International Conference on Eating Disorders

Educational Session 2
Friday, March 15, 2019
11:15 - 12:45 
(10 Workshops and 5 SIG Panel Discussions) 

W2.1 | From Client Vacations to Natural Disasters: Ethical Provision of Eating Disorder Telebehavioral Interventions for Continuity of Care

Deborah Michel, PhD, CEDS-S¹, Ellen Broxmeyer, LCSW, CPHRM², Ashley Solomon, PsyD, CEDS³, Karen Schneller, LMFT, CEDS^4  
1Eating Recovery Center, The Woodlands, TX, USA; ²Eating Recovery Center, Denver, CO, USA; ³Eating Recovery Center, Cinncinati, OH, USA; ⁴Eating Recovery Center, Sacramento, CA, USA 

A challenge that many clinicians face in provision of behavioral healthcare is interruption of treatment due to planned and/or unplanned absences, which may include vacations, illnesses, and unforeseen conditions such as inclement weather. Telebehavioral healthcare may be able to fill the gap in provision of mental health services which may otherwise be lacking. The use of telebehavioral health services has grown dramatically over the past decade with applications in underserved populations, rural areas, and post-disaster locales. It includes various modalities of technology such as telephonic, internet-based, mobile applications, and videoconferencing. Despite the increased usage, many clinicians express lack of knowledge on how to ethically and responsibly provide this type of care, as well as confusion about the circumstances under which they may or may not do so. This workshop will outline 1.) routine applications, which include planned client absences such as illness or vacations 2.) nonroutine applications, such as widespread disruption of services for an unknown time frame due to natural disaster, and 3.) ethical guidelines and governmental regulations on use. Specific examples of eating disorder telebehavioral health services provided around the globe will be detailed. Attention will be given to different levels of outpatient care including standard outpatient services, intensive outpatient programs, and partial hospitalization programs. With respect to nonroutine applications, a case study of interventions utilized before, during, and after Hurricane Harvey in the greater Houston metropolitan area will be given. Open dialogue regarding ethical and responsible use of services as well as discussion of the efficacy of telebehavioral healthcare in comparison to traditional services will be encouraged. Attendees will also be invited to interact with virtual components of the workshop as well as provide their own examples examples of ethical dilemmas.

Learning Objectives:

1. Describe routine applications of eating disorder telebehavioral healthcare.
2. Describe nonroutine applications of eating disorder telebehavioral healthcare.
3. LIst ethical guidelines and governmental regulations on the use of telebehavioral health.

 

W2.2 | From Exclusive to Inclusive: Strategies to Make Eating Disorder Treatment Accessible to All

Marisol Perez, PhD¹, Lesley Williams, MD, CEDS^2  
1Arizona State University, Phoenix, AZ, USA; ²KellerLife/Liberation Center, Phoenix, AZ, USA

The purpose of this workshop is to improve treatment outcomes for eating disorder patients representing marginalized communities. Regardless of color, size, gender, ethnicity or disability, eating disorder patients require culturally sensitive and weight neutral treatment that understands their unique challenges. We will demonstrate strategies that professionals of varying disciplines can use to adapt their treatment approach and environment to better meet the needs of these patients. The methods used for the workshop will include an open discussion re: the treatment experience for patients from marginalized communities and the challenges faced by professionals when working with them. We will use the audience feedback as a catalyst for sharing strategies that have been employed to create more welcoming and inclusive eating disorder treatment environments. We will review the literature available re: how being from a marginalized community impacts treatment access and outcomes. We will then open the floor to a discussion re: ongoing challenges that exist and how we can be advocates for changes on a more global scale. At the conclusion of the workshop, participants will be better equipped to incorporate inclusivity into their eating disorder practice.

Learning Objectives:

1. Describe why it's important to understand the unique treatment challenges for patients from marginalized communities .
2. Assess when patients from marginalized communities need individualized treatment interventions.
3. List 3 strategies for creating a more inclusive treatment environment.

