‘My name is Lucy. I am in recovery from anorexia nervosa and major depression, each of which almost killed me.’

So begins this extraordinary depiction by a 19-year-old woman of her descent into the tortured existence of anorexia and her arduous and remarkable recovery from it.

As Lucy states in this powerful depiction of the reality of the condition, ‘Forget about misguided notions of vanity and thin models, this is what anorexia is really about.’

Beautifully and evocatively written, with devastating insights into the condition and recovery process, Biting Anorexia is ultimately inspiring.

Come along and meet the author, all welcome!
NSW Writers Centre
Callan Park, Balmain Road, Rozelle
23 July 2008
5.00pm to 6.30 pm
Launched by Amanda Jordan, Founder, Eating Disorders Foundation

RSVP essential by 16 July, as numbers limited
Call Finch Publishing on 9418 6247 or email meredith@finch.com.au

Book available from 16 July in bookshops or at www.finch.com.au.

Pauline Anderson

June 6, 2008 — More than 10% of adolescent girls and 3% of boys binge eat or purge at least once a week, according to a new study published in the June issue of the Archives of Pediatric and Adolescent Medicine.

The frequency of this disordered eating is surprising and concerning, said 1 of the study authors, Alison E. Field, ScD, associate professor of pediatrics, in the division of adolescent medicine at Children’s Hospital, Boston, in Massachusetts. “I would believe that 10% [of girls] would at least experiment with these behaviors, but once a week is quite severe.”

Dr. Field and her colleagues analyzed data from 6916 girls and 5618 boys who were part of the Growing Up Today Study (GUTS). The subjects, who were aged 9 to 15 years at the start of the study, were children of women participating in the Nurses’ Health Study II. The younger participants filled out questionnaires every 12 to 18 months from September 1, 1996 to November 11, 2003, and in 2004, a questionnaire was sent to their mother.

The study found that more girls started to purge at least weekly (5.3%) than started to binge eat (4.3%). In contrast, among boys, binge eating, at 2.3%, was more common than purging, at 0.8%. Interestingly, very few youngsters in the study engaged in both disordered-eating behaviors.

Purging On People’s Radar Screen

Dr. Field found the extent of the binge eating to be disturbing, especially with the country facing an obesity epidemic. But perhaps of more concern was the phenomenon of purging. “It’s very serious if someone is binge eating weekly, but it’s probably much more serious if someone is purging at least weekly,” she said. “The purging group is really coming onto people’s radar screen right now, and our data suggest it’s a really important group to consider.”

The study also investigated risk factors for developing these behaviors and found that among girls, frequent dieting, especially in those younger than 14 years, was a predictor of starting to purge or binge eat, as was concern about weight.

Predictors of Purging and Binge Eating Among Girls

Rates of some eating-disordered behavior varied by age. For example, girls younger than 14 years whose mother had a history of an eating disorder were almost 3 times more likely than their peers to start purging at least weekly (OR, 2.8; 95% CI, 1.3 – 5.9), although maternal history of an eating disorder was not related to an elevated risk among older teens.

Teasing Important Area to Focus On

Teasing was a factor in increased risk for disordered eating, according to the study. Although negative comments about weight from a mother, father, or female friends were not related to binge eating or purging among girls, teasing about their weight by boys did increase their risk of starting to purge. “Influences early in life such as teasing by boys seem to be scaring events,” said Dr. Field. Among boys, if their fathers made negative comments about their weight, they were twice as likely to binge eat.

Teasing might be considered a “normal rite of passage,” she added, but the study results “suggest that this is an important area to focus on, because you might be able to prevent some children from becoming disordered eaters.”

A first step might be for parents to watch what they say about weight issues in front of all their children. “A lot of parents may realize they shouldn’t make comments to their daughter about her weight, but our results also suggest they shouldn’t make comments to their son about his weight,” said Dr. Field.

As for physicians, Dr. Field stressed the importance of considering bulimic behaviors among male as well as female patients and of talking with all their overweight patients. “It’s important to find out if the children are being teased and what’s going on in their lives.”

It is also important for parents and physicians to stress healthy behaviors and not overemphasize the issue of weight. “There are a lot of reasons why kids should eat a healthy diet and get rid of the soda and junk food at home,” but weight loss should not be the main goal, said Dr. Field.

