Have We Bitten Off More Than We Can Chew?

By Diane R. Girardot

On November 9th, the Renfrew Center Foundation will host its 22nd Annual Eating Disorder Conference. Diane Girardot will be blogging for us daily during the conference, giving us extensive coverage of how presenters and attendees will attempt to sort out the moral dilemmas of eating disorders.

Now that the national "war on obesity" is pretty much coast to coast, have we bitten off more than we can chew? Concerns are sprouting up that obesity-prevention programs can unintentionally lead someone into developing a severe eating disorder or other mental illnesses.

Mental health professionals worry there will be perceived sanctioning of "fat" people as the enemy since the nation has declared war on their body weights and the sizes of their sodas.  Overweight teens and adolescents, already brutally bullied, could face an increase in shame, depression and even self harm if they are singled out for "help" to slim down.  Heavy employees could certainly feel a flush when tapped to come down for weekly weight loss meetings.

Will the results outweigh the risks?

Presenters and attendees at the 22nd Annual Renfrew Center Foundation Eating Disorders Conference, Nov. 9-11, in Philadelphia will attempt to sort out this moral dilemma and others. They will do so in the annual conference's "usual and customary interaction between front-line clinicians/researchers and new voices who feel they have wisdom and observations to share," according to Conference Chair Judi Goldstein, MSS, LSW.

The 2012 conference run by the non-profit foundation arm of the Philadelphia-based Renfrew Center is "Exploring Controversy, Building Collaboration"  with this year's meeting.  More than 600 clinicians - including physicians, nurses, mental health providers and nutritionists - are expected to attend from across the globe.

Goldstein says many obesity-prevention strategies unfortunately invoke shame in the obese population that is can be more harmful than helpful. "Those who may be susceptible may be pulled into a severe eating disorder to deal with their obesity."

A keynote presentation by Deb Burgard, PhD, will more closely examine the obesity war and its "shamed for their own good" practices. Burgard, a founder of the Health at Every Size model and co-author of Great Shape: The First Fitness Guide for Large Women,  will discuss the eating disorder community's moral dilemma in preserving positive body image while encouraging weight loss.

Goldstein is hoping the conference will generate new language and innovative ways to cope with shame-based patterns so obesity strategies don't spiral into an eating disorder.  Specifics are in flux at the moment but weight "balance" rather than "loss" leads the wording exchange, Goldstein points out. Also, therapists working within the field are finding the "voice" they encourage obese patients to follow regarding weight loss, is often the same "voice" that underlies restrictive and purging practices associated with eating disorders.

So when a person is asked to visually imagine a sleeker self fitting into a smaller size to persuade them to eat smaller portions, is that the same "language" used by the restrictive eater to warrant weight loss so they can make the cheerleading squad?  Better to visualize smaller portions as a means to an end that has you taking fewer medications, being more active, and feeling you can bend to pick up a stray quarter without hurting yourself.

The conference is notable as one that encourages discourse on controversial topics.  In addition to obesity, attendees will again consider "nature or nurture" in the onset and maintenance of eating disorders. Once deemed solely socially or peer motivated, some of the most ground-breaking research examines the genetic and biological risk factors of eating disorders and categorizes them as inheritable as any other mental illnesses such as schizophrenia and bipolar disorder.

Goldstein says "how an eating disorder starts and why it is maintained" can have very different origins as well as purposes.  A full-day workshop led by Michael Strober, Phd. and Craig Johnson, Phd, will identify research in this area from the brain-based theories of inheritance and the role of environmental experiences to a variety of intervention strategies - including psychotherapy as a pathway to understand risk, manage triggers and ultimately to recovery.

The conference will further seek collaboration from field professionals to define recovery, especially in anorexia which has a one in five death rate as well as the highest suicide rate of any psychiatric condition.

Is it solely weight restoration or does psychotherapy have a greater role?  Followers of structured, guided restorative models don't ordinarily do psycho/social profiles or explore family dynamics.  Other theories consider a more "abundant package", Goldstein explains, that includes a qualitative assessment of relationships as well as restoration and sustenance of weight gain.

"Weight restoration is crucial but an impaired sense of self can be a barrier."  A chicken and egg metaphor fits here because many health care professionals differ on which should come first:  restoration or psychotherapy?

The Renfrew Center Foundation conference is hailed as a training conference that provides discussion, camaraderie and networking, according to Goldstein who has been it's chair since 1994. Goldstein, a founder of the National Eating Disorders Association, has been with The Renfrew Center, the largest eating disordered treatment network in the country, since it opened in 1985.