 

W2.3 | The Therapeutic Use of Humor and Irreverence in Treatment for AN: Levity in the Context of a Deadly Serious Disorder

Nancy Zucker, PhD¹, Katharine Loeb, PhD², Daniel le Grange, PhD³, Martin Pradel, LCSW⁴, Kathryn Huryk, BA², Gina Dimitropoulos, MSW, PhD, RSW⁵, University of Calgary, Calgary, AB, Canada^5 
1Duke University, Durham, NC, USA; ²Fairleigh Dickinson, Teaneck, NJ, USA; ³University of California, San Francisco, San Francisco, CA, USA; ⁴Royal Children’s Hospital – Adolescent Medicine Department, Melbourne, Victoria, Australia; ⁵University of Calgary, Calgary, AB, Canada

The use of humor in a therapeutic context can be a powerful tool that can aid in reducing blame, externalizing the illness, addressing caregiver burden, modeling imperfection, and building therapeutic alliance. However, this therapy process technique is rarely taught, and manualized interventions for eating disorders are often silent on this topic or even prescribe a grave demeanor to foster adaptive anxiety. This workshop will elucidate the various purposes and places for the use of humor in the treatment of anorexia nervosa, and discuss how to balance a respectful stance that acknowledges the seriousness of the disorder with the inclusion of appropriate moments of levity. Literature from the broader field on the use of humor in the treatment of severe and chronic illness will be incorporated, as will irreverence techniques from dialectical behavior therapy. Further, we present a series of cartoons that were developed to help in the management of AN aimed at both practitioners and families. We present qualitative data pertaining to the helpfulness and changes in understanding and attitude that occur as a function of considering a dangerous disorder from a playful perspective without a loss of vigilance or care. Further, we present systematic strategies and considerations for integrating these videos in the context of family-based care and parent groups. Sample themes addressed include the phenomenology of anorexia (mind vs. body); different parenting styles and their impact on meal support; the management of driven exercise; the consequences of rigid dieting on food craving; and weight stigma. Interactive audience components of the workshop will include paired practice activities and group discussion.

Learning Objectives:

1. Participants will be able to define irreverence and describe the history of humorous and irreverent strategies in the context of family therapy.
2. Participants will learn to recognize non-verbal cues and features of individuals receiving treatment that would benefit from the integration of humorous or therapeutic approaches.
3. Participants will learn to use a moment in which humor was attempted - but was not integrated optimally - as an additional therapeutic and educational moment. Examples will be incorporated in the context of family-based and individual treatment and drawn from family systems and dialectical behavior therapy approaches. Cartoons in which these approaches are illustrated will be used both as a teaching tool and as a resource for clinicians.

 

W2.4 | Involving Parents in Prevention of Body Image and Eating Concerns: Practice and Possibilities

Susan Paxton, BA (Hons), MPsych, PhD FAED¹, Laura Hart, BSc(Hons), PhD¹, Rebbecca Manley, BA MSc², Phillippa Diedrichs, BSc (Hons), PhD, FAED³, Niva Piran, PhD, C.Psych. FAED^4  
1La Trobe University, Melbourne, Victoria, Australia; ²Multi-Service Eating Disorder Association, Newton, MA, USA; ³University of the West of England, Bristol, Bristol, UK; ⁴University of Toronto, Toronto, Ontario, Canada

Parents play an important role in creating a positive body image environment for their children. They may be salient role models by communicating attitudes about the body, food and eating, or influence their child through direct comments about their child’s appearance. In addition, they may mediate the impact of other environmental influences. In light of their important role, parental involvement has been explored in a number of prevention programs. This workshop aims to provide insight into two such programs, and also explore new possibilities. One resource that has been designed to assist parents to provide a positive body image and eating environment for 2- to 6-year old children is Confident Body Confident Child (CBCC). CBCC has also been adapted to provide specific support for parents with a lived experience of an eating disorder. In addition, the Dove Self Esteem Project Website for Parents, designed to assist mothers build positive body image in children, has been evaluated. Further, there are many other untapped possibilities for including parents in prevention. In this workshop, participants will first be provided with a brief rationale for the inclusion of parents in prevention (10 mins). Second, CBCC resources will be introduced (10 mins) followed by exploration of issues that parents might raise using role plays, completing activities in the resource, and small group discussions (15 mins). Third, participants will explore ways in which CBCC may be used with parents with a lived experience of an eating disorder in groups discussions (15 mins). Next, the Dove website will be described (5 mins) and participants will engage in experiential aspects of the resource (15 mins). Finally, from the perspective of research anchored in girls’ and women’s lived experiences, participants will discuss future possibilities for the inclusion of parents in prevention (20 mins).