Media Images Unattainable

The media also play a role in influencing dieting behavior in young people. Girls in the study who strove to look like figures in magazines, on television, and in the movies were about twice as likely to binge eat and were also significantly more likely to purge. “It’s really important for young people to realize the print images they see have almost all been touched up, so what they’re looking for is completely unattainable,” said Dr. Field.

It is an important issue for boys, too, as more and more images of scantily clad males with six-pack abs appear in magazines and on billboards, added Dr. Field.

Approaches to preventing these behaviors might include media literacy and other approaches to make young people less susceptible to the media images they see, the authors write.

The researchers hope to get a better handle on which girls who start to binge or purge continue this behavior, Dr. Field told Medscape Psychiatry. “We’re trying to understand now who are the young people who just experiment with the behavior — say, do it for 1 year and then stop — vs those who go on to have a very persistent problem.”

The researchers are interested in looking more closely at the possible role of genetics in eating disorders and plan to collect DNA from this cohort to try to get some answers, said Dr. Field.

Arch Pediatr Adolesc Med 2008;162:574-579.

IT took a while for Sydney mother Jan to realise something wasn’t quite right with her daughter Ashleigh, then aged 13 1/2.
At that stage weighing 62 kilograms, Ashleigh was sensitive about her weight - which was perfectly healthy, but towards the upper end of the normal range. Ashleigh mentioned to Jan (not their real names) that she wanted to shed a bit of the “puppy fat” that was making her unhappy.

For the next couple of months, until about October 2006, all seemed to be going well. Ashleigh continued to eat well, was sporty, healthy and - so it seemed - happy. Her mother noticed a bit of weight had come off, but nothing to cause concern.

Slowly, that changed.

“I started to notice that she was making different choices about food,” says Jan. “There was always an excuse - ‘No, I don’t want a salad sandwich, I’ll just have the salad without the bread’.”

So began a near year-long ordeal during which mother and daughter consulted their GP, then waited weeks to see a psychologist and dietitian, before Ashleigh was finally taken to the eating disorders unit at the Children’s Hospital at Westmead, Sydney.

At the time of her admission, Ashleigh had lost over 20kg. Her periods had ceased eight months earlier. Her hair was falling out, and was being replaced by a soft fuzz similar to that on baby’s heads. Her teeth were brittle and chipping, her skin was breaking out and she had dark circles under her eyes.

Whereas a normal heartbeat would have been somewhere between 60 and 70 beats per minute, Ashleigh’s scarcely rose above 42.

“They had to tube her immediately, and put her under heat lamps for three to four days,” her mother recalls. “She was tubed for a week.”

Anorexia nervosa is a lethal disease that kills 20 per cent of those affected - a higher mortality rate than for either depression or schizophrenia.

There is a paucity of research comparing different treatments for anorexia, but there is a push in Australia to widen the availability for a treatment method that has the most research evidence to back it up.

Called the Maudsley Approach, it is suitable for people who have had anorexia for less than three years. Contrary to previous treatment protocols - many of which have involved hospitalising the patient when they become dangerously ill, effectively separating them from their families for weeks on end - the Maudsley Approach puts parents in the front line by teaching them how to handle the problem at home.

Once patients are well enough to leave hospital if they initially required inpatient treatment, phase one of the three-stage treatment focuses on weight restoration. A therapist works with the family, emphasising to the anorexic patient the severe health dangers associated with starvation, and coaching the parents on how to insist the child eats.

Siblings are also involved to be a support for the patient.

Once the adolescent has accepted the need to eat and weight is returning, the treatment moves into phase two, when the therapist and parents help the child take more control over their own eating, gradually trusting them to take more meals unsupervised. Phase three starts when the adolescent can maintain their weight above 95 per cent of their ideal weight, and is aimed at establishing a healthy identity.

The three phases usually take one year.

Trial results show between 60 and 70 per cent of adolescent patients have recovered by the end of the year-long treatment, while 75 to 90 per cent have regained their normal weight five years later.

The method is not without its critics, who say not all parents are able to give up work in order to supervise children all day. They also question the effect on siblings of being sidelined, and having nightly dinnertime confrontations - sometimes including, as in Ashleigh’s case, threats of suicide - played out nightly near or in front of them.

