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Nine Truths to Build On

Pat Hartman April 15, 2025 No Comments

A few years back, the Academy for Eating Disorders published a list of nine facts about such ailments. While, of course, plenty of work has been done in the interim, and many discoveries have been made, it is interesting to look back on this document created by 19 authors from three institutions of higher learning, two of them European and one American.

The very first fact mentioned is that many people who suffer from eating disorders may appear healthy, as in “no big deal,” while they are nevertheless quite sick. The problems exist in three different areas: the body, the mind, and the person’s interactions with society in general. To break it down even further, the somatic risks show up in “multiple organ systems including the cardiovascular, gastrointestinal, musculoskeletal, dermatologic, endocrine, hematological, and neurological,” while psychological/psychiatric difficulties present further potential for malfunction.

To complicate matters even more, the affected person’s appearance is not always a clue to the underlying problem. Someone who engages in restrictive eating might look emaciated; on the other hand, their physique might be quite hefty. Neither bulimia nor binge eating can be deduced from an individual’s looks, either. It is important to not make assumptions without evidence.

Another fact is that the majority of people troubled by eating disorders cope on their own, or simply give up, and never even seek treatment. They might keep the problem a secret for years, fooling family members, friends, medical personnel, and even themselves.

Old assumptions die hard

Premise #2 is, no one should leap to the conclusion that family malfunction is the cause. Fault does not always lie with the parents, and, in fact, a child’s eating disorder, especially if it becomes life-threatening, can bring a lot of stress into the family dynamic. Caregivers may be in for a rough ride, especially when the troubled person is anorexic. Parents might suffer “higher levels of distress than individuals caring for patients with psychoses.”

On the other hand, once the “identified patient” is under treatment, attention must also be paid to educating the caregiver/s in self-care, to prevent further erosion of the overall situation. This sounds distressing, but it is very positive news because, in contrast, the historical fact mentioned in a recent post, a “parentectomy” is no longer considered the first, best course of treatment for anorexia.

Start with the positive

In fact, family-based treatment has proven to be very effective, particularly in cases of anorexia. The first step is to help the older members recognize the knowledge and skills they already possess as a strong basis on which to build. When the affected person is an adult, a couple-based intervention can be successful, and might begin with teaching the well partner how to overcome the fear of making the situation worse with inappropriate actions or words.

Up to that point in the history of understanding such illnesses, family-based success had mostly been achieved in cases of anorexia. The study’s authors urged much more research into how BN (bulimia nervosa) and BED (binge eating disorder) could be affected. Still, no matter how good the intentions and how ambitious the family-based treatment may be, the functioning of the family as a whole, in addition to the well-being of individual members, cannot help but be affected.

In particular, there may be an unavoidable financial burden. For teenagers, dealing with these matters as either the identified patient or as a relative can add extra stress to the already multitudinous problems of adolescence. For adults, the more obvious areas of difficulty are intimate relations and reproductive health, as well as adaptation to the theory and practice of new parenting skills.

This should go without saying…

In the realm of family, it ought to be very obvious that prevention is much preferable to intervention. To raise healthy children is such a difficult undertaking, parents ought to have access to comprehensive training — early and often. If for any reason such education is not provided by official entities, perhaps this is a signal that groups of other types need to step up and take responsibility for offering solid advice and practices under which children can flourish.

Your responses and feedback are welcome!

Source: “The Science Behind the Academy for Eating Disorders’ Nine Truths About Eating Disorders,” NIH.gov, October 2017
Source: “Identified Patient Psychology: Unraveling Family Dynamics and Treatment,” NeuroLaunch.com, 09/15/24
Image by pixelRaw/Pixabay

Around the World With BED

Pat Hartman April 10, 2025 No Comments

Binge Eating Disorder has made some astonishing strides in the past few years. First, we go back a decade to an article titled, “11 Countries with the Highest Rates of Eating Disorders in the World.”

At that point in time, it was already impossible to ignore the influence of media on the behavior of people, especially young ones. The author noted that about 50% of teen girls and 30% of teen boys were restricting their diets in some way, with weight loss as the goal. Of those dieters, it was estimated that around one-quarter of them eventually wound up with eating disorders. Worse yet, at best guess, most of them never tried to get treatment.

As one of the 11 countries most troubled in this way, the piece surprisingly named Bangladesh, which had in 1974 attracted world attention and aid because of famine conditions that killed as many as a million and a half people. Given that history, it stretches the imagination to picture the inhabitants suffering from any sort of eating problem other than starvation.

Really?

That Vietnam, Pakistan, and Indonesia would be named as prominent eating disorder hotspots is also disconcerting. Another surprise to find in this category at the time was Brazil, with around 37% of its teenagers into binge eating, and almost one-quarter of them being “serial dieters.”

At around the same time, a WHO survey of world mental health noted that very few countries other than the United States even kept track of Binge Eating Disorder (BED), and that fewer than half of either BED or bulimia nervosa sufferers ever received treatment. Apparently, BED was not at the time regarded as a very serious problem, but the authors of the document warned that in terms of public health, it mattered at least as much as bulimia. They added,

Low treatment rates highlight the clinical importance of questioning patients about eating problems even when not included among presenting complaints.

In 2021, a specially-purposed world map designed to indicate the spread of only two disorders, anorexia nervosa and bulimia nervosa, was published. It showed Australia as the undisputed winner, with about 2% of the country’s population suffering from one or the other.

