The 19th Annual Meeting of the Eating Disorders Research Society took place on September 19-21, 2013 in Bethesda, Maryland. Among the winners of the top-five abstract awards was "How Do We Define 'Recovery' from Anorexia Nervosa and Bulimia Nervosa at 25 Years?" This is the first paper out of the 25-year follow-up to Dr. David Herzog's NIMH-funded Longitudinal Study of Anorexia and Bulimia Nervosa.
Dr. David Herzog | BlogSpot
Emeritus Professor of Psychiatry at Harvard Medical School
Thursday, October 17, 2013
Update: Longitudinal Study
The 19th Annual Meeting of the Eating Disorders Research Society took place on September 19-21, 2013 in Bethesda, Maryland. Among the winners of the top-five abstract awards was "How Do We Define 'Recovery' from Anorexia Nervosa and Bulimia Nervosa at 25 Years?" This is the first paper out of the 25-year follow-up to Dr. David Herzog's NIMH-funded Longitudinal Study of Anorexia and Bulimia Nervosa.
Monday, June 24, 2013
Eating Disorder Symptoms: Differences among Ethnic Groups
Dr.
David Herzog, Emeritus Professor of Psychiatry at Harvard Medical School, is an
internationally renowned expert on eating disorders. He founded and directed the Harvard Eating
Disorders Center, which later became the Harris Center for Education and
Advocacy in Eating Disorders at Massachusetts General Hospital.
Detection
of high-risk attitudes and behaviors is critical in the goal of preventing
eating disorders. In 1996, the National Eating Disorders Screening Program
(NEDSP) was launched on 409 college campuses across the United States. The
NEDSP reached a diverse student population and used a self-report screening
questionnaire to identify those at risk for eating disorders. NEDSP participants were offered an
opportunity to meet with an on-site counselor to review their responses to the
questionnaire in order to receive a recommendation for what, if any, further
clinical evaluation would be necessary.
Dr. Herzog and his team analyzed
data from 5,435 NEDSP questionnaires for a study of ethnic differences in the
prevalence of eating disorder symptoms and related distress. Questionnaire
items assessed the presence and frequency of restrictive eating, amenorrhea, binge eating, self-induced vomiting, use of laxatives and diuretics, and potentially problematic
exercise behaviors. Three questions were used to measure distress related to
the reported symptoms. Participants were asked to select the best response on
4-point scales ranging from ‘‘never’’ to ‘‘all of the time’’ reflecting the
degree to which eating and weight concerns (a) caused a great deal of distress,
(b) interfered with relationships, and (c) interfered with academic/work
performance.
The frequency of binge
eating, restrictive eating, vomiting, and amenorrhea
did not differ
significantly across ethnic groups. However,
significant between-group differences were found with respect to modes of
purging. Binge correlates (such as eating until uncomfortably full) were
significantly more frequent among Caucasian than African American participants.
Binge eating was the best predictor of distress among Caucasians, African
Americans, and Latinos, whereas vomiting was the best predictor of distress
among Asians. Asian participants who used laxatives were significantly less
likely to receive a recommendation for further evaluation than non-Asian
participants.
The findings suggest
there may be some important differences among ethnic groups in regard to eating
disorder symptoms, symptom-related distress, and likelihood for referral that
merit further investigation. Clinician recognition of this
potential diversity
may enhance culturally competent care for eating disorders.
Weight Gain, Restoration of Menses, and Bone Density Change in Adolescent Girls with Anorexia Nervosa
Dr. David Herzog—Emeritus Professor of Psychiatry at Harvard
Medical School—founded the Harvard Eating Disorders Center in 1994, which later
became the Harris Center at Massachusetts General Hospital (MGH). For over 25 years, Dr. Herzog has collaborated
with the Neuroendocrine Unit at MGH to learn more about the biology of eating
disorders. This team found that bone loss is a serious complication for most
adolescents with anorexia nervosa, placing them at increased risk of
debilitating fractures.
Dr. Herzog
and his colleagues in the Neuroendocrine Unit went on to conduct a prospective,
observational study on the effects of weight gain and menstrual recovery on
measures of bone mineral density. Sixty-seven girls between the ages of 12 and
18 participated; thirty-four of the girls had anorexia nervosa and 33 were
healthy controls. Dual energy x-ray absorptiometry (DXA) was used to measure
participants’ lumbar and whole-body bone density at baseline and at 6 and 12
months.