One of the main international advocates of the approach, Daniel le Grange from the University of Chicago - who helped develop it further after it was first developed at the Maudsley Hospital in London, where he once worked - has been in Australia for the past several weeks, briefing health workers on how the program works and what training is required.

The program is non-drug-based and has negligible commercial links. The main outlay for parents and health workers is a text book on what to do, costing about $20 and $50 respectively. It has now been adapted for treatment of bulimia, which is more common than anorexia but does not have such serious outcomes.

After a slow takeup by a handful of centres in Sydney and Melbourne, and a few in Victoria, availability of the Maudsley Approach for anorexia may soon widen more rapidly thanks to a more enthusiastic backing from NSW Health.

For many families, it’s a better option than some in-patient treatment programs, which can be extremely expensive and which in some cases have forced families to sell their homes to finance it.

Even so, it’s not for the faint-hearted.

Jan remembers her daughter “screaming, arguing, (and) my husband and I sitting on either side of her at the table so she couldn’t escape. We would be at the table for three hours so she would eat something - not one night, but night after night after night.”

Le Grange concedes the program can be “gruelling”, but counters criticism that it’s not a realistic option for those parents who can’t afford to take several weeks off work to give the sick child the care and supervision required.

“If parents don’t have that luxury, we can look for grandparents or aunts,” le Grange says. “You just have to be creative as clinicians.”

The only other reason why someone might not be suitable, says le Grange, other than having anorexia for more than three years, is that they are too sick. The cut-off is if someone is below 75 per cent of their healthy weight, a category that covers about 20 per cent of patients presenting with anorexia.

Stephen Touyz, professor of clinical psychology at the University of Sydney, and co-director of the Peter Beumont Centre for Eating Disorders at the Wesley Private Hospital, says the Maudsley Approach received the top rating of any treatment for anorexia from Britain’s National Institute for Health and Clinical Excellence, which assesses the cost-effectiveness of therapies for the UK’s National Health Service.

Touyz, who is working on a tool that will allow doctors to grade a patient’s anorexia by severity - much as cancers are currently graded from one to four - says the strength of Maudsley is that it encourages early intervention in anorexia.

“The message is: if you think your child has anorexia, you want to get in early, and treat it early,” he says. “Because if it becomes chronic, it’s very hard to treat … and Maudsley does have highly successful outcomes.”

Ashleigh, meanwhile, has stabilised her weight at 52kg. Jan, who says she would recommend the Maudsley Approach to others, says the next milestone will be when Ashleigh’s periods restart, which the doctors think could be within three months if she can keep her weight up.

“It’s not a quick fix. But we’re absolutely stronger as a family. We always were strong.”

The Weekend Australian
Adam Cresswell, Health editor | May 31, 2008

AUSTRALIA’S childhood obesity epidemic has been “exaggerated” and government-led national prevention efforts may be misdirected, with childhood obesity only increasing in lower-income families.

Controversial new research into childhood obesity rates has called into question whether the millions of dollars allocated by the federal Government for obesity prevention programs should be targeted to the highest-risk groups, rather than focused at the general population.

The findings, based on measurements taken from thousands of Australian children in two nationally representative samples in 2000 and 2006, found that the growth in childhood obesity overall has slowed to a crawl, and the only statistically significant increases are now among boys and girls from low-income homes.

The overall obesity rate rose only slightly, from 6 per cent in 2000 to 6.8 per cent in 2006 - an increase researchers said was not statistically significant.

Among low-income boys, obesity almost doubled from 5.4 per cent in 2000 to 9.3 per cent in 2006. The increase for wealthier children was much less, rising from 4.9 per cent to 6.8 per cent among middle-income boys and from 3.7 per cent to 4.9 per cent for the wealthiest.

Among low-income girls, the obesity rate increased from 3.9per cent in 2000 to 6.8 per cent in 2006, whereas the rate stayed flat at 5.5 per cent for middle-income girls, and increased from 2.4 per cent to 3.9per cent among high-income girls.

Australia’s health ministers in 2003 labelled obesity “an epidemic”. In this month’s budget, the Government said it would spend $62 million under its National Preventative Health Strategy to fight obesity, including nearly $13 million to fund a kitchen garden program in 190 schools nationally.

