PSU Fourth Eating Disorders Conference

Keynote Speaker

Weight-related problems in adolescents: What? Why? And How can we Help?

Dianne Neumark-Sztainer, PhD, MPH, RD
Dr. Neumark-Sztainer is a Professor in the Division of Epidemiology and Community Health, School of Public Health and an Adjunct Professor in the Department of Pediatrics, both at the University of Minnesota. Her research focuses on adolescent nutrition and the prevention of weight-related problems including eating disorders, unhealthy weight control behaviors, body dissatisfaction and obesity. Dr. Neumark-Sztainer has published about 250 articles in peer-reviewed scientific journals and a book for parents of adolescents entitled: “I’m, like, SO, fat!” Helping your teen make healthy choices about eating and exercise in a weight-obsessed world. Dr. Neumark-Sztainer is involved in outreach work aimed at the prevention of eating disorders and obesity via presentations at scientific meetings, community presentations, and media interviews. She has received several awards for her work including awards from the National Eating Disorders Association and from the Eating Disorders Coalition.

Description:
This presentation will include an overview of major weight-related problems facing young people today. We will discuss what these problems are, why they develop, and how we can help in their prevention. Weight-related problems in adolescents include obesity, eating disorders, unhealthy weight control behaviors, binge eating, inappropriate levels of physical activity, and body dissatisfaction. Research suggests that these problems are not independent of each other, but can co-occur and lead to other problems over time. Weight-related problems are caused by a complex interaction of individual, familial, peer, school, community and societal factors. We can take action to prevent the broad spectrum of weight-related problems in young people. Examples of actions that can be taken within the home and at school will be presented. In particular, an innovative school-based program, New Moves, designed to prevent obesity while promoting a positive body image among adolescent girls will be discussed.

Objectives:
Participants will know:

1. Discuss prevalence of different weight-related problems in adolescents and factors associated with these problems.
2. Discuss how parents can utilize at home to prevent weight-related problems.
3. Discuss an effective school-based obesity prevention program that promotes a positive body image in adolescent girls.

Session I

Clinical (A)
The Self of the Therapist: Counter-transference and Self Disclosure in the Treatment of Patients with Eating Disorders

Douglas Bunnell, Ph.D., FAED
Dr. Bunnell is Vice President and Director of Outpatient Clinical Services for the Renfrew Center and oversees the clinical programs at Renfrew’s seven non residential treatment centers. He is also editor of Perspectives, Renfrew’s bi-annual journal on clinical aspects of eating disorders. He is a former president of the National Eating Disorders Association and has been active in eating disorder advocacy. Dr. Bunnell also maintains a private practice in Wilton, Connecticut.

Description:
Therapists’ emotional reactions to their patients can be a rich source of information about the patient’s inner world. Patients with eating disorders, in particular, often evoke powerful feelings in their therapists. Therapists often feel anxious about their patients’ medical stability, frustrated by the ambivalent commitment to recovery and change, and pressured by the need to promote real changes in symptoms and behaviors. In reviewing the common transference-countertransference patterns in the psychotherapy of patients with eating disorders, this session also lays out a model for therapists to use to organize and understand their emotional and somatic reactions to their patients. This session explores ways in which therapists can systematically examine their reactions to their eating disordered patients and outlines a process for making decisions about counter-transference and self-disclosure.

Objectives:

1. Describe four common transference-counter-transference patterns that occur in the treatment of patients with eating disorders.
2. Discuss a systematic approach for evaluating and understanding counter- transference reactions to their patients.
3. Review the pros and cons of self-disclosure in the psychotherapy of their patients with eating disorders.

Education (B)
Finding Your Way: A case-study discussion

Claudette Peck, LCMHC, RD, LD
Claudette is a licensed clinical mental health counselor, and registered, licensed dietitian. She is employed by Dartmouth College as their staff nutritionist, and is a member of Dartmouth College’s Eating Disorder Consultation Team. Claudette has been very involved in recent policy changes to Dartmouth College’s Eating Disorder program, and recent revisions to Dartmouth College’s Eating Disorder Treatment manual, 2008 edition. Claudette is an adjunct faculty member of the Eating Disorders Graduate Institute at Plymouth State University, teaching Nutrition Counseling. Claudette has been working in the field of eating disorders treatment for 19 years. Additionally, Claudette is trained as an online facilitator for Vtrim, a behavior management weight loss program. She resides in Enfield, NH.

