By KRISTIN JAVARAS
Published: April 22, 2014

This year’s International Conference on Eating Disorders (ICED) took place in Times Square, New York City from March 27-29, 2014. The location was a treat: members of the UNC Center of Excellence for Eating Disorders (UNC CEED) used their free time to enjoy New York’s many great eateries and take in performances ranging from the musical Pippen to the play All the Way. But above all, the conference itself was a treat: it gave attendees a chance to hear the latest developments in the field and connect with eating disorder researchers and clinicians from across the globe. In fact, this year’s conference set an attendance record, with 1357 attendees from numerous countries across the world.

Since the UNC CEED is committed to sharing knowledge gained from research with the broader community, we wanted to take this opportunity to pass on some of the things we learned at the conference. Below is a favorite nugget of information (or two or three) from members of the UNC CEED who attended ICED 2014:

Cristin Runfola, PhD:
• “As someone developing manualized couples-based interventions for bulimia nervosa and binge-eating disorder, I wanted to learn more about factors that make clinicians more or less likely to read and follow a manual. We have a number of structured manualized therapies for eating disorders out there, but few clinicians use them regularly. Research suggests the use of manuals in clinical care is associated with better outcomes, so I was interested to learn the factors that contribute to uptake.” (Aside to blog readers: in a manualized therapy, there is a written guide for clinicians that describes in detail the material to be covered in each session and/or the approach to be taken by the clinician in that type of therapy.) “Glen Waller presented results showing that about 50% of clinicians use manuals often or all the time. Clinicians with negative beliefs about manuals thought they downplayed the importance of the therapeutic alliance (i.e., the relationship between the clinician and the patient), overlooked case examples (i.e., illustrative examples of how the therapy was used to help a specific patient), and were imposed for financial reasons. Based on these findings, he recommended that manuals emphasize the importance of a good therapeutic alliance, include case material, and report evidence on how following manuals can lower costs of care AND provide better outcomes than eclectic approaches. Personally, I think all supervisors should provide solid training in manualized therapy and require trainees to experiment with manualized protocols during training. (Of course, this training would complement the development of other important therapeutic skills, such as learning how to build a strong relationship with the patients.) Unfortunately, too few clinicians receive training in conducting manualized therapies. Dr. Waller highlighted that implementing a manual in therapy is a skill and requires practice to achieve competence in its delivery.” [From Attitudes Towards Psychotherapy Manuals Among Clinicians Treating Eating Disorders by Glenn Waller, Victoria Mountford, Madeleine Tatham, Hannah Turner, Chloe Gabriel, and Rebecca Webber; the published article related to this talk is available here]
• “I also learned that it’s not energy density (i.e., the number of calories in a diet) but rather diet variety (i.e., eating a range of foods from all food groups) and the consumption of fat that predicts recovery and is associated with reduced risk of relapse from anorexia nervosa. [From Couch to Table: Eating Behavior and Treatment of Anorexia Nervosa by Joanna Steinglass, Janet Schebendach, Evelyn Attia, and Daniel LeGrange].

Susan Kleiman:
• “I’m interested in improving refeeding protocols for anorexia nervosa, so I attended a talk that presented results on the thermic effects of eating. (Aside to blog readers: “refeeding” refers to increasing caloric intake in order to rebuild the body after starvation. The thermic effects of eating refer to the energy that gets burned up through the process of eating and metabolizing food. We actually prefer the term renourishment, but the talk was about refeeding) “I learned that, in healthy individuals, the post-prandial metabolic rate (i.e., the metabolic rate after eating) is about 10% higher than the resting metabolic rate. However, during refeeding for anorexia nervosa, the post-prandial metabolic rate is up to 40% higher! In combination with parallel increases in resting energy expenditure during refeeding, patients with anorexia nervosa show a biological resistance to weight gain that we don’t yet understand.” For blog readers, what this means is that when someone with anorexia nervosa eats food, the body uses up extra energy in digesting and metabolizing it. Thus, a lot of energy from the food is getting used up in the digestion/metabolization process itself, rather than for rebuilding the body, which means that person will need to eat even more to rebuild their body. [From Refeeding Revisited: How Fast, How Slow? A Re-evaluation of Inpatient Refeeding in Anorexia Nervosa by Neville Golden, Andrea Garber, and Michael Kohn].

Hunna Watson, PhD:
• “I learned about Project HEAL, a non-profit that provides treatment scholarships for people suffering from eating disorders, among other goals. Kristina Saffran, one of the co-founders, spoke eloquently and honestly about the role that social media played in her own recovery. She described how participating in online eating disorder communities, even those ostensibly focused on recovery, was at times triggering and unhelpful for her. She noted that (other people’s) posts detailing their struggles and relapses were particularly triggering, tempting the competitive side of her eating disorder to outdo them. However, she also talked about how social media and the Internet can be used for good (e.g., for eating disorder advocacy). [From The Voice of a Recovered Adolescent: Good and Bad Media Influences and How Advocacy Can Come Out of Recovery by Kristina Saffran].

