Prevalence and Correlates of Eating Disorders in Adolescents. Results from the National Comorbidity Survey Replication.

Waiting for mental health parity

By Pete Domenici and Gordon H. Smith,

Every day across the United States, families struggle with the challenges of mental illness or substance abuse. The 68 million Americans with these issues include people of all income levels, all races and all political affiliations. Mental illness does not discriminate.

Often, the difference between being overwhelmed as a family or meeting the challenges head-on and making progress against the illness can be just one factor: access to meaningful health insurance. Even those who think they have quality health coverage can be overwhelmed when a loved one receives a diagnosis of mental illness or is a substance abuser. They discover that their health insurance does not cover needed services or that the out-of-pocket expenses are prohibitive and significantly more than what is charged for physical ailments.

In 2008, Congress passed and President George W. Bush signed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. This law, which garnered bipartisan support, requires that large group health plans and Medicaid managed-care plans provide coverage for mental or substance-use disorders on par with the coverage offered for physical ailments. But when any law is passed, the federal government must implement and enforce it to make its benefits and provisions a reality.

President Obama voted for the bill as a U.S. senator, and all indications are that he remains supportive. Yet regulatory action has stalled since 2010. The final rule that would provide clarity to the millions who have a mental illness or substance-use disorder, and to their employers, has not been issued. This has created uncertainty and confusion for employers over what they must cover and when parity applies.

For example, many health insurance plans still refuse to cover lifesaving treatment for eating disorders. Others create discriminatory barriers to care, such as imposing stricter prior-authorization requirements for mental health and addiction treatment than for medical benefits. Sadly, as underscored in a recent report by the assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services, levels of care for evidence-based behavioral treatments, such as residential psychiatric services for children, are being eliminated because of uncertainty about what is required.

The most recent National Survey on Drug Use and Health, published last year, found that fewer than half of the 45.9 million adults with a mental illness receive treatment or counseling and that only 10 percent of the more than 23 million people who need help for a substance-use problem received any specialized treatment in 2010. Even more troubling is the fact that people with either disease have shorter life expectancies than most Americans; a 2006 study put the difference at 25 years.

The Obama administration should issue its final regulations to implement the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. Doing so would allow employers to plan with certainty and stability — and would let families know that help will be there when they need it.

The decision of Vogue to publish “Weight Watcher” in the April 2012 issue about a mother’s story of her 7 year old daughter’s weight loss journey is irresponsible.  Dara-Lynn, mother to Bea, subjected her daughter to a rigid diet complete with mixed messages around food, stigmatizing remarks, and damaging body image comments. Vogue must take responsibility for publishing an article that normalizes disordered eating and contempt for bodies. Experts and advocates in the field of eating disorders and obesity do not support the approach used by mother Dara-Lynn and urge her to evaluate her own relationship with food and body image.

Vogue’s decision to run this article adds to the child’s humiliation and shame. Bea is not an adult who can determine whether or not her journey should be public. With the publication of this story, readers from all over the world are privy to BEA’s story and she will likely be increasingly judged, based on her size, over and over again throughout her childhood, adolescence, and adulthood. This is worrisome for her overall health, including mental status.

Laura Discipio, executive director of ANAD comments: “Dara-Lynn stated that Bea has not exhibited symptoms of intense psychological damage, yet the article reports “tears of pain fill her (Bea’s) eyes as she reflects on her year long journey.” Dara-Lynn was engaging in behaviors that most clinicians and parents would agree were detrimental to Bea.  The methods and tactics used by Dara-Lynn in front of Bea’s peers coupled with public shaming in a well-read magazine may indeed produce long-term psychological damage, including an unhealthy relationship with food and her body. ANAD advocates for overall wellness not weight, including help for emotional, physical and social well being.”