Description:
Eating disordered clients can present many challenges to clinicians (therapists, physicians, nutritionists) working in outpatient practice. This work can often leave providers feeling ill-equipped to effectively treat their clients. Some research suggests that a team approach is recommended for the treatment of eating disorders, and yet, when working in a rural setting, establishing a team may feel, or be impossible. Through the use of a progressive case-study, participants will work in small and large groups to discuss screening, diagnosing, goal-setting, and referring as well as how to better manage situations when clients demonstrate resistance, non-compliance, or stagnation in treatment.

Objectives:

1. Assess their ability to manage resistance, limit-setting, and other challenging aspects to treating eating disordered clients.
2. Demonstrate their ability to screen, diagnose and create treatment goals for certain eating disordered clients.
3. Share experiences from others in various settings about how to creatively formulate “teams” for treatment of the client and support for the clinician.

Special Issues (C)
Swimming With Sharks: Negotiating Your Way to Get Insurance Companies to Pay What They Should

Edward P. Tyson, M.D.
Dr. Tyson is Medical Director of Cedar Springs Austin, an eating disorders treatment center. In addition, he is in private practice caring for males and females of all ages with eating disorders. He considers himself to be an advocate for those with eating disorders. Dr. Tyson presents nationally and internationally on eating disorders and is active in NEDA, AED, IAEDP.

Description:
Getting insurance companies to pay for eating disorder care is often critical to get the care that one needs. The process can be complicated, daunting, and adversarial, and the methods used by companies to avoid payment are varied and legion. This talk will cover many of these problems and methods for getting that coverage approved.

Objectives:

1. Discuss methods used to delay payment or avoid coverage.
2. Describe specific ways to address tactics used to delay or deny coverage.
3. Strategize how to manage appeals of cases.

Session II

Clinical (A)
Clinical Director: Laurel Hill Inn

Melissa Freizinger, Ph.D.
Dr. Freizinger. has extensive training and experience in the treatment of eating disorders as well as other women's health issues. Dr. Freizinger trained at Laurelwood Hospital in Cleveland with Drs. Warren and Wisniewski studying DBT approaches to eating disorders. Dr. Freizinger was the 2006 Murphy Fellow at Harvard Medical School Massachusetts Mental Health Center Dialectical Behavior Therapy program. Dr. Freizinger conducts research studying the prevalence of eating disorders in infertile women and is currently involved in several research protocols. She has presented and published in the areas of DBT and eating disorders, validation therapy, and depression in infertile women. Dr. Freizinger is currently the Clinical Director of Laurel Hill Inn, a residential center for eating disorders in Medford, Massachusetts.

Description:
Eating disorders affect more than 5 million Americans each year. Fifteen percent of young women have substantially disordered eating attitudes and behaviors; as many as 1 in 10 college women suffer from a clinical or nearly clinical eating disorder. Eating disorders frequently co-occur with other psychiatric disorders such as depression, substance use, anxiety disorders and personality disorders. When these patients present in an outpatient college counseling center, it is often difficult to manage these challenging patients.

Dialectical Behavior Therapy (DBT) is a cognitive-behavioral treatment that was developed for chronically suicidal patients with self-injurious behaviors. Dr. Wisniewski of the Cleveland Center for Eating Disorders has modified and developed DBT for clients with primary EDs and co-morbid diagnoses. In this training, you will learn basic DBT techniques for treating patients who have multiple problems, including eating disordered behaviors and mood dysregulation. Additionally, you will understand how to utilize DBT strategies to teach patients coping skills in an outpatient practice.

Objectives:

1. Provide a brief theoretical overview of Dialectical Behavior Therapy (DBT) including the dialectical biosocial theory used to guide treatment planning.
2. Discuss DBT treatment targets and how to structure treatment for eating disorder patients.
3. Discuss specific, clear, and practical information necessary to incorporate DBT skills into their clinical practice.

Education (B)
YouTube’s “Thinspiration” Videos: innocent expression or online proanorexia tutorial for vulnerable teens?