Learning Objectives:

1. Demonstrate an understanding of current activities in interventions for parents
2. Apply prevention strategies to parents with a lived experience of an eating disorder
3. Identify possibilities for including parents in prevention of body image and eating concerns

 

W2.5 | Maximizing Recovery After Weight Restoration via Relapse Prevention in Anorexia Nervosa

Tamara Berends, MSc¹, Sahib S. Khalsa, MD PhD², Angela Guarda, MD FAED^3  
1Altrecht Eating Disorder Center Rintveld, Zeist, Utrecht, Netherlands; ²Laureate institute for Brain Research, Tulsa, Oklahoma, USA; ³Johns Hopkins Hospital, Baltimore, MD, USA

Relapse after treatment for anorexia nervosa (AN) is common, yet we have a limited understanding of the forces that drive it. Heterogeneous definitions of remission, recovery and relapse complicate analyses of treatment outcome across studies, and there is a comparative need for the adoption of consistent outcome measures and risk adjustment metrics. This workshop will engage participants in a practical case-based discussion focused on these topics and will cover three main areas. First, presenters will review the literature on predictors of relapse in AN and outline a recently published proposal for standardized definitions of relapse, remission and recovery. Attendees will be encouraged to provide input and feedback on this scheme through an interactive small-group sampling process to measure consensus and divergent perspectives. The second part of the presentation will review strategies for collection of common outcomes across laboratories and eating disorder treatment programs including diagnosis and patient characteristics, treatment characteristics, key clinical outcome measures, optimal follow-up frequency, and data sharing. Finally, the third part of the workshop will focus on relapse prevention strategies. Relatively few treatment interventions have been developed that directly target relapse prevention in AN. The utility of a pragmatic manualized program, the “Guideline Relapse Prevention Anorexia Nervosa (GRP)” will be illustrated using interactive case-based exercises. This guideline describes how the healthcare professional, patient and family members can work together to understand the patient’s individual process of relapse and proactively strategize how to mitigate risk. Data from a cohort study implementing this guideline in 83 patients with AN and demonstrating a relapse rate of 11%, considerably lower than that reported in other studies (30-57%) will be presented.

Learning Objectives:

1. Introduce standardized definitions of relapse, remission and recovery in anorexia nervosa.
2. Discuss standardized outcomes measurements in anorexia nervosa treatment.
3. Describe and apply the Guideline Relapse Prevention to clinical cases.

 

W2.6 | How to Develop a Neuroethically Informed Study of Deep-Brain Stimulation in Severe Enduring Anorexia Nervosa (Se-An): Which Patients Might Benefit and How?

Rebecca Park, MB BCh, PhD, FRCPsych¹, Jacinta Tan, MB BS, PhD, FRCPsych^2  
1University of Oxford, Oxfordshire, UK; ²Swansea University, Swansea, Wales, UK

Purpose: To help participants appreciate the clinical and ethical complexity of patient selection and support for Deep Brain Stimulation. We have been investigating Deep Brain Stimulation to the Nucleus Accumbens as an experimental treatment for Severe enduring Anorexia Nervosa. We integrate a neuroethical gold standard into our work. Our data include not only neural and clinical effects but also detailed assessments of capacity, and ethical analysis arising from in-depth discussions with patients and their accounts of the research experience. Our study protocol and ethics gold standard are published and registered with clinicaltrials.gov. NCT01924598, with ethical/ HRA approval (Project ID 128658). A key issue is ethically informed patient selection and engagement. This workshop shares and discusses practical and clinical lessons learnt. We invite discussion and debate on this novel and invasive treatment, and discuss potential pitfalls. We also describe and discuss experiences of the patients who have completing protocol, and that of their families. Detailed data on results is presented in a seperate paper AED submission. In half our patients DBS has been associated with marked improvements in ED pathology and reported as ‘ life changing’ and ‘liberating’. There were no serious adverse events or side effects. Capacity assessments and detailed ethical interviews challenged the standard principles of informed consent, with patients speaking movingly about their desperation for treatment . They are thus a particularly vulnerable research population in spite of excellent understanding of potential risks and benefits, rendering selection decisions particularly complex for researchers. Moreover the course of recovery journeys was fruitful but at times challenging. The workshop focuses on issues of patient selection and support during the research and the crucial underpinnings of our neuro-ethical gold standard to guide future clinicians and researchers

Learning Objectives:

1. To appreciate and reflect on what DBS for SE-AN involves, and the inherent ethical complexities of this experimental treatment .
2. To appreciate and reflect on the clinical complexities and demands of DBS for SE-AN.
3. To extend and deepen general knowledge of research ethics in a vulnerable eating disorder population.

