Nine Truths about Weight and Eating Disorders

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The Academy for Eating Disorders (AED) has released a new document titled Nine Truths about Weight and Eating Disorders in order to increase awareness of eating disorders in people along the full spectrum of body sizes. Despite the stereotype of patients being extremely underweight, eating disorders can occur at any weight. A companion to the “Nine Truths about Eating Disorders,” this document aims to eradicate the stereotypes and educate both medical professionals and the public about these deadly disorders.

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Eating disorders have one of the highest mortality rates among psychiatric illnesses, second only to opioid addiction. Although doctors previously believed that only patients at very low weights were at risk for fatal medical complications, recent research has shown that the risk extends the range of body weights.1 Cardiac issues due to caloric restriction, use of diet pills and laxatives, and self-induced vomiting are a leading cause of death in eating disorders, regardless of weight.2-3 Early intervention is an important factor in lowering rates of death and medical complications, but diagnosis in higher weight patients is often delayed. Instead, these patients are often given recommendations to lose weight, which can exacerbate their behavioral symptoms.

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Weight-based discrimination and bullying are prevalent in healthcare, employment, and educational settings. This stigma has been shown to affect both mental and physical health, including greater levels of depression and lowered self-esteem, with higher risk for diabetes and disordered eating behaviors.4 Individuals who have experienced weight bias from medical professionals are more likely to avoid routine healthcare, which can lead to delayed diagnoses of other medical issues.

“Weight stigma is pervasive, pernicious, and cuts to the core of our mission by both increasing the risk of eating disorders and making sustained recovery so much more difficult,” said Dr. Bryn Austin, President of the Academy for Eating Disorders. “The more a person takes the ubiquitous demeaning and dismissive messages in media and in society about fat bodies to heart, the likelier they are to develop an eating disorder and the more they will struggle with recovery, regardless of how much that person weighs. In addition, frank discrimination in healthcare against people living in larger bodies takes a direct and sometimes devastating toll on health and well-being regardless of whether or not a person believes the stigmatizing messages. With our new Nine Truths about Weight and Eating Disorders, we hope to offer our fellow health professionals — whether pediatricians or geriatricians, social workers or cardiologists – new insights on these topics, new ways of understanding patients’ and families’ experiences and, hopefully, more compassion to the care they provide.”

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Creation of the Nine Truths about Weight and Eating Disorders was led by Dasha Nicholls, MBBS, MD and Phillippa Diedrichs, PhD. Dr. Nicholls is on the Faculty of Medicine, Department of Brain Sciences at the Imperial College, London, UK. She is past president of the Academy for Eating Disorders and past chair of the Eating Disorders Faculty at the Royal College of Psychiatrists. Dr. Diedrichs is Professor of Psychology at the Centre for Appearance Research, University of the West of England in Bristol, UK. She has served as an advisor to the British Government, including the Equalities Office, the Minister for Women and Equalities, the All Party Parliamentary Group on Body Image, and the Mayor of London. Both are Fellows of the Academy for Eating Disorders.

References:

  1. Garber, A. K., Cheng, J., Accurso, E. C., Adams, S. H., Buckelew, S. M., Kapphahn, C. J., . . . Golden, N. H. (2019). Weight loss and illness severity in adolescents with atypical anorexia nervosa. Pediatrics, 144(5), e20192339.
  2. Jáuregui-Garrido, B. & Jáuregui Lobera, I. (2012). Sudden death in eating disorders. Vascular Health and Risk Management, 8, 91-98.
  3. Crow, S. J., Peterson, C. B., Swanson, S. A., Raymond, N. C., Specker, S., Eckert, E. D., & Mitchell, J. E. (2009). Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry, 166(12), 1342-1346.
  4. Wu, Y.-K. & Berry, D. C. (2018). Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: a systematic review. Journal of Advanced Nursing, 74(5), 1030-1042.
  5. DiGiacinto, D., Gildon, B., Stamile, E., & Aubrey, J. (2015). Weight-biased health professionals and the effects on overweight patients. Journal of Diagnostic Medical Sonography, 31(2), 132-135.