All over the place

When researchers want to know about the prevalence of binge-eating disorder in various parts of the world, a number of questions immediately present themselves. How should the areas be differentiated? Strictly by national borders? That would be the easiest way, because research tends to be done, if at all, by a particular country’s academic and scientific establishments. Or does it make more sense to categorize unhealthy people by race? By political dogma? By religion? By language? By gender and/or sexual orientation?

A recently published cross-cultural study, with the goal of setting up a standardized framework for assessing Binge Eating Disorder, stated that it…

[…] aimed to evaluate the reliability and validity of the Binge Eating Disorder Screener-7 (BEDS-7) across 42 countries and 26 languages, assessing its reliability and validity […] in diverse cultural contexts.

The researchers note that BED, which is associated with non-trivial risks to psychological and physical health, is ”often underdiagnosed across diverse cultural and clinical settings.” Furthermore, most people who have it do not seek treatment directly for the condition itself, but look first for help with other physical and mental disorders. Along with depression and anxiety, individuals with BED also tend to have histories of substance use (or abuse). The authors note,

When translating and applying questionnaires measuring eating disorders across different cultural contexts, challenges arise due to varying cultural norms related to food, body image, and mental health, which can affect how individuals interpret and respond to questions.

Additionally, there is the fact that many people with disordered eating behaviors do not know it. Women may think it is perfectly normal to obsess over their bodies. Men may believe it is unmasculine to even think about such issues. Researchers also find that, depending on which country information is gathered from, certain groups are under-represented. People with more education and less self-consciousness about their sexuality, for instance, tend to show up for surveys and reply to questionnaires.

Your responses and feedback are welcome!

Source: “11 Countries with the Highest Rates of Eating Disorders in the World,” InsiderMonkey.com, 06/12/15
Source: “The prevalence and correlates of binge eating disorder in the WHO World Mental Health Surveys,” nih.gov, 05/01/14
Source: “Eating disorders prevalence, 2021,” OurWorldInData.org, 2021
Source: “Cross-Cultural Validation of the Binge Eating Disorder Screener-7 (BEDS-7) Across 42 Countries,” Wiley.com, 03/05/25
Image by Mohamed Hassan/Pixabay

Social Media Encourages Eating Addiction

Tatyana Meshcheryakova April 9, 2025 No Comments

A new international review has shed light on the extensive and often subtle ways that social media platforms expose children and teenagers to ultra-processed food marketing, raising serious concerns about its impact on youth health and global childhood obesity trends.

Published in BMJ Global Health in February 2025, the study highlights how the digital environment is saturated with advertisements for foods high in sugar, salt and fat. These ads, frequently integrated into entertainment content, are designed to be persuasive and often go unnoticed by young audiences. From breakfast cereals and cookies to soft drinks and fast food, unhealthy food promotions are a constant presence in kids’ online lives.

The report examines 80 previous studies involving nearly 20,000 children and teens and shows a strong link between exposure to digital food ads and increased consumption of unhealthy foods. Children not only crave these items more but also pressure their parents into buying them. One study cited revealed that junk food promoted by influencers notably increased immediate food consumption among children aged 9 to 11, unlike healthy food promotions, which had little impact.

Unlike traditional media, social platforms such as TikTok, YouTube and Instagram tailor content using algorithms based on user behavior. Ads are cleverly disguised within games, quizzes and videos, making them difficult for young users to identify as marketing.The researchers noted,

Digital marketing strategies are nearly universally effective in shaping young people’s eating habits and encouraging the consumption of unhealthy foods.

Social media as a commercial determinant of health

The review adds to growing evidence that social media functions as a commercial determinant of health (CDoH), comparable to industries like tobacco and alcohol. These platforms not only facilitate food marketing but also shift public perception and promote corporate agendas.

In the U.S., over 95% of teens have access to a smartphone, and more than a third report near-constant social media use. In the U.K., most children have a phone by age 11, and even children as young as five to seven are active online. Australia recently introduced a ban on social media use for children under 16, reflecting rising concerns.

Researchers note that just like other health-harming industries, the food sector uses social media to resist regulation, co-opt health language, and reshape public discourse. For instance, Australian studies found that processed food companies actively lobbied against public health policies on Twitter while pushing for voluntary measures and using misleading narratives.

This review is the first to focus on how these marketing tactics target youth, deepening health inequalities and contributing to rising rates of non-communicable diseases (NCDs) such as diabetes and heart disease.

Youth flooded with food ads daily

The research team, made up of experts from the U.K., Canada, and New Zealand, analyzed 36 studies and editorials published between 2000 and May 2023. They found that exposure to digital food marketing differs by country, age, and gender.

For instance:

In Mexico, children were shown an average of 2.7 food ads per hour on weekdays.
Australian teens were exposed to roughly 168 food promotions weekly via mobile devices.
In Canada, 72% of youth ages 7-16 saw food marketing within 10 minutes of opening their favorite apps. Of all food ads on popular children’s sites, over 93% promoted high-fat, salty, or sugary products.

Boys were more often targeted with ads centered around sports and performance, while girls received more interactive content, such as quizzes and polls. The platforms often gather and sell user data to companies that harm public health, further complicating efforts to track or regulate ad exposure.

Teenagers, in particular, face the greatest risk, with many studies pointing to a correlation between food marketing, poor body image, and disordered eating patterns. Brands also quickly adapt their marketing strategies to current events. During the COVID-19 pandemic, 14 of the top 20 unhealthy food brands in New Zealand released pandemic-themed promotions to stay relevant.