Chevese Turner, CEO of BEDA adds: “Research indicates dieting at such a young age can actually result in weight gain and eating disorders, which have the highest death rate of any mental health illness.  Childhood is a dynamic period; professionals and parents need to think twice before prescribing or implementing a diet. They must also consider that research shows stigmatizing, shaming, and bullying around a person’s size can also result in weight gain and eating disorders. Every good intention can have a negative outcome”

We invite Vogue editors and Dara-Lynn Weiss to contact BEDA or ANAD so they can talk to experts and others whose life of pain and struggles around food began with eerie similarity to Bea’s experience over the last year.  We also ask that concerned people respond to Vogue editors with their dismay at using this child’s experience to sell magazines.

 The Condé Nast Building

4 Times Square #12

New York NY 10036

212-286-8398 or 212-286-2860

Email: talkingback@vogue.com

Washington Post.com,  JERUSALEM — Told she was too fat to be a model, Danielle Segal shed a quarter of her weight and was hospitalized twice for malnutrition. Now that a new Israeli law prohibits the employment of underweight models, the 19-year-old must gain some of it back if she wants to work again.

Not that she was ever overweight. At 1.7 meters (5-feet-7), she weighed 53 kilograms (116 pounds) to begin with. Feeling pressure to become ever thinner, she dropped another 13 kilograms (29 pounds). The unnaturally skeletal girl weighed 40 kilograms (88 pounds) by then, or about as much as a robust pre-teen, and her health suffered.

The legislation passed Monday aims to put a stop to the extremes, and by extension ease the pressure on youngsters to emulate the skin-and-bones models, often resulting in dangerous eating disorders.

The new law poses a groundbreaking challenge to a fashion industry widely castigated for promoting anorexia and bulimia. Its sponsors say it could become an example for other countries grappling with the spread of the life-threatening disorders.

It’s especially important in Israel, which, like other countries, is obsessed by models, whose every utterance and dalliance is fodder for large pictures and racy stories in the nation’s newspapers. Supermodel Bar Refaeli is considered a national hero by many. She is not unnaturally thin.

The new law requires models to produce a medical report no older than three months at every shoot for the Israeli market, stating that they are not malnourished by World Health Organization standards.

The U.N. agency relies on the body mass index, calculated by factors of weight and height. WHO says a body mass index below 18.5 indicates malnutrition. According to that standard, a woman 1.72 meters tall (5-feet-8) should weigh no less than 119 pounds (54 kilograms).

Also, any advertisement published for the Israeli market must have a clearly written notice disclosing if its models were made to look thinner by digital manipulation. The law does not apply to foreign publications sold in Israel.

In Israel, about 2 percent of girls between 14 and 18 have severe eating disorders, a rate similar to other developed countries, experts said.

The law’s supporters hope it will encourage the use of healthy models in local advertising and heighten awareness of digital tricks that transform already skinny women into seeming waifs.

“We want to break the illusion that the model we see is real,” said Liad Gil-Har, assistant to law sponsor Dr. Rachel Adato, who compared the battle against eating disorders to the struggle against smoking.

The law won support from a surprising quarter: one of Israel’s top model agents, Adi Barkan, who said in 30 years of work, he has seen young women become skinnier and sicker while struggling to fit the shrinking mold of what the industry considers attractive.

“They look like dead girls,” Barkan said.

Aspiring model Segal says she’s thrilled with the new law and wishes it had been passed years ago. “I wouldn’t have grown up thinking that this (being underweight) is a model of beauty. I wouldn’t have reached the point I reached,” she said.

Segal said an agent told her three years ago that she had a beautiful face — but not a “model’s body.” Trying to attain that ideal through drastic diets, she ended up in the hospital twice and stopped menstruating.

Segal said she met Barkan during her modeling work, and he convinced her that she could succeed as a model without being unnaturally thin. Segal, who now weighs around 50 kilograms (110 pounds) and would have to gain 3.5 kilograms (almost eight pounds) to qualify for work.

Barkan estimated about half the 300 professional models in Israel would have to gain weight to work again.

Top Israeli model Adi Neumman said she wouldn’t pass under the new rules, because her BMI is 18.3. Neumman said she eats well and exercises. “Make girls go to a doctor. Get a system to follow girls who are found to be puking,” a symptom of bulimia, she said.