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ABOUT

The Academy for Eating Disorders (AED) is an international professional association committed to the leadership in eating disorders research, education, treatment, and prevention. The goal of the AED is to provide global access to knowledge, research, and best treatment practice for eating disorders. For additional information, please contact Elissa Myers at (703) 626-9087 and visit the AED website at www.aedweb.org.

Saving the Planet, One Drop at a Time

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Scientists at the Johns Hopkins Applied Physics Laboratory (APL), in Laurel, Maryland, have identified highly absorbent materials that can extract drinkable water out of thin air — which could potentially lead to technologies that supply potable water in the driest areas on the planet.

For many of the world’s poor, one of the greatest environmental threats to health remains lack of access to safe water. Scientists at the Johns Hopkins University Applied Physics Laboratory (APL), in Laurel, Maryland, have identified highly absorbent materials that can extract drinkable water out of thin air – which could potentially lead to technologies that supply potable water in the driest areas on the planet.

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The researchers – a team from APL’s Research and Exploratory Development Department led by Zhiyong Xia, Matthew Logan and Spencer Langevin – describe their discovery in the Jan. 30 issue of Scientific Reports, a journal of the Nature Research family. 

Their research leverages metal-organic frameworks (MOFs), an amazing next-generation material that has the largest known surface areas per gram – a single gram of the MOF can soak up a football field’s worth of material, if the material were laid in a single layer across the field. The sponge-like crystals can be used to capture, store and release chemical compounds – like water – and the large surface area offers more space for chemical reactions and adsorption of molecules.

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MOFs have shown promise for water harvesting, but little research has been done to determine the best properties for fast and efficient production of water.

“Initial experiments have proved that the concept can work,” says Xia. “But the problem has been capacity. Other research teams have been able to produce as much as about  1.3 liters of water per day per kilogram of sorbent  under arid conditions – enough only for one person. To create an optimal water harvesting device requires a better understanding of the structure property relationship controlling absorption and delivery.”

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Xia and his team studied a series of MOFs – unraveling the fundamental material properties that govern the kinetics of water sequestration in this class of materials as well as investigating how much water they can absorb. They also explored the potential impact of temperature, humidity and powder bed thickness on the adsorption-desorption process to see which one achieved optimal operational parameters.

“We identified a MOF that could produce 8.66 liters of water per day per kilogram of MOF under ideal conditions, an extraordinary finding.” Xia said. “This will help us deepen our understanding of these materials and guide the discovery of next-generation water harvesting methods.”

Xia and his team are now exploring other MOFs with low relative humidity influx points, high surface areas, and polar functional properties to see how they perform in very dry environments. They are also exploring different configurations of MOFs to determine which allow for optimal absorption.

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The researchers drew on APL’s ongoing efforts in water purification methods. APL has developed a novel way to remove highly toxic perfluoroalkyl substances — an ever-expanding group of manufactured chemicals that are widely used to make various types of everyday products — from drinking water. A separate effort yielded a cost-effective method to remove toxic heavy metal ions from drinking water.

“Our scientists’ and engineers’ collective strengths and expertise in materials and chemistry have positioned APL to make extraordinary impact and invent the future of clean drinking water for deployed warfighters, as well as for citizens around the world,” said Ally Bissing-Gibson, APL’s Biological and Chemical Sciences program manager. “We look forward to saving the planet, one drop at a time.”

Want to change your personality?

Most people have an aspect of their personality they’d like to change, but without help it may be difficult to do so, according to a study led by a University of Arizona researcher and published in the Journal of Research in Personality.

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Contrary to the once-popular idea that people’s personalities are more or less set in stone, research has proven that personalities do change throughout the lifespan, often in line with major life events. For example, there is evidence that people tend to be more agreeable and conscientious in college, less extroverted after they get married and more agreeable in their retirement years.

While it’s well-established that personalities can change in response to life circumstances, researcher Erica Baranski wondered if people can actively and intentionally change aspects of their personalities at any given point simply because they desire to do so.

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She and her colleagues studied two groups of people: approximately 500 members of the general population who ranged in age from 19 to 82 and participated in the research online; and approximately 360 college students.

