New treatment enlists parents
Using parents as resources in treating anorexia nervosa is a radical new approach being taught at Wayne State Univesity. Conventional wisdom suggests that family conflict sets the stage for teenage eating disorders, so parents are usually counseled to allow teens to take charge of their own recovery. But since many are unable to do this, a growing number of therapists say specially trained parents may be the most effective cure.
   One group of 19 girls and their parents met jointly with therapists who put the parents in charge of their daughters' eating. In another group, 18 girls were treated in individual therapy sessions; their parents were counseled separately and told to give up cajoling or ordering their daughters to eat. Most girls in both groups responded well to treatment, and 70 percent reached target weight. But the girls whose parents were trained to oversee their food gained more weight and faster. One year later, even more of those girls had reached healthy weights.
   Parents spend hours each day with their daughter and, when properly trained, can monitor and guide the eating process, says Amy Baker Dennis, Ph.D., an assistant professor at Wayne State University Medical School. When a truce is called in the battle for control, they can help her surmount the hurdles she faces. Dennis cautions, however, that this approach won't work for all famlies, especially if parents have serious problems of their own. (Healthy Weight Journal 2000:14:5:66 / Proceedings 9th Intl Conf Eat Disorders, New York City, WebMD 5/4-7/00; Robin AL. J Am Acad Child Psychiatry. December 1999)

Early treatment critical in bulimia
In a follow-up study of 44 bulimic patients after an average of 9 years from diagnosis and treatment in a Louisiana university research clinic, about two-thirds were recovered. When treated during the first few years of illness, the probability of recovery was above 80 percent. But when diagnosis was delayed 15 years or more after onnset, the probability of recovery fell below 20 percent. Duration of bulimia nervosa was the only factor that predicted whether outcome was successful. The particpants estimated that they had spent an average of $25,164 for their psychiatric and medical treatment. The not-recovered patients had spent about $45,095, compared with $14,091 for those who recovered. The researchers conclude that early intervention is critical to recovery. (Healthy Weight Journal2000:14:4;51 / Reas DL, Williamson DA, Martin CK, et al. Duration of illness predicts outcome for bulimia nervosa: a long-term follow-up study. Int J Eat Disord 2000;27:428-434)

Disturbed eating for toddlers
   When do eating disturbances begin? Perhaps very early, even soon after birth, according to a study that followed a community sample of 216 newborns and their parents in the San Francisco Bay area from birth to 5 years. Mothers completed eating and body image scales, and each year answered questions related to their child's eating. Over the 5-year period the mother's reports indicated that 10 percent of the children showed inhibited eating, 18 percent secretive eating, 34 percent overeating, and 10 percent overeating-induced vomiting. Most had few episodes and only exhibited one behavior at a time. Risk increased annually through age 5, and did not differ by sex.
   Secretive eating by the child was related to mother's body dissatisfaction, disinhibition, and bulimic symptoms, as well as parental weight -- suggesting that perhaps a mother with secretive eating may model this for her child. Overeating was linked to maternal restraint and drive for thinness, perhaps suggesting that a mother's dieting and idealization of thinness may promote the child eating less than wanted, followed by overeating. Overall, a mother's body dissatisfaction, internalization of the thin ideal, dieting, bulimic symptoms, and maternal and paternal body mass predicted eating disturbances for the child. (Healthy Weight Journal 2000:14:3:34 / Stice E, Agras WS, Hammer LD. Risk factors for the emergence of childhood eating disturbances: a five-year prospective study. Int J Eat Disord 1999;26:375-387)

Fluid restriction in anorexia
   Anorexic patients often drink copiously so as to feel full or resist consuming calories. But others restrict fluids for weight control, although this is not often documented. In a study of seven fluid-restricting patients with very low hydration, researchers at the University of Sydney, in Australia, said once fluid restriction had begun it progressed rapidly, with patients refusing to drink anything with a few days. None voluntarily reported this fluid restriction, and all denied the symptoms of dehydration. In all cases, food restriction was severe prior to fluid restriction. In treatment, fluid intake was recommended before food intake.
   Two common reasons these patients gave for restricting fluid was that it made them feel bloated and they believe even water contains some calories, through its impurities. Restricting fluids give dieting-disordered patients a strong sense of control, the researcher report. They suggest that some anorexia patients may restrict food and fluid proportionately, citing animal studies that show when subjects are deprived of food, less water is consumed. Similarly, when the lab animals are deprived of water, less food is eaten. (Healthy Weight Journal 2000:14:3:34 / Lowinger K, Griffiths RA, Beumont PJV, et al. Fluid restriction in anorexia nervosa: a neglected symptom or new phenomenon? Int J Eat Disord 1999;26:392-296)