Critics say the legislation should have focused on health, not weight, arguing that many models are naturally thin.

“The health of the model … should be evaluated. Our weight can change hour to hour,” said David Herzog, a professor of psychiatry and a leading U.S. expert on eating disorders.

Pressure on the fashion industry has intensified in recent years, sparked by the deaths of models in Brazil and Uruguay from medical complications linked to eating disorders.

Uruguayan model Luisel Ramos, 22, collapsed and died soon after stepping off the runway in August 2006, reportedly of anorexia-linked heart failure.

Other governments have taken steps to prevent “size zero” medical problems but have shied away from legislation.

The Madrid fashion show bans women whose BMI is below 18. Milan’s fashion week bans models with a BMI below 18.5.

The U.K. and U.S. have guidelines, but their fashion industry is self-regulated.

Unrealistic body images in the media are believed to shape eating habits, especially among young people, though there is debate about how influential they are. Other factors include psychological health, trauma like sexual assault, or a tendency within one’s family to emphasize physical appearance as a sign of success.

It’s not certain that the law will have a measurable impact, because Israeli teens take their cues from both international media and local publications, said Sigal Gooldin, an eating disorder specialist at Hebrew University in Jerusalem.

Social worker Uri Pinus, who treats seven teens with eating disorders at a Jerusalem hospital, said the law was unlikely to affect his patients.

“But our expectation is that this law will impact the wider public,” Pinus said. “(It) will reduce pressure on the girls to lose weight.”

Segal said putting weight back on would be a challenge. But, she said, “in the end it’s a very low price to pay when I think about other girls who won’t grow up sick in the future.”

Washington Post World News online

According to the DSM-IV, binge eating is defined as “eating, in a discrete period of time (e.e., within any 2-h period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.” As we move toward the release of the DSM-V (2013), binge eating will be described in very specific terms.  Currently the question for many is:  “So, exactly what is a binge?”  Arikian et al. (2012)  set out to discover what quantifies as an “amount of food that is definitely larger.” Participants were chosen in three different samples: college student, community, and ED, to complete questionnaires which would establish self-reported definitions of overeating. They found that self-reported definitions of “unusually large” amounts of food varied by BMI, gender, and the presence of ED symptoms.  “This study supports the importance of understanding potential influences (e.g., weight and gender) on perceived binge size thresholds.”

To access the full article, click here.

Arikian, A., Peterson, C., Swanson, S., Berg, K., Chartier, L., Durkin, N., & Crow, S. (2012, March). Establishing Thresholds for Unusually Large Binge Eating Episodes. International Journal of Eating Disorders, 45(2), 222-226.

ORLANDO, Florida | Fri Mar 2, 2012  By Barbara Liston

(Reuters) – Obesity experts on Friday applauded Walt Disney World for shuttering a new attraction that drew fierce criticism for its potential to shame overweight children and misrepresent the causes of the global obesity crisis. “I think they (Disney) likely subscribed to that common misconception that this is something we should just be able to push away from the table and cure,” said Ottawa bariatric surgeon Yoni Freedhoff, whose blog post sparked a public outcry over the attraction at Walt Disney Co’s world-famous Florida theme park. “The truth is, if it was that simple to manage weight, I’m pretty confident we wouldn’t have a problem,” said Freedhoff.

Disney last month unofficially opened the interactive exhibit called “Habit Heroes” at Epcot, one of the sites at the park, and introduced a companion online game.  In both, svelte heroes, “Callie Stenics” and “Will Power,” combat fat and misshapen villains with names like “Lead Bottom” and “The Snacker.”  “Here, they (children) are in Disney, the happiest place on earth, and basically Disney is being the schoolyard bully that’s been making fun of them for years at home,” Freedhoff said.

Disney closed the exhibit two days later following complaints and petition drives by other advocates for the overweight and people with eating disorders.  Disney spokeswoman Kathleen Prihoda told Reuters no date has been set for Habit Heroes to reopen.