WHO and researchers call for stronger regulation

The World Health Organization (WHO) has long warned that aggressive food marketing negatively affects children’s dietary habits. In 2023, it urged countries to adopt strict mandatory rules to shield children from advertisements promoting foods high in sugar, salt, and unhealthy fats.

The current review echoes that call, emphasizing that voluntary industry standards have largely failed. Many current policies don’t reflect the complexities of digital advertising or cover adolescents, who are heavy users of online platforms but often fall outside regulatory definitions of “children.”

In the U.S., regulatory challenges are compounded by First Amendment protections of commercial speech, limiting the government’s ability to restrict harmful marketing practices. Tech companies are even pushing back against state-level efforts—such as Florida’s social media age restriction law — designed to better protect minors.

Researchers stress that traditional rules designed for TV and print media won’t work in today’s digital ecosystem. Instead, they advocate for updated approaches tailored to social media’s unique environment.

Key recommendations from the study:

Define what counts as child-targeted marketing in digital spaces
Coordinate internationally to close legal and regulatory gaps
Introduce mandatory restrictions on unhealthy food ads targeting minors
Implement media literacy programs to build youth awareness
Establish better tracking systems for monitoring digital ad exposure

While parental involvement is vital — particularly in teaching children how to recognize and question digital marketing — the authors say structural reform is essential.

“Parents and caregivers should push for policy change,” the study concludes. “Social media is deeply woven into young people’s daily lives, and recognizing the health risks posed by the digital food environment is essential to improving outcomes for children and teens globally.”

Your responses and feedback are welcome!

Source: “Social media is fueling the childhood obesity crisis, global study warns,” U.S. Right to Know, 4/8/25
Source: “The impact of the social media industry as a commercial determinant of health on the digital food environment for children and adolescents: a scoping review,” BMJ Global Health, 2/19/25
Source: “Teens and Internet, Device Access Fact Sheet,” Pew Research Center, 01/05/24
Image by Tim Gouw/Pexels

Binge Eating — What’s the Problem, Anyway?

Pat Hartman April 8, 2025 No Comments

Why is binge-eating disorder such an easy trap to fall into? An argument could be made that this is how humans were naturally trained to eat, far back in antiquity. When hunter-gatherers roamed the earth, there was no other choice. If a large animal could be brought down, sliced up, and cooked, everybody had to gobble up as much of it as possible, right there on the spot.

There were no refrigerators, and even people who never went to college can figure out that after a while, meat goes bad and makes them sick. Gathering, or reaping fruit, vegetables, and grains worked the same way. When some fruit was in season and people found a tree full of it, what else could they do but grab as much of the bounty as possible and keep their systems stoked with it until the next lucky find appeared? When food presented itself, hungry people ate while the eating was good.

It probably should not be surprising that many humans feel the ancestral urge to fill up whenever we can. Some of us are still in the situation of being forced to eat whatever is available, because of uncertainty over when another chance will occur. But millions upon millions of us are not in dire circumstances, and do not have to gorge just in case there is nothing to eat tomorrow. So let’s look at why this habit is so destructive.

Registered dietician Elyse Resch lists seven excellent reasons why anyone embroiled in a binge-eating pattern would do well to get a clue and make the effort to stop the habit. A very valid reason is that it interferes with sleep. First, it might take longer to fall asleep, but then you might wake up feeling thirst, or the jabs of acid reflux, or the simple local discomfort of a distended belly.

The second reason is very important because a condition is created in which we cannot trust the signals sent by our own bodies via the appetite hormone ghrelin or the fullness hormone leptin.

Studies show people who frequently binge-eat have lower levels of ghrelin and have difficulty responding to hormones in general. Binge-eating on a regular basis makes it harder for your body to figure out if you’re still hungry, or satiated.

The third reason is that the postprandial surges of glucose and insulin can interfere with the body’s immune system and make us more vulnerable to colds and other infectious conditions.

Next, the American Psychological Association has determined that, as with alcohol and some drugs, a food overdose can put the brain into a state of oblivion that allows the eater to escape self-awareness. Needless to say, this happens at a time when the brain most needs to be asking, “Hey, what the heck am I doing?”

The binge eater’s goal is to induce a state of peaceful relaxed bliss, but the body knows enough to reach for homeostasis, or balance. It attempts this by producing stress hormones, which in turn speed up the heart rate and produce anxious sweat, along with unpleasant irritability, and lethargy — an emotion qualitatively different from peaceful relaxation.

After consumption of a bunch of simple carbohydrates and sugar, the pancreas leaps into red alert mode trying to compensate by producing enough insulin to cope. This is a further deterrent to the body’s preferred state of homeostasis.

A reasonably balanced meal induces the brain to release dopamine, which is fine, but after overeating becomes habitual, the brain struggles to catch up and needs more and more fat and sugar input to pump out the dopamine reward. Gradually but inevitably, overeating becomes over-overeating and over-over-overeating.

Bonus list

Also from BestHealthMag.ca, here are the warning signals that a person is consuming too much sugar. Does anything strike a familiar note?

1. An acne breakout
2. A mid-day energy slump or headache
3. Dental cavities
4. High blood pressure
5. High cholesterol
6. A post-exercise energy crash from using simple sugars for fuel
7. Clothes that used to fit are too tight
8. Depression caused by systemic inflammation
9. The body doesn’t get the message that food has been taken on board, and doesn’t “feel full.”