Both groups completed the 44-item “Big Five Inventory,” which measures five key personality traits: extroversion, conscientiousness, agreeableness, openness to experience and neuroticism, also referred to as emotional stability. The participants were then asked whether they desired to change any aspect of their personality. If they answered yes, they were asked to write an open-ended description of what they wanted to change.

Across both groups, most people said they desired to increase extroversion, conscientiousness and emotional stability.

The college students were surveyed again six months later, and the general population group was surveyed again a year later. Neither group had achieved the personality goals they set for themselves at the beginning of the study, and, in fact, some saw change in the opposite direction.

“In both samples, the desire to change at ‘time one’ did not predict actual change in the desired direction at all at ‘time two,'” said Baranski, a postdoctoral psychology researcher in the University of Arizona Institute on Place, Wellbeing & Performance. “In the general population sample, we didn’t find that personality change goals predicted any change in any direction.”

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College Students Saw More Change

While the general population group exhibited no change in personality traits between the first and second rounds of data collection, the college student group did show some changes; however, they were either in the opposite direction than desired or were for different personality traits than the one the person intended to change.

Specifically, college students who expressed the strongest desires to be more conscientious actually exhibited less conscientiousness six months later. That could be because those individuals exhibited low levels of conscientiousness to begin with, putting them at a disadvantage from the outset, Baranski said.

In addition, students who said they wanted to be more extroverted showed increases in agreeableness and emotionally stability rather than extroversion in the follow-up. Baranski said that perhaps as part of their effort to become more social and extroverted, they actually focused on being friendlier and less socially anxious – behaviors more directly related to agreeability and emotionally stability, respectively.

Baranski said college students may have exhibited more change than the general population because they are in such a transformational period in their lives. Still, the changes they experienced didn’t align with the goals they set for themselves.

“College students are thrown into this new environment, and they may be unhappy and may look within selves to become happier and change some aspect of their personality,” Baranski said. “But, meanwhile, there is a bombardment of other things that they’re told they need to achieve, like doing well in a class or choosing a major or getting an internship, and those goals might take precedence. Even though they know more sustained and introspective change might be better, the short-term effort is more attractive and more necessary in the moment.”

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Overall, Baranski’s findings illustrate how difficult it can be for people to change aspects of their personality based on desire alone. That doesn’t mean people can’t make the changes they want. They just might need outside help doing so – from a professional, a friend or maybe even a mobile app reminding them of their goals, Baranski said.

Baranski intentionally did not interact with study participants between the first and second rounds of data collection. That approach differs from that of another researcher, Southern Methodist University’s Nathan Hudson, who in several other separate studies assessed personality change goals over a 16-week period but followed up with participants along the way. In that research, which Baranski cites, experimenters assessed participants’ personality traits and progress toward their goals every few weeks. With that kind of interaction, participants were more successful in making changes.

“There is evidence in clinical psychology that therapeutic coaching leads to change in personality and behavior, and there is recent evidence that suggests that when there’s a lot of regular interaction with an experimenter, personality change is possible,” Baranski said. “But when individuals are left to their own devices, change may not be as likely.”

Future research, Baranski said, should look at how much intervention is needed to help people achieve their personality goals, and which types of strategies work best for different traits.

“Across all the studies that have been done on this topic over the last several years, it’s clear that most people want to change an aspect of their personality,” Baranski said. “If left unattended, those goals aren’t achieved, so it would be helpful for people who have those goals to know what is necessary for them to accomplish them.”

Borderline Personality Disorder Potentially at Higher Risk for Heart Attacks

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Mental health professionals should recommend screening patients for cardiovascular risks

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Middle-aged adults who show symptoms of borderline personality disorder may be at greater risk for a heart attack, as they show physical signs of worsening cardiovascular health more than other adults, according to research published by the American Psychological Association.

“Although borderline personality disorder is well studied for its relationship to psychological and social impairments, recent research has suggested it may also contribute to physical health risks,” said Whitney Ringwald MSW, MS, of the University of Pittsburgh and lead author of the study. “Our study suggests that the effects of this disorder on heart health are large enough that clinicians treating patients should recommend monitoring their cardiovascular health.”

The study was published in Personality Disorders: Theory, Research, and Treatment.

