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Susan Cowden, MS

Eating Disorders Blog


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Plus-Sized Images Can Change Body Size Preferences

Thursday November 8, 2012

Eating disorder professionals and advocates have long discussed the effect of the 'thin-ideal' on body-image and self-esteem.  Westerners see an average of 2,000 images in advertising alone, on a daily basis, and images of thin bodies far outweigh the number of normal and plus-size bodies seen in the media.  There have been multiple studies on how this may play into the creation of eating disorders and how it affects the self-image of people who don't have eating disorders.

Interestingly, there is new research that society's preference for small bodies could be changed by viewing more images of plus-size models.    A study done recently at Durham University in the United Kingdom, showed women images of both slim bodies and plus-sized bodies.  When shown the photographs of the plus-sized models in 'aspirational' settings (such as a beauty product or fashion advertisement), the preferences of the women being surveyed changed.

Although it is unknown if viewing larger people would change preferences long-term, it is an important finding and one that encourages fashion designers and magazines to continue to increase the number of plus and normal sized women who are featured on their pages and in their shows.

What do you think of this study's results?  Do you think that viewing more normal and/or plus-sized women would change your preferences?


Lynda G. Boothroyd, Martin J. Tovée, Thomas V. Pollet. Visual Diet versus Associative Learning as Mechanisms of Change in Body Size Preferences. PLoS ONE, 2012; 7 (11)

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Family Therapy or Individual Therapy?

Tuesday October 30, 2012

Deciding what treatment philosophy and level of care is right for you and your family can be a tricky decision.  Everyone needs to have a personalized treatment plan, but it is also important to take into account the types of treatment research supports.

Researchers at Stanford University and the University of Chicago have compared the difference in outcomes between family-based treatment (also known as Maudsley) and adolescent focused individual therapy for adolescents with anorexia nervosa.  The study included over 100 adolescent participants, all with a diagnosis of anorexia nervosa.  The participants were randomly assigned to either 12 months of family-based treatment or 12 months of individual therapy and were assessed at the beginning of the study, at the end of treatment and at 6 and 12 month follow-up after treatment ended.

At the end of the 12 month treatment protocol, there was no statistical difference in full remission rates between the two treatments.  However, at both 6 month and 12 month follow-up, family based treatment was shown to be statistically superior to individual therapy - meaning that those participants who participated in the family-based treatment had fewer relapses and made more progress in recovery than those who only received adolescent focused individual therapy.

Do you have experience with either family-based or adolescent focused treatment for anorexia nervosa?


Lock, J., LeGrange, D., Agras, W.S., Moye, A., Bryson, S.W., Jo, B. Randomized clinical trial comparing family-based treatment to adolescent focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry. 67(10). 1025-1032.

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Interpersonal Therapy for Anorexia: The Most Effective Treatment?

Thursday June 14, 2012

A recent study performed by researchers in the United States and in New Zealand examined three types of therapy and their effectiveness at treating anorexia nervosa in adults.  The 56 participants were all women, aged 17-40 and were randomly assigned to receive either interpersonal therapy (IPT), cognitive-behavioral therapy (CBT), or a control group therapy that the researchers called 'specialist supportive clinical management' (SSCM).

The interpersonal therapy focused on four interpersonal (relationship) problem areas and promoting independent coping.  Cognitive-behavioral therapy in this study focused on education, monitoring symptoms, challenging eating disorder thoughts and relapse prevention.  The SSCM was designed as a control group for this study and simply provided a general supportive therapy.

The researchers examined the participants immediately after treatment and after an average of 6 years.  Interestingly, immediately after treatment, the control-group SSCM was most likely to have a good outcome (75%).  Only 33% of CBT participants and 15% of IPT participants were found to have a positive outcome.

However, at the long-term (6 year) follow-up, researchers found that 64% of IPT participants had a good outcome, with 42% of SSCM participants and 41% of CBT participants reporting positive outcomes.

This research study is extremely limited by it's small sample size.  However, it gives insight into how different therapies work over time.  Although this study didn't examine this, it may suggest that some sufferers would be helped by an approach combining the different strategies at different stages of treatment.

Do you have experience with a particular form of therapy being more effective than another?

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Does Parental Divorce Trigger Eating Disorders?

Monday June 11, 2012

The causes of eating disorders are complex and most professionals believe that environmental and genetic (biological) factors interact in order to trigger the development of an eating disorder.  A research study by professionals at Michigan State University and the University of Minnesota has looked at the interaction of genetics and parental divorce to see if this specific interaction puts people at a higher risk of developing an eating disorder.

Previous research has found that there are higher rates of parental divorce for people who have bulimia nervosa than those in the general population.  Research has also shown that stressful life events often precede the development of an eating disorder.  However, this is one of the first studies to examine how divorce interacts with genetics.

In order to look at this interaction, researchers administered questionnaires on disordered eating symptoms to over 2,000 pairs of twins.  However, the results showed that the only symptom of disordered eating that was associated with parental divorce was body dissatisfaction.

There are certainly limitations to this study in that it looked at a general population of twins rather than specifically seeking out a clinical population of eating disorder patients.  It also didn't examine other stressful factors that often surround parental divorce, such as parental fighting.  These other factors may have more to do with the triggering of symptoms than the actual divorce itself.

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If you have an eating disorder and your parents are divorced, do you think it triggered it?


Suisman, J.L., Burt, S.A., McGue, M., Iacono, W.G., & Klump, K.L. (2011). Parental divorce and disordered eating: An investigation of a gene-environment interaction. International Journal of Eating Disorders, 44(2). 169-177.