Your responses and feedback are welcome!

Source: “7 Reasons to Stop Binge-Eating,” BestHealthMag.ca, 07/16/19
Source: “9 Clear Signs You’re Eating Too Much Sugar,” BestHealthMag.ca, 01/03/17
Image by The Digital Artist/Pixabay

Monkey See, Monkey Do

Pat Hartman April 3, 2025 No Comments

In an earlier post, the question about learning came up. Does someone with an eating disorder discover the lifestyle on their own, spontaneously? Or do they absorb the concept, either covertly or openly, from an older relative, or from a peer, or from the older relative of a peer? Or read about it in a novel, or see a TV show?

Of course these questions are already archaic, because now this dangerous information is easy to pick up from social media and other internet sources. But in the old days, how might someone have stumbled onto the idea of, for example, habitual vomiting as a method of weight control?

In the close confines of the family environment, a child can hardly avoid noticing behaviors associated with eating disorders. The thing about children is, they not only notice things, but assume that what they see at home is how things are supposed to be. By and large, it is helpful to society for children to make this assumption. Babies are born fully prepared to look at and imitate the older humans in their environment who take care of them. Parents, older siblings, and other relatives are expected to be role models, who demonstrate to babies how to form themselves into people.

Children have eyes and ears

In the past, a typical one-family home or apartment would only have one bathroom. What on earth was Aunt Cindy doing, spending so much time in there? How many moms spent extra moments in the basement, next to the wringer washing machine, throwing up into the utility sink?

What other behaviors could be discovered or learned? How many teenage girls have appreciated the convenience of making unwanted food disappear into the mouth of the family dog? And if kids don’t pick up eating disorder behaviors from grownups, how do those notions originate? For instance, is throwing up after meals, like masturbation, a behavior that any child can eventually discover on their own, without witnessing a demonstration?

A bit of history

Bulimia nervosa has been described as “insatiable waves of overeating followed by compensatory methods,” driven by the irresistible urge to overeat that is in constant conflict with the fear of obesity. Once bulimia was formally introduced into the medical literature, many more cases were identified and diagnosed, as might be expected. In successive editions of Diagnostic and Statistical Manual of Mental Disorders, as well as other literature, definitions were characterized according to the frequency with which patients employed compensatory behaviors. This fine-tuning allowed cases to be sorted into the categories of mild, moderate, and extreme.

It appears that bulimia usually kicks in at the age of 16 or 17, and the author mentions the unexpected detail that “the rates are highest among the Hispanic/Latino population, second highest among African-Americans and lowest in non-Latin whites.” (Anorexia, on the other hand, is most prevalent among non-Latin whites.) Elena Bowie writes,

Studies have found that eating disorders are inheritable, in addition to several other parental factors that can influence the susceptibility of developing an eating disorder, like parental mental illness or parents with negative views of weight…

To diagnose bulimia may be difficult because patients “are likely to hide their symptoms and physical signs are usually absent.” Often, the evidence is provided by parents or other people in a position to notice changes in behavior. Some of them notice the signs because they have had personal experience with an eating disorder, and have overcome the urge to make it a lifestyle. The author cautions,

The most important thing to take note of is that recovery from Bulimia is not a one size fits all approach and requires careful planning of the physical, psychological, and social needs to create the best possible chance for recovery.

Your responses and feedback are welcome!

Source: “History of Bulimia nervosa,” Emory.edu, 04/01/21
Image by Shutterbug75

Zepbound vs. Wegovy, and New Diabetes Study

Tatyana Meshcheryakova April 2, 2025 No Comments

In the ongoing battle against obesity and type 2 diabetes, two medications — Zepbound (tirzepatide) and Wegovy (semaglutide) — have emerged as leading treatments. Both are FDA-approved and have demonstrated effectiveness in weight management, but they differ in mechanisms, dosage, and overall effectiveness. If you’re considering either of these drugs for weight loss or for weight loss of your kids, here’s what you need to know, according to VeryWellHealth.com.

How do these medications work?

Zepbound and Wegovy belong to a class of medications known as GLP-1 receptor agonists, which help regulate blood sugar levels and metabolism. However, Zepbound (tirzepatide) has an added advantage: It is also a glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. This dual action may contribute to greater weight loss and improved blood sugar control compared to semaglutide.

Both drugs slow down gastric emptying, making you feel fuller for longer, which helps reduce appetite and calorie intake. Research suggests that tirzepatide’s additional GIP receptor activation enhances its effectiveness.

Effectiveness for weight loss

Both medications are effective for weight loss, but studies suggest tirzepatide may be superior. Consider these findings:

A 2024 study found that patients with obesity or overweight treated with tirzepatide experienced greater weight loss compared to those on semaglutide.
A 2023 review revealed that tirzepatide users had an average total body weight loss of 17.8%, compared to 12.4% for semaglutide users.
A 2021 study indicated tirzepatide was more effective than semaglutide in reducing blood sugar levels in people with type 2 diabetes over 40 weeks.

While these studies indicate tirzepatide’s potential advantages, it is important to note that the dosages in these studies were not always equal, which could impact the results. More direct comparisons are needed to confirm these findings.

