well.

So I was pretty excited about the recently published randomised controlled trial comparing focal psychodynamic therapy (FPT), cognitive behaviour therapy (CBT), and optimised treatment as usual in adult (a harder to treat demographic than adolescents) anorexia nervosa patients.

Reading the paper, I was pretty impressed with how good the study design was; I’m not going to go into all the nitty-gritty details, but if you have access to and the chance to read the paper, do it. You’ll appreciate, I think, the amount of effort that went into this.


Patients were recruited from ten universities across Germany. They had to be adult females with a BMI between 15-18 and with … Continue reading →

The Art of Therapy: Using of Arts-Based Therapies in Eating Disorder Treatment

Arts-based therapies are often used to supplement more “traditional” eating disorder treatment protocols in various different settings, ranging from individual therapy to inpatient units. However, as Frisch, Franko & Herzog (2006) note, no published research provides empirical support for the use of arts-based therapies for eating disorder treatment.

You might be wondering: if there is no empirical support, why are clinicians still using these therapeutic practices? You might also be wondering why I’ve chosen to dissect an article from 2006.

I’ll address the first question in this post (teaser: it’s really hard to say!). As for my delving back into the depths of academia, there is surprisingly little literature that touches on arts-based therapy, despite its continued use. This article provides an overview of why this might be, and where we can go from here.


Arts therapy is an umbrella term used to refer … Continue reading →

Calorie Restriction, Anorexia Nervosa, and Memory Gaps

This post has been translated into Russian by Polina here.

I have often heard anorexia nervosa sufferers complain of “memory gaps,” particularly during the times they were really sick. As if they weren’t really there.  It can be scary and unnerving, to say the least. A few months ago, a Tumblr user asked me about this:

Hi Tetyana, I’m not sure if this is merely based on my own subjective experience of if there is any grounding at all, but I was wondering if there could perhaps be a link between EDs and a sort of memory loss. It’s hard to describe but I definitely seem to have huge “gaps” in my memory of during that time, as if I selectively block things out. I have limited inaccurate knowledge with regards to memory on a molecular/neurological basis so I do not know if there’s anything there. Perhaps with calorie

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Can Puberty Affect the Development of Eating Disorders?

Eating disorders typically begin in adolescence. One common explanation for this is that during adolescence females are increasingly exposed to the media, thin models, and dieting. While this is probably true to some extent, it doesn’t explain why the rates of eating disorders are quite low despite the high levels of exposure to thin models in the media. Out of 100 girls, only a handful develop eating disorders, yet all of them are exposed to the same magazines and TV shows.

This means there must be some other factors that differ between this group of girls. One hypothesis is that hormonal changes during puberty may modulate the genetic risk factors for eating disorders. These changes may “turn on” genes that predispose individuals to eating disorders. Previous research has shown that genetic factors modulate disordered eating (eating disorders have a high heritability), but how? What are the mechanisms of this … Continue reading →

Should Anorexia Nervosa Patients Get the Flu Shot?

Is getting the flu shot a good idea if you have anorexia nervosa? Is it safe?

To be honest, I’ve never asked myself that question before. Last year, when I was underweight, I got a flu shot mainly because the laboratory where I am doing my graduate degree is in a hospital–the same hospital that was at the centre of the SARS epidemic in Toronto–and I didn’t want to put patients at risk. Sure, I spent most of my time staring at worms through a microscope (true story) but in the rare event I ventured outside for a coffee, I didn’t want to cough on newborn.

So I was kind of excited to find out the answer when someone asked me this question earlier today on tumblr. As expected, I didn’t find much information, but I did find one relevant paper published online in 2011 by Arne Zastrow and … Continue reading →

Should Insurance Companies Cover Residential Treatment for Eating Disorders?

Should insurance companies cover residential treatment for eating disorders?  The price tag is high, about $1,000/day on average, but evidence of treatment effectiveness  is astonishingly low. Practically nil, as I’ve recently discovered. Despite spending my free time punching away different keywords into the PubMed search bar, I came up with very little. And you know what I think? I think treatment centers should be embarrassed. And I think, wow, maybe insurance companies have a point? (A scary thought! I don’t actually think they do, though – but then, I just can’t wrap my head around for-profit healthcare, having lived all my life with socialized healthcare, and loving it.)

Carrie over at ED-Bites recently blogged about the fact that there a dearth of evidence-based treatment for eating disorders. It is a complicated issue, I know, but I do think that any organization or center that offers treatment (especially … Continue reading →

Who Gets Treatment? Your Ethnicity Matters

In 2010, I wrote a literature review on eating disorders in women of color in North America. I expected to find only a few articles on this subject – every lecture in my undergrad psychology classes, every piece of information targeted to the public, every discussion I had, it seemed, either omitted the existence of EDs in non-stereotypical (white, female, heterosexual, adolescent, upper/middle-class) populations altogether – or glossed over it with a footnote on “acculturation” that reductively attributed the disorder to a misguided desire to fit into the dominant culture, much as other women might aspire to look like the images of female bodies in mass media. (Acculturative stress is actually far more complex than this, and furthermore is not necessarily the sole or even the primary cause of EDs for all people of color.)

[Some people] think that I hate being Asian and want to look

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When Clinicians Do More Harm Than Good (Attitudes Toward Patients with Eating Disorders)

I was going to blog more about mortality rates in eating disorder patients, but recent ED-related deaths have left a bitter taste in my mouth (huge understatement). So, I’ve decided instead to write about a paper requested by the founder of The Joy Project on clinician reactions to patients with eating disorders by Thomspon-Brenner and colleagues that came out this year.

If you have an eating disorder or are close to someone with an eating disorder, you’ve likely heard many stories about dismissive or down-right negative and harmful attitudes that clinicians often have toward patients with EDs.

I’ve experienced it myself: I had to find another doctor to refer me to an outpatient clinic, because the first one didn’t – he didn’t think I needed help (probably because I was very aware that things were not heading in the right direction even before I was at a low weight). Needless … Continue reading →