But Jenny O’Dea, associate professor of child health research at the University of Sydney, willtell a Nutrition Australia conference next month that obesity in children “has not increased overall” between 2000 and 2006.

In comments that have already drawn fire from some other obesity experts, Professor O’Dea told The Weekend Australian there was “no doubt that it (childhood obesity) has been exaggerated”.

“Some kids are more at risk than others, and that’s where the prevention efforts need to go,” she said.

Last night, Health Minister Nicola Roxon said obesity was “a significant challenge in health and a cause of several major chronic diseases - and will remain a priority for the Rudd Government”.

The findings are based on two studies using nationally representative samples, one conducted in 2000 and based on 4500 primary and high school children, and a further study of 6000 children in 2006. Although the overall rate of childhood obesity rose only marginally, further analysis showed a significant rise among children from lower socio-economic families.

Professor O’Dea said there had been “an assumption that all of our children are at risk of obesity and ill-health”.

“This latest data shows that’s not really true - there’s something protective about high income and middle income, and the real risk has been in low-income children,” Professor O’Dea said. “They (other experts) have to look at the evidence, and they are refusing to do it.

“I’m not saying there’s no risk in other children. I’m just saying if there’s going to be a focus (on prevention), you get a bigger bang for your buck by focusing on these disadvantaged groups.”

Last week, a US study found there had been “no significant increase” in the prevalence of obesity in American children and teenagers from 1999 to 2006, contrary to figures from prior years. The study, published in the prestigious Journal of the American Medical Association, found obesity rates varied by racial group, being higher for non-Hispanic black and Mexican- American girls than for non-Hispanic white girls.

Professor O’Dea said her Australian data showed the rate of obesity was 25 per cent among Pacific Islander children, 18 per cent among Middle Eastern children and 10 per cent among Aboriginal children.

“It’s politically incorrect to point the finger of risk at social class. But when you have the data sitting in front of you, it’s very clear - it’s not an issue of prejudice, it’s an issue of social justice.

“There’s a lot of money to be made out of childhood obesity, and … I think that’s where a lot of the hysteria comes from.”

The head of at least one school in an affluent part of inner-eastern Sydney yesterday agreed the obesity problem was neither as ubiquitous nor as uniform as sometimes supposed. Gabrielle McAnespie, principal of St Charles’s Primary School in Waverley, said: “This is my 28th year in teaching, and over that period of time I can’t say I have noticed an increase (in childhood obesity).”

Jan Wright, director of the Child and Youth Interdisciplinary Research Centre at the University of Wollongong, agreed the problem had been exaggerated and dramatised, and said prevention programs needed to focus on improving neighbourhoods with poor facilities, rather than blaming individuals.

“In one Victorian primary school, overweight children were singled out and told to do laps of the oval - which were known within the school as ‘fat laps’,” Professor Wright said.

Ian Caterson, director of the Institute of Obesity, Nutrition and Exercise at Sydney University, said it “would be encouraging if it’s true” that childhood obesity had levelled off.

“I would like to see a bit more data,” Professor Caterson said.

But he said focusing on obesity only, and ignoring the lesser category of overweight, meant the problem was understated.

The Annual General Meeting of the Eating Disorders Foundation Incorporated will be held:

Monday 16th June 2008, 8 pm - 8:45pm at the EDF offices in Artamon.

The purpose of the meeting is to discuss the following business:

1. Confirmation and acceptance of the minutes of the previous AGM
2. President’s Report
3. Executive Officer’s Report
4. Treasurer’s Report
5. Election of Office Bearers for the Board of Management

Notice for the 2009 Annual General Meeting will be publicised not less than 14 days from the date set at the 2008 AGM.

All members and friends of the Eating Disorders Foundation Inc are invited to attend. Please note, only financial members of the Foundation are eligible to vote.

To register your interest in attending the meeting, please call the office on (02) 9412 4499.

The University of Sydney (in conjunction with the University of London and University of Chicago) is conducting a treatment program for females over the age of 18 who have had anorexia nervosa for more than seven years (even if there have been periods of recovery). It aims to determine which of two currently available psychological treatments have the best outcome for people with longstanding anorexia nervosa.