Weight gain was defined as a 10% increase
in body mass index and menstrual recovery as three menses or more in the previous
6 months. The 34 subjects with anorexia were characterized as AN recovered (AN-recovered)
if they had both weight gain and menstrual recovery (n=14) and as AN not
recovered (AN-not recovered) if they did not have both weight gain and
menstrual recovery (n=20). Median duration of recovery was 9 months.
The girls with anorexia had lower
spine bone mineral content for bone area and lower whole-body bone area for
height, compared with controls. Weight
gain and menstrual recovery in anorexia (AN-recovered) resulted in
stabilization of bone mineral density measures, whereas bone density continued
to decline in those with anorexia who did not gain weight and resume their menses
(AN-not recovered). AN-recovered also predicted greater increases in spine bone
mineral content for bone area and whole-body bone area, compared with AN-not recovered.
The data indicate that weight gain
and menstrual recovery are associated with a halting of deterioration in bone
measures, even in the short term. This raises the question of whether sustained
recovery would result in significant increases in bone density parameters. The
findings underscore the importance of optimizing weight gain in adolescents
with anorexia and highlight the beneficial effects of even short-term weight
increase with resumption of menses.
Bone Metabolism in Adolescent Boys with Anorexia Nervosa
For over 25 years, Dr. David Herzog,
Emeritus Professor of Psychiatry at Harvard Medical School, has worked closely
with the Neuroendocrine Unit at
Massachusetts General Hospital (MGH) to better understand the
biology of eating disorders. Research conducted by this team found that bone
loss is a serious complication for the majority of adolescent girls and adult
women with anorexia nervosa, placing them at increased risk of fracture and
permanent disability.
Dr.
Herzog and his team in the Neuroendocrine Unit went on to conduct the first
controlled study of bone mineral density in boys with anorexia. Thirty-four
boys between the ages of 12 and 19 participated; seventeen of the boys had
anorexia nervosa and 17 were healthy controls.
Dual energy
x-ray absorptiometry (DXA) was used to measure participants’ bone density.
Blood was drawn for IGF-1 (insulin-like growth factor 1); testosterone; SHBG (sex hormone-binding globulin); estradiol (a
main form of estrogen); the appetite-regulating hormones ghrelin, PYY, and leptin;
and biochemical markers of bone formation and bone resorption. The participants
completed questionnaires that assessed their food intake and levels of physical
activity.
The boys with anorexia nervosa had
lower bone mineral density at the spine, hip, femoral neck, trochanter,
intertrochanteric region, and whole body, compared with controls. The hip and
its subregions were affected by low bone density at least as severely as the
spine. The markers of bone formation and bone resorption were reduced in the
boys with anorexia compared with controls, who were in a state of increased
bone turnover. Low body mass index and lean mass and low testosterone levels
were important predictors of low bone mineral density.
The findings of this study are
concerning for low bone mineral density and possibly a decreased rate of bone
mass accrual during adolescence, a period characterized by marked increases
in bone accrual toward achievement of
peak bone mass. This raises questions regarding bone health and fracture risk
in later life. Because body mass index
is a key predictor of low bone density, emphasizing weight recovery is
critical.
Thursday, June 20, 2013
Pregnancy and Eating Disorders
Dr. David
Herzog was the first Endowed Professor of Psychiatry in the Field of Eating
Disorders at Harvard Medical School. He is board certified in pediatrics, child
and adolescent psychiatry and general psychiatry and has treated over 3,000
individuals with anorexia nervosa, bulimia nervosa, and associated diagnoses.
Dr. Herzog founded and directed the Harvard Eating Disorders Center, which
later became the Harris Center for Education and Advocacy in Eating Disorders
at Massachusetts General Hospital.
As part of the Longitudinal Study,
Dr. Herzog and his team examined the course of pregnancy and neonatal status
for babies born to women with eating disorders. Forty-nine live births were
included. The participants were
interviewed by trained assistants and completed a brief self-report
questionnaire that assessed both birth statistics and birth-related
complications. Medical records and/or self-report data describing the babies’
birth status were obtained.
In 1987, Dr
Herzog initiated his National Institute of Mental Health-funded Longitudinal
Study of Anorexia and Bulimia Nervosa, mapping the course and outcome in 246
women followed at frequent intervals. The Longitudinal Study – the largest and most extensive of its kind – has provided
a better understanding of how anorexia and bulimia progress, including rates of
recovery and relapse, medical consequences, associated psychiatric illnesses,
the quality of patients’ relationships, and functioning at school or at work.