Dosage differences

Both medications are taken via weekly subcutaneous injections, but their dosage regimens differ:

Tirzepatide (Zepbound) Dosage:

Initial dose: 2.5 mg per week for four weeks
Dose increases: Gradual increments of 2.5 mg every four weeks
Maximum dose: 15 mg per week

Semaglutide (Wegovy) Dosage:

Initial dose: 0.25 mg per week for four weeks
Dose increases: Gradually up to 0.5, 1.0, 1.7, or 2.4 mg
Maximum dose: 2.4 mg once weekly

Side effects and safety

Both medications share common side effects, including:

Nausea
Vomiting
Diarrhea
Constipation
Decreased appetite
Stomach discomfort
Fatigue
Heartburn

Muscle loss has been reported in patients taking both medications, but this can also occur with significant weight loss.

Cost and availability

One major concern for many patients is affordability. The annual cost for GLP-1 receptor agonist drugs can range from $5,000 to $10,000 in the U.S. While tirzepatide tends to be more cost-effective than semaglutide, prices depend on insurance coverage and availability of manufacturer discounts.

Previously, both drugs experienced shortages, leading to increased demand for compounded versions. However, as of February 2025, neither medication was still in shortage.

Can you switch between the two?

Yes, switching between these medications is not uncommon, especially if one is not yielding the desired results. However, a healthcare provider should always guide the transition to ensure safety and effectiveness.

Which one should you choose?

Both Zepbound and Wegovy can effectively aid in weight loss, but the choice depends on individual factors such as:

Effectiveness: Tirzepatide may offer superior weight loss benefits.
Cost: Tirzepatide tends to be more affordable, but insurance coverage varies.
Age Restrictions: Tirzepatide is not currently approved for use in children.
Tolerability: Both drugs have similar side effects, but individual experiences may differ.

GLP-1 Drugs for Type 2 diabetes may not be safe for Type 1 patients

Then there’s this. Medications originally developed to manage type 2 diabetes may not be suitable for patients with type 1 diabetes, according to researchers from the Johns Hopkins Bloomberg School of Public Health.

A recent study highlights concerns regarding the use of GLP-1 receptor agonists among type 1 diabetes patients. GLP-1 receptor agonists have been available for over two decades to help manage type 2 diabetes. Over time, some were also approved for reducing cardiovascular disease risk and treating obesity. However, type 1 diabetes patients have started using these drugs even though they were excluded from clinical trials due to concerns about hypoglycemia (dangerously low blood sugar levels).

Unlike type 2 diabetes, which is characterized by insulin resistance, type 1 diabetes is an autoimmune condition where the body does not produce insulin, requiring lifelong insulin therapy. The study, which analyzed over 200,000 anonymized medical records from 2008 to 2023, found a significant increase in obesity rates among individuals with type 1 diabetes across all age groups and ethnic backgrounds.

The findings, published on March 3 in Diabetes, Obesity and Metabolism, emphasize the need for more research on the use of GLP-1 receptor agonists in type 1 diabetes patients. Senior author Dr. Jung-Im Shin, an associate professor at the Bloomberg School’s Department of Epidemiology, commented:

These findings highlight the urgent need for better data — including clinical trials — on the effectiveness and safety of GLP-1 receptor agonists in people with type 1 diabetes, to inform clear guidelines on their use in these patients.

As usual, more studies need to happen, and researchers have their work cut out for them.

Your responses and feedback are welcome!

Source: “Zepbound (Tirzepatide) vs. Wegovy (Semaglutide) for Weight Loss,” VeryWellHealth.com, 3/31/25
Source: “Weight-Loss Drug Use Has Risen Sharply Among Children and Adults With Type 1 Diabetes,” John Hopkins Bloomberg School of Public Health, 3/26/25
Source: “Trends in obesity and glucagon-like peptide-1 receptor agonist prescriptions in type 1 diabetes in the United States,” Diabetes, Obesity and Metabolism, 3/3/25
Image by Chokniti Khongchum/Pexels

Eating Disorders at Home

Pat Hartman April 1, 2025 No Comments

Historically, the relationship between food calories, energy expenditure, and fat was not thoroughly investigated or catalogued. But even before the reign of the enormous British monarch Henry VIII, it was understood that eating a lot made people grow large. Rather than a cause for criticism, obesity was social currency, proof that a breadwinner was indeed prosperous enough to overfeed himself and his family. Such people were looked up to as role models. Now, we know better, but don’t always do better.

In an essay about the societal ramifications of eating disorders, eating disorder therapist Kate Sutton wrote,

Social interactions play a significant role in the development and maintenance of eating disorders through various mechanisms…

Then she went on to give examples. At any type of gathering, there are others to whom a person can make self-comparisons. Even for kids with a restricted upbringing, whose only contacts are made in homes and at church, and maybe not even at school, there is still plenty of opportunity for comparison and judgment. Those factors of course lead inevitably to self-judgment, and from there, to seeking a way to change the self in order to be more acceptable to the majority.

Adults of course play a huge role, particularly with regard to children and youth. The relentless pressure of influence is out in the open, because of the presumption that grownups are supposed to be teaching, through every possible means, at every moment. With adult peer pressure, the methods and effects are more sly and insidious. Among a group of young people, peer pressure can go either way, advocating either conformity or non-conformity.

… Or else!

At any age, the pressure is felt in various forms. Some people can give you a look that just makes you want to sink through the floor. Others may talk about you, or to you. The message is delivered loud and clear: You are inadequate and you need to change, before the situation reaches the point where no one wants anything to do with you. Peers and random strangers are bad enough, but when a family member starts picking on you, even with alleged best intentions, it’s the worst. There is no escape. You live in the same house with this person whose eyes critically weigh you every day, and who keeps track of every bite you put into your mouth.