If you would like more information about the program, or if you are interested in taking part, please contact Rebecca Smith (Project Coordinator) at the University of Sydney

Phone: 02 9351 7329
Email: rebeccas@psych.usyd.edu.au

Download a flyer about the program (~228kb)

Australian children as young as six are presenting at hospitals with eating disorders so advanced that almost half require forced feeding to save their lives, a study has found.

New data has confirmed that anorexia and starvation are becoming increasingly common among children, with a third of cases seen in under 18-year-olds now occurring in kids under 13.

The disease in children is more severe than teenagers and adults because it is being picked up too late, say specialists releasing the data at a psychiatry congress in Melbourne tomorrow.

Australia has, proportionately, more than double the number of extreme cases reported in both the United Kingdom and Canada.

“This is an extremely concerning situation because these kids are very, very unwell,” said lead researcher Dr Sloane Madden, a child and adolescent psychiatrist at Sydney’s Westmead Children’s Hospital.

“We in Australia are much poorer at recognising this as a problem and getting these children treated.”

Dr Madden will present the data on 101 cases of so-called early onset eating disorders among five to 13-year-olds collected Australia-wide over three years.

Most children were aged 10 and 11 but several were six-year-olds, and many more were seven and eight.

About two thirds had classic anorexia with body image problems usually associated with teenagers and adults, while the rest had starvation and weight loss alone.

“Over 50 per cent of the children presented with severe medical complications from malnutrition like very slow heart rate and low blood pressure, which puts them at severe medical risk,” Dr Madden said.

About 80 per cent required hospital admission, and of those, 50 per cent required tube feeding as a life-saving measure to manage starvation, the research showed.

One third were treated with antidepressants.

Girls were three times more affected than boys, but boys had more severe weight loss and medical deterioration than girls.

The researchers also discovered the prevalence was much higher among boys than it was among teenage or adult males.

“The number of children who are medically unwell was nearly double that of Canada and Britain and the number requiring tube feeding was between three and five times higher.

“We don’t believe the incidence is any higher here but we seem to be much poorer at identifying the disease until it is life-threatening,” Dr Madden said.

“This is very unfortunate because of the permanent damage such conditions can have on growing bodies and minds.”

He said treatment success rates were much higher for children than for older patients, with 70 per cent well within a year.

A NEW way of tackling anorexia that gives parents the prime role in insisting their child eats properly is winning official backing after promising results at hospitals that have adopted it.

The Maudsley Approach is being piloted by NSW Health in Campbelltown, in southwest Sydney, where health professionals are being asked to use it for new patients seeking treatment for the eating disorder.

If successful, the method - named after the London psychiatric hospital where it was developed in the 1980s - will berolled out across the state.

The Maudsley Approach is drug-free and allows anorexic adolescents to be cared for at home. Parents are taught how to insist the child eats, and to allow a staged acknowledgement of thechild’s autonomy as weight and healthy eating patterns are regained.

Studies have shown that two-thirds of adolescent anorexia patients recovered by the end oftreatment, and 75 to 90 per cent were of normal weight after five years.

It is the only treatment for anorexia to have a substantial research base suggesting it works.

US-based expert Daniel le Grange, director of the eating disorders program at the University of Chicago, helped develop the treatment at the Maudsley Hospital.

In Sydney yesterday to hold a workshop on the treatment, he said its key benefits included the acknowledgement that parents were best placed to help children recover. It also avoided protracted and costly periods of hospitalisation.

Professor le Grange said: “If you want to dilute it to one primary goal - weight gain - that’s the last thing the adolescent wants, and the parents have to work pretty hard to make it happen.”

Date: Tuesday 8th July 2008
Where: Wagga Wagga RSL Club
Time: 7pm - 9pm

For more information please download the flyer below.
To book your place at the Information Evening - please email us or give us a call on 02 9412 4499.

Download an Information Evening flyer (~124kb)

Free sessions of outpatient treatment are available in this study conducted jointly by the University of Sydney and the University of Chicago.

Please contact Rebecca Smith (Project Coordinator) if you would like more information.

Phone: 02 9351 7329
Email: rebeccas@psych.usyd.edu.au

Download an flyer for more information