 

W2.7 | Joining Forces for Empirically-Supported Treatment Models: Family-Based Treatment with Cognitive-Behavioral Models as Follow-up for Eating Pathology and Comorbidities

Jenna DiLossi, PsyD¹, Laurel Weaver, MD, PhD², Rebecka Peebles, MD², Melissa Harrison, MA¹, Eleanor Benner, PsyD^3  
1Center for Hope & Health, LLC., Ardmore, PA, USA; ²Children's Hospital of Philadelphia, Philadelphia, PA, USA; ³Center for Integrated Behavioral Health, Bethlehem, PA, USA

The primary goals of this workshop are to give treatment providers a clearer understanding of how to navigate through implementation of the empirically-supported treatments for eating disorders that we have available at this current time. The specific focus will be on Family-Based Treatment (FBT) and Cognitive-Behavior Therapy-Enhanced (CBT-E) in adolescent and young adult populations, with other CBT models utilized as a follow-up treatment for additional diagnostic comorbidities. Researchers have worked to create thorough, user-friendly treatment manuals for clinicians to implement; however, there has not been much empirical attention given to cases wherein it may be clinically indicated to implement both approaches throughout the course of treatment. Workshop speakers (i.e., Jenna DiLossi, PsyD, LPC; Rebecka Peebles, MD; Laurel Weaver, MD, PhD; Melissa Harrison, M.A., LPC; & Eleanor Brenner, PsyD) will draw upon the current literature in addition to clinical work in a didactic PowerPoint presentation (35-40 minutes) to discuss the following: 1) Assessing when to implement FBT vs CBT-E as the first line of defense for eating pathology; 2) Transitioning from FBT to either CBT-E or another CBT manual for a different disorder (i.e., Exposure & Ritual Prevention for Obsessive-Compulsive Disorder); 3) Managing possible road blocks to success. Speakers will engage participants in a group discussion by prompting them to share cases and questions from their clinical work wherein this type of combined treatment plan could be applied (25 minutes). Case vignettes will also be used to facilitate participants working in pairs to identify treatment recommendations and interventions, while workshop speakers rotate around the room for assistance (25 minutes).

Learning Objectives:

1. Assess how diagnostic comorbidity impacts the utility of FBT vs CBT-E for eating disorder treatment.
2. Assess when either CBT-E or another CBT model is clinically indicated as a follow up to FBT.
3. Understand how to implement successful transitions from FBT to CBT, while navigating possible problems that may arise.

 

W2.8 | Acceptance and Commitment Therapy (ACT): Application to Anorexia Nervosa and the Spectrum of Anorectic Behavior

Rhonda Merwin, PhD
Duke University, School of Medicine, Durham, NC, USA

Acceptance and Commitment Therapy (ACT) is a contemporary cognitive-behavioral therapy that emphasizes acceptance, mindfulness and values in treatment. ACT is increasingly used to treat eating disorders, and although evidence is still in its infancy, results are promising. There have been seven case series (Berman et al., 2009; Heffner et al., 2002; Hill et al., 2015; Hill, et al., 2015; Masuda et al., 2016; Merwin et al., 2013; Wildes & Marcus, 2011), three open trials (Juarascio et al., 2017; Timko...Merwin, et al., 2015; Wildes et al., 2014), two randomized control trials (RCTs) (Parling et al., 2016; Strandskov et al., 2017), and two other nonrandomized studies with a control condition (Juarascio et al., 2013; Pinto-Gouveia et al., 2017). ACT addresses eating disorder behavior by increasing psychological flexibility (or the ability to behave flexibly and effectively in the presence of unwanted thoughts and feelings) and helping individuals clarify and align behavior with deeply held personal values. ACT might be particularly well-suited for individuals with anorexia nervosa who are often high in experiential avoidance and low in self-directedness, and may struggle with motivation for change. This workshop will teach the core principles of ACT and ACT case formulation. Participants will be oriented to the 6 core ACT processes or functional domains, and how they may be leveraged in the treatment of anorexia nervosa and the spectrum of anorectic behavior. The workshop will be presented by a Peer-Reviewed ACT trainer recognized by the Association of Contextual and Behavioral Science. Content will draw heavily from "Using ACT to Treat Anorexia Nervosa and the Spectrum of Anorectic Behavior" (Merwin et al., in Press, Guilford Press). Learning methods will include didactic presentation, but will rely on highly interactive discussion and participants will practice case formulation and experiential exercises.

