The Maudsley Institute

It's not really called that, but that's how I think of the new training program for Maudsley therapists, organized and run by Drs. Daniel le Grange and James Lock, co-authors of Help Your Teenager Beat an Eating Disorder. Its official name is the Training institute for Child and Adolescent Eating Disorders, and it aims to do something incredibly important: train therapists to do true family-based treatment.

Right now, many families in the U.S. who want to use family-based treatment to help their children recover from eating disorders face the unhappy choice of trying to go it alone, drive many hours to see a Maudsley therapist, or go with a different treatment. FBT is hard--the hardest thing most families will ever do. They need support. But at the moment, there just aren't enough true Maudsley providers to go around.

Maybe more important, families have no way to tell the faux Maudsley providers from those who truly practice and believe in FBT. There's a surprising number of therapists out there who say they practice Maudsley but who've given it their own unfortunate spin, like this one. And there are outpatient and inpatient programs who claim the same. Too often, what they're doing is NOT true FBT.

Lock and le Grange's new institute will put the seal of approval, as it were, on professionals who not only train with them but actually practice true FBT. This is good for everyone: Providers will get more training from the folks who know the treatment best, and families will have a measure by which to judge quality and competence of potential therapists. It's win-win.

The first training will be held February 27-28 in Palo Alto, California. It will take some time to "graduate" the first group of Maudsley therapists. Personally, I can't wait. Thanks to Drs. le Grange and Lock for doing this.

What do YOU do?

So I'm sitting at brunch with some neighbors--new neighbors, people I don't yet know very well but whom I like a lot--and the subjects of eating disorders and weight come up, as they inevitably seem to do. It is just after New Year's, after all, and we are sitting at brunch--a feast of a brunch, actually, with omelets and homemade waffles, a big bowl of whipped cream, berries, lox, roast potatoes, clementines. Everything is delicious and there's plenty of it.

So of course the conversation turns to dieting and New Year's resolutions, obesity and anorexia. And in the space of about 5 minutes I hear pretty much every myth about eating and weight there is:

"Children are much much fatter today than they've ever been and we have to do something about it."
"There's an explosion of diabetes among children today."
"Anorexia--that's all about control, isn't it?"
"Anorexics are doing that because they want to be thin. It's a cultural pressure kind of thing."

As I've said, these are people I like but don't know very well. But I can't just keep my mouth shut. I can't. I try to maintain a reasonable facade but within minutes I'm arguing, spouting statistics and opinions, trying to keep my voice friendly, hearing the urgency in my own words. I explain that one reason for the so-called explosion of obesity in America (among adults as well as children) is that the cutoffs for overweight and obesity changed overnight, so millions of people woke up one morning and were suddenly considered overweight or obese. That while more children are diagnosed with diabetes now than, say, 30 years ago, some of that number is certainly due to increased awareness and earlier diagnosis, which is a good thing. That the numbers don't differentiate between cases of Type 1 diabetes, which is largely genetic, and Type 2, which is linked to diet and activity.

I tell them about Health At Every Size, and try to conjure as many of Deb Burgard's talking points on size acceptance as I can remember. I tell them that Tom Cruise has been considered obese according to the BMI charts.

I tell them that no, anorexia is not about control, that it's not "about" anything except having the shitty luck to be genetically vulnerable. I tell them that for a person with anorexia, eating is like--oh, I don't know, maybe jumping out of a plane without a parachute. Covered in writing snakes. Giving a lecture on the way down. That for some people, restricting (aka dieting) sends them straight down the rabbit hole, that anorexia distorts thoughts and perceptions and feelings, that it's not a question of just picking up a fork and eating.

One of my new neighbors is in medical school. She's particularly interested in these subjects because she will have to adopt a professional attitude about them sometime soon. She'll have to figure out what she thinks and how to talk to people on all parts of the weight and eating spectrum--her patients. She listens. Everybody listens. We actually have a lively and interesting conversation. I think.