Borderline personality disorder is characterized by intense mood swings, impulsive behaviors, and extreme emotional reactions. Their inability to manage emotions often makes it hard for people with borderline personality disorder to finish school, keep a job, or maintain stable, healthy relationships. According to the National Institute of Mental Health, 1.4% of adults have BPD, but that number does not include those with less severe symptoms, who nevertheless may experience clinically significant impairments, said Aidan Wright, PhD, of the University of Pittsburgh and another author of the study.

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“It can be challenging to treat BPD because you are seeking to change a person’s longstanding patterns of thinking, feeling and behaving that are very well ingrained,” he said. “There are several evidence-based treatment options that can be helpful, so there are many reasons to be optimistic, but treatment may take a long time.”

The researchers analyzed health data from 1,295 participants in the University of Pittsburgh Adult Health and Behavior Project. This is a registry of behavioral and biological measurements from non-Hispanic white and African American adults, 30 to 50 years old, recruited between 2001 and 2005 in southwestern Pennsylvania. The researchers looked at self-reported basic personality traits, as well as those reported by up to two of the participants’ friends or family members, and self-reported symptoms of depression. By combining several physical health measurements, including blood pressure, body mass index and the levels of insulin, glucose, cholesterol and other compounds in the blood after a 12-hour fast, the researchers established a relative cardiovascular risk score for each participant.

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They found a significant association between borderline personality traits and increased cardiovascular risk. The researchers also looked at the potential role of depression, as people with BPD are also often depressed. While borderline personality traits and depression were both significantly associated with cardiovascular risk the effect of borderline traits was independent of depression symptoms.

“We were surprised by the strength of the effect and we found it particularly interesting that our measure of borderline personality pathology had a larger effect, and a unique effect, above and beyond depression in predicting heart disease.” said Wright.  “There is a large focus on depression in physical health, and these findings suggest there should be an increased focus on personality traits, too.”

The researchers said their findings have important implications for primary care doctors and mental health professionals who treat patients with BPD.

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“Mental health practitioners may want to screen for cardiovascular risk in their patients with BPD, ” said Wright. “When discussing the implications of a personality disorder diagnosis with patients, practitioners may want to emphasize the link with negative health outcomes and possibly suggest exercise and lifestyle changes if indicated. Primary care physicians should attend to personality as a risk factor when monitoring patients for long-term health as well.”

Article: “Borderline Personality Disorder Traits Associate with Midlife Cardiometabolic Risk,” by Whitney R. Ringwald, MSW, MS, Aidan G.C. Wright, PhD,  Stephen B. Manuck, PhD, University of Pittsburgh; and Taylor A. Barber, BS, Philadelphia College of Osteopathic Medicine. Personality Disorders: Theory, Research, and Treatment, published online Oct. 28, 2019.

Help with Heavy Menstrual Bleeding

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In women with uterine fibroids, the drug elagolix suppresses ovarian hormone production and prevents heavy menstrual bleeding

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About 50 % of women with uterine fibroids—non-cancerous muscle tumors that grow in the uterus—experience heavy menstrual bleeding and other symptoms.  Surgery is commonly recommended when these symptoms are severe enough to prompt a woman to seek treatment.  The most common surgery used to treat fibroids is removal of the uterus (hysterectomy), though in some cases, removal of the fibroids and repair of the uterus (myomectomy) are performed.  Surgery is usually extensive in both cases.  Long-acting hormone injections can reduce symptoms such as heavy bleeding in women with fibroids, but side effects can be significant and it can take months for the effects of the medications to wear off.

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In a study published in the New England Journal of Medicine on January 23, 2020, researchers reported on the effectiveness of a new, rapidly reversible oral pill that was used to reduce heavy menstrual bleeding in women with uterine fibroids. The study, which included a large group of researchers from across the country, was led by Dr. William Schlaff, Chair of the Department of Obstetrics and Gynecology at the Sidney Kimmel Medical College at Thomas Jefferson University.

