Bariatric surgery: a primer for eating disorder professionals.

Obesity is a public health epidemic with medical, psychological and economic consequences. It continues to increase globally in prevalence and severity. Despite numerous behaviourally, medically or pharmacologically guided treatments, an effective non-surgical long-term treatment approach has not been identified. Bariatric surgery has surfaced as a viable option for a subset of individuals with medically complicated obesity who have failed non-surgical approaches. Pre-operative evaluation followed by post-operative, longitudinal follow-up by a multidisciplinary team specializing in surgery, medicine, psychiatry/psychology, exercise science and nutrition constitutes recognized and necessary standard of care for these complex patients. More information is needed regarding factors that interfere with successful outcomes and mechanisms of optimal follow-up for bariatric surgery patients to prevent and detect post-operative medical, psychological and social difficulties. We will review these issues with a focus on issues relevant to eating disorders professionals.

Monetary costs associated with bulimia.

OBJECTIVE: The direct monetary costs for food and laxatives, diet pills, and diuretics used by individuals with bulimia nervosa (BN) have not been studied. METHOD: Ten participants with a presenting clinical diagnosis of BN completed a 7-day food record at the outset of treatment in order to provide estimates of weekly and yearly monetary costs for food and associated symptoms. RESULTS: Participants reported means of 3.6 purge episodes, 2.5 objective binge episodes, and 2.4 subjective binge eating episodes per week. Mean total food costs were $106.98/week (SD = $53.88) or $5,581.79/year (SD = $2,811.58). Costs associated with binge eating and purging were 32.7% of all food costs (average: $1,599.45/year). CONCLUSION: Financial costs of bulimia symptoms are significant, and appear to constitute a substantial minority of all food spending by individuals with BN.

Eating disorder treatment among women forty and older: increases in prevalence over time and comparisons to young adult patients.

OBJECTIVES: There is limited information on the prevalence of middle-aged women seeking specialized treatment for an eating disorder and whether middle-aged patients are significantly different from young-adult patients. This two-part study sought to identify changes in the past two decades in the prevalence of middle-aged (MA; 40+ years) and young-adult (YA; 18-39 years) women seeking treatment for an eating disorder (ED) and to identify differences and similarities between both groups. METHODS: For study 1, all unique female inpatient admissions from 1989 to 2006 were reviewed (n=1,040). For study 2, women admitted to any treatment level from January-May 2007 were compared, based on age at intake admission, on psychological questionnaires and factors relevant to an eating disorder. RESULTS: In study 1, the overall percent of MA women who presented for inpatient ED treatment increased significantly from an average of 4.7% (1989-2001) to an average of 11.6% (2002-2006). In study 2, at intake, MA women were more likely than YA to be married, be older at ED onset and report a longer duration of illness. Self-esteem, depression, anxiety, ED psychopathology, and BMI were not significantly different between groups. CONCLUSIONS: Findings indicate an increase in the prevalence of inpatient admissions among middle-aged women, but few differences between middle-aged and younger-aged women at treatment admission. However, the longer duration of illness among MA warrants in-depth investigation of factors related to resistance to seeking treatment and to existing treatments failing patients, and consideration of tailoring treatment to course of illness.

Residential treatment for eating disorders.

OBJECTIVE: The current study describes residential treatment for eating disorders in the United States. METHOD: A national study involving 22 residential eating disorder treatment programs was conducted using a survey to determine treatment program descriptions and trends. Data from 19 respondents, representing 86% of all residential treatment programs in the United States, were examined. RESULTS: Residential treatment options for individuals with anorexia nervosa and bulimia nervosa are becoming increasingly more common. A wide variety of techniques and methods are employed in the treatment of individuals with eating disorders in residential treatment programs. The average length of stay in treatment was 83 days, with an average cost per day of 956 US dollars. CONCLUSION: The residential treatment of individuals with eating disorders is a growing, variable, and largely unregulated enterprise. Future research is needed to focus on quantifying treatment program effectiveness in the residential treatment of individuals with eating disorders.

Arts-based therapies in the treatment of eating disorders.

Arts-based therapies are increasingly being employed, in conjunction with empirically valid traditional therapies, in the residential treatment of eating disorders. A systematic database search of arts-based therapies in the treatment of eating disorders was conducted. In addition, program staff at 22 residential eating disorder treatment programs were contacted to provide information regarding arts-based therapy utilization rates. Of the 19 programs that participated in this study, all incorporate arts-based therapies on at least a weekly basis in the treatment of eating disorders. However, while published narrative reflections on arts-based therapies and eating disorders imply a generally positive outcome, no known, empirically valid studies exist on this experiential form of therapy within the area of eating disorders.