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Eating Disorders Spotlight10

A Review of Internet-Based Treatment Shows Mixed Results

Sunday March 30, 2014

As more and more of our lives and businesses are conducted online, the mental health world is no different.  Many therapists have looked into providing services online, whether it be through video-conferencing or e-mail.  Other providers have designed online based treatment programs and self-help software for various issues as well.  Online and computer-based treatment options have many benefits such as being cost effective and anonymous, but, are these treatment options actually effective?

A recent review of the literature by researchers in the Netherlands examined twenty-one different studies that looked at the efficacy of internet-based treatments on eating disorder symptoms.  Although the majority of the studies did show improvement in symptoms, the results were truly mixed.  For example, the most improvement was seen in people suffering from binge eating and purging symptoms with little improvement seen in people struggling with restrictive eating symptoms.  And, as might be expected, the most improvement was seen in people with the fewest and least severe eating disorder symptoms as well as those without any other types co-occurring issues.

One of the major limitations of this research is that all of the studies compared internet-based treatment options to people who were on a waiting list for treatment (not currently receiving treatment) rather comparing them than to traditional face-to-face therapy.  The authors did note that there is currently a study being done to compare internet-based treatment with face-to-face cognitive behavioral therapy so hopefully more information on these types of treatments will be forthcoming in the future.

In short, while internet-based treatment may be helpful for a select few people who have few symptoms and are extremely self-motivated, it's probably not for everyone (or even most people).  It may also be important for treatment providers to work the kinks out of any current internet-based programs to see how they can be made more helpful.

Do you have any experience with internet-based therapy, either as a primary form of treatment or as an adjunct to traditional therapies?


Aardoom, J.J., Dingemans, A.E., Spinhoven, P., &Van Furth, E.F. (2013). Treating eating disorders over the internet: A systematic review and future research directions. International Journal of Eating Disorders, 46(6). 539-552.

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America's Outcry Over The Biggest Loser

Friday February 7, 2014

The past couple of days there have been a storm of tweets and news articles related to the outcry regarding the weight and appearance of the most recent winner of The Biggest Loser, Rachel Frederickson.  Many people are saying that she appears to be anorexic or unhealthy at best. I don't know and won't comment on if Frederickson is anorexic. Why? Because I only know her weight and her appearance and eating disorders are not diagnosed on these two criteria.  For what it's worth, according to the numbers presented on the show, Frederickson now has a BMI that puts her in the 'underweight' category.  Although the use of BMI as a measure of health is limited, at best, being underweight is actually considered more dangerous than to be overweight.

I do have a multitude of thoughts about the show and it's been somewhat of a challenge to organize them coherently as I could get on a soapbox for a while.  I think that I may have watched one episode during one of the initial seasons and was so dismayed by it that I haven't watched it since.  So, in case you're like me and you don't know exactly how the show works, here it is in a nutshell: Essentially, fifteen contestants stay at a ranch where they work with trainers for a period of 3-4 months (I couldn't find the exact timeline) and then return to their homes where they lose weight for another 6 months and then return for the finale.  Over the course of the show, contestants are sent home, but can achieve 'immunity' by losing the most weight each week.  The final winner is determined by who loses the most weight, by percentage, since the beginning of the show.  It is my understanding that the method of weight loss is drastic calorie restriction and exercising up to six hours per day.

One former contestant, Kai Hibbard, from the third season of the show has spoken out and has said that being on the show triggered an eating disorder for her.  In an interview, Hibbard recounts how physicians on the show recommended an electrolyte supplement but that trainers encouraged the contestants to "throw it out" because it would result in water retention (and higher weights).  She also reports that, "the lighter I got during that T.V. show, the more I hated my body." I suspect that she's not the only one.  I'd also venture that because of the complicated relationship many of these contestants have with food and weight, that some may have already had an eating disorder before the show began.

Other than the obvious disordered behaviors such as calorie restriction and over-exercise, I also think it is worth pointing out that weight is the only measure of 'health' seen on this show.  Although certainly some of the contestants have grown larger than their genetics alone would have dictated, there is no mention of their blood pressure, cholesterol or other measures of health.  Were these contestants actually unhealthy before they began the regimen?  Did these measures of health actually improve over the course of the show?  For those who used food as a coping mechanism, do they now have other ways to cope with life's stresses?  What is their relationship with food and their bodies like now?  My guess is that none of the answers to these questions would make for a successful television show.

It is extremely troublesome anytime that people are willing to sacrifice their health (both physical and mental) in the name of weight loss.  Although I am glad that Americans are finally reacting negatively to this show, I worry that Rachel Frederickson's appearance is only the tip of the iceberg.


Flegal, K., Kit, B., Orpana, H., & Graubard, B. (2013). Association of all-cause mortality with overweight and obesity using standard body mass index categories: A systematic review and meta-analysis. Journal of the American Medical Association, 309(1). 71-82.

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Seeing Yourself Through a Child's Eyes

Thursday January 23, 2014

If you are a regular reader, you have likely noticed that the past few months I have been posting sporadically, at best. This is a result of the birth of my second child. As such, I've been busy and sleep-deprived much of the time lately. If you've had children you likely know that there are some days when I am lucky to shower and put on 'real' clothes rather than hanging out all day in pajamas or yoga pants.

I am also acutely aware of the dramatic changes that have occurred in my body through both the pregnancy and post-partum time periods. Going to my closet is currently an adventure to see what will fit and how it may fit differently than it did prior to my pregnancy. Sometimes I am excited to put on an old favorite, while other times I am disappointed that something doesn't fit. All of this culminates into not always feeling like 'myself' and often feeling self-conscious in the way that I look.

However, a few days ago, my three-year-old boy padded into my room in the morning and crawled up beside me in bed to wake me up. As he sat there, he began stroking my tangled, slept-on hair and said, "Mama, I love your crazy hair." My heart melted, but he continued, "I love nose, I love your eyes," running his hands over my face. I am amazed by his sweet innocence and the fact that he doesn't know that my hair isn't "supposed" to be crazy and tangled or that I feel more confident with my makeup done. He simply sees me and loves me as I am.

Imagine what it would be like if we could all accept each other in this simple way - or even more importantly if we could accept ourselves in this way. How would you think about yourself differently if you saw yourself through a child's eyes?

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Happy New Year!

Tuesday December 31, 2013

It's hard to believe that 2014 is already here.  It is always surprising to me how quickly the holiday season goes by and also how nice it is to get back into a regular routine and schedule.  My holidays consisted of tons of traveling so I am thankful to be back in my own bed and home.

The new year can symbolize a new beginning for many people, especially those who are struggling with something or going through a difficult time in their lives.  I've had multiple clients tell me that they want a new year to be eating disorder-free or to be a year of recovery.  I think that is a wonderful idea.  However, I also think it is important to be realistic with your goals for the year.  Try to make goals that are achievable and flexible.  Eating disorder recovery is imperfect and by asking yourself for perfection, you may be setting yourself up for disappointment.

Did you make resolutions this year?  What are they?  Don't worry if you haven't made them yet, you can make resolutions any time that you like!

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