Battling back from size double zero

Eating disorders seem to be woven into modern western culture. “There is a tribe of women who exist on the edges of starvation despite living well above the poverty line,” writes Kate Spicer of the London Sunday Times. “Rich in handbags, they are poor in diet, eating as little as a pitiable victim scrabbling for food in war- and drought-torn corners of Africa.”

This mentality affects not only adults, but also adolescents and children. BBC News [1] recently reported statistics from The Eating Disorders Association showing an increase in Northern Ireland where children as young as ten are reported to be suffering from anorexia and bulimia. This troubling trend seems to be aggravated by the Internet. Some websites actually promote anorexia as a positive lifestyle choice.

Bulimia is an illness which usually affects adolescent girls. These girls swing back and forth – sometimes several times a day – between bingeing (or overeating) and purging, often by vomiting or using laxatives. Girls with bulimia usually know that their eating habits and rituals are peculiar and often try to hide them from family and friends. By some estimates, as many as one in 20 adolescents in the US and Europe have some bulimic symptoms.

Despite its prevalence among teenage girls, almost all of the rigorous research on treatments for bulimia has been conducted with adults. To begin to fill in this gap, a research team from the University of Chicago compared bulimic teens receiving family-based therapy to similar teens receiving traditional, individual therapy. The study involved 80 teens in total, mostly girls.

In the family-based treatment, parents attended clinic sessions with the patient. Parents also encouraged their adolescents to eat as normally as possible and monitored them during and after meals. Patients receiving traditional therapy were encouraged to explore emotional problems that might be the cause of their eating disorders. Patients from each group made 20 visits to the clinic over a six-month period.

The study found that almost 40 percent of participants in family-based treatment had stopped bingeing and purging by the time the treatment ended compared to only 18 percent of those who received the traditional therapy. Six-months after treatment, almost 30 percent of participants who received family-based treatment had not succumbed to poor eating habits compared to only 10 percent in the other group.

"Parents are in a unique position to help their adolescents," says study author Daniel le Grange, Associate Professor of Psychiatry and Director of the Eating Disorders Program at the University of Chicago, "yet treatment typically excludes them from the process. Now we have the evidence that we need to bring them back in".

• Summary of “Randomized Controlled Comparison of Family-Based Treatment and Supportive Psychotherapy for Adolescent Bulimia Nervosa” by Daniel le Grange, Ross D. Crosby, Paul J. Rathouz, and Bennett L. Leventhal in Archives of General Psychiatry, Volume 64, Issue 9, pp 1049-1056, September 2007.
Another summary of the research is available from Eureka Alert [2].

[Kate Spicer is featured in a new documentary called Superskinny Me: The race to size double zero which follows her and another journalist as they go on a no-holds-barred journey into the world of extreme dieting, exposing the dangers to both mind and body. Spicer describes her experience in the Los Angeles Times [3].]