Learning Objectives:

1. Identify the principles of ACT and conduct an ACT case formulation.
2. Define the 6 core ACT processes (or functional domains) and demonstrate one strategy for each.
3. Describe adaptations of ACT interventions for adults with anorexia nervosa.

 

W2.9 | Start Spreading the News--But HOW? A Workshop on Creating a Cultural Dialogue.

Erin Parks, PhD¹, Heather Hower, MSW, LICSW, QCSW, ACSW², Michael Cortese, BA³, Carrie Arnold, MA, MPH⁴, Lisa Sabey, BA⁵

¹University of California San Diego, San Diego, CA, USA; ²Brown University, Providence, RI, USA; ³Salucore LLC, Brooklyn, NY, USA; ⁴Williamsburg, VA, USA; ⁵Denver, CO, USA

The eating disorders field is making great strides in improving prevention, screening, treatment, and access to care for eating disorders. However, despite this progress, the majority of schools don’t use our prevention techniques, the majority of pediatricians don’t use our screenings, the majority of clinicians don’t practice our treatments, and the majority of sufferers don’t have access to affordable, evidence-based care. As we seek to bridge the research-implementation gap, it becomes more essential than ever to mobilize the public. From mandatory automobile seat-belts, to routine screening for autism, consumer demand drives regulations, funding, and access. But how do we get the public to care about our research? How do we shift the cultural narrative around eating disorders away from the myths, and towards the research? This workshop panel features a blogger, a documentary film-maker, a media executive, and a science journalist discussing how we can spread the word about eating disorders and the evidence-based prevention, screening, and treatments that are available. Workshop time will be spent as follows: 40 minutes--Lead author will serve as a moderator, as each panelist presents on what they’ve learned within their individual mediums. They will each discuss their communication process and skills, lessons learned, and take questions from attendees about how to turn research findings into cultural dialogue. In the second half of the workshop, the moderator will lead the attendees and panel in dissecting and improving tweets, elevator pitches, interviews, social media posts, and headlines. Attendees will work in small groups to practice their personal elevator pitch and will also craft communication proposals for the Eating Disorders Truths.

Learning Objectives:

1. Describe the concept of socializing research.
2. Deliver a socially salient elevator pitch.
3. Propose communication strategies for their areas of research/practice.

 

W2.10 | Times Up: When to Call it Quits with FBT and What to do Next?

Chris Thornton, MClinPsy¹, Annaleise Robertson, DCP/MSc², Kate Godfrey, DCP/MSc. formerly^2 
1The Redleaf Practice, Sydney, NSW, Australia; ²The Children's Hospital at Westmead, Sydney, NSW, Australia

While Family Based Treatment (FBT) is the gold standard for treating anorexia nervosa in young people, research demonstrates that less than 50% of patients achieve full recovery with this treatment model. Although a number of enhancements to the FBT model have been proposed in recent years, there has been less discussion around when to discontinue FBT and utilize other treatment models. This workshop will draw upon three clinical case studies to spark discussion around how to recognise when FBT is failing the patient and family, and what to do next. We will cover a) the clinical indicators that suggest that FBT is no longer beneficial to the family b) the decision making process around how and when to transition to a new treatment model, c) and how to use formulation and clinician skills/experience to implement a sound treatment framework moving forward. The cases presented will be diverse and will demonstrate how individual psychotherapy, Attachment Based Family Therapy and trauma-based therapy were used to promote further recovery in our patients. An overall relational frame will be emphasized amongst the three cases. Lesson Plan Outline 25 minutes Brief introduction: anorexia nervosa in young people; FBT Interactive discussion: indications that FBT is not/no longer effective Interactive discussion: process in deciding when and how to transition to a different treatment model 50 minutes Case presentations: illustrate how to use case formulation to transition to a new treatment model; demonstrate how three different treatment models were utilized when FBT was no longer effective; the importance of a relational frame 15 minutes Small group discussions: applying concepts learnt today to participant cases