Jessica Baker, PhD:
• “I’m interested in the role that hormones play in eating disorders, so I attended a series of talks on the ‘Neurobiology and Neuroendocrinology of Eating Disorders.’ Among other things, I learned that among underweight patients who are hospitalized for eating disorders, lower levels of estrogen are related to higher levels of anxiety. Given that estrogen levels can become very low in the course of eating disorders such as anorexia nervosa, this suggests that low levels of estrogen may play a role in the extremely high levels of anxiety exhibited among acutely ill individuals.” [From Low Estrogen State in Underweight Hospitalized Patients with Eating Disorders is Associated with Increased State and Trait Level Anxiety Independent of BMI by Colleen Schreyer, Janelle Coughlin, Graham Redgrave, and Angela Guarda].
• “I also heard Glen Waller speak about the role that weighing patients plays in cognitive behavior therapy for eating disorders. He noted that up to 40% of therapists don’t weigh their patients at each session, citing reasons including concern about how to handle patients’ reactions to their weight. He noted that therapists with higher levels of anxiety and depression are less likely to weigh their patients. In contrast, Dr. Waller advocated consistently weighing patients, and using it as opportunity to help patients work through their fears surrounding their weight. [From How and Why to Weigh Adult Eating Disordered Patients within Cognitive Behaviour Therapy (and why most CBT therapists avoid doing something so very essential) by Glenn Waller].

Kristin Javaras, DPhil, PhD:
• “I was inspired by Frank Bruni’s talk, in which he so articulately described the development and course of his struggles with bulimia nervosa, as well as the factors that have helped him manage those struggles. He recounted how, as early as toddlerhood, he had a prodigious appetite that outmatched even his mother’s “don’t leave hungry” approach to feeding people. This struck me because, as therapists, we often take the view that hunger and cravings for food are actually masking hunger and cravings for other things (e.g., intimacy, engagement). While this can certainly be the case, and this realization can be an important therapeutic tool, it’s important to remember that cravings for food may actually be about the food itself, and that some people have always had bigger appetites and a greater love of food than others. [From In the Belly of the Beast: What Happens and What’s Learned, When a Food Addict Makes Food His Profession by Frank Bruni].
• “I attended a great session on eating disorders in males. Ted Weltzin, MD spoke about the importance of research focusing on eating disorder presentation and treatment in males. He reviewed the various stages of treatment, noting male-specific complications that arise in each stage. For example, deciding on a goal weight (as is typically done at the beginning of treatment) can be even more complicated for males because frame size and musculature vary more substantially across males. Thus, even if two men are both 5’10”, one man’s ideal weight range might center around 140 lbs, but another man’s ideal weight range might center around 180 lbs if he is larger framed and more muscular. In another talk, Scott Griffiths spoke about muscle dsymorphia and cited a statistic that 50% of men with muscle dsymorphia attempt suicide at some point, which starkly illustrates the extreme levels of suffering and distress that accompany this disorder.” (Aside to blog readers, muscle dysmorphia is a disorder in which an individual becomes obsessed with the idea that he or she is not muscular or big enough.) [From Males with Eating Disorders: Anorexia Nervosa, Muscle Dysmorphia and Everything In-Between by Stephen Touyz, Scott Griffiths, Stuart Murray, Phillipa Hay, and Theodore Weltzin].
• “Ursula Bailer gave a fascinating talk on the role of serotonin and dopamine receptors in anorexia and bulimia nervosa. She presented data on the differences in the response to amphetamines (a stimulant drug) among individuals with a history of anorexia nervosa. Among “healthy” individuals, lower levels of dopamine binding (after amphetamine administration) in the brain’s ventral striatum tend to be accompanied by higher reported levels of euphoria. (Aside to blog readers: Amphetamines stimulate the release of dopamine, a chemical involved in reward, in the brain. One way of examining the effects of amphetamine administration is to use brain imaging techniques to measure dopamine binding in the brain.) However, among individuals with a history of anorexia nervosa, lower level of dopamine binding (after amphetamine administration) in the brain’s dorsal caudate tend to be accompanied by higher level of ANXIETY.” For blog readers, these data provide us with insight into the biology of a phenomena long noted by clinicians – that for some individuals with anorexia nervosa, things that would be perceived as rewarding by most people may actually be anxiety-inducing. [From Brain Imaging in Eating Disorders: How to Interpret the Data (presented by the Neuroimaging SIG)].

Cindy Bulik, PhD:
• “Hearing Frank Bruni talk was amazing and delightful, as always. He should run for president.”

photo credit: denise carbonell via Creative Commons