Eating Disorders Podcast

@jamesldowns When people report their ED just started or they recently relapsed, my *immediate* response is to check and see if there is a major transition or stressful scenario happening in their life. EDs can be protective mechanisms. They’ll need support there, too.

Thank you to people who have shared things they’ve been told that have been unhelpful in eating disorder treatment. I’m also so interested in the ways people can communicate with you that are helpful. It can be what they say but also how/how it makes you feel. Ideas?

@jamesldowns “Luckily, you’ve still got a little weight on you, so we won’t worry TOO much. That means you don’t need as much support….” 🤮🤮🤮🤮

I'm thinking about clinical communication skills at the moment, and whilst this is the negative side, I'm in need of examples of "what not to say" to patients with eating disorders. What are some of the unhelpful things people have told you?

@jamesldowns “Guys like girls with meat on their bones”… literally some people with a history of SA intentionally use their ED to protect against THAT VERY THING. Add in the fact that not everybody’s looking for a man.. or that people don’t NEED to please others…. Just don’t say that.

@holdspacefree @HLAUnited They didn’t even get to the part about how AI mines user data, how the bots are not HIPAA-compliant, and how these companies often sell user data. Even the NEDA bot terms of use say the company claims user inputs as the company’s own intellectual property once received.

JMIR recently publ this paper "Ethical Challenges in AI Approaches to Eating Disorders". Includes mention of NEDA "chatbot" (I still have ???s about). Quick publication, seems intended to calm fears raised, my speculation. I'm still afraid. @HLAUnited jmir.org/2023/1/e50696/…

@CheriLev One MAJOR issue is that “obesity” is based on weight, and it is not in and of itself a disease. There may be medical factors related to specific behaviors or metabolic processes, but *bodyweight* is not the way to measure that.

@AgnesAyton Not a very trauma-informed approach… If being at a healthy weight prevented ED thoughts/behaviors, then ED behaviors wouldn’t START until somebody was already malnourished… we all know that’s not the case.

Important paper. Full weight restoration in the treatment of anorexia nervosa should be standard and compassionate to help the patient achieve optimal brain health. cambridge.org/core/services/…

@EDCoalition @MarkWarner Anybody know how the NEDA chatbot is doing these days? 🤔

Thank you, @MarkWarner for your continued commitment to helping those with eating disorders, including emerging harms through #AI and calling on tech companies to end their business practices that promote deadly disordered eating behaviors. warner.senate.gov/public/index.c…

@Blalock_24 @DBelardoMD @tarekmd THANK YOU

@DBelardoMD @tarekmd Have you considered it might be also a system failure that was not able to provide what the patient considered important? Had the PCP, internist or cardiologist provided an integrative approach from the begining, communication and trust could have been better

Today, for the first time as a cardiologist, I had a patient tell me they need pre op clearance/input from their naturopath before seeing CT surgery for urgent CABG. The naturopath/holistic world has irreparably harmed our patients. And no one is stopping it.

@AgnesAyton If authoritarian treatment regimes didn’t follow such an all-or-nothing, our-way-or-the-highway structure, we wouldn’t need to wait until all hope was gone before actually asking the client what they really need in the moment.

SpringerCitations - Details Page Thinking about the terminal anorexia debate which came out of nowhere: Patients are alarmed and eloquently arguing the dangers of this concept. The field needs to listen. citations.springernature.com/item?doi=10.11…

@AgnesAyton It’s frustrating, because palliative care may be a necessity for a few. However, it’s currently being presented as “if you don’t follow our orders exactly, prepare to die”. What happened to meeting patients where they’re at? There is much middle ground.

@BBennettPhD What are the privacy settings of this app? Does it track user data and claim it as its own intellectual property like the NEDA app did?

While Twitter is still here, I might as well share more of my work! 🧵In this paper recently published in Eating Behaviors, we tested the feasibility and acceptability of delivering a media literacy intervention for body dissatisfaction through an app. 1/6 authors.elsevier.com/a/1hFdc5EU5noL…

@EDCoalition It doesn’t help that major adolescent “health” agencies want to put them on diet pills and remove parts of their stomachs. I’d be upset, too…

"Other recent research has similarly shown a rise in #MentalHealth challenges among youths, particularly adolescent girls. A 2021 CDC survey found that nearly 57% of teen girls reported feeling 'persistently sad or hopeless'..." Read here: ow.ly/gma250PizoP

@Lundberg_lab That’s nice, dear. When people start their anorexia journey at 300lb and end up at 200lb a month later, that’s clinically significant and their body is in an incredibly stressed state. You’re welcome.

“Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.” I find average BMI =19.7 very difficult to align with this the first criterion of AN according to DSM-V.

@epikrisa @OxPsychiatry @LiveScience There is no BMI cutoff for AN these days. We’ve moved past that. Get with the times.

Anorexia nervosa "has the highest mortality of any psychiatric disorder and is notoriously costly and challenging to treat and recover from". Associate Prof Rebecca Park says new treatments for anorexia urgently need to be developed @LiveScience livescience.com/health/medicin…

@AgnesAyton Not sure why people would be against further study on this topic. Anorexia treatments in general have a high failure rate, so a 40% success rate is actually promising. There’s room for more tools in the toolbox.

“Ten patients with anorexia were treated with psilocybin and reported a positive experience, and four experienced remission of their symptoms.” Not a magic wand.

@IntJEatDisord Who determines what’s “significant” and how much did they pay for it?

@MPStOngePhD @FZuraikat Another interesting paradox: people can recognize that restricting sleep causes physical/behavioral change. But docs happily suggest cutting food intake, expecting no bad side effects….

In a within-subject RCT, we asked healthy adults with habitual adequate #sleep to maintain >7h sleep/night for 6 wk or reduce their sleep by 1.5h/night for 6 wk (SR). What happened? jcsm.aasm.org/doi/10.5664/jc… @FZuraikat Rocio Arnal Barragan

@NEDAstaff Body image can be damaged by sexual assault, oppressive societal norms, abuse, gender dysphoria, and more. Your bot thinks it can help by just telling people to just “think positive!”, as if that makes the other things disappear. (Actual chat message). Gaslighting, much?

To learn more about body image and eating disorders, visit bit.ly/3Cxh6Ox 💙

@danceswithfat People can easily recognize that if you force yourself to stay awake all night, you’ll sleep extra tomorrow. But when we talk about food, suddenly they think the body doesn’t have built-in ways to self-regulate. It’s wild.

The vast majority of people who attempt weight loss will lose weight short term, and gain it back long-term. These two phases are part of the same biological reaction that bodies have to intentional weight loss attempts. This weight cycling is independently linked to harm.

@lisacfogarty @AnorexiaMyths The fact that ED parent-advocates are unironically out here throwing a fit at the very idea of being asked to look inward is an excellent example of why this subject still needs more attention.

@EdOfftopic68292 @AnorexiaMyths I feel like you are missing my point. I'm not in favor of censoring subjects. But there is a very limited amount of research funding as it is, which I'm sure you know. Anyway, best to you. We are both obviously on the side of finding solutions, though we may disagree on methods.

Stop making up ideas (mentalizing anyone? Not a word) and then using them to blame parents for their children’s illness. Absolute nonsense dressed up as science. jeatdisord.biomedcentral.com/articles/10.11…