Gwenn Schurgin O’Keeffe, M.D., F.A.A.P.
Dr. Schurgin O’Keeffe , a board-certified pediatrician and Fellow of the American Academy of Pediatrics, is founder of Pediatrics Now (www.pediatricsnow.com). An experienced columnist, educator, and health journalist, her work can be seen nationally in print, online, on internet radio and podcasts, and on TV. Dr. Gwenn is a national Spokeswoman for the American Academy of Pediatrics and is quoted frequently in the media as an expert in child health, parenting and "new" media. Dr. Gwenn has been very active in medical education throughout her career and currently consults to a number of national websites and organizations on child health, parenting and social media issues. Her first book is due out next year with the American Academy of Pediatrics on web 2.0 and social media issues parents need to know about to keep their children healthy online.

Dr. Gwenn graduated from Tufts University School of Medicine and completed her pediatrics Internship and Residency at New England Medical Center/Floating Hospital for Infants and Children in Boston, MA. Dr. O'Keeffe practices urgent care pediatrics in Massachusetts and lives in Metrowest Boston with her husband and two daughters.

Description:
Teens have an impressive control of today’s web 2.0 and social media technologies. There’s a growing concern that visual, multimedia websites and social networking venues pose more harm than good by the power of their material and images and by connecting teens with people who fuel their insecurities with faulty information. To add insult to injury, many parents are unaware of their teens online activities. For body image issues, we only have to look as far as You Tube and the “Thinspiration” videos to understand just how insidious the material online can be and how much harm it can cause. Art or proanorexic? Are we overreacting? Teens love to hang out with other teen and are now finding ways to extend that urge online. Unlike with their off line lives, however, no one is looking over their shoulder online to make sure they are safe. Once we learn where to look and the questions to ask, our teens will be safe again and we’ll be better able to identify teens at risk for eating disorders and other high risk issues. Today starts your journey to learning just how to do that.

Objectives:

1. Describe how the web is seen by teens and discuss the developmental issues of teens that place them in danger online.
2. Model behavior like “Dr. Google” when online, especially on web 2.0 and social networking sites, and be able to discern the validity of the material teens are reading and viewing to understand why teens are getting into trouble online with their eating disorders.
3. Be able to immediately use questions about teens online use in any formal interview with teens at risk for body image issues and eating disorders.

Special Issues (C)
Gastric Bypass Surgery

Maureen Quigley, ARNP
Maureen Quigley is a nurse practitioner, who has worked with the DHMC Bariatric Surgery Program since 2000. She evaluates patients pre-operatively and provides lifetime follow up care of patients who undergo bariatric surgery.

Description:
Morbid obesity is a major public health epidemic. Sustained weight loss by dieting, exercise and medication management produces modest weight loss, which is difficult to sustain long term. Obesity is associated with significant comorbidities including diabetes, hypertension, dyslipidemia, metabolic syndrome, obstructive sleep apnea and degenerative joint disease and Polycystic Ovarian Syndrome. Bariatric surgery is an effective strategy that produces sustained weight loss in many individuals, as well as improvement in weight-related comorbidities.

Comprehensive pre-operative multidisciplinary evaluations and education are critical, as well as lifetime follow up care by the surgical program. Although many individuals qualify for bariatric surgery based on body mass index and comorbid conditions, not all are ideal candidates for surgery. The components of the pre-operative psychological evaluation will be summarized. A comprehensive overview of the most commonly performed bariatric surgery procedures, Roux en Y gastric bypass; adjustable gastric banding and sleeve gastrectomy will be presented. Case studies will be highlighted to illustrate the challenges of the selection process and long term post-operative care.

Objectives:

1. Name three criteria for bariatric surgery according to the NIH Consensus Guidelines
2. Discuss three key components of the pre-operative bariatric surgery psychological evaluation
3. Discuss transfer of addictions after weight loss

Luncheon Keynote

Is it Necessary to Lose Weight to Be Healthy?

Glenn Gaesser
Dr. Gaesser is a Professor in the Department of Exercise and Wellness as well as the School of Applied Arts and Sciences at Arizona State University. Professor Gaesser has had prior faculty appointments at the University of Virginia and UCLA. He has given more than 200 invited regional, national and international presentations to a variety of professional, business, and lay audiences on the subjects of health, fitness and body weight, and is interviewed frequently by the media on these topics, including appearances on Good Morning America, ABC’s 20/20 and World News Tonight, CNN, NBC Nightly News, and Dateline NBC. He is also the author of several books, including Big Fat Lies: The Truth About Your Weight and Your Health(Gurze, 2002).