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A total of 790 women, ages 18-51, with heavy bleeding due to fibroids, were enrolled into one of three study arms. One group received the oral pill, elagolix, which reduces the production of the hormones estrogen and progesterone normally produced by a woman’s ovaries.  When these hormones are suppressed, fibroids usually get smaller and bleeding is reduced.  A second group received elagolix plus a low dose of estrogen and progestin (“add-back” therapy) with the hope that the additional hormones would produce the same benefit but reduce the side effects of elagolix used alone (like hot flushes and bone loss).  A third group received identical placebo pills that did not contain elagolix or the “add back” hormones.  All of the women enrolled in the two identical trials reported by these researchers were confirmed to have uterine fibroids by ultrasound and heavy menstrual bleeding (more than 80mLs of blood loss per cycle) for at least two cycles. 

The results showed that 80.4% of the women treated with elagolix alone had a reduction of menstrual bleeding of 50% or more compared to 9.6% of the women in the placebo group.  Of those women treated with elagolix plus “add back” therapy, 72% had a reduction of 50% or more.  Women treated with elagolix alone had significantly more loss of bone mineral as compared with the women treated with placebo, a known and clinically significant side effect of this class of medications.  However, there was no difference between the loss of bone mineral in the group treated with elagolix and “add-back” as compared to those in the placebo group. 

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For many women with fibroids, severe symptoms like bleeding have a major impact on the quality of life.  Surgery and long-acting injectable medications are acceptable treatments for many, but certainly not all women in this situation. 

“The potential value of an oral, easily reversible medication that can be combined with low-dose hormonal “add back” to reduce heavy menstrual bleeding while avoiding problematic symptoms and side effects could be a major step forward,” says Dr. Schlaff.

AbbVie Inc. funded these studies and participated in the study design, research, analysis, data collection, interpretation of data, reviewing and approval of the publication. Consult article reference for complete list of disclosures.

Article reference: William Schlaff et al., “Elagolix Therapy for Heavy Menstrual Bleeding in Women with Uterine Fibroids,” New England Journal of Medicine, DOI: 10.1056/NEJMoa1904351, 2019.

Why eating yogurt may help lessen the risk of breast cancer

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One of the causes of breast cancer may be inflammation triggered by harmful bacteria say researchers.

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Scientists say their idea- as yet unproven – is supported by the available evidence, which is that bacterial induced inflammation is linked to cancer.

The paper in the journal Medical Hypotheses is by Lancaster University medical student Auday Marwaha, Professor Jim Morris from the University Hospitals of Morecambe Bay NHS Trust and Dr Rachael Rigby from Lancaster University’s Faculty of Health and Medicine.

The researchers say that: “There is a simple, inexpensive potential preventive remedy; which is for women to consume natural yoghurt on a daily basis.”

Yoghurt contains beneficial lactose fermenting bacteria commonly found in milk, similar to the bacteria – or microflora- found in the breasts of mothers who have breastfed.

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Dr Rigby said: “We now know that breast milk is not sterile and that lactation alters the microflora of the breast.

“Lactose fermenting bacteria are commonly found in milk and are likely to occupy the breast ducts of women during lactation and for an unknown period after lactation.”

Their suggestion is that this lactose fermenting bacteria in the breast is protective because each year of breast feeding reduces the risk of breast cancer by 4.3%.

Several other studies have shown that the consumption of yoghurt is associated with a reduction in the risk of breast cancer, which the researchers suggest may be due to the displacement of harmful bacteria by beneficial bacteria.

There are approximately 10 billion bacterial cells in the human body and while most are harmless, some bacteria create toxins which trigger inflammation in the body.

Chronic inflammation destroys the harmful germs but it also damages the body. One of the most common inflammatory conditions is gum disease or periodontitis which has already been linked to oral, oesophageal, colonic, pancreatic, prostatic and breast cancer.

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The researchers conclude that: “The stem cells which divide to replenish the lining of the breast ducts are influenced by the microflora, and certain components of the microflora have been shown in other organs, such as the colon and stomach, to increase the risk of cancer development.

“Therefore a similar scenario is likely to be occurring in the breast, whereby resident microflora impact on stem cell division and influence cancer risk.”

Talks With Kris Godinez

Covert Narcissists/Hermit BPD/ Passive Aggressiveness

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