But I lay awake last night replaying it in my mind, wondering if I should have taken a different approach to the discussion. It's not so much that I think I was obnoxious (though maybe I was, a little) as it is the fact that I find these conversations exquisitely painful. Every time I hear the words It's all about control, isn't it? it's like some synapse in my brain starts overheating. How do I offer my knowledge and opinions without being obnoxious or driving myself beserk?

What do YOU do when the conversation turns to subjects like this?

OT: Clearing the air on Kawasaki Disease

My heart goes out to John Travolta and his family for the loss of their 16-year-old son, Jett. What a devastating nightmare to lose a child. Any parent who's faced a child's mortality can empathize, I'm sure.

The Travolta family blames Jett's childhood bout with Kawasaki disease. We won't know for sure what happened until the autopsy is complete. But I'd like to clear up a few misconceptions about KD, as it's called, in the meantime

Kawasaki disease is a full-body vasculitis, meaning that blood vessels all over the body become inflamed. That's why the whites of the eyes turn red, along with the the soles of the feet and palms of the hands and the tongue. The heart, of course, is vascular, and it, too, becomes inflamed and can suffer permanent damage. KD affects mainly babies and toddlers of Japanese descent, and is often not diagnosed quickly. Children can indeed wind up with scarred and damaged hearts.

My younger daughter, Lulu, had KD when she was 8 years old. Luckily, a pediatrician recognized and diagnosed it promptly. Lulu spent 5 days in the hospital on intravenous gamma globulin and months convalescing at home. Today, at 13, her heart is fine.

No one knows what causes KD--and believe me, people have speculated galore. The Travoltas have been convinced for years that Jett's KD was caused by carpet cleaners. That's one of the theories that's circulated about it. I don't buy it, partly because hey, we never clean our carpets. KD is statistically more common in the winter and early spring (Lulu came down with it in January); maybe there's a correlation because people clean their carpets more in winter. I wrote a piece on KD for the New York Times and talked to all the leading researchers on it. They don't buy the carpet cleaners theory, either. It's more likely to be related to Staphylococcus aureus (Staph A) or toxic shock syndrome.

There is absolutely no evidence that KD causes autism. Repeat: KD does not, to the best of our knowledge, cause autism.

Of course there's a lot we don't know. We don't know that Jett Travolta was autistic, and frankly, it's none of our business. But we do know that kids who have had KD do not typically wind up with seizure disorders or autism.

I'm thinking of the Travolta family in their grief and loss, and hoping that Jett's death doesn't add to the misconceptions around Kawasaki disease. Maybe this well-publicized incident will inspire some researchers to get on the stick. There's been very little research done on KD. How about it?

Support Project Feed Me

One aspect of food and eating that I rarely write about is the fact that many people in this country and elsewhere go hungry because they're poor. Now an enterprising group of Syracuse University freshmen is trying to do something about that.

Project Feed Me is designed to not just feed the hungry but to inspire young people to get involved with community projects. The group's founder, Patrick J. Alvarez of New York City, has organized turkey dinners in Harlem, banquets, and basketball tournaments. Now the group is looking for the next level of support, including corporate sponsors and partners, volunteers, and donations.

You can do something to help right now with just a click of your mouse. The group is in the running for a grant from Best Buy.All you have to do to help it win one is click here every day and vote for Project Feed Me. You'll also find out about some of the other cool projects up for grants, and since you have to vote for 2 every day, you'll have a chance to support some other groups as well.

My metaphorical hat's off to Mr. Alvarez and the rest of the PFM group, for doing more than sitting around talking about it. They're walking the walk. Give them a hand, won't you?

Looking your best: One writer's (tongue in cheek) advice for dealing with the "obesity epidemic"

Pieces like this are just part of the reason I love the New Yorker magazine. Much better than the cartoons, IMO.

Enjoy, and happy new year!


Thanks to Caylin for the link!