Description:
This presentation will examine the published scientific evidence on the relationship between body weight, weight loss, and health. It will show that current body weight standards are not good predictors of health status, that most “obesity-related” health problems can be ameliorated independently of weight loss, and that a weight-centered focus on health does more harm than good. It is not necessary to be thin to be healthy, nor is it necessary for the vast majority of those considered overweight or obese to lose weight in order to improve health.

Objectives:

1. Discuss the current literature on the relationship between body weight, weight loss and health
2. Use the information presented on health effects of non-weight-centered lifestyle interventions
3. Describe the health risks associated with weight-centered focuses on health and on the health risks of weight loss and weight cycling

Session III

Clinical (A)
Maudsley Methods for Parents and Professionals

MARCIA HERRIN, EdD, MPH, RD, LD
Dr. Herrin is an adjunct professor of Community and Family Medicine at Dartmouth Medical School, is the founder of Dartmouth College’s nationally renowned eating disorders and nutrition programs. Dr. Herrin authored The Parent’s Guide to Eating Disorders (2007) and Nutrition Counseling in the Treatment of Eating Disorders (2002). Dr. Herrin conducts a private practice specializing in eating disorders, weight management, and obesity in the Hanover area of New Hampshire.

Description:
Despite the growing research that establishes that Maudsley's home-based methods are effective, many parents and clinicians lack the knowledge, tools and strategies to implement the Maudsley approach. In this workshop, the fundamentals of the Maudsley approach will be described, case examples will be provided, and the research will be reviewed. Participants will have opportunity to observe and to play a part in a coached meal experience, the cornerstone of the Maudsley approach. In addition, participants will explore other effective food-related interventions with families and with individual patients.

Objectives:
Upon completion of this workshop, participants will be able to:

1. Explain the principles and techniques of the Maudsley approach to refeeding
2. Describe how parents can be effective as therapeutic feeding agents
3. Demonstrate helpful interactions with family members during a coached meal

Education (B)
Motivational Interviewing and Health Behavior Change

Ellen R. Glovsky, PhD,RD,LDN
Dr. Glovsky is a Registered Dietitian and a member of the Motivational Interviewing network of trainers (MINT). She is a member of the faculty of Northeastern University where she teaches courses in nutrition, public health, health behavior change, and Motivational Interviewing. Dr. Glovsky also maintains a private practice in which she utilizes Motivational Interviewing in the treatment of eating disorders, weight management and nutrition for the prevention of illness.

Description:
This lecture will provide an overview of the theory, spirit, and techniques used in Motivational Interviewing (MI) and its applications to health behavior change. A highly refined form of the guiding style of communication, MI is effective in addressing the health behavior changes associated with prevention of illness with diet, and the treatment of eating disorders, diabetes, heart disease, obesity, other illnesses with strong diet and lifestyle components. Motivational Interviewing is well-suited to the needs of practitioners and teachers whose daily work entails conversations with patients, clients, and students about health behavior change.

Objectives:
Attendees will be able to:

1. Describe the spirit of Motivational Interviewing;
2. Describe the difference between typical counseling for eating disorders and the use of Motivational interviewing;
3. Discuss two or more MI listening and instruction skills in conversations with clients.

Special Issues (C)
Wolves in Sheep’s Clothing: Medical Complications of Eating Disorders

Edward P. Tyson, M.D.
Dr. Tyson is Medical Director of Cedar Springs Austin, an eating disorders treatment center. In addition, he is in private practice caring for males and females of all ages with eating disorders. He considers himself to be an advocate for those with eating disorders. Dr. Tyson presents nationally and internationally on eating disorders and is active in NEDA, AED, IAEDP.

Description:
Eating disorders have medical complications that run the gamut from the annoying to the immediately life-threatening. This session will address these issues in an easy to understand way for the non-physician as well as the physician. The physiology will be explained and as well as how even non-medical professionals can become aware of what problems may be existing in someone. A simple screening toll will be made available to help screen for these problems. Case presentations will highlight the salient issues and an extensive handout will be available.

Objectives:

1. Discuss common medical complications of eating disorders
2. Use some simple methods to screen for medical complications
3. Discuss the physiology involved in creating the medical complications