Anorexia marks steady increase
   A long-term trend of rising rates of anorexia nervosa is documented in a Rochester, Minn. study. During a period of 55 years, from 1935 to 1989, 193 female and 15 male community residents met the criteria for a first diagnosis of anorexia nervosa. The youngest was 10; the oldest, 57. Highest rates were between 1980 and 1984. In the next 5 years rates dropped slightly; however, the researchers say this was merely a short-term fluctuation and the overall trend has since continued upward. In the most vulnerable group, 15- to 24-year-old females, anorexia rose steadily throughout the 55 years.
   Overall, the incidence was 8.3 per 100,000 person-years. Estimated increase is 1.03 per 100,000 person-years for every calendar year. Some studies have failed to show an increase in eating disorders, but most are small and use incomplete data. The Rochester researchers use data which can be meaningfully integrated, since this area has long been a major medical center in which most residents are diagnosed locally. (Healthy Weight Journal 2000:14:3:35 / Lucas AR, Crowson CS, O'Fallon WM, Melton LJ. The ups and downs of anorexia nervosa. Int J Eat Disord 1999;26:397-405)
 

Eating disorders in female athletes
   College female athletes participating in judged sports are at a higher risk for eating disorders than women in refereed sports, according to a Louisiana State University study of 131 female students. The researchers looked at three groups: women in judged sports such as diving, cheerleading, and gymnastics; women in refereed sports such as tennis, basketball, volleyball, and track; and nonathletic women. They administered nine tests related to body image and eating disorders, including interviews and body measurements. Although the number diagnosed with eating disorders was too small for significant differences, the researchers found 13.5 percent of women in the judged sports had clinical eating disorders, compared with 3 percent in the refereed sports, and 3 percent of the nonathletic women. (Mean body mass index was about 22, and did not differ among the three groups.) The researchers conclude that being in a refereed sport may be protective against the female athlete triad. (Healthy Weight Journal 2000:14:2:19 / Zucker NL, Womble LG, Williamson DA, et al. Protective factors for eating disorder in female college athletes. Eat Disorders 1999;7:207-218)
 

Does dieting trigger bulimia?
   A drop in serotonin levels in the brain may trigger the symptoms of bulimia nervosa in vulnerable individuals, according to a study published in the February issue of the Arhives of General Psychiatry (pages 171-176). Even healthy but vulnerable women who diet may experience this drop in brain serotonin levels, which may set up the cycle of bingeing and purging, says the report.
   In the study, 10 recovered female bulimics and 12 healthy women were given a mixture of amino acids that lacked tryptophan, an important precursor molecule for producing serotonin. A week later, the women were given a balanced mixture of amino acids. The women who had recovered from bulimia were more likely to feel fat and fear losing control of eating in the 7 hours after ingesting the tryptophan-free mixture, but not with the balanced mixture. Six of them reported such feelings compared with none of the healthy women. Dieting is known to lower blood levels of tryptophan, which may alter serotonin levels. Therefore, the researchers say, this may be one way that dieting may trigger bulimia. (Healthy Weight Journal 2000:14:1:3 / Serotonin drop may trigger gulimia. New York: Reuters Health, February 15, 1999)
 