Obviously, in recent decades inescapable media influence has changed the culture immensely, with magazines, advertisements, television, movies, and the internet relentlessly illustrating exactly how thin human beings are “supposed to be.” The cultural pressure from those multiple sources has been documented extensively.

But even before media saturation, even before that influx of visual overload, some segments of the population were relentlessly pressured about excess weight because of professional requirements. As Sutton wrote,

In certain sports and professions where appearance and weight are emphasized, such as ballet, gymnastics, modeling, swimming, and wrestling, there is a heightened risk of developing eating disorders due to the pressure to maintain a specific body type.

The insidious factor, as “Counselor Kate” reminds readers, is that the family is where an environment is easily created that normalizes disordered eating behaviors, ranging from mild to severe, for no good reason (as ballet training, for instance, might be excused as), but just because.

As we have seen, entertainer Marc Maron describes his mother as a former obese child and a “functioning anorexic” who reacted with panic to the presence of overweight people, and whose main mission in life was to keep her own weight below 120 pounds. He in turn was indoctrinated to be phobic about butter, cheese, and double chins.

This type of upbringing is a constant reminder, “There’s good enough, and there’s not good enough, and you are very close to the edge.” Relentlessly delivered day after day, a message of this sort can be extremely damaging. In this respect, a person with the career of professional comedian is very fortunate, because there is somewhere to “put” the trauma.

Your responses and feedback are welcome!

Source: “Understanding How Eating Disorders Affect Friends and Social Circles,”
CounselOrkate.com, undated
Image by Pixabay/Free for use under the Pixabay Content License

The Rise of Bulimia

Pat Hartman March 27, 2025 No Comments

A recent post asked the question, “When did bulimia become “a thing”? The short answer is, more recently than anorexia.

Back in the Middle Ages, the phenomena that we today identify as eating disorders had religious overtones. People who refused food as a form of spiritual discipline, known as ascetics, were sometimes revered and sometimes persecuted. A condition known then as “wasting disease” probably encompassed what later came to be known as anorexia. The term “anorexia nervosa” was coined in 1874 and “bulimia nervosa” was named more than a hundred years later.

In the earlier part of the 20th century, anorexia was an upper-class disease, but in the 1970s it became more democratic. It has been called the most deadly of any psychiatric disorder because even though it may take years, many of the victims do succeed in eventually starving themselves to death.

Over the years, knowledge about anorexia and bulimia grew hand-in-hand. For Psychology Today, Emily Deans, M.D., wrote,

Bulimia (binging and then purging via exercise, vomiting, or laxatives) is first reliably described among some of the wealthy in the Middle Ages, who would vomit during meals so they could consume more. Apparently this behavior did not happen in ancient Rome despite a common conception otherwise.

Plain old binge eating disorder does not include purging or indeed any other effort to avoid obesity. Of the obese individuals who look for medical help today, about one-third of them are binge eaters. Quite recently, purging disorder has also been recognized as a separate entity.

Dr. Emily Deans also wrote,

The eating disorders also appear to be genetic, perhaps related to inherited differences in serotonin receptors. Much of the natural progression of anorexia can be explained by disordered thinking about body image combined with the process of starvation itself.

Anorexia afflicts about 0.5% of women and 0.1% of men. Bulimia around 1-3% of women (also 0.1% of men), and binge eating disorder 3.3% of women and 0.8% of men.

Now to back up a little, Britt Berg, M.S., compiled for the Eating Recovery Center a comprehensive history of eating disorders that fills in more details. Binge eating used to be called Night Eating Syndrome until psychiatrist Albert Stunkard clarified that it can occur at any time of day, changing the name of it to the more familiar Binge Eating Disorder, shortened to BED.

Anorexia nervosa, over time, underwent a transition from signifying “a pursuit of spiritual perfection to a pursuit of bodily perfection,” to identification as a distinct disease. Also, in due course, the medical profession realized that women were not the only sufferers of any of the disorders, because men are also affected. An interesting detail about the evolving state of the art is:

“Parentectomy” was considered an appropriate treatment for anorexia nervosa well into the 20th century. Essentially, a person with an eating disorder would be separated from their parents as a “cure.”

In the 1970s, in the United States, England, France, and Germany, eating disorders of every kind increased dramatically. Over the years, as successive editions of the Diagnostic and Statistical Manual of Mental Disorders were published, descriptions of the various conditions became more detailed and differentiated. Just over 10 years ago recognition of BED as a distinct entity allowed victims to obtain insurance coverage for treatment.

Berg notes that now, the available treatment for eating disorders includes a range of care levels including inpatient, residential, partial hospitalization programs, intensive outpatient programs, and virtual intensive outpatient programs. Consequently many therapeutic approaches are employed, including:

Acceptance and commitment therapy (ACT)
Cognitive behavioral therapy (CBT)
Dialectical behavior therapy (DBT)
Exposure and response prevention (ERP)
Emotion-focused family therapy (EFFT)
Family-based treatment approaches (FBT)

Next: More questions and answers.

Your responses and feedback are welcome!