Learning Objectives:

1. When to move from a strict FBT adherence model
2. The need for clinical case formulation in the decision making process around discontinuing FBT
3. Adjuncts and alternatives to FBT in the treatment of Anorexia Nervosa

 

SP2.1 | Neuroimaging Training: Everything You Might Not Know You Need to Know

Laura Berner, PhD¹, Ann Haynos, PhD², Kendra Becker, PhD³, Lauren Breithaupt, MA⁴, Andrea Goldschmidt, PhD⁵, Jason Lavender, PhD¹, Walter Kaye, MD, FAED^1  
1University of California, San Diego, San Diego, CA, USA; ²University of Minnesota, Minneapolis, MN, USA; ³Massachusetts General Hospital, Boston, MA, USA; ⁴George Mason University, Fairfax, VA, USA; ⁵Brown University, Providence, RI, USA

Up to 60% of adults who receive empirically supported treatments for eating disorders (EDs) do not achieve full remission, and among those who do, relapse is common. One barrier to more effectively targeted treatments is limited understanding of the psychobiological processes that promote and maintain symptoms. Therefore, there is a critical need for additional research on the neurobiological mechanisms of EDs. Despite the necessity of further research in this area, U.S. National Institute of Health estimated spending in 2018 for ED research will be just 10% of spending for psychiatric disorders with comparable prevalence and lower mortality rates. Training in neuroimaging, a useful tool to pinpoint biological targets that aligns with most funding agencies’ research priorities, can assist in advancing the scientific goals for the field. However, many ED experts interested in pursuing neuroimaging training may be uncertain about where to start, or what the scope of their training should include. This panel will guide researchers who wish to develop neuroimaging knowledge and skills, those planning training grant applications, and clinicians hoping to become informed collaborators of neuroimagers. We will first review the importance of neuroimaging training for ED experts. Next, panelists awarded a variety of neuroimaging training grants (NIH F31, F32, and K23 awards; NSF fellowships; institutional awards) will review the essential steps in developing a neuroimaging training plan, including how to: 1) determine what kind of neuroimaging user you want to be; 2) connect with the right mentors and consultants; 3) effectively set up a new neuroimaging study; and 4) learn to analyze and publish neuroimaging data. Examples from panelists’ grant applications will be presented. Attendees will outline and receive feedback on personalized training plans and receive a syllabus of workshops and key reading. We will conclude with time for questions and discussion (30 min).

Learning Objectives:

1. Describe the importance of neuroimaging training for eating disorder experts, including those who plan to be only consumers or collaborators
2. Outline key elements of neuroimaging training
3. Develop a personalized neuroimaging training plan

 

SP2.2 | If You are not Counted, You Don’t Count: Best Practices in Population-Level Assessment of Eating Disorders and Disordered Eating Behaviors

Katherine Loth, PhD, MPH, RD, LD¹, Brittany Bohrer, MA², Lisa Hail, PhD³, Carly Pacanowski, PhD, RD⁴, Bryn Austin, PhD⁵, Deborah Katzman, MD⁶, Jocelyn Lebow, PhD, LP^7 
1University of Minnesota, Minneapolis, MN, USA; ²University of Kansas, Lawrence, KS, USA; ³University of California San Francisco, San Francisco, CA, USA; ⁴University of Delaware, Newark, DE, USA; ⁵Harvard School of Public Health, Boston, MA, USA; ⁶Hospital for Sick Children, Toronto, Ontario, Canada; ⁷Mayo Clinic College of Medicine, Rochester, MN, USA