Sexual abuse and eating disorders
   A study that compared sexual abuse for three subtypes of eating disorders found clear differences. Exual abuse was most frequent and most severe when bulimia nervosa was combined with comorbid substance dependance (65 percent), whereas 37 percent of bulimia nervosa patients who were not substance dependent, 23 percent of anorexia nervosa patients, and 7 percent of a control group suffered abuse. The research compared 20, 27, and 26 eating disordered patients in these three groups, respectively, with 44 control women without a history of eating disorders. All subjects had reasonably intact congnitive functioning and were interviewed face-to-face by psychologists with extensive experience. Relatives also were interviewed.
   About half of all bulimia nervosa patients had been sexually abused, and one fourth of anorexia nervosa patients, rates that are similar to other studies. Subjects were asked if they had ever been sexually traumatized, (e.g., rape, incest, or unwanted sexual touching) and were encouraged to elaborate on the nature of events. Half of the patients with bulimia nervosa and substance abuse had been raped, 15 percent were victims of incest (intercourse or fondling by a family member), and 10 percent reported fondling by a nonfamily member. Incest was the most common form of sexual abuse among the bulimia nervosa without substance abuse patients, with 19 opercent reporting incest, 11 percent reporting rape, and 7 percent fondling. Fondling by a nonfamily member was the most common form of abuse among anorexia nervosa patients (12 percent fondling, 8 percent incest). Fondling and incest were the types of abuse reported by control subjects.
   There were no differences for the age of eating disorder onset compared to ages of first sexual abuse, but for the majority of patients in all three groups sexual abuse preceded eating disorder onset. (Healthy Weight Journal 1999:13:4;51 / Deep AL, Lilenfeld LR, Plotnicov KH, etal. Sexual abuse in eating disorder subtypes. Int J Eat Disord 1999;25:1-10)

Meatless diets put athletes at risk
   Menstrual abnormalities and the female athlete triad are linked to the meatless diets that are common among female athletes, warns an article in The Physician and Sportsmedicine. One study cited reported menstrual irregularities in 26.5 percent of vegetarian women, compared with 4.9 percent in nonvegetarian women. Another compared 9 regularly menstruating runners with 8 amenorrheic runners and found 44 percent of the menstruating runners ate red meat, while none of the amenorrheic runners did. Still another study showed that, of 13 amenorrheic runners, 12 were vegetarians, and 8 had eating disorders. Only 3 of the 19 menstruating runners were vegetraians, and none had eating disorders.
   The review shoed that even though intake of iron and calories was the same, female runners who ate a modified vegetarian diet (less than 100 grams of red meat per week) had significantly lower iron levels than those who regularly ate red meat. One study showed that female runners who did not eat meant, chicken, or fish had protein levels below the recommended minimum for encurance athletes.
   Although it is theoretically possible to compete athletically on a meatless diet, the researchers emphasize thtere is risk. They recommend that female athletes who call themselves vegetarians be screened for disordered eating and amenorrhea, and if either is found, for osteoporosis. The American College of Sports Medicine recently published a position statement on the female athlete triad. (Healthy Weight Journal 1999:13:4;50 / Loosli AR, Ruud JS. Meatless diets in female athletes: A red flag. The Physician and Sportsmedicine. 1998;26:45-48,55)

Anorexia trends
   In 40 years, anorexia nervosa seems to have increased greatly among women in their 20s and 30s, but not much for teenagers, according to a Canadian review. In a comprehensive data search, the researchers found 12 relevant, population-based studies using 45 independent samples from several countries between 1950 and 1992, about half from the United States. The incidence of anorexia was approximately 51 per 100,000 for teenage girls (54.3 from 1980-1992), compared with 10 for women age 20 and older. The increase for teenagers during the last 20 years was only 10 percent, not statistically significant in these small samples, but there was a three-fold increase for women of 20 and over.
   However, the Candian researchers report that eating disorder statistics are based on small, incomplete studies. The largest they found included only 166  cases. As yet, no single large population-based study has been reported in the scientific literature, they said. (Healthy Weight Journal 1999:13:3;34 / Pawluck D, Gorey K. Secular trends in the incidence of anorexia nervosa. Int J Eat Disord 1998:23;347-352)

Dieting behaviors in college students
 Of 84 college females tested with the Eating Attitudes Test (EAT-40), 18 percent indicated high eating concerns and were consuming 415 fewer calories than subjects with normal eating concerns and 629 fewer calories than subjects with very low eating concerns. They were also eating less fat. Of the total, 80 percent had dieted to lose weight and 32 percent had dieted 6 or more times. Currently dieting were 46 percent of these women students even though 82 percent of the dieters were within the recommended body mass index range of 19 to 25. On average they wanted to lose 11.5 pounds. (Healthy Weight Journal 1999:13:1;3 / Pereyra L, et al. Eating attitudes, dietary intake, and dieting behaviors in college females. J Am Diet Assoc 1997;97(S):9:A-48)