Source: “A History of Eating Disorders,” PsychologyToday.com, 12/11/11
Source: “Bulimia Nervosa/Purging Disorder,” NCBI.NLM.NIH.gov, April 2017
Source: “Let’s Get Real About the History of Eating Disorders,” EatingRecoveryCenter.com, 07/13/23
Image by Alexa/Pixabay

Addressing Pediatric Obesity With Digital Tools and Personalized Care

Tatyana Meshcheryakova March 26, 2025 No Comments

Currently, one in five children and adolescents in the U.S. has obesity — a rate that has steadily increased over the past decade. Between the early 2010s and 2020, childhood obesity rates rose from 17.7% to 21.5%, according to a study published in JAMA Pediatrics. In response to this growing crisis, the American Academy of Pediatrics (AAP) released updated clinical guidelines in 2023, recommending at least 26 hours of health behavior and lifestyle treatment within three to twelve months. While welcomed by pediatricians, these recommendations posed a significant implementation challenge. Enter Dr. Yum, highlighted in a recent article on Medscape.

Bridging the gap with practical solutions

Dr. Nimali Fernando, a pediatrician in Virginia, understood the difficulties families faced in maintaining a nutritious diet. In the 2010s, she founded Yum Pediatrics, a teaching kitchen and garden that served as a foundation for practical nutrition education. Realizing the potential of digital tools to expand her reach, she transitioned from private practice in 2023 to launch Touchpoints, a multimedia program under Dr. Yum’s umbrella, designed to help clinicians implement the AAP guidelines.

Through step-by-step modules on topics like mindful eating, picky eating, and food insecurity, Touchpoints equips pediatricians with structured conversation guides to engage families. These resources provide a practical solution for overwhelmed healthcare providers who may lack nutrition training but want to offer evidence-based guidance.

The reality of implementing new guidelines

Although the AAP guidelines were well-received, logistical challenges remain. Many pediatric clinics lack access to multidisciplinary teams, leaving primary care providers to shoulder the responsibility of obesity management. Furthermore, insurance companies often do not reimburse for lifestyle and behavior treatment programs, making implementation even more difficult.

To navigate this issue, clinicians bill office visits under comorbid conditions associated with obesity, such as high cholesterol, sleep disturbances, or prediabetes. This approach allows them to provide personalized care while addressing the broader health concerns linked to weight management.

Expanding access through telehealth

Recognizing the importance of accessibility, some pediatricians conduct the Touchpoints program entirely through telehealth. This method aligns better with families’ schedules and fosters a consistent relationship between providers and patients. By meeting monthly, pediatricians can offer ongoing support and track progress effectively.

Telehealth also enables a whole-family approach to weight management. With rising rates of eating disorders post-pandemic, Touchpoints promotes a food-neutral and weight-neutral perspective, reducing stigma and fostering sustainable healthy habits.

Tools for sustainable change

Currently, over two dozen clinicians subscribe to Touchpoints, with researchers from UTHealth Houston launching a study to assess its impact on BMI changes among patients. However, many of the resources remain free through the original Dr. Yum website. One standout feature, the Meal-o-Matic, allows families to create customized recipes based on available ingredients, empowering children to take ownership of their meals. Through meal tracking and photo uploads, children engage with their progress in a supportive, interactive way.

Getting started with pediatric weight management

For pediatricians interested in expanding their approach to obesity care, the AAP offers valuable resources, including staff training on weight bias and stigma. Additionally, the CDC provides a list of evidence-based weight management programs ready for implementation.

Starting small can be an effective strategy. For example, begin with two or three motivated families, using intake forms and food journals to identify those most likely to commit to the process. Naturally, positive outcomes depend on a family’s readiness to engage.

A study on digital health interventions

While digital health strategies may benefit children and adolescents struggling with overweight and obesity, their role in replacing or enhancing components of standard multicomponent care remains uncertain, according to an umbrella review published in Obesity Reviews.

To assess the impact of digital health interventions on weight management in young people, researchers conducted a comprehensive review of existing reviews and meta-analyses. The selected studies focused on the effectiveness and experiences of digital health technologies in managing obesity among children and adolescents (aged 0 to 19) based on the World Health Organization (WHO) criteria.

The review encompassed 16 systematic reviews and 10 meta-analyses, with 15 primarily relying on quantitative data from primary studies. Nine reviews exclusively included randomized controlled trials (RCTs), while the remaining seven incorporated both RCTs and non-RCTs. Most of the primary studies were conducted in high-income regions such as the United States, Europe, and Oceania, with limited representation from middle- and low-income countries.

The number of participants across the included reviews ranged from 195 to 5,777. When evaluating body mass index (BMI) scores, researchers observed small but statistically significant effects of digital interventions on body measurements.

The researchers concluded:

Overall, digital health interventions had a small impact on anthropometric measures when assessing BMI and BMI-z-scores… It remains unclear how these interventions could complement or replace elements of standard care for children and adolescents with overweight or obesity.

It takes a village

Obesity management is not limited to pediatricians alone. Nurses, dietitians, and nutritionists can all play a role in delivering weight management programs. By integrating digital tools, structured programs, and telehealth solutions, pediatricians can make a meaningful impact in the fight against childhood obesity — one family at a time.

Your responses and feedback are welcome!

