Transcription:
Adolescent Eating Disorders

Melanie Cole (Host):  There’s no handbook for your child’s health. But we do have a podcast featuring worldclass clinical and research physicians covering everything from your child’s allergies to zinc levels. This is Kids Health Cast by Weill Cornell Medicine. And our topic today is Adolescent Eating Disorders. My guest is Dr. Tara Deliberto. She’s an Assistant Professor of Psychology in Clinical Psychiatry at Weill Cornell Medicine. Dr. Deliberto, it’s such a pleasure to have you with us today to talk about this very important topic. What’s considered an eating disorder and are there different types?

Tara Deliberto, PhD (Guest):  So, in short, eating disorders are characterized by behaviors such as calorie restriction, food avoidance, binge eating, purging, et cetera that occur in the context of shape and weight concerns or fearing weight gain. So, the four main eating disorder diagnoses are anorexia nervosa, bulimia nervosa, binge eating disorder and what’s called other specified feeding and eating disorder or OSFED.

Host:  How common are these Dr. Deliberto? Are they more common in girls or boys? Are boys susceptible to them too? Is this very common?

Dr. Deliberto:  It is very common actually about 30 million people in the US across age, gender and race have an eating disorder and I think that works out to be about 9% of people. So, regarding gender, adolescent girls are thought to have a higher rates of eating disorders and the statistic used to be that for every ten girls there would be about one boy with an eating disorder. But that disparity is actually closing. Because it’s likely that males are both less likely to seek out treatment and be screened by professionals for eating disorders; we don’t have exact numbers on that. There are probably a few more boys out there than one in ten and the last thing I’ll say on this, regarding gender, about 16% of transgender college students actually have an eating disorder which is pretty high.

Host:  That’s so interesting. So, I’m going to ask you a very complicated question now because I know there are probably many facets. Do we know what causes an eating disorder? Is it personality traits? Are they more common in individuals with eating disorders? Is there a genetic component? And can parents be looking to unreasonable expectations in the media and social media and all around because out kids are getting it from all sides that thin is the best.

Dr. Deliberto:  A lot of different variables go into creating an eating disorder. So, eating disorders are really strongly influenced by genetics, neurobiology, temperament and the environment such as social media. So, it is currently thought that actually about 50-80% of the risk for developing an eating disorder such as anorexia or bulimia nervosa is actually genetic. Neurobiological factors do also play a role as does temperament. So, for instance, people with AN, anorexia nervosa, have difficulty on neuropsych testing for instance telling the forest through the trees so to speak. So in other words, they are really detail oriented to the point of missing the larger picture. And we also see a high degree of perfectionism. So, there’s a lot of again, temperament and neurobiological factors as well as genetic factors and of course the environment has to play a role in some way as well.

When you have somebody with the genetic loading and the neuropsychological makeup with the temperament put into an environment where the thin ideal is really praised; then there’s a really kind of high likelihood that that eating disorder might be set off.

Host:  So interesting. So, if we are worried that someone, we care about has anorexia or one of the other eating disorders, if we are a parent; how do we tell if it’s just normal weight loss or if they need help? Tell us about some symptoms and when you’re telling us this, Dr. Deliberto, give us tips especially for parents on how to broach the subject, on how to talk to someone or bring it up to your child or mention it to your friend. So, tell us about symptoms and how to bring these things up.

Dr. Deliberto:  So, broaching the subject of having an eating disorder with a loved one can be really difficult. The person first of all, may not be aware that they have a problem and regardless of whether or not they are aware; they might actually retaliate in some sort of way. So, if you’re the parent or a caregiver of a child under the age of 18 and suspect any type of eating disorder; my advice it to take them to their medical doctor for evaluation right away as well as specialized therapists in the treatment of eating disorders for assessment. And as a parent, you have that kind of power to make sure that the person is getting treatment.

If it’s an adult about whom you are concerned; your approach might have to be a little bit different. You can try supportively confronting the matter and they may react defensively or not, but my advice is to really stand strong by recommending that they go see a doctor and a specialized therapist who can help.

Host:  Well that’s really great information. So, you recently published a book on treating eating disorders in adolescents and helped develop IMT, Integrative Modalities Therapy. Tell us a little bit about it and how with this collection, what do you hope to provide as a way for clinicians in the trenches to effectively communicate core treatment concepts and close some of those gaps and help their patients for better outcomes?

Dr. Deliberto:  So, Integrative Modalities Therapy or IMT is an approach that I created that incorporates many elements of what’s called evidence-based treatment for eating disorders or treatments that have been shown by research to be helpful. And what we did is we really looked through all of the literature for different interventions that were helpful, and we put them into three different collections of handouts for use in individual group and family therapy. So, the idea is to make really complicated treatment concepts that have been scattered throughout the literature in one place for both clinicians, families and patients and to make sure that these handouts that are in these different collections have really crystal clear concepts in them that can be used in this ala carte fashion in either a hospital or an outpatient setting. So, the idea is to make a really flexible treatment and it makes it easier for the therapist to tailor treatment for the individual’s needs.