Disordered eating on campus
   In a sample of 1,226 university students, faculty, and staff in North Carolina, 23 percent of women and 8 percent of men tested above 20 points on the Eating Attitude Test (modified, approved version), indicating disordered eating patterns. When asked if terrified about being overweight, 80 percent of women and 20 percent of men reported being terrified. 
   One third (85 percent women, 15 percent men) reported being preocuupied with the desire to be thinner. Half thought about burning calories when exercising (65 percent women; 35 percent men). Over one third were preoccupied with the thought of having fat on their bodies (73 percent women; 27 percent men). Over one-third ate diet foods (83 percent women; 17 percent men). Nearly one third dieted (84 percent women; 16 percent men). Eleven percent had the impulse to vomit after meals, and 7 percent said they vomited after meals (98 percent women, 2 percent men). Hartung concludes that this study shows that males are more conscious of their appearance, body fat content, and self-control around food than previously believed. It supports the need for continued nutrition education and psychological support on college campuses for both sexes. (Healthy Weight Journal 1998:12:5;66 / Hartung L. Disordered eating patterns in relation to gender in the college environment. J Am Diet Assoc 1997; 97:9 (Suppl):A-60)

Thin models upset women
   College women who viewed pictures of thin female models experienced higher levels of private self-consciousness, body competence, and state anxiety, than those who looked at control pictures, in a West Virginia University study. College men viewing pictures of attractive male models were unaffected by such self-doubts or anxieties. 
   Subjects were 103 psychology students, predominantly white, who veiwed the pictures briefly alone in a small room. Three sets of pictures were used: one, thin female models from magazines marketed to women; two, attractive men from male magazines; and three, a control set of mixed photos of older men and women, babies, and children playing. Women students were randomly assigned to view set 1 or 3; men were assigned set 2 or 3. 
   Results showed that even for this brief time the women's sense of internal self-awareness was disturbed as they compared themselves to thin models. They felt upset, nervous, tense, and ill at ease. 
   The researchers concluded that it is quite easy to influence college women to feel more negatively about their bodies, while no such impact exists for male college students. They cited studies that show women exposed to media images of thin women are affected in negative ways, rate themelves lower, have increased depression, stress, guilt, shame, insecurity and body dissatisfaction, and that advertisers target women far mor  than men with ads that create body dissatisfaction. One study found that after viewing nude pictures of Playboy and Penthouse models, subjects rated women of average attractiveness more negatively. Conversely, the researchers said their own research showed the women's increased sense of body competency suggests they felt stronger than the models.
. (Healthy Weight Journal 1998:12:4;50 / Kalodner C. Media influences on male and female non-eating-disordered college students. Eating Disorders 1997; 5:47-57.)

Eating disorders increase in Asia
 Eating disorders are fast going global. Anorexia, first documented in Japan in the 1960s, now afflicts an estimated one in 100 young Japanese women, about the same as in the United States. In the past 5 years, the self-starvation syndrome has spread to women of all socio-economic and ethnic backgrounds in Seoul, Hong Kong, and Singapore. Cases are reported in Taipei, Beijing, and Shanghai, and even in countries where hunger remains a problem, including the Philippines, India, and Pakistan. 
   "Appearance and figure has become very important in the minds of young people," said Dr. Ken Ung of the National University Hospital in Singapore. "Thin is in, fat is out. This is interesting, because Asians are usually thinner and smaller-framed than Caucasians, but their aim now is to become even thinner." 
   Liposuction surgeons are popular, as are diet powders and pills, cellulite creams, weight loss teas, and other herbal treatments. In Singapore, headlines were made last year when a 21-year-old, 70-pound college student at the prestigious National University died of complications related to anorexia. 
   Thinner faces are now also desired by Asian women. The Takano Yuri Beauty Clinic chain offers a 70-minute facial slimming program for $157 at 160 salons across Japan and reports business is booming. Drugstores and beauty salons offer face-reducing seaweed creams, massage, steam, and vibration treatments and even Darth Vader-like facial masks designed to promote sweating. (Healthy Weight Journal 1998:12:3;35 / Efron S. Eating disorders in Asia. Los Angeles Times October 21, 1997)