Source: “Digital Health Interventions May Aid Pediatric Obesity Treatments,” Endocrinology Advisor, 3/18/25
Source: “Digital health interventions to treat overweight and obesity in children and adolescents: An umbrella review,” Obesity Reviews, 2/19/25
Source: “Feeding Change: How Dr. Yum Is Helping Pediatricians Tackle Childhood Obesity One Meal at a Time,” Medscape, 3/21/25
Image by Alex Green/Pexels

The Obesity-Related Addiction That Isn’t Even Fun

Pat Hartman March 25, 2025 No Comments

People with bulimia have a lot going on. It’s not simply that they can’t see themselves accurately. Visual hallucinations are only one aspect of an entire array of sensual experiences. An anorexic person can eat a teaspoonful of rice and feel full. Looking bloated is not the worst nightmare; feeling bloated is.

Just like other types of enthusiasts, some folks who cherish and cultivate their eating disorders have favorite slogans that they live by. A person may be horrified by the concept of foreign matter being inside her or his body, even if that intrusive substance is food. They don’t like excess fat on their communication, either. Why say “Emptiness is freedom” when “Empty is free” conveys the message so eloquently?

The quest for emptiness becomes grotesque and horrifying. An 80-pound person wrote:

i purge for 45 mins to 2 hours flushing over and over again
i am bloated (not as bloated as i was before purging my binge), and i feel like things are still inside me
i never feel empty, even when i restrict or when i get hunger pains after my b/p session

Another appreciates precision in distinguishing similar but not identical phenomena: “I frequently get the hunger feeling after purging, but never the truly ’empty’ feeling. I consider those two distinct sensations.” But wait, it gets worse, in the next entry:

Well yes, I do get the empty feeling. I purge down to my morning weight or less… When I get to the point that I taste literally just bile and it burns coming up, I feel pretty empty… When I push [on my stomach], it feels like there’s nothing in there at all. It’s not every time because I just don’t have the willpower to stand there all night and push it all out, but it does happen.

In looking forward to the day when they can live in their own place and make up the rules, a person might fantasize about “keeping the refrigerator and cupboards empty, and free of food.” (There’s that “f” word again.) Again and again, respondents mention the adjectives light, fresh, thin, empty, and free. One person says,

I get so frustrated seeing my parents bring a bunch of junk into the house. It’s very triggering having it just there… When I’m on my own I finally won’t have to worry about binging… And no one will be there to pressure me to eat.

People with these feelings may not even be able to define exactly what the emptiness represents freedom from, or what it replicates — but isn’t part of the ideal of freedom, the concept of not needing to explain your dream or its conditions to others? Shouldn’t it be a basic rule of human conduct, that each person is allowed the leeway to chase their own particular definition of the ideal life? The philosophical ramifications are deep and wide.

If someone wants to be very skinny, why should they not be allowed to pursue their vision of fulfillment (which paradoxically, in this case, is emptiness) — just like the person who aspires to drive a race car or climb a mountain? Those are, after all, life-threatening modes of existence, and the lucky drivers and mountaineers who make it through might win piles of money and acclaim.

Okay, maybe this line of thought goes a bit too far into the territory of the absurd. But people who are mentally or emotionally disturbed do not know that. They may deeply believe in their right to self-destruct, borrowing the reasoning of patriots and freedom-lovers everywhere, to rationalize their lifestyle to themselves and justify it to others.

But the person who binges and purges, what do they get in return for all that risk? Disapproval, scorn, and possibly torture (unwanted treatment) in a place with locked doors. This quotation illustrates the common tendency to regard doctors and other medical personnel as the enemy:

I got out of hospital today for refeeding syndrome (ironically not ED related) I have physical issues that cause malnutrition but also some food body issues that no one really knows about other than I have low self esteem/can’t see myself as others do. They haven’t connected those two, luckily.

Other respondents are eager to share thoughts like these:

I also have no interest in gaining back to a healthy bmi…
I know I would feel that way no matter how low it went so it’s completely illogical and unsustainable…
I have felt more confident in myself since being underweight. Even if I’ll never feel beautiful or thin I can rationalise the thoughts… So in a way I have a peace of mind…
just feel sad and lost and stuck…

So many questions arise, like, when did bulimia become a “thing?” Do the afflicted people discover the behavior by themselves, or learn it from peers or older relatives? Did people binge and purge during the two world wars? Did the disorder even exist then? During the Depression? Did bulimics rejoice that cupboards were bare and no one had enough to eat? Did banquet guests in ancient Rome really vomit on purpose just so they could gobble down more food?

Currently, is binging and purging an American phenomenon, or does it span the globe? If not for the cultural trend toward fat-phobia and fat-hate, would people choose to live this way?

Your responses and feedback are welcome!
Source: “ED Support Forum, EDSsupportForum.com, 06/06/20
Source: “ED Support Forum,” EDSsupportForum.com, 02/24/17
Source: “ED Support Forum,” EDSsupportForum.com, 11/01/22
Image by Gerd Altmann/Pixabay

Old assumptions die hard

Start with the positive

This should go without saying…

Really?

All over the place

Social media as a commercial determinant of health

Youth flooded with food ads daily

WHO and researchers call for stronger regulation

Children have eyes and ears

A bit of history

How do these medications work?

Effectiveness for weight loss

Dosage differences

Side effects and safety

Cost and availability

Can you switch between the two?

Which one should you choose?

GLP-1 Drugs for Type 2 diabetes may not be safe for Type 1 patients

… Or else!

Bridging the gap with practical solutions

The reality of implementing new guidelines

Expanding access through telehealth

Tools for sustainable change

Getting started with pediatric weight management

A study on digital health interventions

It takes a village

Profiles: Kids Struggling with Weight

The Book

About Dr. Robert A. Pretlow

Presentations

Food & Health Resources