The
researchers found that women with eating disorders who regain their health
prior to conception and remain nutritionally stable throughout pregnancy are
not more prone to obstetrical problems than those who have never had an eating
disorder. However, engaging in abnormal weight control behaviors during
pregnancy can increase the risk of complications such as miscarriage, premature
delivery, Cesarean delivery, low-birth-weight babies, and postpartum
depression.
The results of this study emphasized
the importance of viewing pregnant women with past or current eating disorders
as high risk and monitoring them closely both during and after pregnancy to
optimize maternal and fetal outcomes.
Tuesday, June 18, 2013
Weight Suppression and Bulimia Nervosa
Dr. David Herzog, Emeritus Professor of Psychiatry at Harvard Medical School, is a renowned expert on eating disorders. He is a distinguished researcher, teacher, clinician and advocate and is the recipient of many honors and awards. Dr. Herzog was the first Endowed Professor of Psychiatry in the Field of Eating Disorders at Harvard Medical School. In 1994, he founded the Harvard Eating Disorders Center, which later became the Harris Center for Education and Advocacy in Eating Disorders at Massachusetts General Hospital.
Dr. Herzog collaborated with
researchers at Drexel University in Philadelphia to investigate the role of
weight suppression in predicting recovery or relapse in bulimia nervosa. Weight suppression is defined as the
difference between a patient’s past highest weight and her weight at entry into
the study. The participants were 110 women with bulimia nervosa from Dr.
Herzog’s National Institute of Mental Health-funded Longitudinal Study. At study entry, these 110 participants were,
on average, 25 years old and had been ill for an average of 6 years. The
researchers collected data by interviewing the women at 6-12 month intervals over
8 years about their eating behaviors, mood symptoms, and general life
functioning.
Weight suppression was significantly
associated with time to first full remission, indicating that women who were
more weight-suppressed at study entry took longer to recover. These results support
previous research suggesting that high weight suppression may fuel binge eating
and make weight gain more likely. Future research is needed to explore methods
of improving treatment outcome for highly weight-suppressed individuals with
bulimia nervosa.
Thursday, June 13, 2013
Anorexia Nervosa and Stigma
Dr.
David Herzog, Emeritus Professor of Psychiatry at Harvard Medical School, is an
internationally respected scholar on eating disorders credited with over 280
publications. He is board certified in pediatrics, child and adolescent
psychiatry, and general psychiatry and has treated over 3,000 individuals with
eating disorders such as anorexia and bulimia
nervosa. He founded and directed the Harris Center for Education and
Advocacy in Eating Disorders at Massachusetts General Hospital and, prior to
that, the Harvard Eating Disorders Center.
Dr. David Herzog and his
staff collaborated with Boston University to explore public stigma associated with eating disorders. In 2010, 173 college students were
shown one of three videos describing anorexia as a product of either biology,
culture, or an interaction between the two.
Each video ran about 5 minutes and
consisted of two parts. All three videos opened with the same two-minute
segment, in which an average-weight actress portrays a young woman who has
recovered from anorexia. She describes her descent into the disorder and the
suffering she experienced while actively ill, including her self-loathing,
impaired concentration, physical consequences, obsessionality, and social
isolation. She also discusses her attempts to appear fine to the outside world
while feeling miserable inside.
The second part of each video varied
by condition, but each consisted of a three-minute segment in which a
middle-aged actor portrays a doctor who is an expert on anorexia nervosa. In
all conditions, the basic structure of the segment was the same, though specific
content varied. First, the doctor describes the seriousness of anorexia. Next,
he indicates that much debate surrounds the etiology of anorexia but that a
great deal of evidence points to the role of (biological/sociocultural/both
biological and sociocultural) factors in the development of the disorder.
Then, he elaborates the research evidence supporting the roles of
(biology/society/an interaction between biology and society) in the
development of the disorder.
Finally, in each video, the expert
states that anorexia can be treated but often requires a team of doctors and
sometimes occurs in the context of hospitalization. He also says that "adequate
insurance coverage and other supports for those with this disease are very much
needed."
After watching the
videos, the participants completed a questionnaire designed to measure which
explanation evoked the least stigmatizing attitudes. Those who viewed the
interaction video demonstrated less stigma than those who viewed the
sociocultural video but more than those who viewed the biology video. The stigma against anorexia tended
to be blame-based, meaning that the disorder was seen as the patient’s own
doing. Both the biological and the
interaction groups showed more intention to engage in helping behavior than the
sociocultural group.
The
preponderance of empirical evidence points to anorexia as a product of an
interaction between both biology and culture.
More research is needed to learn how to accurately portray the etiology
of the disorder while, at the same time, trying to reduce stigma.
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