Eating Disorders Increase Risk of Dying Prematurely

Thursday May 10, 2012

In case you didn't already know, eating disorders can be deadly. A new, extremely large-scale study on the topic was presented this week at the American Psychiatric Association's annual conference by Jaana T. Suokas, MD.

The study was conducted at the University of Helsinki Central Hospital in Finland and followed 2329 women and 113 men in treatment for eating disorders between 1995 and 2010.  It looked at all causes of premature death for the sufferers, including suicide.  People suffering from anorexia were 6 times more likely to die prematurely.  Those suffering from bulimia had a 3 times greater risk of premature death, and those suffering from binge eating disorder had a 1.78 greater risk.

Interestingly, the risk of premature death for people suffering from anorexia went down the further out the sufferers got from treatment.  However, those with bulimia had the highest risk of premature death about two years after treatment.

Although I don't know that this study tells us a great deal that we didn't already know about eating disorders, it does underscore the importance of early treatment and recovery.  It is a sad, but important, reminder of the seriousness of this disease.

Do you know someone who has died as a result of their eating disorder?

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Life Cycle Transitions Can Trigger Eating Disorders

Friday April 27, 2012

Researchers at the University of Minnesota recently published new research regarding triggering events for eating disorders.  They found, after interviewing 27 individuals in treatment for an eating disorder, that stressful family life cycle transitions often trigger the onset of an eating disorder.  These included life transitions such as entering middle school or leaving for college, the divorce of one's parents or the death of a family member or close friend.  Other transitions such as relationship changes, serious illness and abuse or sexual assault were also considered triggering events.

Interestingly, over half of the participants in the study reported two or more transitions as triggering events in the history of their eating disorder.  It is theorized that while most people go through stressful transitions without developing an eating disorder, that having a lack of needed support can increase the likelihood that eating and body image issues will surface.

Did you or someone you know experience a stressful transition prior to developing an eating disorder?

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Survey Links Facebook Use to Negative Body Image

Tuesday April 10, 2012

The Center for Eating Disorders at Sheppard Pratt sponsored and has released the results of a national (U.S.) survey of Facebook users to determine how it affects their body image and self esteem.  The online survey was of 600 Facebook users from age 16-40 and showed that:

  • 75% of those surveyed are unhappy with their body
  • 51% of those surveyed said that Facebook makes them feel more conscious of their body and weight
  • 51% of those surveyed find themselves comparing their own bodies with those of friends
  • 32% of those surveyed report that they feel sad when looking at friends' photos

These results are consistent with those released from another survey by the University of Haifa in Israel that linked Facebook use to eating disorders in adolescents.  Unfortunately, it seems that the immediate access to photographs and the need to always be 'camera ready' is impacting users of Facebook in a negative way.

Do you believe that Facebook affects how you view yourself? Do you feel pressure to always look 'camera ready' in case a photo ends up online?

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Facebook May Be Linked to Eating Disorders in Adolescents

Wednesday April 4, 2012

The University of Haifa in Israel recently released the results of a survey of adolescent girls regarding their television and internet use, eating habits, satisfaction (or dissatisfaction) with their physical appearance and their sense of personal empowerment. The results of the survey indicate that the more time a girl spent on Facebook, the likelier she was to suffer from an eating disorder such as anorexia, bulimia, or other issues such as extreme dieting.  Additionally, a similar link was found between viewing gossip-type television shows and eating disorders.

Not surprisingly, the survey also revealed that girls who have a stronger sense of personal empowerment and a more positive body image are less likely to develop an eating disorder.

The survey took things one step further and found that an adolescents sense of empowerment and body image are linked to parental involvement - meaning that when parents are actively involved in monitoring and discussing social media activities and television shows, girls have a stronger sense of personal empowerment and, in turn, are less likely to develop issues with eating.  The survey also showed that when parents do not monitor the media consumption of their adolescent daughters, they are more likely to experience a low level of personal empowerment, raising the risk for eating issues.

Do you think Facebook (or other forms of social media) affect how you view yourself?

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School Based Obesity Prevention Programs May Promote Worrisome Behaviors

Friday January 27, 2012

The University of Michigan C.S. Mott Children's Hospital released a report this week that raises serious questions about the helpfulness of school-based programs aimed at obesity prevention.  The hospital polled 976 households with children ranging  in age from 6-14.  Of those who completed the survey, 82% reported that there was some type of prevention program being implemented in their child's school and 30% of those parents whose children are in a school with a prevention program reported that they had observed 'worrisome eating behaviors' in their children.

Most of the worrisome eating behaviors covered in the survey were found to have no association with the obesity prevention program.  However, a correlation was found between parents who believe their children exercise too much and exercise incentive programs.

Additionally, 7% of the parents reported that their children had been made to feel bad about what or how much they are eating.

While there are certainly limitations to these findings (a relatively small sample size and little is included in the report about exactly what types of programs these children are in), this survey does raise important questions about the efficacy of obesity prevention programs and whether or not they may actually be promoting unhealthy behaviors.  It also underscores the importance of researching these programs and the importance of parental involvement so that any worrisome behaviors or symptoms of eating disorders can be addressed early.

If you are a parent or student, have you noticed negative effects from obesity prevention programs?


C.S. Mott Children Hospital National Poll on Children's Health.  School Obesity Programs May Promote Worrisome Eating Behaviors and Physical Activity in Kids.

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