“We’ve closed it for the time being to further improve and refine the experience,” Prihoda said. “We’ve received feedback from a variety of sources and we’re taking it all into consideration at this time.”

MANY CAUSES

Laura Discipio said her organization, the National Association of Anorexia Nervosa and Associated Disorders, was one of several that urged its supporters to put public pressure on Disney to rethink Habit Heroes.  “They (Disney officials) said the goal is really to teach people how to be healthy. I said I get that, but you can’t be villainizing children of size,” Discipio said.

The exhibit was sponsored by two independent Blue Cross and Blue Shield organizations.

Spokesman John Herbkersman of Blue Cross and Blue Shield of Florida told Reuters that initial reaction from Disney guests was positive. He said the Disney Imagineers created the exhibit, and that he did not know how much input his organization had in crafting its message. The World Health Organization, which calls childhood obesity one of the most serious public health challenges of the 21st century, cites many causes, including a global shift in food processing, food marketing, the fat and sugar content of food, increased urbanization and changes in the way people get around.

“Kids have not suddenly suffered an epidemic loss of will power. I think the world in which children are growing up has changed very dramatically,” Freedhoff said.

In January researchers with the U.S. Centers for Disease Control and Prevention reported that in 2009 and 2010, about one in three American adults and one in six children and teenagers were obese.

A petition started by the National Association to Advance Fat Acceptance logged more than 300 signatures before the exhibit was closed, according to spokeswoman Peggy Howell.  “The attraction and game feature negative stereotypical characters, traditionally used to torment overweight kids, will potentially reinforce and strengthen a cycle of bullying, depression, disease, eating disorders and even suicidal thoughts,” the petition stated.

Chevese Turner, founder of the Binge Eating Disorder Association is excited about the 2012 conference  occurring March 2 – 4th in Philadelphia. Aside from education, networking and advocating, another important aspect of this year’s conference is to prepare for the release of DSM V, the so-called bible of psychiatry. The Diagnostic and Statistical Manual is currently being overhauled, and binge-eating disorder will appear as a separate diagnosis. In the current DSM, “BED”  symptoms are listed under “eating disorder not otherwise specified. (This manual is the reference tool for both the medical and insurance community).

“The separate category could mean increased awareness and more research, but could also cause backlash,” Turner said.   “I expect there will be media reports that say we are pathologizing overeating, but this is not about just overeating,” she said.  The members of BEDA are preparing information, resources and videos to respond to the changes anticipated with this redefined clinical diagnosis.

Urgent action is needed.  Blue Cross Blue Shield of Florida recently terminated mental health and addiction service providers and is seeking new contracts at substantially reduced rates through its affiliate New Directions Behavioral Health. This could affect patient access to care.

We need to send a strong message to other insurers throughout the country, to Congress, and to the Administration that the termination of mental health and addiction service providers violated the Mental Health Parity and Addiction Equity Act and should not be permitted in Florida or anywhere else in the country.

 Whether or not you live in Florida, please sign this petition and send the link to everyone you know who wants to see parity in treatment for mental health and substance use patients http://www.ipetitions.com/petition/mental-health-parity/.

 Your participation is important to ensuring quality care for mental health and addiction recovery patients.

On Saturday morning, Disney suddenly closed the newest Epcot Innoventions attraction and supporting website, Habit Heroes. This means that merely two days after ANAD joined with you and BEDA, Disney reacted.

Our Executive Director, Laura Discipio, said, “This is such a huge stride in raising awareness that the focus should be on health and on wellness, not on weight.  This goes to prove that each of our single voices can join together to make a huge difference.”

And after a discussion with Disney, Chevese Turner, CEO of BEDA, said, “The closing is temporary, but we are discussing changes that need to be addressed… I think we are on our way. This was a great example of the ED community pulling together and using our voices. We were heard!”

ANAD and BEDA want to take this time to thank each and everyone of you that joined us. Thank you for your calls, emails, blogs, Facebook posts, news articles, and tweets that called Disney to shut down it’s newest attraction. They heard you, they heard us.

For more information: USA Today and Calgary Herald