And because eating disorders are so difficult to treat, we wanted to provide other clinicians in the trenches like ourselves, with an easy to implement treatment package. So, IMT has been called evidence-based practice in a box and because so few clinicians are trained in the treatment of eating disorders; we thought that by creating this type of treatment, more therapists might be willing to treat eating disorders and therefore, the treatment gap could hopefully be closed because, so few people really do treat it or know how to treat it. by making this kind of evidence-based practice in a box available; we hope that more patients are able to be treated because more clinicians are able to effectively implement treatment.

Host:  Wow, what a great modality. So, while we’re talking about treatment, what are some forms of treatment that are effective for various eating disorders? Tell us a little bit about your program at Weill Cornell Medicine and what you do for patients every day.

Dr. Deliberto:  The first thing that I will say is that if a person has a body in the underweight range or their health is at risk in some way for instance if they are purging very often; they very likely need outside help recovering. It’s really difficult for someone to recognize that they have an eating disorder and kind of take matters into their own hands and recover. They really need outside support. And that could be getting someone into treatment but also once a person is in treatment; they really need again, that outside support.

So, I recommend higher level of care of course such as inpatient or what’s called a partial hospitalization program and I can talk more about that. And so, we have both of these levels of care at the White Plains Campus of New York Presbyterian. We have inpatient and a partial program. And if someone is able to seek outpatient care; then IMT could be an effective approach or for adolescents with anorexia nervosa, something called family based therapy or FBT. Another great outpatient treatment for adults is called Cognitive Behavioral Therapy Enhanced or CBTE, for again, adults. So, there are all these different treatment options but what I would say is one of the most important things is to make sure that a person is getting treatment at the appropriate level of care with the appropriate team supporting.

And then beyond that, they need to be enrolled in some sort of treatment that has been shown by research to be effective. So, with that said, I can tell you a little bit about the program at New York Presbyterian that I opened and directed for a period of time. So, back in 2015, I opened a partial hospitalization program, or a PHP and this PHP runs from 8:30 to 3:00 Monday through Friday and patients receive treatment for those hours during the week. So, they kind of come in almost like it’s a job. And we have a psychiatrist, a nurse practitioner, several social workers, a dietician, psychologist all working together to best treat our patients.

And the patients at the program have breakfast lunch and snacks supported each day with staff members who specialize in the treatment of eating disorders and they also attend two skills groups and a nutrition group a day as well as individual therapy and medication management weekly. So, it’s really a kind of comprehensive program where our patients have a lot of outside support from specialists to help them recover and eat meals and gain weight and the like.

So, last thing I’ll say on this is that unlike many places, we accept all forms of insurance including Medicare and Medicaid and we are currently taking patients.

Host:  Wow, what a great comprehensive program for people that are in such need. Now as we wrap up, Dr. Deliberto, what do you feel the minimum a parent needs to know about these dangers and please reiterate for us, the symptoms that parents need to watch out for whether it’s going in the bathroom for a long time or not eating family meals. What do you want parents to know about the complications that can result and the symptoms they really, the red flags they should be looking for?

Dr. Deliberto:  the number one most important thing that parents need to know is that eating disorders are deadly. They have the highest mortality rate of any psychological illness and really can cause a lot of medical complications. So, for instance, if someone is underweight and they are also purging and maybe taking medications or using substances; this combination of factors really is extremely dangerous. It can cause electrolyte imbalances, sudden changes in a person’s vitals and stability so eating disorders are very dangerous.

And so if you suspect that your child has an eating disorder, again, do not wait another day to start addressing it. Take them to treatment providers now. Because each day that passes by your child will get older and older and the older a child gets, the more difficult it will become for you as a parent to intervene and help. So, the younger, not the earlier, but the younger a child is diagnosed with an eating disorder, the better the prognosis. Because parents are more able to get in there and help. So, don’t wait. That would be my number one message for parents is that eating disorders are deadly and do not wait. You have the power to do something now and act fast.

In terms of what to look for; what I would say is when a person is really showing that they are afraid in some way of gaining weight so they are afraid of eating certain foods, they are afraid of not exercising, they become very irritable when they are told that they need to eat something or told that they can’t exercise; when something gets in the way of them engaging in eating disorder behaviors; again, it is just like food restrictions, limiting the overall amount of food, food avoidance, avoiding specific types of food, exercising, this kind of thing; then you likely have some sort of either eating disorder or disordered eating on your hands. Other signs like you suggested, Melanie, might be going to the bathroom after meals, during meals, purging, if the child is coming back with lots of cavities from the dentist that are unexplained or the dentist has some evidence maybe that there’s some acid erosion of the teeth, things like this are really big warning signs.

So, make sure that if you’re catching any of these red flags again, don’t wait, take you child in to be evaluated.

Host:  What great advice and so important for parents and listeners to hear. Thank you to our guest Dr. Tara Deliberto and to out listeners. This concludes today’s episode of Kids Health Cast. Please remember to subscribe, rate and review this podcast and all the other Weill Cornell Medicine podcasts. For more health tips, and updates on the latest medical advancements and breakthroughs please follow us Facebook and Twitter. I’m Melanie Cole.