Brief assessment tools that are capable of providing valid and reliable data on population-level prevalence and incidence of eating disorders (EDs) and disordered eating behaviors (DEBs) are critical; epidemiological data helps assess which public-health programs are working and identifies where more resources and services are needed. Knowing this, the Assessment & Diagnosis and Public Health SIGs propose an interactive panel focused on approaches to population-level assessment and surveillance of EDs and DEBs. Through a series of five lightning talks followed by facilitated conversation, participants will: 1)  learn about assessment best-practices; 2)  become familiar with brief assessments currently utilized for the epidemiological study of EDs and DEBs; 3) develop an understanding of how population-level data is utilized to improve ED and DEB prevention and treatment programs; 3) gain insight regarding the unique challenges associated with population-based assessment of EDs and DEBs; and 4) engage in discussion about how to best develop and implement ED and DEB assessment tools into various existing infrastructures (government surveillance surveys, primary- and specialty-care settings, strategic science for policy makers). Facilitated, interactive discussion will occur between each lightning talk, as well as during the second half of the panel. Suggestions for discussion questions will be collected via 1) the AED Online Community prior to the conference, 2) live-Tweet during the panel lightning talks as well as throughout the discussion time period, and 3) direct audience participation. Panel attendees should expect to leave with increased awareness of the importance of public health surveillance of EDs and DEBs, a deepened understanding of the barriers associated with this type of work, and new ideas to pursue this type of ongoing surveillance in a variety of public-health settings.

Learning Objectives:

1. Evaluate approaches to population-based assessment and surveillance of eating disorders and disordered eating.
2. Consider a strategic-science approach to epidemiological assessment of eating disorders in order to facilitate communication with policy-makers and advocates to apply research to policy debates.
3. Identify best-practices for engaging primary- and specialty-care providers in the assessment of eating disorders and disordered eating.

 

SP2.3 | Good Neighbors Provide Great Treatment: Toward Collaborative Care Networks for Regional Patients

Jason McCray, PhD¹, Jilllian Lampert, PhD, MPH, RD, LD FAED², Heather Dlugosz, MD, FAPA, CEDS³, Paul Houser, MD^4 
1The Center for Balanced Living, Columbus, OH, USA; ²The Emily Program, Minneapolis, MN, USA; ³Eating Recovery Center, Cincinnati, OH, USA; ⁴Linder Center of Hope, Cincinnati, OH, USA

The eating disorder treatment facilities within the state of Ohio have been working together in a collaborative network for several years.  Facilities from a range of settings and backgrounds work together to provided collaborative care to the community and offer training opportunities for independent practitioners to ensure an excellent standard of care in our state and region.  We will describe how our network functions and the benefits our facilities have seen from the collaboration and offer thoughts on how other regions might adopt a similar model.   Representatives from four of the sites within the network will discuss how the cooperative network has improved patient outcomes by facilitating smoother transitions between facilities and programs based on patient needs, level of care, diagnosis and/or optimal treatment modality.  The relationships fostered by the network allow for strong communication and collaborative attention to challenges when they arise. Working together in this way benefits the patient and family while elevating the standard of care in our industry.  By working together rather than directly competing with one another each site, our patients and the broader community all benefit. Panelists will discuss how the state network provides a touch point for activism around the national healthcare issues being addressed by EDC and REDC.  We will discuss the annual conference we host drawing on the expertise of our sites and offering training to one another and the broader community of eating disorder treatment professionals.  Time permitting Dr. Houser will present a case vignette of how the collaboration fostered by the network changed the course of treatment for a family facing a challenging and complex situation.  Kitty Westin will moderate an interactive discussion with the panelists and the audience about the novel network and its benefits.

Learning Objectives:

1. Participants will foster a recognition of how of how treatment centers and communities can benefit from creating regional collaborative working groups within the specialty of eating disorder care.
2. Facilitate discussion about the importance of treatment centers establishing community norms for high quality eating disorder care and the ways that collaborative working groups can contribute to doing so.
3. Participants will be familiar with one working model for how to build state or regional working groups to collaboratively address community eating disorder treatment/prevention needs in ways that improve patient care and increase opportunities for the treatment centers.

 

SP2.4 | Risk Factor Reduction and Treatment of Body Image and Eating Disorders in Athletes

Jennifer Harriger, PhD¹, Tiffany Brown, PhD², Laura Moretti, MS, RD, CSSD, LDN³, Riley Nickols, PhD⁴, Sasha Gorrell, PhD⁵, Carolyn Becker, PhD, FAED^6  
1Pepperdine University, Malibu, CA, USA; ²University of California, San Diego, San Diego, CA, USA; ³Boston Children's Hospital, Waltham, MA, USA; ⁴Victory Program, McCallum Place, St. Louis, MO, USA; ⁵University of California, San Francisco, San Francisco, CA, USA; ⁶Trinity University, San Antonio, TX, USA

Eating disorder intervention efforts in athletes must take into account unique factors, including sport performance, increased nutritional balance, and influences from coaches/teammates; however, many providers feel intimated in adequately addressing these factors with their patients. This presentation, co-sponsored by the Sport & Exercise and the Body Image & Prevention SIGs, has assembled a panel of experts on body image and eating disorder intervention efforts in athletes. The panel will focus discussion on three core aims, which include: (1) improving understanding of athletic identity and unhealthy exercise behavior (2) describing up to date risk factor reduction efforts in athletes and (3) discussing the unique challenges related to treating eating disorders in male and female athlete populations. First, Drs. Brown & Harriger will provide a brief introduction to the topic of eating disorders in athletes (~10 minutes). Next, the session will begin with concise overviews of each of the main topic areas by the presenters (~40 minutes). Laura Moretti will discuss nutritional needs and appropriate fueling for athletes and exercisers. Sasha Gorrell will discuss unhealthy exercise practices in athletes, and Riley Nickols will present on athlete identity. Carolyn Becker will discuss results and insights gleaned from the Female Athlete Body Project, a program designed to reduce risk factors for the development of eating disorders. Finally, Tiffany Brown and Jennifer Harriger will moderate an interactive panel discussion, which will include identifying panelists to answer questions generated from the audience earlier in the session. Audience members will also be invited to ask additional questions and to participate in the discussion.

Learning Objectives:

1. Explain how athletic identity and unhealthy exercise behaviors can affect athletes
2. Discuss recent efforts to reduce body dissatisfaction and disordered eating in athletes
3. Describe unique challenges related to treating eating disorders in female and male athlete populations

 

SP2.5 | Screening and Early Recognition of Eating Disorders: A Collaboration of Medical Providers and Registered Dietitian Nutritionists

Therese Waterhous, PhD, RDN, CEDRD¹, Lori Lieberman, RD, MPH, LDN, CDE², Sondra Kronberg, MS, RD,CDN, CEDRD-S³, Kortney Parman, RD, RN, MS, FNP-C^4  
1Willamette Nutrition Source, LLC, Corvallis, OR, USA; ²Lori Lieberman and Associates, Sharon, MA, USA; ³Eating Disorder Treatment Collaborative, New York City, NY, USA; ⁴San Francisco Dept. of Public Health, San Francisco, CA, USA

Eating disorders have the best prognosis when diagnosed early and treated promptly with effective treatments. While screening for eating disorders enhances early recognition, in the primary care setting, screening for eating disorders is generally absent. Other avenues for screening for early detection have not been widely explored. Given the shame, denial and the secretive nature of eating disorders, they often go undetected. The focus on BMI screening versus exploration of eating behaviors further compounds the problem, as the medical guidance provided (supporting dieting or reinforcing weight loss) is often contraindicated to eating disorder recovery.   During this interactive panel we will discuss several problems associated with early recognition of eating disorders, including provider awareness and education,  time limitations, increasing demands on medical providers, lack of experience with eating disorders, and the challenge of identifying eating disorder resources. We will explain the use of validated screening tools, and describe several initiatives in using screening tools in non-traditional settings. Original data from research conducted to educate and train various providers will be shared, showing effects of training in eating disorder screening. Situations where allied health professionals such as RDNs took the lead in implementation of  screening protocols will be described.   Sharing attendee experiences, we aim to identify and discuss possible solutions for implementation of eating disorder screening, discuss and learn from similar screening challenges and create steps to act locally.

Learning Objectives:

1. After attending this panel, the audience will be able to describe why screening for eating disorders in the outpatient setting is met with resistance from the medical community and barriers to doing universal screening for eating disorders.
2. After attending this panel, the audience will be able to discuss non traditional methods for instituting eating disorder screening in local communities.

After attending this panel, the audience will be able to identify  the next steps that eating disorder professionals would recommend to PCPs, after they perform eating disorder screening.